Dáil Éireann Debate, Wednesday - 7 April 2004
5 Mr. Neville asked the Minister for Health and Children the progress on the implementation of the European working time directive for non-consultant hospital doctors to be introduced by August 2004; and if he will make a statement on the matter. [10920/04]
Amharc ar fhreagraIreland will be legally obliged to begin applying the conditions stipulated in the European working time directive to doctors in training from 1 August 2004. I am determined that every effort will be made to effect these employment rights from that date. As part of the early preparation for implementing the European working time directive, a national joint steering group on the working hours of non-consultant hospital doctors was established in June 1999 and reported in January 2001.
In order to reduce non-consultant hospital doctors' hours, the group recommended that the following measures must be progressed: a reduction in the number of grades of doctor on call at any one time; the introduction of cross cover arrangements; the introduction of centralised rostering and shift work; and changes in skill mix and practice for other grades of hospital staff.
Following from this work, the national task force on medical staffing also recommended the introduction of a consultant-provided service, a significant increase in the number of consultants and the adoption of a team-based approach to consultant work. In line with this and with the role proposed for non-consultant hospital doctors, the task force report outlined that there should be a significant reduction in the number of NCHDs as the number of consultants increases. The objective must be to reverse the current ratio of more than two NCHDs for every one consultant.
There are some important reasons for this approach. First, even if it was desirable, it would not be possible to recruit sufficient extra NCHDs to cover existing rostering arrangements under the European working time directive. This is particularly the case in smaller hospitals where there are already problems in maintaining the current numbers of NCHDs. Second, best practice requires that doctors should be recruited to accredited training posts to ensure the provision of quality patient care and appropriate clinical decision-making.
Medical manpower managers appointed under the NCHD 2000 agreement are overseeing the reduction in NCHD working hours and they are essential to the phased implementation of the Hanly report recommendations, especially where roster management is concerned. Latest returns indicate that well in excess of 60% of NCHDs will be compliant with the actual 58-hour requirement of the directive by 1 August 2004. However, difficulties arise when the specific details contained in the directive are applied, that is, rest breaks and compensatory rest. These issues are being considered and will be progressed on an ongoing basis.
Negotiations between health service management and the Irish Medical Organisation on the reduction of NCHD hours have taken place in the Labour Relations Commission on a sporadic basis over the past 18 months. Progress to date has been slow and a number of key issues have yet to be agreed. The Hanly report clearly outlines that we need to establish a working group in each hospital to implement the required measures and to monitor progress in the reduction in NCHD hours. A national implementation group is also urgently required to co-ordinate the work being undertaken at local level and to monitor progress. These groups should include appropriate hospital managers, consultants, NCHDs, nurses and other relevant health-care professionals.
The urgent need to establish these groups at both national and local level has been discussed with the Irish Medical Organisation at the meetings in the Labour Relations Commission. However, to date, the IMO has refused to agree to their establishment. The IMO has been lobbying for many years to achieve a significant reduction in NCHD working hours. That aim could be progressed by full participation in the national and local implementation groups.
Additional information not given on the floor of the House
CEOs of both health boards and voluntary hospitals and hospital managers, together with senior officials from the Department and the Health Service Employers Agency, are in regular contact to reduce NCHD working hours and are identifying the various steps at national and local level which are required to implement the directive by 1 August. In addition, a national co-ordinator and support team have been seconded to oversee the implementation process in the health agencies and to provide direction and guidance on specific issues. Work is also progressing on the development of IT software to record NCHD working hours.
In February 2002, the medical education and training, MET, project group of the national task force on medical staffing was established to prepare an implementation plan, for medical education and training arising from the requirements of the European working time directive and the proposal for a consultant-provided service. The MET group is continuing with this task and I expect to have interim recommendations on meeting the training requirements within the European working time directive in the near future.
The CEO of each health board and each voluntary hospital has responsibility for the management of the workforce, including the appropriate staffing mix and the precise grades of staff employed within that agency, in line with service plan priorities, subject to overall employment levels remaining within the authorised ceiling. Hence, the recruitment of health service staff in 2004 and beyond will take place in the context of the implementation of each agency's service plan, taking into account new policy initiatives such as those necessitated by the implementation of the European working time directive for doctors in training.
On 27 January, I announced the composition of a group to prepare a national plan for acute hospital services. The group is chaired by Mr. David Hanly and contains a wide range of expertise from the areas of medicine, nursing, health and social care professions and management. It also includes an expert in spatial planning and representation of the public interest. The group has been asked to prepare a plan for the interim health service executive for the reorganisation of acute hospital services, taking account of the recommendations of the national task force on medical staffing, including spatial, demographic and geographic factors. Rapid progress is reliant on all parties commencing this urgent work and preparing the plan for acute hospital services which will further help to implement changes in the reduction of working time for doctors in training.
The existence of significant difficulties and the relatively short timeframe available in no way alleviate our legal obligations arising from the directive and only serve to emphasise the urgency of making rapid progress on implementation. Excessive working hours are unsafe for both doctors and their patients. The necessity to deliver appropriate training to our doctors while maintaining necessary levels of service provision will present a range of challenges. I am convinced, however, that this also presents a unique opportunity to improve training, services and the working lifestyles of all NCHDs.
The fact that the necessary groups are not established impedes the progress made in meeting the deadline. With just four months to go before the deadline and with 40% non-compliance with the directive, does the Minister accept that there will be severe difficulties to meet that deadline of 1 August? Will he outline the situation on employers, bearing in mind that a breach in this directive will result in a €1,500 fine for a first offence and a €500 fine for each day of non-compliance? Does the Minister agree that the experience is unique to Ireland, despite the statement of the Taoiseach that such difficulties were experienced all over Europe? Is he aware that the European Commission has pointed out the special difficulties in Ireland that do not apply to other European countries?
I do not agree with the Deputy. The Government will do everything it can to achieve progress on this issue. There will be a legal obligation on the State after 1 August as a result of this directive. It is regrettable that the partners are not coming to the table with the enthusiasm that I anticipated, given the amount of campaigning in 2000 on the hours that junior doctors work. We negotiated a generous package at that time on overtime with junior doctors. It is time to do sensible things about the hours people work in our hospitals for the benefit of all concerned.
The situation on the directive across the EU is that many countries have articulated difficulties, not so much with the directive, but with some of the court judgments that have interpreted the directive, in particular the SiMAP and Jaeger cases. The judgments of these cases define the European working time directive. Issues emerging from that include compensatory rest periods and the issue of on-site on-call. We have paid on-site on-call since 2000 as part of the deal to which I referred. In other words, if one is on call on the site, it means one is working. The problem now is that if a doctor is called out for an hour or two, there has to be an immediate provision of compensatory rest. At the request of other countries, as part of the Irish Presidency, we prepared a paper in the health working group which was submitted to the employment Ministers who have primary responsibility for the directive. Rather than undertaking a major review of the directive itself, they are considering issues such as compensatory rest periods and reference periods, that is to say the period over which average weekly working time is calculated — it is currently at 17 weeks. The Commission has sought views on the need for longer reference periods, for example 12 months.
This is not something that is unique to Ireland. We want to change the equilibrium between junior doctors and consultants, which is not satisfactory. We need a consultant provided system.
What about the difficulties experienced, especially by smaller hospitals, if they do not meet the directive and are subjected to daily fines?
I explained that. There is a legal obligation on us and we are vulnerable if someone takes a case against us and we are not compliant.
