Vol. 486 No. 2
8 Mr. Durkan asked the Minister for Health and Children if he has satisfied himself as to the adequacy of medical and nursing staffing levels in hospitals; the requests, if any, he has received for an increase in staffing levels; if he is likely to give a favourable response to these requests; if he is currently in contact with various hospitals in relation to this issue; and if he will make a statement on the matter. [2222/98]
137 Mr. Durkan asked the Minister for Health and Children whether he has received information relating to staffing levels at public hospitals throughout the country; if his attention has been drawn to the inadequacies, if any, in these staffing levels; the proposals, if any, he has to address the problem; and if he will make a statement on the matter. [2320/98]
I propose to take Questions Nos. 8 and 137 together
The public hospital system currently employs 3,852 doctors and 27,265 nurses. The number of doctors in the system has been increased by 17 per cent since 1990 and the number of nurses has increased by 10 per cent in the same period. This increase in staffing has been accompanied by an increase in the quality of service provided as well as an increase in the range of services available to patients.
The level of staffing to be provided in any hospital is a matter, in the first instance, for the health board or hospital concerned. Staffing levels are assessed in the light of local needs and having regard to the nature of the service provided.
My Department constantly receives requests from health boards and hospitals to enhance and expand the range of hospital services. These requests are considered in the light of available resources and in the context of their own priorities.
Letters of determination setting out funding levels for 1998 were issued to health agencies in December of last year. My Department is now examining the service plans submitted by the agencies, as required by the letters of determination. The service plans will be the subject of intensive discussions between officers of my Department and the health agencies. Overall numbers employed, including medical and nursing staffing levels, will be discussed with the agencies in this context.
Future medical and nursing staffing requirements will be the subject of study as part of a general review of medical staffing structures and as part of the work of the Commission on Nursing.
Would the Minister not accept that there are major problems in relation to staffing and that anomalies have been highlighted in the Tierney report and, more recently, when Professor Muiris Fitzgerald sounded a note of alarm in relation to the imbalance in the ratio of junior hospital doctors to consultants and the introduction by the Irish Medical Council of a language and competency examination for non nationals? Is the Minister not aware that this has become a major issue in the medical profession and internally in the Department which produced the Tierney report? Does he not accept that there are major problems regarding staffing of our hospitals, particularly our public hospitals, where we have major waiting lists and where we have junior doctors with inadequate training working in accident and emergency units in a way that is unacceptable and which has been seriously criticised by Professor Fitzgerald and in the Tierney report?
I am aware that changes in that respect will require changes in medical manpower policy. The need to improve training for junior hospital doctors has been a hoary chestnut for some time. The need for consultants to make time available for proper training is another issue. I commend Professor Muiris Fitzgerald's lecture in this regard. It was highly enlightening in terms of its scope and the implications of what he had to say. Certainly there is food for thought in it.
There will always be a case for more staff in our hospitals and health services generally. The problem for successive Ministers is that the Department of Health and Children is a Department which seeks to accommodate infinite expectations with finite budgets. Unfortunately I am subject to budgetary constraints, although this Government has increased this year's allocation by 12 per cent against a background of an economic policy that sees public spending increase in Government terms of 4 per cent. Clearly, within Government policy implementation the Department of Health and Children is obtaining the sort of priority one would expect from a Government like ours which is trying to implement some of the policies that I and my junior Ministers are enlightening the House on today. There are costs involved, but there is always an argument for spending more.
I take the point that there are medical manpower issues. We are aware of them in the Department. I have had discussions with top management about it. We are devising strategies for counteracting those changes. The role of non EU doctors in our hospital system has been much underrated. Without them it would be difficult to manage our hospitals. Unfortunately many of our medical graduates have seen it as a necessary step in their career path to emigrate as senior registrars and get experience elsewhere. It was the only way they felt they could get consultant positions in this country. We need to change that so that we do not have a situation where half of our medical graduates are emigrating. We need them in our hospital system. That, it is hoped, will be reflected in an increased level of quality care. We need to ensure that the consultant-led hospital service we have does not preclude the type of training that is necessary if we are to maintain quality.
In relation to nurses and other paramedics, for example, physiotherapists, there are many instances where one would like to see a greater complement of people. Here again, finite budgets and financial constraints delimit what one can do year on year. However, in the service plans which have come back from the health agencies as a result of the allocations in December 1997, we have seen prospects for improved staffing arrangements in some of our hospitals.
I have a further supplementary question.
Question Time is almost over. If I allow the Deputy to continue, it will prevent Question No. 9 being reached.
I want to support Deputy Shatter on this. A certain fairness and justice should be applied in this House, and we have not been able to get that today.
Hear, hear.
In fairness and justice to Deputy Clune, I want to include her question because she is present in the House.
