I propose to take Questions Nos. 31, 49, 57 and 162 together.
The standard working week for non consultant hospital doctors, NCHDs, is 39 hours. However, as part of an agreement with the Irish Medical Organisation, NCHDs may be rostered for duty for up to an average maximum of 65 hours per week. This includes periods spent on call as well as time actually at work. This agreement was re-negotiated as recently as 1997. The 1997 agreement includes provision for a mechanism designed to deal with situations where NCHDs feel they are being asked to work hours consistently in excess of those laid down in their rosters. Given the nature of the services provided by hospitals it is inevitable that the work periods laid down in rosters will be exceeded from time to time. The mechanism is designed to deal with persistent and serious breaches of agreed hours.
The monitoring and control of doctors' working hours is the responsibility of local hospital managers and the consultant medical staff on whose teams the NCHDs work. The mechanism introduced in the 1997 contract provides a forum for hospital managers, consultants and NCHDs to deal with the problems which arise at local level.
NCHDs as doctors in training were one of a number of groups excluded from the original EU Working Time Directive adopted in 1993. Other excluded groups were transport workers, sea fishermen and offshore oil and gas workers. Following adoption of the 1993 directive the European Commission endeavoured to bring forward proposals to deal with the excluded sectors. The Commission recognised that there would be serious difficulties in bringing these sectors within the precise scope of the 1993 directive. Therefore, the Commission embarked on a series of consultative exercises to address the specific requirements of the excluded sectors.
Ireland has never opposed the idea of offering NCHDs a level of protection equivalent to that provided by the 1993 directive. However in so doing, any provisions covering hospital doctors would have to take account of the need to provide 24 hour medical cover for hospitals and of the need to afford reasonable continuity of care to patients. There would also have to be a reasonable transition period to reach the objective of 48 hours per week without significant disruption to the existing medical career structure. As you may be aware the medical manpower forum was established in 1998 to examine the entire issue of medical staffing in hospitals. One of the current problems is the imbalance between trainee posts – NCHDs – and career posts, i.e. consultants. This in part is a legacy of the creation of 400 extra NCHD posts in 1989-90 to allow for the introduction of the 65 hour week.