James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Question 8: To ask the Minister for Health and Children the details of the number of non-consultant hospital doctor posts that are vacant; the number of consultant posts that are vacant; what the planned ratio was; what the planned ratio is now, in view of the fact that it is policy to have a consultant delivered service; and if she will make a statement on the matter. [35142/10]

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

One of the main recommendations of the National Task Force on Medical Staffing in 2003 was to increase the number of consultants and to implement a corresponding decrease in the number of NCHD posts in order to create a consultant-provided service. At the time of publication the consultant to NCHD ratio was 1:2.27. The task force concluded that a team-based consultant-provided service was required to ensure high quality patient care and achieve compliance with the European working time directive. It stated that this would entail a significant increase in consultant numbers.

The move to a consultant-provided service was reflected in the 2008 contract. This provided for consultants to work as part of a team over an extended working day of 8 a.m. to 8 p.m., an increase in the length of the working week and structured weekend work. It is also provided for in the HSE's employment control framework which allows for new hospital consultant posts to be created by the suppression of two non-consultant hospital doctor, NCHD, posts.

As of September 2010, the approved number of consultant posts was 2,410. This represents an increase of 679 posts, or 39%, since the task force reported. The current ratio of hospital consultants to NCHD posts is 1:1.7 compared with 1:2.27 in 2003. For comparison purposes, both ratios exclude interns.

Since 2008, the HSE has created almost 500 new or replacement consultant posts. As of June 2010, approximately 223 contracts had been issued to individuals taking up HSE consultant posts. This reduces potential vacancies to approximately 275, of which 89 consultants are currently being recruited by the Public Appointments Service. While the remaining 186 approved posts are recorded as being vacant, the large majority of these are in HSE-funded agencies, including voluntary hospitals, where the recruitment process has already taken place and the HSE has been asked to establish how many of them have been filled.

Approximately 260 of the 4,638 NCHD posts are vacant, but many of these posts, in particular high priority service positions, are being filled by locums or other short-term contractual arrangements. The moratorium on public sector recruitment is not a factor in these NCHD vacancies.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I thank the Minister for her response. I wonder why interns were excluded for comparative purposes. They are NCHDs and would clearly impact on the ratios considerably.

It is important to point out that emergency pediatric and obstetrics maternity and surgical services across the country are likely to be curtailed as a result of the critical shortage of junior hospital doctors. An anaesthetist consultant in Our Lady of Lourdes Hospital has written a letter to the press outlining the difficulties being faced there with some nine posts in the junior ranks being vacant. This will make the delivery of a service difficult. In the context of events at Navan hospital, this will mean a serious diminution.

Apart from the intern issue, what services will be curtailed or reconfigured due to the forecasted shortages, what action has been taken by the Department and the HSE to fill the vacancies and does the Minister accept that the staffing crisis means hospitals will become increasingly dependent on locums, a matter to which she has alluded? An over-reliance on locums will lead to an increase in adverse incidents as occurred previously, particularly in the north east.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

The process of recruiting consultants continues unaffected by the moratorium. The process includes suppressing two non-consultant posts for one consultant post and is working well, as is evident from the ratios. The first report on this matter was the 1994 Tierney report which was to get us there ten years later. We have made good progress since 2003.

The HSE, the Medical Council and others have been engaged in a process of dialogue concerning training posts. Among the initiatives being pursued are the 80 additional specialist training posts in emergency medicine to deal with shortages, 38 posts in general practice and 85 in surgery, together with the relaxing of visa restrictions for the recruitment of individuals from overseas and offers of longer contracts instead of the short-term contracts that were unattractive relative to Northern Ireland or the rest of the UK and put us at a disadvantage. These initiatives will be in operation and the visa changes have been made. I can give the Deputy the details. These and other changes will be in effect from 1 January 2011.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context

I want to allow Deputy Reilly a further supplementary question.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

I will not ask a supplementary question, rather I will repeat the questions I asked that the Minister did not answer. Why were interns excluded and what services will be curtailed or reconfigured due to the forecasted shortages? If she is answering only one question, the most important one is the latter.

Mary Harney (Dublin Mid West, Independent)
Link to this: Individually | In context

Services to patients will not be curtailed and are constantly being reconfigured. There will be a question later on Navan Hospital and I shall deal with the matter then in line with recommendations on patient safety and so on. Regarding interns, the issue is to have a comparative figure that compares like for like, comparing our position when the manpower study reported with where we are now. That was the intent of the question. The shortages that arose on 1 July are being dealt with as a result of dialogue between the Medical Council, the HSE and the training bodies. In the longer term the initiatives, including central recruitment and so on, for those who will come from outside the country will offer two-year contracts rather than a six-month contract. This will make Ireland more attractive and will deal with the pressure points. Most of the vacancies at consultant and non-consultant hospital doctor level are being filled by temporary locums and although I hear what the Deputy has to say, there is much more vigilance in this area now than might have been the case previously.