I propose to share my time with Deputies T. Ahearn, Connaughton and Bradford. I move:
"That Dáil Éireann:
–deploring the failure of the Government to make reasonable proposals to resolve the current dispute with non-consultant hospital doctors,
–alarmed at the continuing deterioration in our health service at a time of unprecedented economic prosperity,
–acknowledging that the hours presently worked by non-consultant hospital doctors detrimentally impact on doctors' health and undermine their ability to provide proper patient care,
–concerned at the inability of the Health Service Employers Agency to constructively address and resolve industrial relations issues within the health service as evidenced by its failure after six months of negotiations to make any substantive proposal to resolve issues in dispute relating to non-consultant hospital doctors,
–conscious of the serious damage to the health service that will result from strike action by non-consultant hospital doctors and the effect of such a strike on patients resulting in the further escalation of the in-patient hospital waiting lists,
–acknowledging the crucial role played by non-consultant hospital doctors in our hospitals,
–agreeing that the hours presently worked by non-consultant hospital doctors are totally unacceptable and are inadequately remunerated,
–deploring the fact that some non-consultant hospital doctors have been forced to take legal action to secure overtime pay ments due to them and that substantial arrears of remuneration for overtime hours worked are presently payable to non-consultant hospital doctors,
–noting that 98% of non-consultant hospital doctors voted for industrial action for higher overtime rates, shorter working hours and better staffing ratios,
–condemns the failure of the Minister for Health and Children to intervene at an early stage to facilitate the reasonable resolution of the issues in dispute, and calls on the Minister for Health and Children to immediately enter into substantive negotiations with the Irish Medical Organisation in order to resolve the current dispute and to avoid a damaging strike occurring."
Political brinkmanship, crisis management and industrial relations ineptitude are the hallmarks of the Government's approach to our health service. Last October, the Government's failure to engage in constructive dialogue in negotiations with the nursing unions resulted in the first ever nurses' strike in the State. In the past six months, the Irish Medical Organisation, in discussions with the Health Service Employers Agency, has attempted to resolve a number of serious difficulties that affect non-consultant hospital doctors. This has proved impossible and we are now confronted with the possibility of non-consultant hospital doctors taking strike action on 17 May next to force the Government to resolve genuine grievances which in justice must be addressed.
The present Government and both the current Minister for Health and Children and his predecessor have failed to realise that our health services have entered not only a new millennium but a new era. Nurses have already fought part of the battle to force the Government to recognise this fact. Junior doctors are now fighting on another but related front. Their fight should not be categorised as simply an industrial relations dispute; it is more than that. Like the battle fought eight months ago by the nursing unions, it is concerned not simply with working conditions and remuneration but about the type of health service we should have in this State and crucial standards of patient care.
Our hospital service is consultant-led. There are currently 1,250 consultants in hospitals throughout the State and 2,700 junior hospital doctors. It is now widely acknowledged that our consultant numbers fall far below what is required to provide proper patient care and it is estimated there is a need to appoint an additional 800 consultants to properly meet patients' needs and to bring to an end the escalating waiting lists crisis. Without the 2,700 junior hospital doctors in our hospitals, we would not have a functioning health service. The reality within our hospital services is that junior doctors are expected as a minimum to work a 65 hour week. This is supposed to be their maximum working time. In fact, a substantial number of junior doctors are on continuous duty for up to 36 hours and work between 80 to 100 hours per week. The hours junior doctors are currently required to work detrimentally impact on their health, impair their capacity to make clinical judgments and, as the doctors themselves accept, put patients at risk. The hours currently worked by junior doctors are totally unacceptable and should not be tolerated by either the medical profession or by the general public.
For some time now there have been discussions at European level about the Working Time Directive and its application to non-consultant hospital doctors. While final decisions have yet to be made as to the exact date by which the 48 hour week will be extended to junior doctors, it seems that at European level, from the date when the directive comes into force, a gradual reduction of working hours will result in taking a nine year time span before the working week for junior doctors is reduced to 48 hours. There is no commitment from the Government to do better than that. Fine Gael believes that there should be commitment to a speedier time frame by which junior doctors will not be obliged to work in excess of a 48 hour week. In moving towards the reduced working week, a junior doctor should not be required to work in excess of a 65 hour week or be required to work the excessive hours previously referred to. Essentially, an 80, 90 or 100 hour week is a consequence of the failure of the State and of this Government to ensure our hospitals have available to them the crucial number of required consultants in a variety of specialities, including consultants who specialise in accident and emergency procedures.
The pay currently received by junior doctors for work in excess of 48 hours in any week is equal to half the basic hourly rate paid to them for normal work. They receive a salary scale known as "half time". No one else within the public or private sector would work overtime for half their normal hourly working pay. To add insult to injury, we learned in recent weeks that hundreds of junior doctors throughout the State are due overtime arrears payments going back many months and some have been forced to take legal action against their employers. A number of hospitals have been named and shamed for failing to pay junior doctors the miserly salary to which they are entitled for overtime hours already worked. These include, St. Vincent's Hospital, Dublin, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Cork University Hospital, Galway University Hospital and Limerick Regional Hospital.
In what other area of the public service would a State employee tolerate being required to work excessive overtime for a half time payment which is not even made? In years gone by, we watched in wonderment, scenes from the old Soviet Union and then in the newly reformed Russian State where State employees took to the streets to demand pay State bodies had withheld from them for many months. The manner in which junior doctors have been treated by the Department of Health and Children by health boards and hospital administrators has much in common with the treatment of Siberian miners by the old Soviet administration. Since the naming and shaming of the various hospitals, some of them have cried foul. Are they to be believed? An independent inquiry conducted by the ICTU former president, Mr. Philip Flynn, found that non-consultant hospital doctors in one of the country's biggest hospitals, University Hospital Cork, were required to work unrostered hours for which they were not paid. He recommended in his report that compensation payments be paid to the doctors concerned.
University College Hospital, Galway, is currently facing a number of Labour Court actions from non-consultant hospital doctors demanding adequate pay for overtime worked. One case was already before the Labour Relations Commission just last week. The commission gave the hospital three weeks to resolve matters and presumably to make payments that are clearly due. From my contact with a number of different doctors, it is now clear that hospitals and health boards have consistently failed to honour the 1997 NCHD agreement. Junior doctors, on whom the functioning of the health service is dependent, are entitled to be angry.
The lack of insight by the Department of Health and Children, health boards and hospital administrators is extraordinary. It is almost beyond belief that at the very time non-consultant hospital doctors were balloting on proposed strike action, health service employers were depriving them of basic salary entitlements. Under Partnership 2000, the 1% increase in basic salary was due from 1 April. This should have been added to the most recent pay cheques received by junior doctors. However, reports from Cork, Galway, Limerick and Dublin show that payments have not been made. Neither health boards nor hospitals are entitled to ignore partnership agreements. Neither are they entitled to withhold overtime payments due to doctors for hours worked.
The Fine Gael motion before the House this evening in acknowledging the crucial role played by non-consultant hospital doctors in our hospitals not only seeks agreement from this House that the hours currently worked are totally unacceptable, it also asks the House to agree that junior doctors are inadequately remunerated. Proper pay scales must be put in place to adequately reward doctors for the overtime hours worked by them. Immediate action must also be taken by the Minister for Health and Children to require that all arrears of remuneration of overtime already worked, which is currently outstanding, be paid immediately by the health boards and hospitals liable for such payments. If our health boards and hospitals have been so under-funded by the Government as to render it impossible for them to discharge their salary obligations, the Minister should provide immediately the additional funding required to resolve this extraordinary problem.
No junior doctor anywhere in the State should be forced to take legal action or to bring an application to the Labour Relations Commission to obtain from his or her employers, money due for overtime worked. In this context, junior doctors have been treated scandalously. Instead of being given the respect to which they are entitled, they are being treated with contempt by their employers. They are effectively being exploited.
Junior doctors have other concerns which are not selfish but which are of great importance to a properly functioning health service. These include the essential need to receive well structured, audited training. Many rightly regard their present training as inadequate. For too long doctors have been forced to work abroad for between five and ten years prior to their having any possibility of a consultancy appointment in an Irish hospital. There is something seriously wrong with a system of medical education and training which compels doctors to leave the State and which renders it impossible to obtain a consultancy appointment if they do not do so. Non-consultant doctors have been used and abused by the health service, which has depended on them to provide a cheap acute hospital service at a cost to their well being and training.
For six months the Health Service Employers Agency, on behalf of the Minister for Health and Children, has been engaged in discussions with the IMO about the plight of junior doctors. It is astonishing that during that time, a substantive offer of any kind does not appear to have been made to resolve the issues in dispute. The Minister, like his predecessor, has also failed to take the action necessary to bring about a resolution and to ensure that an unnecessary strike will not seriously damage our health service.
Serious questions must now be asked as to why the Health Service Employers Agency appears incapable of constructively addressing industrial relations issues within the health service within a reasonable time frame and why it is addicted to confrontation rather than committed to dispute resolution by conciliation. The former Minister, Deputy Cowen, sat on the sidelines engaging in megaphone diplomacy in the six months lead-in to the nurses strike and only engaged in substantive negotiations with the nursing unions after strike action had taken place. The Minister, while making more moderate and conciliatory public comment on issues affecting junior doctors than we came to expect from his predecessor, has not done anything to date to effect a resolution of the dispute and to avoid a strike. His meeting last Thursday with the IMO was apparently a mere listening exercise. Seven days before the junior doctors are due to strike, neither the Health Service Employers Agency nor the Minister has made any substantial proposals to the IMO to address the grievance of junior doctors.
On previous occasions in this House I criticised the Government for effectively institutionalising a two tier health service – one for the rich and one for the poor. At a time of unprecedented economic wealth and with a first world economy, near the top of the OECD economic ladder, we have a public health service for a second world economy. We spend less of our GDP on health care than any other OECD country, with the exception of Poland, Mexico, Korea and Turkey. Even such developing economies as the Czech Republic, Portugal and Hungary spend more. Difficulties experienced by junior doctors, the frustrations and problems experienced by patients attending the accident and emergency departments in the acute hospitals, the pain and suffering of patients on the in-patient hospital waiting lists are a consequence of this. Another consequence is the death of patients on waiting lists who are awaiting essential cardiac operations.
Not only is our health service under funded, there is a lack of essential vision. Since his appointment, the Minister has been talking about the health service. In a speech delivered by him on 17 April, he spoke about nurses and nursing as a profession being grossly undervalued and he promised to effect change. We heard similar things from his predecessor two years ago. In his speech to the IMO conference on 14 April, the Minister spoke of health as "the central enabler in our fulfilment of our potential as a nation" and committed himself to "a radical overhaul of Ireland's health care systems" saying such an overhaul was overdue. The Minister has been in Cabinet for almost three years and his fine words bear no relation to decisions made by the Government on the delivery of health care during its term of office and for which he, as part of the Government, is responsible.
A reshuffle of Cabinet duties does not relieve the Government or Ministers from responsibility for past failures. If the structure, organisation and medical manpower in our hospitals is in need of urgent reform, the urgency results from this Government during its three years in office, failing to make many of the crucial decisions necessary for proper patient care and for failing to ensure the speedy implementation of decisions made. If the industrial relations within the health service are in a shambles it is the fault of the Government and the Minister.
The Health Service Employers Agency as a body appears incapable of constructively addressing genuine industrial relations problems within our health service. If the Minister sits back, like a spectator at a football match observing what is happening and doing nothing, the problems that result are his responsibility. Every few days he issues a script proclaiming reforms he believes are required in the health service. A health service cannot be built by proclamation. What is required is action, not words.
A one day strike by junior doctors on 17 May will result in 7,500 out-patient appointments being cancelled or postponed, up to 40% of which will affect new patients, who may have been waiting for many months. On 17 May also, 700 people scheduled for elective surgery throughout the State will have their operations postponed and will continue to languish on the in-patient waiting lists. Many of those whose operations will be postponed will already have been statistics on the waiting lists for well in excess of one year, some for two years and some possibly, in the context of ear, nose and throat operations, for up to three years.
The most effective action the Minister can take today with regard to the health service is to immediately enter into substantive negotiations with the IMO to resolve the current dispute with non-consultant hospital doctors and to avoid a damaging strike occurring. If he is not willing to enter directly into such negotiations he should compel the Health Service Employers Agency to make specific proposals to the IMO to resolve all issues currently in dispute. In the absence of specific proposals being made, either by the Minister or the HSEA, there is no basis on which the Labour Relations Commission can constructively intervene in the present damaging dispute.
We know that non-consultant hospital doctors do not wish to be on strike. We know the strong sense of obligation and commitment they have to patients throughout the country and to those who require their medical care. We also know that many of them have studied long and hard for many years to practice as doctors. The last thing any of them want to do is to withdraw a service that they have dedicated themselves to provide.
It is a scandal that for the second time within a period of 12 months, the Government has allowed a situation to arise whereby dedicated health care professionals feel the only way their genuine grievance can be listened to is to force a Government response by taking strike action so that problems in the health service will be addressed and patients can obtain the care to which they are entitled. We will be confronted by a one day strike on 17 May, which will retain 700 people on the in-patient hospital waiting lists. We will be confronted by a two day strike the following week, which will ensure that another 1,400 people on the elective surgery waiting lists will have operations postponed.
It is time for the Minister to stop talking about the need for reform as if he was an Opposition politician without power to implement decisions. It is also time he did something to bring to an end the rot in the health service, to restore public confidence in the public health care system and to recognise the difficulties and problems confronted by health care professionals, and, especially in this instance, by junior doctors.
It is the Minister's job to ensure these problems, which should have been addressed weeks ago, are now addressed. This debate should not be necessary and the threat of industrial action should not be hanging over this House. Some 98% of the junior doctors who balloted on this issue should not have been forced to vote in favour of strike action because they felt no other course of action was open to them. The Minister has an opportunity this evening to say something constructive and I ask him not to simply urge the junior doctors to go to the Labour Relations Commission. I ask him to specifically set out the Government's proposals to resolve this dispute and, if they will allow the Labour Relations Commission to make very real progress and will allow a strike to be avoided, the Minister will be acting in the public interest. If the Health Services Employers Agency cannot do its job properly, it is the Minister's repsonsibility to intervene and talk directly to the junior doctors. He should not wait until we have had a one day strike, nor should he allow the current difficulties to continue to fester and place the care of patients at risk.