Deirdre Clune (Cork South Central, Fine Gael)
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Question 6: To ask the Minister for Health and Children the progress that has been made in implementing the European working time directive for non-consultant hospital doctors which limits the working week to 48 hours; the manpower implications this will have; and if she will make a statement on the matter. [6626/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Under the European working time directive, the current maximum average working week for non-consultant hospital doctors is 56 hours. This limit will be reduced to 48 hours with effect from 1 August 2009. The directive also specifies minimum daily and weekly rest periods. I am aware that the working hours of non-consultant hospital doctors in our public health service are, in general, not compliant with the requirements of the European working time directive. The matter has been the subject of extensive analysis in recent years.

Negotiations on a new employment contract to facilitate the introduction of reduced working hours for NCHDs have been the subject of protracted negotiations under the auspices of the Labour Relations Commission, but without resolution.

A national implementation group which was established in 2005 to provide guidance and oversee local implementation projects, produced its final report in December 2008. The report indicated the potential for specific actions which could be taken for compliance with the European working time directive.

My Department has requested the HSE to develop a robust plan for achieving compliance with the working time directive by August of this year. The HSE is identifying specific measures to further compliance in each acute hospital over the coming months such as flexibility of work practices; rationalisation of overtime hours; reconfiguration of hospital services; an increase in the number of consultants with a corresponding decrease in the number of NCHDs through savings achieved from the overtime bill. These measure will all be of assistance in this regard.

On 30 January 2009, the HSE advised the IMO of its intention to proceed with implementing changes to the working arrangements of non-consultant hospital doctors, with effect from 18 February 2009. On foot of this proposal, the IMO balloted its members for industrial action. The Labour Relations Commission facilitated a meeting between the HSE and the IMO earlier this week where it was agreed that both parties would engage in intensive discussions on all issues of dispute between them. These discussions will continue to take place until the end of this month, following which any unresolved issues will be referred to the Labour Court.

James Reilly (Dublin North, Fine Gael)
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I thank the Minister for her reply. Notwithstanding the industrial relations issues with non-consultant hospital doctors, I am concerned at the plan to take up the slack. Many doctors are working extraordinary hours — up to 80 a week. If such doctors are now going to be working 48 hours, where are the additional staff to take up that slack? I certainly do not approve of either the overtime bill or of asking doctors to work such hours because I do not believe it is safe. Truck drivers would not be allowed drive for that number of hours in a week. Doctors making life and death decisions when they are half asleep on their feet from exhaustion is not the way to run a safe health service and it is designed to cause trouble. I fully agree with this drive to reduce hours but where are the additional staff? A reduction in staff means a reduction in service unless additional non-consultant hospital doctors are employed and this is not what the Minister wishes to do as she wants a consultant-delivered service and I agree with her. However, where are the consultants?

Brendan Howlin (Wexford, Labour)
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An tAire to reply.

James Reilly (Dublin North, Fine Gael)
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May I ask a final supplementary question for clarification?

Brendan Howlin (Wexford, Labour)
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Please do.

James Reilly (Dublin North, Fine Gael)
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How many new consultants will be appointed this year? When I say, "new", I do not mean people who are new to the job, rather I mean additional posts. How many additional posts will be filled this year?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I appreciate the Deputy's point about patient safety because tired doctors are certainly not safe doctors. The first HSE initiative was to take effect from 18 February and this led to the ballot, which was about three things — a training grant of €3,810 per doctor per annum; a meal break of €25 million per annum; and a living out allowance of €11 million. This is a total of €45 million. These are archaic allowances that are in the system. Much of the change will come through work practices. The new consultant contract which I believe can now be activated, will mean consultants working an extended working day and providing cover in hospitals at weekends. This will mean that daily discharges are possible. A clinical director will be responsible for making all this happen. This will fundamentally alter how our hospitals work. Much of the overtime bill in our hospitals results from not having consultants available in the hospitals up to 8 p.m. or 9 p.m. in the evening or over the weekends. I do not know the precise number of consultants to be recruited this year but we must recruit them in order to reduce the amount of money paid for non-consultant hospital doctors. In the mid-west we are recruiting two accident and emergency consultants, one dermatologist, some for rheumatology. I know the numbers by region but I am not certain what the total number is. There will be many recruited for the cancer area and we are currently recruiting a number of physicians in radiation, oncology and surgery. I understand some of those doctors will be starting very soon.

Jan O'Sullivan (Limerick East, Labour)
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I also accept that in the interests of both the safety of patients and doctors that the hours must be reduced in accordance with the working time directive. However, until such time as those consultants are appointed, the same junior hospital doctors are still going to have to work the same hours as before or else patients will be left unattended. I had a long conversation with a young doctor who is training to be a GP. He told me the doctors cannot leave the patients; there will not be extra non-consultant hospital doctors but the consultants have not yet been appointed. There is a real problem in the meantime which the Minister needs to address. It is unfair on those doctors to be expected to do the hours but their pay is going to be cut by more than half in many cases although I am not defending the long hours. With regard to the cuts in study and training time I remind the Minister that non-consultant hospital doctors must train and study and surely they should be recompensed for that.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am not referring to training and study time, but to allowances for meals and so on, amounting to €25 million for meals, €11 million to live out and €17 million for training. There must be training, but these allowances are not paid to others in the modern era and are not appropriate.

Last year, the bill for overtime amounted to more than €200 million. Among the issues that arise is that, while junior doctors support the idea of implementing the working time directive, they want to be paid the same salary, including overtime, despite working a shorter week. In the current circumstances, no one would regard that as reasonable. The reconfiguration of hospital services and the consultants' extended hours will alleviate significantly pressures on non-consultant hospital doctors.

Some hospitals have shown considerable innovation. For example, hospitals' overtime bills vary considerably across the country. Some have large bills in respect of junior doctors while others, despite treating the same number of patients, have substantially smaller overtime bills. Were hospitals to follow best practice, the bill would be reduced. We have no alternative but to take this measure this year, given the considerable pressures on the HSE's budget stemming from the rising level of unemployment.