Dara Calleary (Mayo, Fianna Fail)
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6. To ask the Minister for Health the way in which he proposes to improve the working conditions of non-consultant hospital doctors; and if he will make a statement on the matter. [39992/13]

Terence Flanagan (Dublin North East, Independent)
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7. To ask the Minister for Health the steps he is taking to deal with the shortage of non-consultant hospital doctors; and if he will make a statement on the matter. [39925/13]

Brian Stanley (Laois-Offaly, Sinn Fein)
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37. To ask the Minister for Health the reforms being undertaken to address the underlying causes of the junior hospital doctors' dispute; and if he will make a statement on the matter. [40045/13]

Thomas Pringle (Donegal South West, Independent)
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58. To ask the Minister for Health the direct involvement he has had with the IMO to resolve the dispute with the non-consultant hospital doctors over the implementation of the European working time directive; and if he will make a statement on the matter. [40061/13]

Bernard Durkan (Kildare North, Fine Gael)
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265. To ask the Minister for Health the extent to which it is expected to be in a position to meet the concerns of junior hospital doctors in the context of the working time directive; and if he will make a statement on the matter. [40300/13]

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 6, 7, 37, 58 and 265 together by agreement. These questions point in the same direction. As I said, Ireland must have sustainable arrangements to train and develop the medical workforce we need to provide safe and effective services to the population. I am committed to retaining our doctors. I find it disturbing that we train some of the brightest and best in this country who go abroad and prove they are the brightest and best working in some of the finest institutions and excelling all over the world. Meanwhile we go around the Third World taking doctors from its countries to buttress the service here. Having been a doctor, I believe it is very good that people go abroad and come back and that we should encourage exchanges of that nature. However, the manner in which it is operating at the moment is not acceptable to me. Like so much else in the Department of Health and the health service, it was allowed to evolve chaotically. What we are trying to do now is use this opportunity, which is a huge challenge, to fix something that should have been fixed years ago and that gives people a proper, clear career path in respect of their future.

One thing that is lacking and that I want to address is the area of final year medicine and having a mentor to advise one about what career path to take within medicine because it has so many different aspects and different careers suit different people. They do not get any mentoring. They finish, qualify and celebrate and then suddenly they are an intern and it is a case of "what am I going to do next? Do I go into surgery? Do I go into anaesthetics?" There is no formal advice available and there should be and I want that addressed as well. I am sure Professor MacCraith will provide that in his interim report. He will give me a final report later next year.

I have met with Commissioner Andor on a number of occasions in respect of the European working time directive and have given him a detailed plan and timelines as to how we are going to address this issue. There is no question that it will be a real challenge. As I said in my earlier answer, it is clear that a whole range of issues need to be addressed to resolve this issue. It is about the type of work they are doing, the numbers and the way they have been rostered in the past. I know that rosters have been drawn up by senior medics that the NCHDs could improve on massively when they look at them in terms of making their lives more bearable and livable. Sometimes, there has been real reluctance on the part of people to change purely because it is change. Change is challenging but we must all grasp and embrace it or we will end up with these recurring problems that we should not have.

The HSE established a national group to bring an urgent focus to implementation of the working time directive. I do not want to repeat all the issues I mentioned earlier. However, I note that progress has been made in the Labour Relations Commission to allow at least the deferral and suspension of the industrial action. I know that a number of further meetings will be necessary and I hope and encourage both sides to try to resolve this without impacting on patients.

With regard to the NCHD shortages, the overall position has stabilised since the last training rotation took place at the end of July and the majority of vacancies are now filled. However, challenges remain, mainly in smaller hospitals and in certain specialities, including emergency medicine, against an international shortage of doctors in these specialities. Where sites continue to experience challenges in terms of vacancies, hospital management implements contingency plans including revised rosters and where necessary, locum arrangements to ensure service delivery. System reform, in particular the implementation of the report on hospital groups and the framework for the development of smaller hospitals, will assist in achievement of a more focused and efficient deployment of NCHD staffing.

The other issue here is that we have a huge resource relating to teaching across our hospital systems and in primary care. We have not made as much use of that in the past as we could in the future so we will engage with the colleges to see how we can expedite that and make better use of the resources that are available to us.

Michael Kitt (Galway East, Fianna Fail)
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I will call Deputies in the order in which they are on the Order Paper - Deputies Kelleher, Terence Flanagan, Ó Caoláin, Pringle and Durkan.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister for his detailed reply. We have had discussions about this issue in the Oireachtas Committee on Health and Children. We have heard from the Minister and representatives from the IMO and others. There is a clear wish for everybody to address this. I hope Professor MacCraith will come up with a strategy and plan and that resourcing will be put in place.

While we welcome the suspension of industrial action, the bottom line is that the HSE has been dragging its feet to a certain extent in addressing this issue. As the Minister quite rightly pointed out, this has been around for many years but it has been two and a half years since the Minister came to office and it seemed to take the threat of industrial action to concentrate minds, particularly in the Department and the HSE, on addressing this fundamental issue. While Professor MacCraith will hopefully bring forward a pathway for non-consultant hospital doctors to find a career in which to specialise in their particular field, has the Minister assessed how many more non-consultant hospital doctor posts would be required to implement the working time directive in its entirety or is the Department still in that process?

James Reilly (Dublin North, Fine Gael)
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We are still very much in that process because the answer to the question is contingent upon implementing the reforms. Going back to the key principle of our health policy, it relates to ensuring the patient is seen at the lowest level of complexity that is safe, timely, efficient and as near home as possible. That means we do not want consultants looking after patients who could be looked after by GPs, GPs or consultants looking after patients who could be looked after by nurses, nurses looking after patients who should be looked after by health care assistants and any of those groups looking after patients who should be looked after by allied health care professionals like physiotherapists and others. Unfortunately, because of the way the system has been allowed to evolve, if I as a GP want to get physiotherapy for a private patient without a medical card who cannot afford to go to a physiotherapist privately, I must refer him or her to an orthopaedic or rheumatology clinic. This is ridiculous because it is wasting the patient's time waiting for an outpatient's appointment at a clinic that I do not think they should go to, to move on to see the allied health care professional they need to see. We are putting in place ways of dealing with that. I will probably have to come back to somebody else on this.

Terence Flanagan (Dublin North East, Independent)
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I thank the Minister for his response. The working conditions, the process involved in becoming a specialist and the pay rates mean that many Irish-trained doctors go abroad. It is not enough for us to compare the pay rates in other EU countries, we must compare our pay rates with other English-speaking countries. The threatened industrial action by junior doctors further undermines the attractiveness of working in Irish hospitals. I am glad that has been suspended.

Does the Minister believe that Irish medical graduates deserve a fair deal and realistic working hours? I know he has responded on this point but does he think it is acceptable that two thirds of Irish-trained doctors are going abroad and will not work in Irish hospitals? That is an investment of about €50 million per year in doctors' education which is leaving the country. It undermines the health service. While our doctors are out there supporting other health systems around the world, we are bringing doctors in from other developing countries.

James Reilly (Dublin North, Fine Gael)
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As the Deputy points out, I share his concern and it is something I am determined to address. I am looking to NCHDs themselves in respect of the work being done by Professor MacCraith. I want to provide a safe place for them to speak.

They are afraid to speak out because they will not get a good reference towards their next job. That goes on, and it is wrong.

I refer to pay rates. Let us be honest and straight about this and let me put this point on the record of the House today. I have been challenged for not tackling consultants' pay. We have tackled it. We have reduced the starting pay by 30% - it is now €116,000 to €121,000 per year. Some would say this will mean consultants will not stay in this country and will go elsewhere because we are paying less than the other English-speaking countries to which the Deputy alluded. The nearest English-speaking country to us is across the water, in Britain, and the other jurisdiction, in Northern Ireland. There the starting pay for a consultant is £80,000, or approximately €100,000. The pay is quite appropriate. If we constantly choose to compare people's pay in this country to that in the wealthiest countries in the world where the best people are, we will never get anywhere. Our country has a financial constraint; the money we are spending on our public service is borrowed and comes with terms and conditions. There is a new milieu and sadly we must all live in it for some time to come.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In the context of agreement being reached, will there be independent verification of the working time performed by junior doctors at our various hospital sites? How will that be confirmed? Will it be confirmed independently? What will be the knock-on effect of adherence to the requirements of the European working-time directive in respect of care of patients and the work-time commitments and responsibilities of other front-line health professionals?

James Reilly (Dublin North, Fine Gael)
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A number of initiatives are on the way. One of my real complaints about the HSE when I was in Opposition was its inability, in spite of being a national organisation, to bring any uniformity of approach to matters. One found excellence in one hospital but this was not transferred across to other hospitals. It is not always appropriate that the same measures should work in every hospital but one that has worked very well in Tallaght Hospital was fobbing in and fobbing out, a measure that cut the overtime bill considerably. The Deputy can draw his own conclusions from that. That must be done. We must transfer work undertaken by NCHDs to other grades and allied professionals. We need the organisation of hospital services to be done in such a way that we can support the European working time directive.

I want to see a situation where doctors can have a career, a life and a hobby. Currently, that is not the case for some - that is wrong and must be addressed. I do not wish to turn this into a political punch and judy show but I must tell Deputy Kelleher that the last Government simply threw money at the problem rather than face it down and reform the system. That is what we are going to do now.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister used to criticise it every day for not giving enough.

Michael Kitt (Galway East, Fianna Fail)
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We are short of time. I call Deputy Pringle.

Thomas Pringle (Donegal South West, Independent)
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Question No. 58, does not relate to working conditions or the conditions of non-consultant hospital doctors, their career paths or anything else in that line so I wonder why it was grouped with these questions. My question relates to the Minister's involvement in the dispute since the IMO balloted for industrial action. Much has been made in this House by the Minister about his taking back responsibility into the Department. He has said that the buck stops with him in terms of responsibility for the operation of the health services, the changes that have taken place within the HSE and the abolition process in that regard. Why did it go down to the wire, to the last minute, for interaction to take place with the doctors in this dispute? I welcome that industrial action has been delayed or postponed and I understand talks are talking place in the LRC today. However, the Minister should have acted long before without there being the need to take this to the wire, with consequent concerns being expressed in the wider community as well as among the doctors. That is a key point.

James Reilly (Dublin North, Fine Gael)
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I am bemused. The reality is that, as Minister, I do not become directly involved in industrial disputes. The Department and the HSE handle these matters. If I have to become involved it is usually when matters have become extraordinarily serious and require direct ministerial involvement. I must put on the record of the House that I have done more in respect of this issue than any previous Minister by setting up the group in question at the beginning of the year in anticipation of this problem. The group was to address and work on the problem so that we would not have the situation we had some years ago when we had to undertake special recruitment overseas to bring in people. That is the first point.

Second, I refer to the group set up under Brian McGrath to create a clear career path. That is the first time this has been done, by involving the actual NCHDs so that they can get what they want from it. No disrespect to any particular group, but it is the interns, senior house officers and registrars who are not on the specialist training schemes. The SPRs are already on that scheme and their career path is clear for them. I want to retain as many of them as I can in this country. They also have an input but it is the lower grades, the younger doctors, that I want to see being sorted out so that they can stay here and continue to contribute to the land that reared and has educated them.

Bernard Durkan (Kildare North, Fine Gael)
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I thank the Minister for his replies. I have raised this issue before with his good self and also with his predecessor because it has been on the cards for a long time. In the context of the present negotiations or previous discussions on the issue, has it been possible to determine whether any structure or arrangement can be entered into which would encourage graduates to take up their internship in Irish hospitals as opposed to going overseas? What is the extent, if any, to which other jurisdictions face and address these problems? Other English-speaking jurisdictions must have a similar problem. Having regard to what the Minister has just said, can he indicate whether non-English-speaking jurisdictions have a similar difficulty in observing the working time directive and keeping their graduates at home, given the Minister's statement that there would appear to be an attraction for doctors in serving their time in that capacity in their own country in the first instance?

James Reilly (Dublin North, Fine Gael)
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As to other English-speaking countries I do not wish to denigrate any country. There certainly were big problems with this across the water in the UK but I do not know how much progress has been made in recent times. I am sure there has been considerable progress.

I believe this comes back to sentiment. Maybe I will be shot for saying this but judging by many of the doctors I have met I do not believe money is the over-riding issue for them, nor, to a lesser extent, are the hours although that is a real problem. What really drives them away is the lack of a clear career path and the lack of respect. They do not feel valued. They feel undervalued and underwhelmed by it all, having studied so hard to reach that zenith and have MB BAO BCH or LRCPSI after their names, only to find they are hit on all sides as to where they will end up. Some see themselves working extraordinary hours for long years, never having enough time to study and to progress, and they become burnt out. That is not something they are going to do so they will leave this country and go somewhere else where they can enter a training scheme today and know that in six years, as long as they work hard and get their exams, they will be specialists at the end of it. That is what I want for this country. Nor do I necessarily mean it should take six years - it should be five.