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

I will not focus on that but I will come to it later because it is important. What is really important is for me to say that I share people's concerns about this action, the disruption to the delivery of acute care and the unnecessary worry and anxiety caused to patients. I will correct the figures out there. I do not have absolute accuracy but no more than 7,400 patients have been affected by this. That is 7,400 more patients than should have been affected because this action will not help the situation.

I believe junior doctors have a right to reasonable working hours and that patients have a right to feel safe in their care. I do not believe it is safe to have doctors working the sort of hours they have been asked to work in the past. We all must work together towards reaching a safe solution. The point is that we have made major progress in tackling this long-standing problem, and a long-standing problem it is, as the Taoiseach said earlier. There is a report from 2001, commissioned by Fianna Fáil's leader, Deputy Martin, in January 2001 at a cost of €254,000, and here we are in 2013.

At my request, the HSE established a national group in February 2013 to bring an urgent focus to implementation of the working time directive. I have met with Commissioner Andor on a number of occasions in respect of this. This group has made progress on the number of doctors working more than 24 hours in a single shift and instances of doctors working more than 68 hours a week. The average number of hours of NCHDs is now declining. Previous surveys have shown that average working hours for NCHDs fell from 60 hours a week in 2009 - notwithstanding the fact that the initial report in 2001 wanted them under 48 - to 54 hours a week in 2012. During the first six months of this year, the number fell to 52.4. I am not saying this is enough. It must come down the rest of the way. Furthermore, the proportion of NCHDs working shifts in excess of 24 hours has fallen from 58% in March 2013 to 34% in August 2013. It is still too many and more must and will be done but we are making serious progress. In addition, I set up a group chaired by the president of DCU to carry out a strategic review of the medical training and career structure of NCHDs with a view to improving retention of graduates in the public health system. An interim report is to be provided in November.

The establishment of the hospital groups will empower hospitals to co-operate and share NCHDs when scarcities arise. This will further reduce average NCHD hours.

Compliance issues arise largely in particular specialties. Virtually all NCHDs in radiology, emergency medicine and psychiatry are fully compliant. Following discussions at the LRC over recent weeks, a joint IMO-HSE verification and implementation process has been proposed. This has already begun and will be proceeding during October. Actions to change rosters and revise work practices identified during this process will be implemented during November. Implementation and achievement of a maximum 24-hour shift would then be verified jointly by the HSE and IMO.

There is clearly going to be a reduction in planned patient attendances. It is estimated that cancellations will arise in respect of about 7,000 outpatient appointments. The patients deferred are being offered the earliest possible re-attendance dates. It is already Government policy that those waiting longest for treatment should be prioritised. The IMO has confirmed that the same level of staffing cover as is normally provided on a Sunday will be in place. It has also undertaken to provide all necessary urgent care as well as oncology, dialysis and transplantation.

We are very keen to resolve this issue and to have clear sanctions in place. The HSE has invited the IMO back to the LRC tomorrow to discuss all manner of sanctions. I have already made a statement that I want to see the sanctions aimed at those who have failed - not patients, doctors or hospitals themselves but rather the management that fails to deliver.

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