Dr. Mark Murphy:

Yes, but working a 100 hour week 20 years ago was not the same as working an 80 hour week today. That 80 hour week is a sleepless one, involving stress and multiple life and death decisions. The average working week is approximately just over 60 hours, but we all know what averages mean. The outliers are working absolutely horrendous hours that would not be inflicted on a dog. Everyone in the State, however, including the Government and our employer, the HSE, is happy for us to do this, but enough is enough and NCHDs have spoken. It harms our physical and mental health, harms patients and the future of the health service. What are we going to do about it? Are we going to have another Hanly report or another expert group report? The HSE is our employer and I hope the committee will ask it for some accountability.

Deputy Caoimhghín Ó Caoláin asked about the essential steps and Senator John Crown referred to the big picture, long-term issues such as the fact that we need more consultants and a reconfiguration of hospital services. We can talk about the difficult changes that need to and should happen in the longer term, but we also need to address the issue of changes that can be made this year. I hope the committee will press the HSE to make these changes. In that context, I will reiterate what Ms Coulter said. First, on the issue of NCHDs and appropriate tasks, the situation is ludicrous. The Minister for Health has described us as "gofors". Is that what the State is training us to be? We have NCHDs who ensure already booked investigations happen. Why? That does not happen abroad. It is not very difficult to sort out this issue. One only has to look at the situation in Australia, New Zealand and other countries where there are six consultants for every two NCHDs. Here, we have one consultant and myriad NCHDs running after him or her, carrying out inappropriate tasks. Reform and change must happen and Dr. O'Kane can expand on how that can be done. Ultimately, though, it is up to the HSE to make change happen. The issue is one of accountability. Those at the top end of the human resources section say they agree with us, but it is not trickling down. Accountability and a change to the culture are vital.

The second issue is rosters which could be changed this year. The IMO and NCHDs need to be involved with local management to make this happen. It is within the gift of the HSE.

These two changes alone would dramatically reduce the hours worked by NCHDs, improve our health and that of our patients, as well as help in the retention of doctors in the system. The health service would be better and the taxpayer would win because we would not be claiming un-rostered overtime that we do not want to work. These two changes, namely, changing our roles and using clever rostering systems, must happen and we must be directly involved. As Ms Coulter outlined, we were not even consulted about various changes that were supposed to take place by 1 March, none of which has actually happened. We must be involved in the process because we have the expertise required to make positive changes.