Vol. 508 No. 2
4 Mr. Shatter asked the Minister for Health and Children the steps, if any, he will take to enable non-consultant hospital doctors work more reasonable hours; and his views on whether patients are at risk as a consequence of the excessive hours these doctors are required to work. [18425/99]
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. My Department has been concerned 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 future structure of the hospital medical staffing 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's proposals have been the subject of discussion in a social questions working group under the aegis of the Labour and Social Affairs Council. A significant number of the member states felt that the Commission's proposals were impractical and could not be implemented in the timescale proposed. The German Presidency then had to work on compromise proposals which might be acceptable to a majority of the member states. These proposals involved a total transition period of 12 years with a gradual reduction in maximum weekly working hours to 48 hours over the period. The United Kingdom proposed a 13 year transition period to reach the objective. In the interests of securing unanimity at the Council this proposal was accepted.
We have progressively reduced hospital doctors' working hours over the years. It is the responsibility of local hospital management to roster non-consultant hospital doctors taking into account the nature of the clinical service to be provided. The basic working week of all NCHDs is 39 hours. However, they are liable to be rostered to work up to an average of 65 hours per week. The 65 hour week was implemented in 1989 following a Labour Court recommendation and in consultation with the Irish Medical Organisation which represents the interests of NCHDs.
Additional Information
A mechanism has been introduced to monitor and control the working hours of NCHDs as part of the revised terms and conditions of the NCHD contract of employment and the complete four stage mechanism, to resolve any breach of the Labour Court recommendation has been in place since 1 January 1997. I am not aware that there has been any use made of this mechanism to date.
The 65 hour week was introduced in 1989-90 at considerable cost resulting in the recruitment at the time of over 400 additional non-consultant hospital doctors. The number of junior doctors has continued to grow since then. This growth has resulted in a serious imbalance between the number of these trainee posts and the number of consultant posts. I established the Medical Manpower Forum to address this and associated medical manpower issues. The forum is taking full account of the need to reduce working hours in its deliberations. However, we have to be realistic in how we approach this complex problem. What we have sought from these negotiations is a practical framework to implement the 48 hour week. I believe that we now have a set of proposals which will allow us to reduce doctors' hours in an orderly and progressive fashion without affecting patients or jeopardising standards of patient care.
What was agreed at the Council meeting on 25 May 1999 is now being considered by the European Parliament. The eventual final content of the directive is a matter for negotiation between the Council and the Parliament. I do not believe that we need to await the final outcome of the EU's deliberations on the draft directive to begin to put in place the preparatory process required to implement the primary provisions of the legislation. In that regard it is necessary to establish the facts on the ground. Accordingly, it has been agreed between representatives from my Department, the Health Service Employers Agency and the Irish Medical Organisation that a study should be undertaken which would look at the hours worked by NCHDs. The study will be over seen by a joint steering group. The steering group will be chaired by Mr. David Hanly, a former chairman of Comhairle na nOspidéal. When the findings of the study and the outcome of the Medical Manpower Forum's deliberations are available, it is intended to reach agreement on how to reduce NCHD working hours in a manner that benefits doctors and patients.
Will the Minister acknowledge that in reality there are non-consultant hospital doctors working 80 and 90 hour weeks? Will he agree that many of them are in a state of exhaustion, as acknowledged by themselves, and are a risk to the patients they are supposed to care for? Will he accept there is a great and urgent need to enter into arrangements which substantially reduce the hours NCHDs have to work and that where they work overtime they are properly paid for it?
A mechanism has been introduced to monitor and control working hours of NCHDs as part of the revised terms and conditions of their contract of employment effective from 1 January 1997. The first stage of the mechanism was introduced on 1 July 1995 and the complete four stage mechanism, to resolve any breach of the Labour Court recommendation has been in place since 1 January 1997. I am not aware that there has been any use made of this mechanism to date.
What was agreed at the Council meeting in May 1999 is now being considered by the European Parliament. The eventual final content of the directive is a matter for negotiation between the Council and the Parliament. I do not believe that we need to await the final outcome of the EU's deliberations on the draft directive to begin to put in place the preparatory process required to implement the primary provisions of the legislation. In that regard it is necessary to establish the facts on the ground. Accordingly, it has been agreed between representatives from my Department, the Health Service Employers Agency and the Irish Medical Organisation that a study should be undertaken which would look at the hours worked by NCHDs. The study will be overseen by a joint steering group. The steering group will be chaired by Mr. David Hanly, a former chairman of Comhairle na nOspidéal. When the findings of the study and the outcome of the Medical Manpower Forum's deliberations are available, it is intended to reach agreement on how to reduce NCHD working hours in a manner that benefits doctors and patients.
Will the Minister agree that the working conditions and length of time non-consultant hospital doctors have to work are inhumane and impractical? Will he acknowledge that, as the British Government has now entered into arrangements to ensure a maximum working week of 56 hours with proper pay for overtime, if we do not put in place urgently a modern and considered framework for junior hospital doctors the growing shortage of such doctors will be exacerbated and many who would work here in that capacity will end up working in England or Scotland? Will the Minister take immediate action to address this problem? Why cannot the Minister make decisions in this area to put in place a new framework? Why is this issue being examined by a committee?
The reason is that we want to try to solve the problem. The Deputy's solution to the problem may not, in fact, be the solution. Sometimes that comes as a surprise to him. An agreed framework has been worked out with the Irish Medical Organisation, the Health Service Employers Agency and the Department on how to seek to resolve this problem. I am interested in addressing this problem. I want to address this problem and I have set in motion a means by which to do so. There may well be some interim proposals, before the study is completed in the middle of 2000, early next year. I have had people out on the continent to see how other countries and other jurisdictions are handling it. It has to be said that in some cases they handle it a little better than we do.
That is no surprise.
That is no surprise. That is why Fianna Fáil is in Government to deal with the problem.
