Wednesday, 26 April 2006
Health Service Staff.
Question 48: To ask the Tánaiste and Minister for Health and Children if the recommendations contained in the report of the national task force on medical staffing, the Hanly report, remains Government policy; the steps she has taken to date on foot of this report; and if she will make a statement on the matter. [15607/06]
The national task force on medical staffing was set up to devise a strategy for reducing the average working hours of non-consultant hospital doctors to achieve the requirements of the European working time directive, address the consequent medical staffing needs of Irish hospitals, analyse the practical implications of moving to a consultant-provided hospital system, and consider the requirements for medical education and training arising from any changes to the current model of delivering services.
The report of the national task force — the Hanly report — made a series of important recommendations. These covered issues such as the changes needed in non-consultant hospital doctor, NCHD, work patterns, the need for a significantly revised contract for medical consultants, the need for a significant increase in the number of consultants, reform of medical education and training, and the reorganisation of acute hospital services.
My Department is working closely with the Health Service Executive to build on, and progress, these recommendations. Negotiations on NCHD work patterns and a new contract for consultants have begun. The Government also announced details of a €200 million initiative for a major reform of medical education and training, including an increase in the number of medical training places. These measures, combined with ongoing investment in acute hospital facilities, extra consultant posts and the organisation of services around hospital networks, are designed to provide patients with faster access to high quality consultant provided services.
The issues that led to the establishment of the national task force remain to be resolved, including the full implementation of the EU working time directive and the introduction of a consultant-provided service. Addressing these issues requires negotiation and agreement with the medical representative bodies. This process is under way.
This report was published in June 2003, almost three years ago. The former Minister, Deputy Martin, wrote the foreword which stated: "the Task Force has also concluded that a consultant-provided service is the only viable means of providing safe high quality patient care while reducing the working hours of NCHDs". If we are to replace junior doctors with consultants, we will need a new consultants' contract which deals with the extended working day and issues around who will be on duty at night and at weekends. There was nothing in the Tánaiste's reply which gave us any indication where this consultants' contract is going. Getting rid of category two consultants is only a red herring; it will not make a fundamental difference. Locating new private hospitals in the grounds of public hospitals will not change this fundamental problem. Who will be on duty at night and at weekends when the EU working time directive is implemented? That is what the Hanly report is all about.
There should have been a new consultants' contract by now which would provide for an extended working day and cover issues around on-call and working at night and at weekends. The Tánaiste has given no indication that we have moved on this issue in the past three years. We are in exactly the same position in which we were when all these discussions started. That is not good enough. Nothing which has been said on this issue will make the crisis in the health service better. We need to see a change to the consultants' contract, a reduction in the number of non-consultant hospital doctors and more consultants doing the job about which we are talking. While the Hanly report has very much been taken up with the closure of smaller hospitals, this fundamental issue covers every hospital in the country, the largest and the smallest.
We would have agreement if we threw in the towel and gave everybody what they wanted, which seems to be Deputy Twomey's attitude, that is, every time we go into negotiations, we should agree and then they will be over. At present non-consultant hospital doctors get approximately €200 million per year in overtime for the long hours they work. One cannot reduce working hours and pay people the same amount. I do not believe anybody would find that acceptable.
An analysis was done in nine different sites where there was agreement with the doctors to do some pilot work around the new working time directive, including rostering, etc. Unfortunately, I understand the Irish Medical Organisation has instructed them not to participate in that process, which is regrettable. In the context of that analysis, it is worth noting that 21.9% of the junior doctor's time was spent reviewing a patient already seen by a colleague while almost 10% of his or her time was spent talking to another clinician.
We must move to a situation where we have fewer non-consultant hospital doctors. At present there are approximately 4,000 non-consultant hospital doctors but we want to move that figure down towards 2,000. We need to double the number of consultants because it is only when consultants — the key decision makers — deliver the service as opposed to leading it that we will get the best outcome for patients and greater efficiency and effectiveness.
The talks are before the Labour Relations Commission. I appeal to the doctors involved to agree to the implementation in the nine sites. We are already in breach of the 58-hour provision in the EU working time directive, which should have been introduced on 1 August 2004. Since we are in the process of implementation, apparently we can be facilitated. However, in the interest of the reform of the health care system, we need to reach agreement. There are proposals from the Government side, including the HSE, on rostering and sharing. It is not a question of people working a 39-hour week from 9 a.m. to 5 a.m. and that everything else will be dealt with on an overtime basis. That is not the manner in which we will get the type of health service we need.
I am not asking the Tánaiste to throw in the towel in any negotiations. I am asking her to tell the House whether she has no hope of renegotiating, or has failed to renegotiate the, consultants' contract or whether there is some light at the end of the tunnel. Given that nothing has happened in the past three years, are we talking about another nine years before we move forward and see these changes? These changes are fundamental and will affect every aspect of hospital services, yet we have not moved one inch in the past three years since this report was published. Rather than criticise me and act like an innocent bystander in all this, the Tánaiste should tell the House if we are getting anywhere on these issues. If we are not, she should tell the House.
The process is under way in the LRC. I accept what the Deputy said, that we need changed work practices whereby doctors work as part of teams and clinical directors. We have already seen some initiatives, especially in Blanchardstown hospital where seven new consultants have been appointed. They will work on a team and on a 24-hour per day basis. These are the types of initiatives which will deliver the best health care for patients. We are in discussions for a contract for consultants too and it may well be that all of them will be concluded together. I know the chairman is hoping to have those talks resumed quickly. We need to move quickly to get a more flexible and appropriate contract of employment for consultants and non-consultant hospital doctors. It is my intention and that of the HSE and the Department of Health and Children to have that soon.