Brendan McGahon
Ceist:16 Mr. McGahon asked the Minister for Health if he has satisfied himself with the number of consultant posts in this country; and if it is envisaged that these numbers will be increased in 1993.
Ceisteanna — Questions. Oral Answers. - Consultant Posts.
Robert Molloy
Ceist:42 Mr. Molloy asked the Minister for Health if he will make a statement on the recent claim by a leading medical professor (details supplied) that many doctors are burnt out by the time they reach consultant level and that the entire career structure should be reformed.
Bernard Allen
Ceist:249 Mr. Allen asked the Minister for Health if he will make a statement on a recent Department of Health/Comhairle na nOspidéal report that general consultant posts should be abolished as part of a major drive towards specialisation in the senior ranks of the medical profession.
Bernard Allen
Ceist:252 Mr. Allen asked the Minister for Health if he will make a statement on the proposal put forward by his Department that hospitals in poorly populated areas would be forced to merge their services.
Liz McManus
Ceist:270 Ms McManus asked the Minister for Health if his attention has been drawn to the major study on equality carried out by the Irish Medical Organisation, which shows that many training structures are unsuitable for the promotion of women; if he intends to act on the recommendations to allow for more part-time and job-sharing posts; and if he will make a statement on the matter.
Liz McManus
Ceist:272 Ms McManus asked the Minister for Health if, in view of the Department of Health's report on NCHD and consultant manpower levels, he intends to act on the recommendation to increase the number of consultants and reduce the number of junior doctor posts; if he has satisfied himself that the impact on hospital services will be beneficial; and if he will make a statement on the matter.
I propose to take Questions Nos. 16, 42, 249, 252, 270 and 272 together. All the issues raised by the Deputies in these questions were examined recently by a group representing my Department, Comhairle na nOspidéal and the Postgraduate Medical and Dental Board. This group had been asked to undertake a comprehensive examination of the number and distribution of consultant and non-consultant hospital doctor posts in acute hospitals. Based on this examination, one group was asked to put forward suggested courses of action designed to achieve an equitable mix and distribution of medical manpower through the country. It was also asked to identify other issues which might need to be considered, such as the medical career structure.
The discussion document proposed by the group has just been presented to me, Comhairle na nOspidéal and the Postgraduate Medical and Dental Board. I am studying it and hope to formally circulate it for discussion to all the interested parties in the near future. It would not be appropriate for me to comment on any of the specific recommendations in the document until that process is complete.
Did the Minister respond to Question No. 16 which asks if it is envisaged that the number of consultant posts will be increased, as there was no reference to this? The report to which the Minister referred recommends a 40 per cent increase in the number of consultant posts throughout the country. What is his view on the appropriate ratio between consultant and non-consulant hospital-doctor posts?
I answered the specific question in conjunction with a number of others. This question asked if I was satisfied with the number of consultant posts. That specific question was put to the review group and their report has just come to hand. I said in my reply that I do not wish to be drawn into commenting on its specifics at present. However, I am on record in Opposition as saying that I am not satisfied with the distribution of non-consultant hospital doctor posts and consultant posts. I will have to address this as Minister fo Health. We must have an attractive career structure for Irish medical students so that they will continue in the profession. I do not think it is appropriate for people to be in training, which I suppose non-consultant hospital doctors are until they become consultants, for a huge portion of their lives. It is not appropriate either that doctors become consultants in their late thirties to early forties as it would be appropriate and beneficial to the health services if they were appointed at an earlier age.
These are my views and I am very interested in hearing the results of the ongoing discussions before I make a final decision in this matter.
It is all very fine for the Minister to be interested in listening to the ongoing discussion but the number of consultant posts is directly linked to the waiting lists, there lies the urgency of the problem. Will the Minister act on the report in front of him within weeks rather than engaging in lengthy discussions?
I would not like the Deputy to think there has been a decrease in the number of consultant posts and that this has led to waiting lists. There has been a rise in the number of consultant posts throughout the past 20 years; for example, in 1984 there were 1,085 consultant posts and in 1992 this rose to 1,170. There has been a dramatic increase in the number of non-consultant hospital doctors which, obviously, necessitated a review. I will look at this review, listen to the advice of those involved and make decisions in the very near future.
On that last point, is it true that the ratio of consultants to non-consultant hospital doctors is very low compared with other countries in the EC? Will the Minister comment on the fact that we continue to train a large number of medical undergraduates at a high cost to the taxpayer and ship them out because there are not enough consultant posts available to them to work their way up through the system? At present we are subsiding the richest country in the world, the US, by exporting highly qualified graduates, who cannot remain because the opportunities for promotion are not available. I presume the Minister is in favour of providing additional consultant posts.
Yes, I presume I will set about providing these posts.
Does the Minister intend to enable consultants to job-share, as has been done in the National Health Service in Britain? Clearly this is the desire of a proportion, not all, consultants and would be immensely beneficial to the Irish service.
The Deputy has raised a number of issues and I am in agreement with her on some of them. As I said, I am concerned about the career path available to doctors, the implications this has for those who were trained at great cost to the State and then take the emigrant boat and secure very lucrative positions elsewhere, particularly in countries that can afford to train their own doctors. As a consequence, up to 34 per cent of non-consultant hospital doctor posts in this country are filled by non-nationals. We can work to achieve a better balance and this was one reason the review was instigated in the first instance.
There have been a number of applications for job-sharing at consultant level in recent times. This has been looked at by Comhairle na nOspidéal and I am interested in its views on this matter. Depending on the speciality involved, some would be more amenable to job-sharing than others where more consistent care is required. I would have to consult with the professionals in relation to that matter. On the initial question relating to the disposition of new consultant posts, one matter that concerns me is the ever-increasing specialisation whereby there may be any number of specialities right down to the tiniest aspect of surgery or clinical medicine. That matter will have to be considered with a view to getting the best possible value and the most efficient means of dealing with the resources available.