I am pleased to have an opportunity to speak on this issue which is of immense importance in creating a proper health service. My party colleague, Deputy McManus, spoke yesterday evening about how a proper adequate health service could be put in place. In the time available to me, I will direct my comments to the dispute itself.
The position of non-consultant hospital doctors has for many years been little less than a scandal. It is hard to read in the year 2000 of conditions where a non-consultant hospital doctor, having finished a period in university and training in a hospital, can be in a position of not being able to secure a basic roster for his or her time and service. When one considers the conditions that prevail, a few matters are very clear. First, it is not possible to address this problem without looking at the inadequacy of consultant posts. It is not possible to address the issue without accepting that a career structure must be put in place to enable people to move from NCHD status to consultants. It is not possible to solve this issue on the basis that it is a dispute that has arisen recently or one that can be solved as a short-term labour negotiations problem. The two sides to the dispute, for example, on the health employers side, are not in a position to negotiate on the structure on the basis of the dissatisfaction in the hospitals at present.
I read with great care the Minister's speech and there is immense dissatisfaction and anger at the description of non-consultant hospital doctors not being fully trained. They clearly point out, and rightly so, that after the longest period of university lectures, exposure to health training and in-hospital training, they are fully qualified doctors and hope to be on their way to specialist qualification as fully accepted and recognised specialists. The idea that one can lean back and take advantage of what could be described as a kind of class system whereby people who might have aspired to becoming consultants must make themselves available under the most inappropriate conditions is simply unacceptable. It is one of the most disgraceful marks of the European Union, and far more indicative of right-wing thinking within it which wants to destroy the social fabric of employment across the board, that there has been this enormously long waiting period for the implementation of the directive in relation to working time. While there may have been a need in the beginning to consider the supply of essential medical services because of its importance to the public, there is no justification for introducing a period of 13 years, adjusting it to nine years and including no interim points when people might see their hours reduced in the short term. It is impossible to ask people to accept a regime of compulsory, non-rewarded, non-recognised overtime. During this time doctors are not off duty but neither are they being remunerated. The Department of Education and Science could play a part in the resolution of this dispute, by providing additional resources for an improved structure which would enable people to build a professional career from the time of their early recruitment as non-consultant hospital doctors.
This dispute, which has been building up over many years, is evidence of a complete erosion of trust. Junior doctors are now being asked to enter into negotiations on one half of the agenda, with the main structural elements left to one side, while at the same time realising that the 1997 contract has not been implemented. If the Minister wishes to enter meaningful talks on any aspect of the problem, the provisions of the 1997 contract should be fully implemented as a gesture of goodwill. The undertakings given on rostering must also be implemented. The Department of Health and Children was to issue a directive to the hospitals in regard to rostering in order that people would know when they would work. My information from people working in the area is that that is not happening in the majority of cases.
How can the Minister state that this dispute can be resolved within the framework of the most recent agreement when the terms of the previous agreements have not been implemented? If the Minister is to be taken seriously at all, he must clear the decks in regard to previous undertakings and deliver on them. He must also make a fundamental commitment to allocate resources, beyond the terms of any negotiations which may occur, to improve structures, increase the number of posts and provide a career structure for transition from non-consultant hospital doctor to consultant status.
The Minister stated that he had taken the most benign interpretation possible of the outcome of the EU negotiations on the nine year issue. When we previously had a 13 year proposal, there were also proposals for stage points at which there would be a reduction in hours. If the Minister now accepts a nine year proposal instead of a 13 year one and takes away these stage points, he will extend the period of time rather than reduce it. The Minister may wish to clarify his position on this matter. What could appear to be an improvement would make the situation worse.
I urge the Government to stop talking about the "gross cost" of the health service. We need a first class health service which will be available to all our citizens. We have real difficulties in recruitment at every level of the health service. Many people are leaving university at an early stage for highly remunerated positions. Students studying medicine make a professional commitment to stay in college longer than others and they then progress to a system which in my time, 30 years ago, displayed more of the characteristics of a caste system than a health professional training system. That must end.
The only way to bring the non-consultant hospital doctors on side is to agree to implement the terms of the 1997 agenda prior to entering into negotiations. Any entry into negotiations will be an acceptance that only part of the problem is being addressed. Talks must open immediately in regard to putting in place a career structure for junior hospital doctors.
The Medical Manpower Forum was established two years ago but has not made a single significant proposal in regard to the structures I have described. How are junior hospital doctors to enter into negotiations as if their dispute was just an ordinary one when the most basic entitlements to time off, knowing what time one is working, what one's career structure is, what proposals for reform are being made and what funding will be provided to implement those are denied them? This is not a little dispute which can be resolved through some kind of administrative adjustment. It has been ripening over a long time and the non-consultant hospital doctors deserve to be taken seriously and to have their dispute resolved.