Tuesday, 2 July 2019

Questions (44)

Louise O'Reilly


44. Deputy Louise O'Reilly asked the Minister for Health the number of consultant doctors operating in the health service, by hospital and speciality; the number of consultant doctor vacancies, by hospitality and speciality; and his views on the shortage of consultant doctors across the health service. [27799/19]

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Oral answers (13 contributions) (Question to Health)

With regard to the Minister's reply to Deputy Donnelly's question, I rarely ask the Minister to spend more. I ask that he reorient the spending away from expensive agency staff and outsourcing and towards directly employed staff instead. The Minister has agreed on a number of occasions that this represents the best value for money.

My question today is very simple and relates to consultant doctors and the shortages thereof that are being experienced across the State. Perhaps the Minister will make the distinction between those consultants who are eligible to be on the specialist register and those who are not. This is an emerging issue within the health service. It is important whenever we count those figures to do so on a realistic basis and only count consultants who are on the register.

I thank Deputy O'Reilly for her question. The number of consultants working in the public health service continues to grow year on year. It increased by 125 whole-time equivalents, WTEs, or just over 4%, in the year to the end of May. I will get the clarification for the Deputy on these 125 WTEs and how many are on the specialist register. I do not have that information with me.

In the five years to the end of May, the number has increased by 533 - more than 20% - and now stands at 3,121 consultants working in the Irish health service. The details by hospital and specialty requested are being provided to the Deputy in response to this question and I have the tables here for the Deputy.

On vacancies, the national doctors training and planning division of the HSE has provided figures up to 27 June. This identifies 362 posts, by hospital and specialty, that have been approved for filling. Of these, 151 have been identified as vacant by the hospital or agency concerned. The hospital or agency concerned have, however, not confirmed the status of the other 211 posts. Again, the detailed figures provided by the HSE in respect of this element of the question are also being provided to the Deputy.

The public health service operates in a global market for medical specialists, which is experiencing a worldwide shortage. Notwithstanding this fact, progress continues to be made in attracting and retaining consultants and in addressing improvements in the training, working environment and career pathways for non-consultant hospital doctors - our future supply of consultant candidates. A range of factors have been identified as contributing to the recruitment and retention challenge, of which pay is a part. I hope the Deputy will recognise that because I understand that in 2012 she wanted to cap consultants' pay and specifically referenced reducing their pay in a policy document. Research published last year by the Royal College of Surgeons in Ireland, RCSI, also identified excessive service demands and the quality and consistency of training as critical challenges; so it is about pay but not just pay.

The issue of new entrant pay is being addressed in general terms under the terms of the Public Service Stability Agreement 2018-2020 and has been examined by the Public Sector Pay Commission. The Deputy will be familiar with that. I have given a commitment to finding a process to now engage with consultants, such as we do with GPs and nurses, to find a way forward on pay issues.

If we are going back over old history, obviously I will refer to the billboard campaign of the Minister's party on ending the scandal of patients on trolleys. How is that working out? It is not going terribly well.

We are making progress.

I will take on board what the Minister said in regard to a policy from seven years ago and I will remind him that it is 2019. We have a recruitment and retention crisis among consultants, which the Care Can't Wait campaign by the Irish Hospital Consultants Association, IHCA, is highlighting. My figures tell me we have 480 consultant vacancies across the State, which is an increase in the number of vacancies. While I am not disputing the fact there have been some hires, they are not keeping pace with demand.

The Minister referred to this being a worldwide problem. It is not a problem they are having in Perth, which is where our consultants and doctors are going, although they are being trained here. I go back to my earlier point that it is not about spending more money but about reorienting what we spend. A lot of the money we spend is spent abroad to recruit consultants, and much is wasted on agency staff and locums to fill the gaps that should be filled by directly employed staff.

It is fair game, when the Deputy asks a question on wanting to recruit more consultants, to point out that the policies she puts forward would result in fewer consultants.

In 2012, Sinn Féin believed consultants were paid too much.

Did the Minister end the scandal of patients on trolleys?

It is not like Deputy O'Reilly to be unruly. I tried to look at a document Sinn Féin published in November 2016 under the tile, Framework for New Pay Agreement, but it does not seem to be available on its website today. I suppose the party wants to try to hide the fact it believed these people were paid too much and it wanted to tax them more and reduce their salaries. Let us see what that will do in regard to sending our doctors to Perth.

We have more to do in this regard. I believe pay is an element of this but I also believe work practice change is an element. I believe the Deputy agrees with me on the need to make sure we have more consultants working in the public health service rather than doing private practice. I will go to Government with the de Buitléir report on proposals in that regard in the autumn.

In direct answer to the Deputy’s question on how we reduce the shortage of consultant doctors across the health service, we do it through engaging on the issue of pay and through a pay agreement and contracts, as I outlined at the IMO conference a few weeks ago. However, I also believe we do it through more radical reform, work practice change and the roadmap I expect the de Buitléir report to outline in line with the Sláintecare strategy.

I do not consider myself to be unruly but nor will I sit here and be misrepresented. As to the engagement the Minister speaks of, how does that manifest itself in his daily work? What is the level of engagement? As the person in charge, what is the Minister's level of engagement with, for example, the IHCA or the IMO? Has he sat down with them directly? Does he have a plan in place?

In recent weeks, both Susan Mitchell and Paul Cullen have quoted from the report to the national doctors training and planning project team on the employment of consultants not registered in a specialist division of the register of medical practitioners. That is a very serious issue and it is not being dealt with. It is not good enough to hide behind what the Minister says is an international crisis. I will get the document the Minister refers to. I have addressed the IHCA conference and I have spoken to the consultants in this regard. I have no difficulty with people being paid well for a job well done but we have a recruitment and retention crisis. Pay is a serious element of that and it needs to be addressed. However, at the moment, the Minister presides over a health service that is a deeply unattractive place to work. That is why we cannot recruit and retain consultants. That is why we are spending money, day in and day out, going abroad to recruit consultants and plugging the gaps with agency staff. I have not heard anything from the Minister today that leads me to believe it will be any different.

As the Deputy says, I preside over a health service that has seen more than 90% of GPs - the front-line doctors in our communities - accept the new agreement and contract that I have put to them. It is probably unheard of to achieve such massive acceptance of a deal, in this case one which will invest €210 million more in general practice. I preside over a health service that has seen our nurses in overwhelming numbers vote in favour of a new nursing contract that will see their pay increase but will also see their work practices change. I preside over a health service that is seeing more consultants work in it this year than last year, and more than in the last five years, to the tune of several hundred.

We have more to do. I believe that, sequentially, much progress has been made with regard to GPs and nursing and midwifery. Consultants are the next issue. I have met the IHCA directly here in Leinster House in relatively recent weeks and my Department has had a number of follow-on engagements with it as well. I have met the IMO and I have addressed its conference in regard to the issue. I and Government colleagues now want to take the Public Service Pay Commission recommendation of putting a process in place to talk about how we address the recruitment issues but I am making the point that, as in any negotiation, both sides will have asks. There are views in regard to pay on the consultant side but there will also be views in regard to work practice changes and the delivery of Sláintecare on our side. I hope and expect to make progress on that in the autumn.