Tuesday, 26 November 2019

Questions (42)

Róisín Shortall


42. Deputy Róisín Shortall asked the Minister for Health the timescale for the full reversal of financial emergency measures in the public interest, FEMPI, for GPs and the ending of the two-tier pay scales for consultants; the other steps he plans to take to address the issue in view of the severe shortage of GPs and hospital doctors and the serious impact which this is having on patient care; and if he will make a statement on the matter. [49074/19]

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Oral answers (14 contributions) (Question to Health)

The health service faces many major issues, which combine to deny people access to basic healthcare. Whether at hospital or community level, there are very significant problems. One of those major problems is the shortage of GPs and hospital doctors. This has now reached crisis point in my view and in the view of many working in the HSE. What precisely is the Minister doing about that crisis?

I thank the Deputy for her question. It raises queries in respect of doctors in general, both GPs and consultants. I will try to take them both. I have outlined a number of the measures in respect of general practice. In the interests of time, I will not elaborate on them, other than to say we reached significant agreement on contractual reform and service development in May this year in return for co-operation with a number of measures. Those measures include some the Deputy pushed for and advocated in respect of chronic disease programmes and a number of reforms concerning multidisciplinary working and e-health medicines. We will increase expenditure on general practice by approximately 40% or €210 million by 2023. We will also bring in more flexible contracts, allow GPs to hold contracts until their 72nd birthday, train more GPs and introduce enhanced supports for rural GPs. More people are now applying to train as GPs.

Regarding consultants, I want to be clear. I believe we are going to need to pay our consultants working in the public health service a lot more money if we want to keep them there. I intend to sit down and engage with the consultant bodies on this, namely, the Irish Medical Organisation, IMO, and the Irish Hospital Consultants Association, IHCA. However, I have no interest, in that process, in worsening the divide between private medicine and public medicine in our public hospitals. I think the Deputy and I agree on this. I agree that the de Buitléir report needs to be implemented in full. Everybody else who has had a conversation about more money or reversals of recessionary measures - GPs, nurses, midwives, SIPTU workers - has had to do that alongside a programme of reform. Consultants are no different in that regard. I want to pay our consultants working in public hospitals more for doing public medicine. I want to look at how we can end the two-tier reality in that regard. I do not want to do anything that would worsen that divide and that would embed further a practice that I genuinely want to end. The Deputy, Sinn Féin and the Labour Party want to end it but I have yet to hear the Fianna Fáil position on it. Every party should come out in this House and say if they want to end the practice of private medicine in public hospitals. As the Taoiseach outlined recently to this House, progress has been made between my Department and the Departments of Public Expenditure and Reform and the Taoiseach on an approach to negotiations with our consultants and the implementation of the de Buitléir recommendations. I expect to bring forward concrete proposals to consultant bodies in that regard.

We have had some discussion on GPs already. It is reported that approximately 70% of GP lists have closed. Many GPs report being under great strain. Stress among GPs is a significant issue. Increasingly, it is difficult to recruit GPs to replace those who are retiring. It is all very well for the Minister to say he is rewinding FEMPI but he is doing so slowly. Deputies and most other public servants did not have to wait four or five years for FEMPI to be rewound.

This is an agreement that the Government reached. That is all very well but as the Minister knows and as we on this side of the House have been saying for a long time, a new GP contract is needed.

We expect GPs to take on new work yet we are not providing the kind of supports necessary for them to do that including ancillary staff, to address the whole issue of chronic disease management.

The Minister talked about the increase in the number of people applying for GP training. That is great but how do we hold on to them? We know that GPs themselves have said this. New GPs want to be working as part of multidisciplinary teams and they want to be operating as doctors not as businesspeople. That means that accommodation must be provided for them.

The Minister promised salaried GPs in the programme for Government. These have not been seen yet. He also promised part-time contracts for many trained GPs, including women, in particular, who want to work for a certain period of their lives as part-time GPs. What is he doing about this? It is hard enough to provide cover during the day. The whole question of out-of-hours coverage is very fragmented because of the dire shortage. What is the Minister going to do about those commitments that he has given for a new contract, for salaried GPs and for part-time GPs?

I do not agree that it is being done very slowly in the unwinding of this. I believe it is being done in quite an equitable way, favouring lower-paid public workers and people who have contracts with the State first. We are not just returning the money that was taken through the Financial Emergency Measures in the Public Interest Act 2009, FEMPI, which was taken by many Governments, 75% of which was taken by Fianna Fáil when in government. We are returning an extra €80 million on top of that, which is paying handsomely for new services to be provided in chronic disease management. We are phasing that in, starting with over 70 year olds with a medical card in the new year, rather than bringing everybody in in one go. This recognises the need to allow our GPs to see the benefit of additional investment before a significant extra workload.

Salaried GPs are now in place in Ireland. I accept there is a need to ramp it up. There is no need for any legislative change to make that a reality. The HSE already has those powers and is already funding a number of salaried GP practices. I share the Deputy's point that could be a lot more. The HSE already knows that it has a clear mandate in that regard as well.

On the out-of-hours services, GPs are contracted under the general medical services scheme and must make suitable arrangements to enable contact to be made with them or with a locum for emergencies outside of normal practice hours. As part of their regular obligations our GPs are contracted provide all-hours access for GMS patients. The HSE supports the provision of these services with infrastructure, call-handling, recruiting nurse staff and currently over 90% of our population has access to out-of-hours GP service. The HSE and the Department of Health were made aware during the summer of this year of a particular difficulty being experienced by some co-operatives in recruiting GPs from abroad to provide services as a result of the terms of the atypical working scheme visa. The Deputy may have seen the announcement by my colleague, the Minister for Justice and Equality, and myself on that in recent days.

On the question of consultants, how long is the Minister going to stand by and watch the haemorrhaging of consultants from the Irish health service? The situation is now at crisis point. There are over 500 vacant consultant posts. Many aspects of the health service are crumbling and in crisis as a result of this. People are dying as a result and are experiencing and enduring life threatening conditions. There are reasons why this is happening. The reasons have been set out by various reviews and surveys that have been done about hospital doctors. There are issues in relation to bullying, for example, inhumane working hours, awful working conditions for many people, no payment of overtime - a whole range of issues. One needs to look at career structure and the over-concentration on specialisation with hospital consultants. We should be training many more generalists, as they do in other countries.

There have long been promises to tackle this issue. The cuts that took place in 2012 and the creation of the two-tier system have been devastating.

The then Minister, Deputy Varadkar, promised in 2014 that he was going to reverse this. The Public Sector Pay Commission has said that it has to be reversed. When is he going to take action to end the two-tier pay system among hospital consultants, which is doing so much damage?

I agree with the Deputy on the generalists' model. We have already seen this begin to work in the new facility in Connolly Hospital Dublin in our new model of care around children. I do not see why that cannot be extended to other areas.

I need to point out when discussing any issue that one would sometimes get the impression that there are fewer doctors working in the health service. There are in fact more. More consultants are working in the Irish health service this year than last year, and there were more last year than the year before that. There are many more now than when I became Minister for Health.

We have a bigger population.

I fully accept that we need more.

The Deputy is correct that the Public Sector Pay Commission said that we need to address the issue of pay parity. I expect in the coming weeks - I am being quite specific in that regard - to have concrete proposals to put to the consultant body. What I am saying very clearly in this House is that the de Buitléir report said very clearly that we should offer a Sláintecare-type A contract, with pay parity for new entrant consultants who take up this contract. I have no interest - none, nada - in using taxpayers' money to further embed a practice that neither I nor the Deputy believes in, which is using public beds in our hospitals to profit private health insurance companies. I am happy to say that on the record of this House. My counterpart in Fianna Fáil will not do so. We need to get serious about radically overhauling work practices regarding private medicine in our public hospitals. We will pay for that and will bring in pay parity for that as part of any talks.

When will that happen?

I will bring forward concrete proposals in the coming weeks.