James Reilly (Dublin North, Fine Gael) | Oireachtas source

I propose to take Questions Nos. 6, 7, 37, 58 and 265 together by agreement. These questions point in the same direction. As I said, Ireland must have sustainable arrangements to train and develop the medical workforce we need to provide safe and effective services to the population. I am committed to retaining our doctors. I find it disturbing that we train some of the brightest and best in this country who go abroad and prove they are the brightest and best working in some of the finest institutions and excelling all over the world. Meanwhile we go around the Third World taking doctors from its countries to buttress the service here. Having been a doctor, I believe it is very good that people go abroad and come back and that we should encourage exchanges of that nature. However, the manner in which it is operating at the moment is not acceptable to me. Like so much else in the Department of Health and the health service, it was allowed to evolve chaotically. What we are trying to do now is use this opportunity, which is a huge challenge, to fix something that should have been fixed years ago and that gives people a proper, clear career path in respect of their future.

One thing that is lacking and that I want to address is the area of final year medicine and having a mentor to advise one about what career path to take within medicine because it has so many different aspects and different careers suit different people. They do not get any mentoring. They finish, qualify and celebrate and then suddenly they are an intern and it is a case of "what am I going to do next? Do I go into surgery? Do I go into anaesthetics?" There is no formal advice available and there should be and I want that addressed as well. I am sure Professor MacCraith will provide that in his interim report. He will give me a final report later next year.

I have met with Commissioner Andor on a number of occasions in respect of the European working time directive and have given him a detailed plan and timelines as to how we are going to address this issue. There is no question that it will be a real challenge. As I said in my earlier answer, it is clear that a whole range of issues need to be addressed to resolve this issue. It is about the type of work they are doing, the numbers and the way they have been rostered in the past. I know that rosters have been drawn up by senior medics that the NCHDs could improve on massively when they look at them in terms of making their lives more bearable and livable. Sometimes, there has been real reluctance on the part of people to change purely because it is change. Change is challenging but we must all grasp and embrace it or we will end up with these recurring problems that we should not have.

The HSE established a national group to bring an urgent focus to implementation of the working time directive. I do not want to repeat all the issues I mentioned earlier. However, I note that progress has been made in the Labour Relations Commission to allow at least the deferral and suspension of the industrial action. I know that a number of further meetings will be necessary and I hope and encourage both sides to try to resolve this without impacting on patients.

With regard to the NCHD shortages, the overall position has stabilised since the last training rotation took place at the end of July and the majority of vacancies are now filled. However, challenges remain, mainly in smaller hospitals and in certain specialities, including emergency medicine, against an international shortage of doctors in these specialities. Where sites continue to experience challenges in terms of vacancies, hospital management implements contingency plans including revised rosters and where necessary, locum arrangements to ensure service delivery. System reform, in particular the implementation of the report on hospital groups and the framework for the development of smaller hospitals, will assist in achievement of a more focused and efficient deployment of NCHD staffing.

The other issue here is that we have a huge resource relating to teaching across our hospital systems and in primary care. We have not made as much use of that in the past as we could in the future so we will engage with the colleges to see how we can expedite that and make better use of the resources that are available to us.

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