Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I submitted this matter to get clarity on the shortage of junior hospital doctors, non-consultant hospital doctors and the need to fill the gaps on certain areas. What is the current position in all hospitals? Will the Minister for Health furnish me with the details of every hospital and those in which the Medical Council stated adequate supervision was not in place?

We passed emergency legislation before the recess - the Medical Practitioners (Amendment) Act - to facilitate the recruitment of additional junior doctors. It was reported on 6 September that just 60 of the 280 junior doctors recruited in India and Pakistan had been given the go-ahead to work in our hospitals. It was also reported that more than 30 of the junior doctor recruits failed the clinical skills examination. Will the Minister confirm if those details are correct?

When he introduced the Medical Practitioner's (Amendment) Bill, the Minister stated:

Some 450 posts, including approximately 180 non-consultant hospital doctor vacancies, mostly in-service rather than training posts, are due to be filled from 11 July when the next rotation takes place. The number of vacancies is decreasing on an ongoing basis as doctors are appointed via the HSE centralised recruitment process. Following an intensive recruitment drive by the HSE, more than 200 doctors from India and Pakistan have applied to fill these vacancies.

I ask the Minister for the up-to-date figures in that regard. What are the other posts to which he referred at that time and about which we spoke at some length? Of the 450 posts, 180 related to non-consultant hospital doctor vacancies. To what range of specialties and consultant posts did the balance of posts correspond? I seek the detail of the other posts and how many of them have been filled through the normal recruitment procedure process.

What is the Minister's view on the reported cost of €113,768 to send 36 people from the HSE to India and Pakistan for ten days to recruit the doctors? That significant expenditure is another reason to ensure a new and better recruitment practice, something he is already on the record as supporting.

The Medical Practitioners (Amendment) Act facilitates - for the time being only - the current system or, should I say, at least prevents its collapse and the consequent loss of services. As I asked during the passage of the Bill, for how long will this ramshackle structure stand before it is replaced by a proper system of medical training and hospital staffing? This year's experience must be the last of what I can only describe as panic recruitment by the HSE. Will the Minister commit to making the required changes to banish those bad recruitment practices to the past where they belong? What is the Minister for Health's plan to end the reliance on junior doctors and to get better value for patients from consultants? He has also shown an interest in achieving this. Does he have such a plan on the resumption of the new Dáil term?

James Reilly (Dublin North, Fine Gael)
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I am pleased to be able to lay out for the House the substantial progress that has been made in the recruitment of junior hospital doctors, or non-consultant hospital doctors, NCHDs. It should be noted that this is being achieved against a background of a general shortage of NCHDs affecting western Europe.

As the Deputy indicated, as an emergency measure, I introduced the Medical Practitioners (Amendment) Act 2011, which was signed into law on Friday, 8 July 2011. It provides for the establishment of a new supervised division of the medical register. Registration in the supervised division means that a person is registered for a period not exceeding two years in an identified post approved by the Medical Council and subject to supervision by the employer in line with criteria set down by the Medical Council.

Medical Council systems are in place to ensure patients will be treated by a doctor who has the education, training and skills to provide safe and appropriate care. In the interests of patient safety, doctors therefore can be registered in the supervised division only once they have met all of the registration requirements.

On Monday 11 July, the Medical Council published draft rules outlining eligibility to the new supervised division. As required under the Medical Practitioners Act, the Medical Council held a period of public consultation on the rules. Following a minimum consultation period of one week, rules were published and disseminated by the Council on 18 July 2011. Simultaneously, the council was developing multiple specialty specific examinations for entry to the supervised division with involvement from medical schools and postgraduate training bodies.

Seven speciality-specific examinations were held for 266 candidates between 2 and 12 August and the results have been published. This sequence of work was undertaken and completed in a very short timescale. I commend the Medical Council on its efficiency in bringing us to this position. I can confirm that 236 candidates were successful and, to date, some 144 junior doctors have been registered by the Medical Council with contracts issued by the HSE and they are now attached to posts in the health service. These doctors are making significant contributions to vacancies which existed in areas such as anaesthetics, paediatrics, emergency medicine and general surgery, delivering a safe, effective service to patients. In addition, and significantly, they are reducing the HSE reliance on expensive agency staff.

I am pleased the situation has improved greatly and I have been assured by the HSE that levels of service are being maintained. In July the chief executive of the HSE informed the Joint Oireachtas Committee on Health and Children that approximately 190 vacancies had been identified at junior doctor level. Today, 76% of those vacancies have been filled and that number is growing at a rapid pace. That is a commendable achievement within a short space of time and the complexities involved in the entire process.

The Medical Council and the HSE are continuing to work diligently to ensure the necessary procedures to facilitate the registration of doctors are completed without delay, so that they can take up duty as soon as possible. I convened a meeting of the HSE, the Department and the Medical Council earlier this week. There are a number of elements to the processing of the applications. The first is the paper-based application by the candidate submitting all relevant documentation on qualifications, and home state clearance among other requirements. The second is the passing of the practical examination stage and the third is the approval of the posts by the HSE including a declaration from the hospitals regarding the appropriate supervision of the applicants. My Department has been informed by the HSE that all outstanding declarations of supervision from the hospitals will be submitted to the Medical Council by the end of this week and issues relating to the necessary candidate documentation will be also finalised as soon as possible. This will allow for further registrations to be completed quickly and the necessary number of junior doctors to be put in place providing safe and effective treatments to patients.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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On the so-called "HIQA Nine", the hospitals about which there has been some concern relating to the potential for medical supervision of recruitments, what is the position with individual hospital sites? The Minister did not have the detail in his reply and if he does not have the information immediately to hand could he furnish it to this Deputy with an update on the situation?

The Minister does not want to have to go through this again and we do not want to look at such a slovenly method of recruitment in such a key and important area of public service provision. On the alternatives that must be pursued in terms of recruitment, what plans are being devised by the Minister to ensure the recruitment process is up to the standard we would expect in 2011?

Yesterday in The Irish Times it was reported that doctors who had resigned their posts in India and Pakistan and made arrangements to travel here were told to stay put, such was the delay in the processing programme. Will the Minister comment on that? I am sure he has seen the report. I wonder if that is the case. Is the Minister aware that some doctors who have travelled here and have been in this country for some weeks have returned home without even being assessed, such was the delay in the process? That is what we are reading in the newspapers. I would like to know what the Minister understands to be the factual position.

The HSE has said the registration process is complex. We understand that, but it also indicates that the Medical Council amended the required HSE documentation in late August, some two to three weeks ago. That was damn late in the process and just prior to our return to the Oireachtas. Surely, going back to the passage of the facilitating legislation, all of that should have been in place, regularised and accepted long before that point in time? What upset has that caused? Does the Minister have any concerns on the Medical Council's position in regard to all of this?

James Reilly (Dublin North, Fine Gael)
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I will try to answer the Deputy's queries in the short period available. I do not have information on the individuals for the hospitals but I will undertake to supply it. I believe in openness and transparency and all Deputies should have that information. There is an ongoing plan, and good will has come from this difficult position. I agree with the Deputy that the circumstances were not ideal. There is now co-operation between colleges, the council and training bodies, and we must introduce other stakeholders.

This process is nearly finished but after that I hope to bring the groups together again with extended stakeholders to examine the training of doctors and the ability to provide clear career paths. We must lay down protocols through the special delivery unit with regard to behaviour and specifically how colleagues behave with peers, juniors, members of the public and other staff. Non-consultant hospital doctors should also be treated with dignity and be allowed a clear career path. It is strange that we could train people to specialist registrar level but only one in four gets a consultant post. It takes almost €1 million to train people to such a level when we take into account the various costs involved.

I want to see the creation of a new specialist grade, which would be a further step on the way to becoming a consultant. Many professions were concerned that career progress would stall without future progress but that is not the intention. We hope to open discussions with various colleges to address the matter.

The Deputy raised the issue of doctors who may have returned to their home. Some 236 doctors passed the exam and only five, to my knowledge, have returned home. I am given to understand some may have done so because of personal issues and those doctors intend coming back, although I am not saying that all intend to come back to Ireland. That number is small.

The Deputy also raised a matter concerning the Irish Medical Council around the end of August. The council sought further adjustment to the supervisory posts, which was done very quickly and did not cause much of a delay. The main delay now is documentation for doctors. I acknowledge the co-operation of the House as we experienced a very difficult problem, which should never have arisen. We addressed the dilemma when it occurred and as the Deputy noted, we have implemented proper plans so as to avoid such a calamitous problem in future.

There was nothing remotely slovenly about the manner in which the recruitment took place. It happened in an orderly fashion, although this is not the preferred way to do business. There should be far better planning and we will have that in future.