Paul Bradford
Ceist:9 Mr. Bradford asked the Minister for Health and Children if all issues in dispute with the non-consultant hospital doctors have been resolved; and if he will make a statement on the matter. [18405/00]
Other Questions. - Hospital Doctors.
Michael Bell
Ceist:65 Mr. Bell asked the Minister for Health and Children the position regarding the negotiations with the non-consultant hospital doctors; and if he will make a statement on the matter. [18532/00]
Alan Shatter
Ceist:116 Mr. Shatter asked the Minister for Health and Children if all issues in dispute with the non-consultant hospital doctors have been resolved; and if he will make a statement on the matter. [18397/00]
I propose to take Questions Nos. 9, 65 and 116 together.
After an intensive series of negotiations held under the auspices of the Labour Relations Commission an agreement has been reached with the Irish Medical Organisation on all the major concerns of non-consultant hospital doctors – NCHDs. The proposals are now being balloted on by NCHDs. As the NCHD committee has recommended that the proposals be accepted, I hope that this dispute is now resolved.
The proposals include a very significant improvement in the overtime rates paid to NCHDs. In addition, a senior manager is to be appointed in each major hospital with specific responsibility to manage NCHD hours. A concerted effort is to be made to improve the working conditions and to reduce NCHD working hours with particular attention to long periods of continuous duty. There is also a substantial training package to be put in place amounting to £10 million per annum. New procedures are to be put in place to deal with NCHD grievances at local level. Relocation expenses are also to be paid to NCHDs who have to move residence as part of formal rotation schemes.
In tandem with these significant improvements to the terms and conditions of employment of junior doctors, the medical manpower forum is looking at the medical staffing in our hospitals. Improving the career prospects for junior doctors is one of the main issues which has been identified from the early stages of this review. The main service, training, research and career issues, and the principles and approaches to be adopted have, to a large measure, been agreed by the Medical Manpower Forum. It has also been agreed that the introduction of these changes should coincide with an extension of the core hospital working day. This is necessary if one of the key principles of the forum is to be achieved, the need to provide the highest quality of medical care for those who require the services of hospitals. This will require an increase in the present number of hospital consultant posts. The Medical Manpower Forum is due to present its first report shortly.
Some of the issues which affect NCHDs working conditions cannot be resolved immediately. Among these are the twin issues of working hours and the restructuring of the medical career hierarchy. The working hours of NCHDs have been the subject of negotiations at European level in the context of the proposed extension of the 1993 EU Directive on Working Time to doctors in training. Deputies will be aware that different stances on this issue had been taken by the Council of Ministers and the European Parliament. I am glad to note that the agreement was reached on a formula which provides for a nine year transition period to apply the directive to junior doctors. Ireland has always stated that it will reduce junior doctors' working hours to an average of 48 per week at least as quickly as required by any European legislation. I am confident that with the full co-operation of the profession we can achieve that objective in the nine year period.
As part of our preparations for this eventuality we are conducting a major study of NCHD working hours on a joint basis with the Irish Medical Organisation. The study is being undertaken at eight hospitals by PA Management Consultants. The report of the study will be available shortly.
This is a substantial and comprehensive response to the issues raised by NCHDs. I appreciate the effort put into resolving the dispute by all the parties involved and, in particular, I thank the officials of the Labour Relations Commission for their assistance. As part of our preparations for this eventuality we are conducting a major study of NCHD working hours on a joint basis with the Irish Medical Organisation. The study is being undertaken at eight hospitals by PA Management Consultants and the report of the study will be available shortly.
Does the Minister acknowledge that as of 1 July we will be short approximately 140 junior doctors or NCHDs in hospitals across the country? Does he acknowledge that the confrontational approach to industrial relations taken by him and his predecessor has contributed to the number of NCHDs graduating in this State who are obtaining positions outside the State and has added to the difficulties in recruiting medical personnel for our hospitals? Can the Minister assure the House that if future industrial difficulties arise they will be addressed in a sensible and constructive way and will not be left to the last hour of pending strike action?
I reject all the Deputy's assertions. I have not taken a confrontational approach to industrial relations since taking office. I take a personal interest in all the issues raised by the different partners in the health area and I have worked tirelessly to make sure we resolve the problems. I am conscious of the industrial relations difficulties in the health services over the years and I am determined to resolve those difficulties. We have already put in place a Labour Relations Commission audit to examine industrial relations in the health services and I am looking to develop a new era of constructive part nership involving all participants in a future vision for the health services.
The treatment of junior doctors through the years, that tradition and history, has placed us in this position. I accept we must change that. We have negotiated a very significant package so far with NCHDs and it will make a difference in the working conditions of junior doctors. We are not finished yet; we have a lot to do.
The Minister depends a great deal on the Medical Manpower Forum report, which we have been waiting a very long time to see. He should clarify the position regarding that report. He says it is due shortly, but we have been waiting 20 months and we are coming into the holiday period. What does he mean by "shortly"?
Given that there will be a shortage of NCHDs, can the Minister ensure the package that has been agreed will hold up in terms of the appointment of roster managers, for example? When will they be appointed? Will they come from outside the present system or will they be drawn from within the current management structure? That structure has been part of the problem rather than the solution. Also, how can the Minister guarantee that NCHDs will be able to take up training grants? Will leave be guaranteed for those who need to take it up or will the result of the shortage mean NCHDs will not be able to get the time?
The roster or manpower manager matter is a key issue that has emerged from the talks and it is something about which we are insistent. We want to recruit the best people for that position because it is a key post which involves ensuring that hours are managed properly.
From within?
We want the best. Therefore, some could come from within and some from without. There will be open advertisements and they will be then recruited. It is important that from the outset these posts have the status they require and that those appointed have the authority required to ensure the agreement sticks at hospital level. There will have to be due consultation with all those involved, but everyone will have to realise who ultimately has responsibility for managing the hours of NCHDs. Having met with junior doctors, I feel this is one of the key weaknesses in what has been happening over the years.
The Deputy mentioned the manpower forum report and we are equally frustrated with the delay. The NCHD dispute meant it went on the back burner, but in a matter of weeks we hope to finalise negotiations on this.
It is the Minister's view that he has handled industrial relations within the health services with greater or lesser sensitivity than his predecessor?
With equal sensitivity.
I hope not.
The Minister should not be so hard on himself. Even I would be more charitable.
The resources my predecessor made available, particularly in the nursing area, have made life easier for me. That has facilitated the full implementation of the recommendations of the Nursing Commission and very significant subheads have been approved for it. I have my predecessor, Deputy Cowen, to thank for that.
Does the Minister accept junior doctors have been treated like skivvies and have been exploited over the years? Does he share my concern that people in such responsible positions could be suffering from sleep deprivation, as some of them have complained? When will we see the 48 hour working week?
I accept the hours junior doctors have to work are unacceptable. I have spoken to many individual doctors and the hours they work, given the positions they hold, are extraordinary. The PA Management Consultants study is very important as it will give us a geographical read and an idea of what is happening on the ground in large and small hospitals. That study has been entered into jointly by the Department and the IMO and it will give us an idea of how many extra positions we will need in the future. The findings will be linked to colleges, universities and the medical schools, as we will need more doctors to get down to 48 hours per week. It is not possible to give the exact timeframe now, but both sides are committed to doing this and doing so in the context of this study.
The Minister mentioned nine years. Will it be less?
If we could do it in less than nine years we would.
Does the Minister agree that if we speeded up the process of achieving the 48 hour week, it might result in having more doctors available and in more of our graduates staying here to work as NCHDs as opposed to working outside the country? One of the reasons for large numbers of them leaving the country is the huge pressure they are placed under in our hospitals, such as working extended hours without always having consultancy backup that would be available to them in other EU states or the United States.
A 48 hour week and better conditions will improve our capacity to retain doctors in the country, but it is also important to have good career paths for young people in medicine. That is the key. We must also have good educational packages for young doctors in our system. We hope the package we have concluded will significantly improve the educational and training package available to junior doctors. We have some distance to go to make that even better and we will have to do so if we are to compete effectively with other countries for what is becoming a much valued resource – young doctors. It is a mobile market. Other countries are endeavouring to recruit from Ireland, while we are endeavouring to recruit from other countries. Given recent changes in terms of higher standards of entry into the system here – by virtue of the Irish Medical Council's new regulations – we will have to step up our efforts.
I asked a question earlier about the educational package which was not answered. Will the Minister be able to ensure NCHDs can take up this opportunity when certain hospitals will simply not have enough NCHDs and people will have to work extended hours as cover? Can the Minister ensure that all NCHDs will be able to avail of this opportunity, which is very welcome?
Absolutely, that was our intention. We are still working flat out to try to ensure there are vacancies in the first week of July.