Ms Laverne McGuinness:

I will ask Mr. O'Brien to deal with the matter of contracts.

Deputies Regina Doherty and Catherine Byrne raised patient care. Patient care, risk to patient and the management of risk is the business of everybody in the hospital and across our entire services, be it the NCHD, the nurse, care assistant or consultant. It is managed in that way. We have clinical directors in all of our hospitals and at all times, not only on this issue, there is an assessment of risk and risk mitigation factors put in place.

We have acknowledged we are not happy that we have not achieved the 48-hour compliance. They set out here the significant challenges in dealing with it. We are saying we have some work done on the rosters that are now there, the reduced on-tier call and the cost cover ranges. We have those changes made. We are making more changes in terms of ensuring that the NCHDs are not doing work that could be done by other staff in the hospital. That, likewise, will free up more hours for the NCHDs so that they need not work extra hours. Similarly, we are looking at the range of services being provided in our smaller hospitals. That framework is just ready. It will be published over the next number of months, as will be the configuration of hospitals. All of those are on the platform of reducing risk to ensure the safety of services that are being provided.

There is much more work to be done. One of two major measures that we would see as risk reduction - one can never totally eliminate risk - is to ensure that by the end of March there is no doctor working over 68 hours where there are outliers because we have smaller hospitals in quite remote locations that would not have the number of junior doctors in place to support larger rotas than what are currently in place. The other is, coterminous with that, by June that there would not be anybody working for a full 24 hours. There is a full range of measures set out. That is done in co-ordination and in consultation with our clinical directorate.

Those are the steps. Some progress has been made. There has been quite significant progress in some areas. There is a road more to travel. We have committed to travelling that road to ensure that the maximum amount of care can be provided across the hospitals and that we can deliver on the full volume of services that we set out in our service plan, while at the same time balancing the issue of patient safety, which cannot be compromised, and the hours worked by the current cohort of junior doctors that we have in play. Obviously, that is augmented by the training programme that is in place with our medical, education and training bodies and by the extra NCHDs who are being put in place. Given the significant challenges of where we are, both financially and in our HR reduction count, we have been putting measures in place in order to protect the patients and we recognise the duty of care to our junior doctors, but there are outliers whom I acknowledged. There are junior doctors who are working far in excess of 48 hours.

Deputy Regina Doherty mentioned one doctor who got overtime to the tune of €167,000 in the south east. We have looked at that. In fact, it is not something that should have happened. What happened in that particular instance is that almost 50% of that was worked by the junior doctor when on leave and it was worked in a different hospital, which is why there was the extortionate amount of overtime. That hospital, which is in the south east, has reduced its agency and rosters by approximately €2 million. It is taking the cost out of the system and it is being addressed. It is an outlier. It should not have happened.