John Perry (Sligo-Leitrim, Fine Gael)
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Question 7: To ask the Tánaiste and Minister for Health and Children if the implementation of the European working time directive would be affected by her plans for public-only consultants; and if she will make a statement on the matter. [8340/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Implementation of the European working time directive will necessitate the following reductions in the working hours of all doctors: a maximum of 58 hours per week from 1 August 2004; a maximum of 56 hours per week from 1 August 2007; and a maximum of 48 hours per week from 1 August 2009.

The national task force on medical staffing was charged with examining how this directive could be implemented without adversely affecting service delivery. Against the background of the required decrease in non-consultant hospital doctor working hours, the task force recommended the introduction of a consultant-provided service and an increase in the number of consultants. These recommendations are being advanced within the context of the HSE-led negotiations on a new consultants' contract. The issue of public-only consultants is also being advanced in those talks. It is intended that as part of a consultant-provided service, such consultants will be remunerated exclusively on a salaried basis, that is, they will not receive additional remuneration for treatment delivered to private patients.

The new public-only consultant contract will help support the implementation of the directive and will improve patient access to care and ensure better delivery of health services.

Liam Twomey (Wexford, Fine Gael)
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I fully support what the Tánaiste is doing regarding public-only contracts, but the European working time directive must be teased out. We must fill people in. Neither the Tánaiste nor I can wait either the ten or the 25 years mentioned to get working health services. Do we need a new consultants' contract that includes the present consultants? Do we need a new work regime for junior doctors to be brought in more urgently? As the Tánaiste pointed out on "The Late Late Show", if the present batch of consultants does not join in a new contract, we will be stuck with the current system for 25 years. Will we find ourselves trying to piggyback two systems, the public-only consultants and the existing ones, along with work practices regarding junior doctors?

That essentially makes it quite clear that the European working time directive will be at least a decade behind before we gain any control over this. The public service cannot wait for that. It has nothing to do with the Hanly report but with getting a health service to patients in their communities. In some respects, the Tánaiste has made the mistake as witnessed in many statements made in this regard. She is selling the concept of what one does with the consultants as a progressive move. I am very concerned at what will happen with the European working time directive. If the hours are cut for any reason, for example, because someone takes a court case, might we not run into massive problems in the health service? Does the Tánaiste have any contingency plans for that case?

I have asked the Tánaiste before whether we have some mechanism to get consultants on public-only contracts into the system quickly. All that I see happening is that we are in a situation, and I would like to know what contingency plans the Tánaiste has if the European working time directive fails. Will we go back to the EU or do we have an emergency plan? If we do not, patient safety and care and the delivery of health services to them will collapse very quickly.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Regarding negotiations under the auspices of the Labour Relations Commission, LRC, with non-consultant hospital doctors, I understand that good progress has been made. On the wider contract issue, we clearly wish to shrink the number of non-consultant hospital doctors and increase the number of consultants. I have received a very favourable reaction from many consultants to the concept of a public-only contract. I have met an amazing number of people who have said that they thought it a very good idea. Quite a number of category one consultants in particular may well opt for that contract.

Unfortunately, consultants are unhappy because of two issues, one being to do with pricing the new contract through the review group on higher pay on the same basis as other public service jobs. They want it priced through the talks process and negotiation. The other issue on which there is dispute is the decision of the HSE board to stop appointing category two consultants who can work on several different hospital sites, something not very satisfactory from a patient or hospital perspective.

We urgently need the new contract in place. I intend for it to have a five-year review clause or something of that kind. Our having a current contract or contracts with no review clauses puts the State and health service in a very vulnerable position. As I said, that contract is clearly for their working lives, but either side could break it. However, there would be financial consequences in doing so. It would be better if we could negotiate a new contract. I certainly hope that we can introduce new consultants to the Irish health care system on a public-only contract very soon.

I was recently in Canada regarding cancer services and met quite a few excellent Irish doctors heading services there. There is a great deal of Irish expertise overseas that I would love to attract back to our health care system. Many of them would return if we could provide an appropriate contract of employment and substantially increase the numbers of people in different areas.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I wanted to come in on that last point. Under the European working time directive, there is a clear need to ensure more consultants in the system. In line with what Deputy Twomey has already put to the Tánaiste, can she outline to us what steps she is now taking and what further measures she is considering to ensure greater throughput, not only regarding indigenously trained staff from whatever community, but also regarding ensuring that they remain in the system? Every citizen is paying for the process. We are not paying for them to go off and take their skills elsewhere. There is massive investment on the part of every taxpayer in this State.

We are losing people at an inordinate rate. What steps will the Tánaiste take to ensure that people remain in the system here? We must gear matters towards that. It must be attractive, and that is not only a matter of money but a raft of different things that affect the conditions of employment. We must make it attractive for people to stay.

I agree with the Tánaiste that the Canadian system is very interesting since it is open to all on the basis of need and free at the point of delivery, excepting only a very small number of services not provided through the national health system. Along with other experiences, it is well worth considering in formulating a new health care system in our own jurisdiction. I would like to know the Tánaiste's response and what she is now doing to attract back some of those whom we have already lost.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Recently, Connolly Hospital in Blanchardstown won approval for seven new consultants to implement what we are attempting through the contract discussions, including team working. Almost all of them are Irish people who have returned from positions in the US, which is very encouraging. I very much agree with the Deputy that it is not all about the salary. It is also about working conditions. It is not just the facilities but such matters as protected time for education, training and research, clinical governance issues and back-up facilities. Many consultants have said to me that they returned, got a job and found themselves virtually on their own without any secretarial or information technology back-up.

It is a range of factors and in Canada, one thing I found very attractive was that after six years one can have a six-month sabbatical to conduct research or attend training. Many consultants there find that very tempting. Others may feel that after the age of 55 they do not want to do night or weekend work. We need a flexible contract of employment that attracts and keeps the best. In particular, we must double the numbers we have. That will make the system very appealing. However, we could not possibly begin to do that on the current contract, which is very unsatisfactory from the perspective of the patient and the health system.

Jimmy Deenihan (Kerry North, Fine Gael)
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Question 8: To ask the Tánaiste and Minister for Health and Children the status of the European working time directive; and if she will make a statement on the matter. [8338/06]

John Perry (Sligo-Leitrim, Fine Gael)
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Question 62: To ask the Tánaiste and Minister for Health and Children the way in which the European working time directive is affecting the delivery of health services; and if she will make a statement on the matter. [8339/06]

Michael Noonan (Limerick East, Fine Gael)
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Question 108: To ask the Tánaiste and Minister for Health and Children if the slow progress of the European working time directive will affect the delivery of health services and lead to the downgrading of services to a number of hospitals here; and if she will make a statement on the matter. [8341/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 8, 62 and 108 together.

The provisions of the European working time directive as it relates to the working hours of doctors in training came into force on 1 August 2004. The relevant provisions were transposed into Irish law by way of the European Communities (Organisation of Working Time) (Activities of Doctors in Training) Regulations 2004. That will ultimately reduce non-consultant hospital doctors' working hours to an average of 48 hours per week. The introduction of new rosters in many sites would facilitate significant progress towards compliance with the directive while maintaining safe patient care and existing levels of service provision.

Employers and the Irish Medical Organisation have been engaged in discussions for some time under the auspices of the Labour Relations Commission to advance proposals to effect a reduction in the working hours of non-consultant hospital doctors. The LRC however, has requested that both parties refrain from engaging in any form of unilateral action for the duration of the negotiation process. Consequently, health employers are at present awaiting agreement between management and the IMO at national level before proceeding with the introduction of these rosters. On 7 February 2005, both sides accepted a proposal made by the LRC to establish a national implementation group. This group co-ordinates the work of local implementation groups in nine pilot sites, issues agreed guidance on matters related to the implementation of the European working time directive and assists in the development of local implementation plans.

Each local implementation group includes consultants, non-consultant hospital doctors, nurses and management. These groups have drawn up pilot projects to try to find viable solutions to the difficult issue of reducing hospital doctors' hours. Suggested projects have been brought before the national implementation group for consideration. It is expected that many of the suggested projects will be up and running in the near future, with the full backing of all of the stakeholders.

Additional information not given on the floor of the House.

The data gathered from this exercise will help to determine how we begin to reorganise services over a 24-hour day to maintain high quality patient care while achieving compliance with the directive.

Service in our hospitals has not been adversely affected by the implementation of the working time directive. I am confident the implementation of this directive, and the introduction of new non-consultant hospital doctors and consultant contracts, will greatly improve service provision generally and hospital care in particular.

Liam Twomey (Wexford, Fine Gael)
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Twelve years after this directive was first mooted, we will now get nine pilot schemes which will not even reduce the non-consultant hospital doctors' hours to the level expected by 2004. Hence, in order to reduce Members' concerns about the impact on the health service in the coming years, what is planned? The Tánaiste mentioned Canada. If we want to establish a consultant-led service, how many Irish graduates are available to return? Does she have any plans to instigate measures similar to those used for decentralisation, that is, to go worldwide in an attempt to gauge how many people might be available? This could even include junior doctors, who are engaged at present in the discussions regarding the European working time directive. How many people might wish to return to Ireland as consultants? It would be useful to know what specialties are available, so we could gauge whether it will be possible to move to a consultant-led service within the next two to three years.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not have an answer to Deputy Twomey's question, unless one takes into account the experience in respect of the seven recent consultant appointments in Blanchardstown. I understand all the appointees came from overseas, mainly from the United States. There are many Irish doctors in the United States, Canada and other countries and many of them might be attracted home. However, much would depend on the new contract of employment as well as the consultants' possible locations. Clearly, the reduction in working hours for the non-consultant hospital doctors will only be successful when they are replaced by consultant-led services. We will then have an appropriate system of health care delivery. One cannot have one without the other, and the sooner we can begin to recruit such consultants, the better.

This is particularly true if we want to provide facilities at a regional level. For example, some regions have no plastic surgeon, possibly only one dermatologist, as well as significant gaps in rheumatology. Until we secure a better contract of employment which is more cost-effective from the health system's perspective, we will be unable to substantially increase the numbers of consultants. The two go hand in hand and I hope the negotiations can be concluded quickly.