I am pleased to advise the committee that excellent progress has been made in filling vacant non-consultant hospital doctor posts over the past three months. It should be noted that this is being achieved against a background of a general shortage of NCHDs affecting western Europe. It is important that these vacancies are filled having regard to service needs and achieving compliance with the European working time directive.
As of 29 September, approximately ten NCHD posts of the 190 identified as vacant by the HSE before the recruitment of doctors from India and Pakistan remain vacant. The decision to recruit from abroad was made owing to an ongoing vacancy level of approximately 150 NCHDs and a significant number of additional vacancies anticipated in July 2011 arising from the cyclical rotation of posts. Some 259 NCHDs have been appointed from centralised recruitment and as of Thursday, 29 September, a further 231 doctors have been recruited in India and Pakistan for the July rotation.
Given the shortage of NCHDs over the past two years, the HSE developed a range of strategies and initiatives to maximise recruitment, including the development of a centralised recruitment process for service or non-training posts. All vacant service NCHD posts were advertised as professional development posts under two year contracts to one of the four HSE areas, with a minimum of six months in a regional centre and participation in a professional development scheme under the relevant postgraduate training body. Notwithstanding these measures, approximately 150 posts remained vacant and it was decided to undertake a recruitment campaign in India and Pakistan.
I introduced legislation on 8 July to amend the Medical Practitioners Act 2007 to facilitate the registration of these doctors, which allowed for the creation of a new supervised division on the medical register. Registration in the supervised division means that a person is registered for a period not exceeding two years in an identified post approved by the Medical Council and subject to supervision by the employer in line with criteria set down by the Medical Council.
The Medical Council then introduced new rules for the supervised division and, with co-operation from the medical schools and postgraduate training bodies, organised specialty specific examinations for the candidates. Some 236 candidates were successful and as of 29 September, 231 of these, to which I have alluded, have been registered on the supervised division. More will be registered in the coming days. Approximately 80 additional doctors are expected to sit further assessments for the supervised division and, if successful, will be offered employment.
These doctors are making significant contributions to vacancies which existed in areas such as anaesthetics, paediatrics, emergency medicine and general surgery, delivering a safe, effective service to patients. In addition, they are reducing the HSE reliance on agency staff, reducing overtime costs, improving the quality of the service and ensuring further compliance with the European working time directive.
The committee may be aware that the Commission issued a reasoned opinion on 29 September last concerning failure by Ireland to fully implement the European working time directive in respect of doctors in training, that is, NCHDs. Under Article 258 of the treaty, the Commission has invited Ireland to take the necessary measures to comply with this opinion within two months of receipt. The opinion states that while Irish law provides for limits to doctors' working time, in practice public hospitals often do not apply the rules to doctors in training or other non-consultant hospital doctors.
I am committed to achieving compliance at the earliest possible date and recognise that the working hours of NCHDs must be reduced and rest breaks granted in accordance with the provisions of the directive. Progress on compliance has been hindered given the shortage of NCHDs experienced over the past two years. It is also necessary to appreciate that the recent recruitment initiative will not in itself deliver European working time directive compliance. Compliance will require significant changes in the manner in which hospital services are organised and delivered, in particular in smaller hospitals where the numbers of NCHDs do not support European working time directive compliant rosters and to the manner in which hospitals rely on NCHDs.
At a more general level, I remind the committee that Government policy in regard to medical education and training in Ireland is guided primarily by the report of the undergraduate medical education and training group, the Fottrell report of 2006, and the report of the postgraduate medical education and training group, the Buttimer report of 2006. Both reports represented a significant review of medical education and training carried out in Ireland and made a series of comprehensive recommendations for its development and reform. The recommendations formed a multi-annual programme requiring implementation over a period of years leading to the successful reform of medical education in both the undergraduate and postgraduate sectors. They also provided a comprehensive evaluation of the provision of medical education and training and how it can best be delivered to prepare doctors in Ireland to meet the health needs of the 21st century.
Many of the significant recommendations of the Buttimer report on postgraduate medical education and training were implemented through the Medical Practitioners Act 2007. These include the assignment of appropriate medical education and training functions to the HSE and the Medical Council, better workforce planning by the HSE to align the number of doctors in training with projected consultant vacancies based on the staffing needs of the service, and the restructuring of the register of medical practitioners. A joint Department of Health and Department of Education and Skills interdepartmental policy steering group on medical education and training has responsibility for the ongoing development of strategy and policy on medical education and training and continues to co-ordinate and progress implementation of Government policy based on the recommendation of the Fottrell and Buttimer reports.
Officials of my Department and the Department of Education and Skills are currently reviewing the extent to which both reports have been implemented. My Department is assessing the adequacy of the current medical education and training work programme and overall direction in meeting the policy requirements and health sector service needs. Government policy in this area is that we should move from a consultant-led health service to a consultant delivered service. This would require a significant increase in the number of hospital consultants and a corresponding reduction in the current reliance on NCHDs. It will be appreciated, however, that the current economic climate will impact on the extent to which this can be achieved.
Against this background, and having regard to the recent shortage of NCHDs, I have asked my Department to develop proposals regarding the creation of a new associate specialist grade of non-consultant hospital doctor. In the UK, a specialty doctor grade has been established. Initially, these doctors deliver routine and emergency clinical care under the supervision of a consultant but with time take on more responsibility. Doctors at the top end of the grade work with only indirect supervision. At all levels, the specialty doctor is part of a team led by a consultant and takes part in all the activities of their specialty, including teaching students and junior doctors. It is not my intention that the specialist grade we would introduce would be exactly same. I want to give a clear assurance to people that these would be clinically autonomous individuals answerable not to the local consultant but to the clinical director and that it would be a progressive step towards becoming a full consultant and they would not, as some allege and others fear, be left in limbo and in this position for many years.
I acknowledge the co-operation and positive support of all parties in both Houses in regard to the legislation necessary to achieve these outcomes which have been a resounding success in regard to addressing the huge gap in the service requirements of our health service. I also thank all the doctors who came to this country and sat the examination. Most of them were successful and passed it but others were not and they will have the opportunity to re-sit it. I am sure the Medical Council will have something to say about that.