Dáil Éireann díospóireacht -
Tuesday, 11 May 1999

Vol. 504 No. 4

Adjournment Debate. - Hospital Doctors.

Ms McManus

I am grateful for the opportunity to raise this vital matter. Junior hospital doctors are working under conditions and for hours which give rise to grave concern about the protection of the doctors themselves and, most particularly, about the protection of their patients. The European directive on working time was adopted in 1993. It allowed for certain exceptions, although there was not an onus on member states to make any. One of the exceptions was for doctors in training.

In 1997 the Organisation of Working Time Act was incorporated into Irish law. That Act exempts doctors in training from all provisions of the Act, including rest breaks, night work and total overall working time limits. This means that doctors can, and do, end up working an intolerable number of hours. There is evidence of doctors working up to, and even over, 100 hours per week. Regularly, junior hospital doctors do not get proper coffee breaks or a chance to eat their lunch. They may head into a day's work, having been on call the night before following a day's work and having had only two hours sleep. If they want to take a holiday they must make reciprocal arrangements with colleagues by providing cover for them. If someone is sick, another doctor must fill the gap.

The current lack of exemption from protection for these doctors is totally unacceptable and poses an unjustifiable risk to patients. It is only a matter of time before a major medical error is made by some unfortunate junior hospital doctor suffering from exhaustion. That is the nightmare junior doctors are conscious of on a daily basis and one which must be addressed within the shortest possible timeframe.

It is unacceptable that any worker, particularly workers who are dealing with matters of life and death, should be deprived of their legal right to rest breaks and working time limits. We do not make the demands on lorry drivers or factory workers that we currently make on junior hospital doctors manning our acute hospital services.

I accept the Minister will say in his reply that the matter of the NCHD working hours is dealt with in the general agreement negotiated between the IMO and health employers, which limits work to 65 hours, save in exceptional circumstances. However, it is quite clear this agreement is totally inadequate. The exceptional circumstances let-out has been grossly abused. It must be remembered that this agreement has no legal backing and there are no legal remedies as exist under the Working Time Act.

While there is a tradition in the hospital service of junior doctors working long hours, conditions are very different today and are more pressurised, demanding and open to litigation than ever before. We have a system in our public acute hospital service that is near breaking point. Junior hospital doctors are working at the coalface all the time. They staff the accident and emergency units and cope with the full range of health demands. Although they are still in training, they are expected to carry a ferocious burden of work and responsibility. That they do so with such skill and dependability is a great credit to themselves and their training.

In November 1998 the EU Commission published a proposed revised directive. This would limit junior doctors to 48 hours, from a seven year lead in period during which the hours could be negotiated up to 54 hours per week. It is now clear the British Government is trying to water down the directive, with a prolonged lead in period of 11 years or longer and reduced protection for doctors and patients. There have been worrying indications that the Irish Government has been supportive of the British approach. Despite repeated calls from junior doctors and the IMO, there has been no public statement from the Government on its position. We are in the dark.

I raise this matter in the House because it is vital the Government makes a clear, unambiguous statement on the EU draft directive and pledges its commitment to resist any attempt at dilution from any quarter. In raising this issue, I am urging the Minister to declare that the injustice being meted out to junior hospital doctors and the risks inherent for patient care will be tackled without undue delay.

I wish to refer briefly to a chart I have just been handed—

An Leas-Cheann Comhairle

The Deputy must conclude.

Ms McManus

—in relation to the rates of pay. It is outrageous what doctors are being paid for the overtime they are working. The intern rate is—

An Leas-Cheann Comhairle

I ask the Deputy to conclude as she has gone beyond her five minutes.

Ms McManus

—50 per cent of the normal rate. A rate of £4.14 is outrageous in this day and age. It must be dealt with quickly.

Minister of State at the Department of Health and Children (Dr. Moffatt)

On behalf of my colleague, the Minister for Health and Children, Deputy Cowen, I thank the Deputy for raising this matter on the Adjournment and allowing me the opportunity of clarifying the Government's position on the issue. There have been several highly inaccurate reports in the Irish and British media on Ireland's position on the inclusion of junior doctors in the working time directive.

The Deputy will be aware that trainee doctors, along with several other groups, were excluded from the provisions of the original working time directive adopted by the EU in 1993. Following adoption of the 1993 directive, the European Commission embarked on a consultative exercise with the sectors concerned and the member states on how a broadly similar level of protection to that provided by the 1993 directive could be afforded to the excluded groups, while taking account of the specific requirements of the industries and services concerned. In the case of hospitals, this involved attempting to balance the need for reasonable working hours for doctors, while recognising the 24 hour nature of hospital services, and the need to guarantee continuity of care for patients. In Ireland's case, we needed a framework which would allow us to move from our present position of having a maximum working week of 65 hours for junior doctors to the 48 hours contained in the 1993 directive. We have never disputed the need to move towards 48 hours per week as a maximum. We simply wanted to achieve this in a manner which would not endanger patients and which would not throw the entire medical workforce career structure into chaos by recruiting large numbers of trainee doctors for whom there would be no reasonable prospect of securing career posts. The Deputy will be aware that the future structure of the hospital medical hierarchy is already being looked at by the Medical Manpower Forum.

The European Commission published its proposals for an amending directive to the 1993 directive in November 1998. The Commission proposed a transition period for junior doctors of seven years from the date of adoption of the new directive. During this period the maximum permitted working week would be 54 hours. We regarded this proposal as unrealistic and not capable of being achieved. I have to point out to the House that European directives have the force of law and are not aspirational. We should not agree to proposals which we cannot implement and adhere to. The Commission's proposals have been the subject of discussion in a social questions working group under the aegis of the Labour and Social Affairs Council. Several member states have expressed dissatisfaction with the Commission's proposals. In an effort to secure a consensus on a proposal to be put to the Council, the German Presidency has brought forward a series of compromise proposals. The latest proposal envisages a total transition period of 11 years from adoption of the directive. Member states would have three years to implement the directive in law. For the remaining eight years, doctors would have a maximum working week of 60 hours for the first two years, 56 hours for the following two years and 52 hours for the remaining four years, with 48 hours being reached at the end of that period.

Ireland did not support the UK Labour Government's proposal for a 15 year transition period, although we understood the reasons it sought this concession. We will fully implement whatever measures are adopted by the Council.