Brian O'Shea (Waterford, Labour)
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Question 2: To ask the Minister for Defence the progress he has made on the implementation of the recommendations of the Independent Strategic Review of the Defence Forces Medical Service. [34969/09]

Willie O'Dea (Limerick East, Fianna Fail)
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I propose to take Priority Questions Nos. 2 and 5 together.

The PA report is an important milestone in addressing the challenges to the provision of medical services in the Defence Forces. Implementation will take time and commitment. This is being achieved in consultation with the representative associations. On receipt of the report in June this year, I asked that implementation of the recommendations proceed immediately.

The PA report reviewed the medical services required for the Defence Forces in light of their roles and operations, assessed the current arrangements for the provision of medical services and proposed a model for future delivery of medical services.

As the House will be aware, the consultants have recommended a programme of major change. The high level recommendations include a centralised command structure for the medical corps and the creation of a medical services management and administrative function which structure will provide strategic planning, resource allocation and overall responsibility for the management and delivery of the medical service. It also proposes the development of medical officer lead care teams, together with a refocusing of medical staff on appropriate clinical tasks. The report also recommends steps leading to a reduction in the number of doctor interventions and medical assessments and better management of health services outsourcing.

The report reaffirms the need for a dedicated medical corps and addresses the challenges facing the Defence Forces in the recruitment and retention of medical officers. The structure and systems recommended have been designed to meet the demands and needs of the modern Defence Forces both at home and abroad and provide medical officers with a fulfilling and rewarding career. The governance structure proposed in the report for the delivery of change in this area has been put in place. It consists of a high-level steering group composed of senior military and civilian personnel. The role of the steering group is to provide planning guidance, to clarify the approach to recommendations where required and to ensure the project is implemented effectively.

A dedicated programme group with civilian and military representatives is now co-ordinating a range of projects. It is making progress on a number of the PA recommendations, including the structure of the medical corps, the alignment of Defence Forces and medical corps strategies and the development of medical information systems. Preparatory work has also commenced on the recommendations on training and education, clinical issues and the centralised command structure.

Valuable consultation has occurred with the representative associations in the preparation of this report. The consultants had a number of meetings with the representative associations and received submissions from them. In addition, the consultants conducted a workshop with the main stakeholders, including the representative associations, to update them on progress and to validate views on a number of issues.

Progress on the ongoing preparation of the implementation programme is being reported to the associations through the partnership medical sub-group and through the normal conciliation and arbitration, C&A, process. The associations will be also formally consulted on the implementation programme when it has been approved by the steering group. Any issues within the scope of representation can be then addressed through the C&A scheme.

Brian O'Shea (Waterford, Labour)
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I am not convinced there is any great urgency in what the Minister has outlined to us. He is talking about structures, but we need results. The Minister must agree that the report was quite an indictment of the present system. For example, the Defence Forces are high users of primary health care compared with the civilian population and other armed forces, and the current requirement for medical assessment is not met, with a shortfall of approximately 60%. What I find worrying is the statement in the report that, "The Medical Corps does not take a systematic, information-based approach to planning and management of services". Does the Minister have a timeframe for bringing about this large cultural and structural change in the services? What is there is obviously adequate, although we have not alluded to the fact that there is a major problem with recruitment. Has there been any improvement in recruitment since the Minister set about implementing the recommendations in the report? All in all, the report describes a shambles. This needs to be put to rights quickly.

Willie O'Dea (Limerick East, Fianna Fail)
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Naturally, I do not accept the Deputy's contention that there is no urgency. I have informed the Department and the Defence Forces that I want progress in this area as a matter of urgency. As the Deputy recognises, it involves a revolutionary change in the provision of medical services within the Army. It is a sea change; we are turning the whole system, which is no longer adequate, on its head. This will take time and we need to bring people with us, which is one of our major problems. We must sit down and talk to people, whether they are from the representative associations, the general Army staff, or the medical corps. One of the recommendations of the group was that we set up an implementation strategy, which we have done in the form of the steering group and the progress group. The latter has done quite a lot of preliminary work and hopes to report back to the steering group within the next two or three weeks.

As I see this evolving, there are a number of specific tasks that need to be done - what they call in departmental jargon "work packages". I am hoping most of those will be done within the next 12 months. Some can be done immediately, while others will require longer consultation. Once those specific tasks have been done and practical matters attended to, the rest will fall into place. I am considering a timeframe of 12 to 18 months for implementation, which is short in view of the depth and width of the report.

The Deputy asked about difficulties with recruitment. I accept what he said about the report's conclusions about the current system, but let me remind the House that under the present system, when it is unable to provide the service for which it has been designed, we outsource the rest of the work. People are not left without medical attention, whether at home or abroad. That is an important point.

If we can put in place the new system as recommended by the consultants, there should be no problem with recruitment because we will not need to recruit many more. We will be able to reduce the establishment of the medical corps, which is at present 47, although there are only 24 working there. In addition, it will be a more rewarding and challenging career - one in which medics are practising medicine rather than spending all their time on administration. They will also get recognition for the work they have done in the medical service of the Defence Forces. However, we are just starting to implement the report, so it would be unrealistic to expect a flood of recruits. I have no doubt that when the report is fully implemented it will be much easier to recruit.

Jimmy Deenihan (Kerry North, Fine Gael)
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I am inclined to agree with Deputy O'Shea about the urgency in implementing the recommendations. In the summary of the major work packages required for the delivery of the future medical services, most of the proposals seem to be scheduled as immediate or short term. Looking at the page, one can see these words all the way down. That no recommendation has yet been implemented from a report that took a number of years to produce and was published last June means it cannot be a matter of urgency. This is not the message that is given out.

The general feeling among the representative bodies is that the Minister should get on with it so they can know what hand he is playing in this. They feel the recommendations should be implemented as soon as possible because they have been waiting around for so long.

I want to ask the Minister about a particular aspect of the report, although he may not be able to answer it here. The report, as he knows, successfully identified many of the obstacles that deter non-consultant hospital doctors from entering careers in the Defence Forces. One of the main issues is that time served in the medical corps is not recognised by professional training bodies. Since the report was published, has the Minister consulted with the Royal College of Physicians of Ireland, the Royal College of Surgeons in Ireland and the Irish College of General Practitioners to secure the necessary recognition for doctors who have served time in the medical corps? This is a critical issue. If the Minister could ensure such recognition, I am assured more doctors would join the Defence Forces.

Willie O'Dea (Limerick East, Fianna Fail)
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Deputy Deenihan is right in that the timescales for many of the recommendations in the report are short term or urgent. That is true for the most part, but there are also recommendations that will require some time to implement. As I said, I am aiming for a timescale of 12 to 18 months, which is short in view of the revolutionary nature of the report. We are talking about moving from a situation in which each officer commanding in a particular area is in charge - he or she decides what medical services are delivered and what the doctors do within his or her brigade - and towards a centralised command structure based in Dublin, the Curragh or wherever. That is a sea change. In addition, qualified doctors who are currently engaged in considerable amounts of administrative work will no longer be doing so but instead will be providing medical services. The number of unnecessary assessments, which, in my view, are a waste of a qualified doctor's time, will be reduced, thus ensuring more efficiency. In addition, we must ensure recognition for people so it will be worth their while, career-wise, to enter the Army.

Deputy Deenihan asked if I had consulted with the Royal College of Physicians and so on. I have not done so because I personally am not implementing the report. It is a matter for the Defence Forces to implement it and report to me. Naturally, my Department will maintain oversight in the matter. The Department, in its discussions with the Defence Forces, has pointed out that the portrayal of the Army as a rewarding career is central in terms of attracting people. If work in this regard has not already commenced, it is about to do so. Initial contacts may already have been made. I will communicate with the Deputy on the matter.

Brendan Howlin (Wexford, Labour)
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I call Deputy O'Shea on a brief supplementary question.

Brian O'Shea (Waterford, Labour)
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What I found most alarming in the report is the finding that medical corps activity is not aligned to the strategic requirements of the Defence Forces, which is a major indictment of what is happening. It underlines the urgency of the matter. The whole system is seriously out of sync. I am aware the Defence Forces is responsible for implementing the recommendations. However, I put it to the Minister that he must adopt a hands-on approach and ensure that, on a week to week basis, progress is being made.

The Minister stated that procedures in terms of sickness absence in the Permanent Defence Force is a driver of primary care demand as most sick leave requires certification by a doctor. As I stated earlier, there is a shortfall of 60% in this regard. The expert panel found that PDF policy emphasis on medical assessments is excessive and inconsistent with international defence health practice. The system, as described, is a shambles. Will the Minister assure us that he will adopt a hands-on approach and drive this?

Brendan Howlin (Wexford, Labour)
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A final supplementary question from Deputy Deenihan.

Jimmy Deenihan (Kerry North, Fine Gael)
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I suggest the Minister invite the steering committee to address the Joint Committee on Justice, Equality, Defence and Women's Rights on this issue. The opportunity presents for the setting up of a general practitioners training course within the medical corps. This would ensure that people who join could pursue, as part of their training, a general practitioners training course which would be of assistance to them in the community. This might encourage a number of people to join.

The last figure we received in respect of medical practitioners in the Defence Forces is 23. How many have we now and how many of them are non-national? Also, how many nurses are there in the Army?

Willie O'Dea (Limerick East, Fianna Fail)
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Deputy O'Shea expressed the urgency of this matter, of which I am aware. My Department is represented on the steering and progress groups. I will keep in touch with staff of both groups. The Army medical service, developed in the 1930s and 1940s and perhaps suitable for the prevailing situation then, has not kept pace with change. I agree there is non-alignment between the strategy of the medical corps and that of the Defence Forces. We must, therefore, bring them into line. The current service is demand driven and we need a strategy driven medical service. That is the reality of the situation. It is what we must achieve. The Deputy can rest assured I will keep in close touch with the steering group in this regard.

On Deputy Deenihan's suggestion in regard to a GP training course and inviting the steering group to address the Joint Committee on Justice, Equality, Defence and Women's Rights, I will discuss both issues with my officials. The current number of doctors is 24, one third of whom are non-national. I will check the figure for the number of nurses and communicate the information to the Deputy.