Billy Kelleher (Cork North Central, Fianna Fail)
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No one in this House or outside it likes to see people in our hospitals involved in industrial action. In making my points, I know that I will receive a historical lecture about why we are where we are. However, we are in a difficult position because commitments have been made by the HSE, Health and Safety Executive, to address the issue. The HSE's service plan 2013 highlighted that it would make efforts to address European working time directive issues. I want to know why we are at the stage that the IMO and non-consultant hospital doctors have no trust or faith in the HSE and its commitment to resolve the issue. It is required only to fulfil employment law and ensure that people work in a safe environment, are allowed periods of rest and work only in a roster in which services can be provided safely. When one looks at the history of the situation and, more important, the past couple of months with the breakdown of trust between the HSE and the IMO, many questions are raised.

The matter has been before the Labour Relations Commission - in fairness, it has huge expertise in bringing about resolutions to industrial disputes and has been doing so for many years - but the fact that it was unable to bring about a resolution raises many questions about why the HSE has not entered into meaningful dialogue in such a way that would allow non-consultant hospitals doctors to believe the HSE's commitment. Given the HSE's role and that the Minister is in charge of and politically responsible for the HSE, does he completely trust the HSE on its commitments to implement the European working time directive for non-consultant hospital doctors?

There are huge strains in the medical service. The non-consultant hospital doctors are an integral part of the medical service - they provide hugely valuable services daily. However, they are working under extreme conditions. We have seen and heard cases - today we saw people outside our hospitals who have worked more than 80 hours a week in providing healthcare. Everyone accepts that is happening. Even the Minister said previously that working arrangements are in breach of European working time directives and are completely unacceptable.

The HSE stated its position on the working time directive in its 2013 service plan, but today there are 3,000 non-consultant hospital doctors who have had to take action to encourage dialogue and a resolution to the situation.

The difficulty is that there are significant swathes of people who depend on the health system and non-consultant hospital doctors to provide the care. A total of 12,000 outpatient and 3,000 elective surgeries have been deferred. This puts significant pressure on individuals. Were 3,000 procedures deferred today because of this action? A total of 12,000 outpatient appointments were deferred as well.

James Reilly (Dublin North, Fine Gael)
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Those figures are incorrect but I will clarify that.

Billy Kelleher (Cork North Central, Fianna Fail)
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They are the figures I have been given so I hope the Minister can correct that. Even if there were no deferrals, the point is that we still have 3,000 people who have no faith in their employers in respect of bringing about their entitlement under European law. I know the Minister will give me the historical lecture on it but we are in a position where we have a complete breakdown of trust. I urge everybody to go back to the LRC to see if this issue can be resolved but in the meantime, as political head of the HSE, the Minister must surely ask the HSE why trust has broken down and tell us whether he has faith in it in respect of how it has negotiated so far with the IMO on behalf of NCHDs.

James Reilly (Dublin North, Fine Gael)
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The Deputy talks about a historical lecture because he does not want to be reminded of the true history-----

Billy Kelleher (Cork North Central, Fianna Fail)
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No, the Minister can remind me but he only has four minutes.

James Reilly (Dublin North, Fine Gael)
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I will not focus on that but I will come to it later because it is important. What is really important is for me to say that I share people's concerns about this action, the disruption to the delivery of acute care and the unnecessary worry and anxiety caused to patients. I will correct the figures out there. I do not have absolute accuracy but no more than 7,400 patients have been affected by this. That is 7,400 more patients than should have been affected because this action will not help the situation.

I believe junior doctors have a right to reasonable working hours and that patients have a right to feel safe in their care. I do not believe it is safe to have doctors working the sort of hours they have been asked to work in the past. We all must work together towards reaching a safe solution. The point is that we have made major progress in tackling this long-standing problem, and a long-standing problem it is, as the Taoiseach said earlier. There is a report from 2001, commissioned by Fianna Fáil's leader, Deputy Martin, in January 2001 at a cost of €254,000, and here we are in 2013.

At my request, the HSE established a national group in February 2013 to bring an urgent focus to implementation of the working time directive. I have met with Commissioner Andor on a number of occasions in respect of this. This group has made progress on the number of doctors working more than 24 hours in a single shift and instances of doctors working more than 68 hours a week. The average number of hours of NCHDs is now declining. Previous surveys have shown that average working hours for NCHDs fell from 60 hours a week in 2009 - notwithstanding the fact that the initial report in 2001 wanted them under 48 - to 54 hours a week in 2012. During the first six months of this year, the number fell to 52.4. I am not saying this is enough. It must come down the rest of the way. Furthermore, the proportion of NCHDs working shifts in excess of 24 hours has fallen from 58% in March 2013 to 34% in August 2013. It is still too many and more must and will be done but we are making serious progress. In addition, I set up a group chaired by the president of DCU to carry out a strategic review of the medical training and career structure of NCHDs with a view to improving retention of graduates in the public health system. An interim report is to be provided in November.

The establishment of the hospital groups will empower hospitals to co-operate and share NCHDs when scarcities arise. This will further reduce average NCHD hours.

Compliance issues arise largely in particular specialties. Virtually all NCHDs in radiology, emergency medicine and psychiatry are fully compliant. Following discussions at the LRC over recent weeks, a joint IMO-HSE verification and implementation process has been proposed. This has already begun and will be proceeding during October. Actions to change rosters and revise work practices identified during this process will be implemented during November. Implementation and achievement of a maximum 24-hour shift would then be verified jointly by the HSE and IMO.

There is clearly going to be a reduction in planned patient attendances. It is estimated that cancellations will arise in respect of about 7,000 outpatient appointments. The patients deferred are being offered the earliest possible re-attendance dates. It is already Government policy that those waiting longest for treatment should be prioritised. The IMO has confirmed that the same level of staffing cover as is normally provided on a Sunday will be in place. It has also undertaken to provide all necessary urgent care as well as oncology, dialysis and transplantation.

We are very keen to resolve this issue and to have clear sanctions in place. The HSE has invited the IMO back to the LRC tomorrow to discuss all manner of sanctions. I have already made a statement that I want to see the sanctions aimed at those who have failed - not patients, doctors or hospitals themselves but rather the management that fails to deliver.

Billy Kelleher (Cork North Central, Fianna Fail)
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The report was commissioned in 2001 and it is now 2013. We have not had a junior doctors' strike in 25 years but we have one today. That is the difficulty. Regardless of whether it was the previous incumbent or not, we did not have industrial disputes of this nature. We now have a situation where over 3,000 NCHDs are outside our hospitals today and it is impacting on the delivery of health care.

We all accept that junior doctors have an integral role to play in the provision of health care in this country. They are the bulwark of our health services and do a huge amount of work. The point, as the Minister has stated, is that the working arrangements are not satisfactory. I know he has commissioned reports, including one by an individual who will report back to us with regard to what is required to attract and retain our NCHDs and the provision of clear pathways in the years ahead with regard to training and career options. I accept that all this is very positive but in the meantime, there has been a fundamental breakdown in trust and I am asking the Minister to tell me why this has happened. Is it because the HSE is dragging its feet? Is it because management in some areas of the HSE is not co-operating in terms of addressing the working time directive because it is being implemented in some hospitals? In these hospitals, rostering is being implemented to accommodate and comply with the working time directive but we do not have that in other areas.

Clearly, the HSE has a major problem in trying to deal with this and trust between the two sides has completely broken down. The key question is why this is the case. Does the Minister have full confidence in the HSE and does it have his full support in dealing with this issue because it is critically important? The NCHDs do not have faith in the HSE and have expressed that on a number of occasions. They do not believe there is a commitment to sanctions for those hospitals that fail to implement the working time directive. Does the Minister have full faith in the HSE management to address this particular issue and to get our junior doctors back to work?

James Reilly (Dublin North, Fine Gael)
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The Deputy has posed many questions. One of them is why there is no trust. The reason there is no trust is because too many dawns have passed and the issue has not been addressed. In the past, money was thrown at it instead of the system being reformed. We do not have money to throw at it, as Deputy Kelleher knows for reasons well known to everyone in this country, but we are reforming the system to address the issue of giving doctors safe working practices so they can deliver safety for their patients.

Deputy Kelleher acknowledged that some hospitals are compliant and yet all hospitals are affected by this. This is an understandable expression of frustration by NCHDs about what they see as inhuman working hours, the lack of a clear career path and facing exhaustion when it is unclear what they will have to show for it. It is so difficult to ensure becoming a specialist in this country with our training times taking on average 12 years, which is far too long.

Deputy Kelleher asked me whether I had faith in the HSE and its management of this situation. I have faith in the new HSE management. I have faith in Mr. Barry O'Brien who is the new HR man and I have faith in Mr. Tony O'Brien and his new management and directors of management and I believe this can be resolved.

I appeal to the IMO NCHDs to come back to the Labour Relations Commission to resolve this issue. It will not be resolved on the picket line or by hurting those to whom they want to provide safe care. I appreciate and respect our young doctors. They are going to be the specialists and GPs of tomorrow and I ask them to come back to the table to resolve this problem in a manner that can reassures them that the ones who fail to provide will suffer not patients or doctors. They will have a bright future in medicine in this country when we clarify the career path for future specialists and GPs.