asked the Minister for Health the steps he proposes to take in relation to the serious grievances of junior hospital doctors which have caused them to threaten strike action.
Ceisteanna—Questions. Oral Answers. - Junior Hospital Doctors.
96.
I think, a Leas-Cheann Comhairle, that I should set out in full the background to this issue.
The present remuneration and conditions of service of junior hospital doctors are based on settlements reached in 1970, prior to the first national pay agreement. In common with other grades of staff in the health services the junior hospital doctors have since got the salary increases provided for in this agreement and the 1972 national agreement.
The present annual rates of remuneration are as follows: (i) Intern, £1,959 (ii) House Officer, from £2,143 to £3,213; (iii) Registrar, from £2,855 to £3,972.
Interns are doctors provisionally registered by the Medical Registration Council who are doing an "intern year" before full registration. House officers and registrars are fully registered doctors employed in hospitals.
The conditions of service for junior hospital doctors are related to a rostering arrangement of being on duty and on call which was arrived at in 1971 by a working party in which representatives of junior hospital medical staff took part. Such an arrangement is not unusual in the special circumstances of hospital services. The position is similar in Britain where, very recently, revised arrangements were made whereby the hours of being on duty and on call are to be reduced from a total of 102 hours to 80 hours per week with effect from 1st July, 1974. This latter figure compares to a figure of 70 hours per week for the junior hospital doctors in this country.
In agreement with the Irish Medical Association and the Medical Union, a claim made by them relating to salaries and conditions, but not to hours of duty, for junior hospital doctors was referred to an agreed arbitrator earlier this year. Following the normal practice, written statements of claim and counter-statement were submitted to the arbitrator on 10th July and exchanged between the parties. The arbitrator then arranged an oral hearing with both sides on 26th July, 1973. In his report, dated 21st September, 1973, the arbitrator found that the claim was not allowable within the terms of the national pay agreement. The rates sought at the arbitration hearing ranged from £2,417 for interns to £5,634 a year for registrars.
The junior hospital doctors, following announcement of the arbitrator's decision, formed an "action committee" which produced a plan of action to press for improvements in their pay and conditions of service. This committee did not, however, formulate any specific claim which could be considered. Under their action plan, hospital authorities were notified that:
1. from 15th October, the doctors would continue to work their normal roster but would claim for overtime payment for all hours in excess of 40 per week, and
2. in the event of no satisfactory conclusion to negotiations, doctors would, as from 1st November, work only a 40-hour week, from 9-5 p.m. on Monday to Friday.
This plan was adopted at a meeting of the doctors on 3rd October.
On 10th October, I met representatives of the Irish Medical Association and the Medical Union, who had acted for the junior doctors in the earlier negotiations. In the meantime, the Medical Union had submitted a claim, dated 3rd October, for a maximum standard working week of 40 hours with effect from October, 1973. No claim from the Irish Medical Association had been submitted at the time, but the association did submit a claim on 11th October. This claim also asked for the implementation of a basic 40-hour week, to be operative from 15th October, 1973, and also sought a 10 per cent salary increase which was related to increases given to other categories of health board personnel, et cetera. This claim also included proposals for overtime rates for hours in excess of 40 per week varying from time and a half up to treble time in certain circumstances.
I had told the organisations at the meeting on 10th October that I would be prepared to arrange for negotiations on any new claims which they made and that such negotiations would be conducted expeditiously. A meeting was accordingly arranged in the Department on 15th October. This was attended by representatives of the Department, the health boards, the voluntary hospitals and the two medical organisations. A further meeting was held on 19th October. That meeting had before it a further claim from the Medical Union. This was for a 10 per cent increase in salary, similar to that requested in the Irish Medical Association claim, for overtime rates varying from time and a quarter to double time, for living-out allowances, for superannuation scheme, for sick pay provisions, for payment of the cost of a telephone in certain circumstances, for postgraduate teaching facilities and for "a proper staffing and career structure within the hospital service." This claim was dated 18th October and the official representatives at the meeting pointed out that the three claims before them would obviously take some time to examine and that it was clear that negotiations could not be completed by 1st November.
It was agreed that a smaller working group would be set up to examine the claims and report back to the larger meeting by 30th November, specifically on the remuneration aspects of them. The official side stressed at all times that, in this examination, consideration could only be given by them to claims which would not contravene the national pay agreement. A further meeting of junior doctors had been called for the evening of the 19th October. In the light of the arrangements agreed expeditiously for negotiation of the claims, it was expected that the junior doctors would abandon or defer their "action plan". However, even though representatives who had taken part in the discussions made the position clear to them, I regret to inform the House that the meeting of doctors did not change their planned programme.
The situation now is that the official side, as represented by my Department, the health boards and the voluntary hospitals, are in negotiation with the two organisations representing the junior doctors. In fact, the first meeting of the group established for this purpose took place on 23rd instant and the next meeting is being held this afternoon. Nevertheless, the threat of action by the junior doctors remains and I have thought it prudent to take certain precautionary moves in relation to this.
I have asked all hospital authorities employing junior doctors to examine the situation and take whatever steps they consider necessary to maintain essential and emergency services in the event of any of the doctors going ahead with their industrial action. I have also drawn the attention of the Medical Registration Council to the situation so that they may consider and advise on the implication of this matter for graduates in the course of the intern year. I should explain that the completion to the satisfaction of the Council of that period of internship is a pre-requisite to full registration of a doctor.
I would hope that special steps will not be necessary and that the junior doctors will realise that I have initiated action, and am seeing that action is continued, to give a fair examination to the claims which have been made on their behalf. Within the constraints which the Government have accepted under the national pay agreement, the claims will be fully and objectively considered. No action by the junior doctors can force me to do any more. I, accordingly, would ask each of them to consider the full facts of this matter before taking a decision of possible grave consequence to the hospital services.
The remaining questions will appear on next Tuesday's Order Paper unless Deputies take written answers which they may obtain in the General Office.
The Dáil adjourned at 5.10 p.m. until 3 p.m. on Tuesday, 30th October, 1973.