Paul Murphy (Dublin South West, Socialist Party)
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90. To ask the Minister for Health further to Parliamentary Question No. 173 of 9 October 2014 the reason almost 65% of medical and dental staff employed by the Health Service Executive are on fixed term and or special purpose contracts; and the effect that has on patient care. [42767/14]

Paul Murphy (Dublin South West, Socialist Party)
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I ask the Minister why it is the case that almost two thirds of medical and dental staff employed by the HSE are not on permanent contracts but are instead on temporary or special purpose contracts. It seems to be an extraordinarily high figure that presumably speaks to the erosion of terms and conditions and the widespread use of agency staff in the health service right across the public service. What impact does that have on patient care?

Leo Varadkar (Dublin West, Fine Gael)
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It is important to note that a significant proportion of medical and dental staff, in particular non-consultant hospital doctors, NCHDs, are employed on a training rotation on fixed-term contracts. Most NCHDs are therefore recorded as being temporary employees. In total, approximately 5,000 NCHDs are employed on fixed term or specified purpose contracts or almost 65% of medical and dental employees in whole-time equivalent terms. Nearly 4,000 of the posts are part of a structured training programme. It is a permanent feature of medical employment that a large proportion of staff are on fixed term or specified purpose contracts at any given time. Ireland is no different from many other countries in that respect.

In July 2013 a working group was established, chaired by Professor Brian MacCraith, to carry out a strategic review of medical training and career structures. The group submitted its final report in June. My Department, in conjunction with relevant stakeholders, is pursuing implementation of the recommendations made by the MacCraith group to support NCHD and consultant recruitment and retention.

Paul Murphy (Dublin South West, Socialist Party)
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I wish to clarify those figures. The Minister said 4,000 out of the 6,221 staff on fixed term or specified purpose contracts are in training. Taking out those involved in training, how many of the remaining staff on temporary or specified purpose contracts are agency staff? What amount of money is spent on agency staff and what proportion of the money goes on agency fees, which is a complete waste from the point of view of the health service? Figures recently emerged to suggest that agency doctors can cost hospitals up to €1,000 a day and up to €300,000 a year, a portion of which is taken by the agencies in question, which speaks strongly against the notion that using temporary staff is a cost-saving measure for the State.

Leo Varadkar (Dublin West, Fine Gael)
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With the greatest respect to the Deputy, he is conflating two different issues, namely, agency staff and permanent contracts.

There are 2,600 consultants in the system, 2,200 of whom are permanent staff and 295 dentists, of whom 275 are permanent. The vast majority of consultant and dentist staff are permanent but of the 5,000 non-consultant hospital doctors only 66 are permanent, the reason being that the nature of being a non-consultant hospital doctor is to rotate from job to job every four or six months. It is not a permanent post but rather it is a training post whereby doctors move from hospital to hospital or to a post in the community in order to learn their job. It is only when a doctor has learned the job and earned his or her certificate of training or becomes a specialist, that he or she is appointed to a permanent post.

The situation is different in the case of agency staff. The use of agency staff arises where the hospital is unable to fill a post, either because nobody has applied or else to fill in for maternity leave or sick leave or to fill a vacancy which arises for some other reason. The reason agency costs have risen so high is because it has been so difficult to fill consultant posts on current salaries and to fill NCHD posts in certain remote parts of the country where it is difficult to get doctors to relocate for work.

A detailed breakdown of the expenditure on agency staff is published monthly in the HSE's performance assurance report, PAR, which is available on its website.

Paul Murphy (Dublin South West, Socialist Party)
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I agree that an important aspect is the inability of retaining trained doctors in this country, of which pay may be an element. However, another important element is the working conditions which continue to be fairly horrific, considering it is regarded as a step forward to agree not to have people working more than 24 hour shifts. This illustrates the problems facing them and it is the fundamental problem for the Minister.

I ask if the Minister may be able to shed some light on the other figures. I refer to contracts of indefinite duration in the case of staff employed on a temporary basis but as a result of staying on over a period of time have become, in effect, permanent. The HSE does not provide a breakdown but this is an important figure because those employees are potentially employed on inferior terms and conditions than those permanently employed from the outset. I ask if the Minister can access those figures and provide the House with information about what proportion of those employees classified as permanent are actually on contracts of indefinite duration.

Leo Varadkar (Dublin West, Fine Gael)
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I can provide the Deputy with a detailed breakdown of the figures to the extent that I have them. The information gives a full breakdown of fixed term, part-time and full-time posts. Terms and conditions of employment are also important, as it is not all about money, and these are improving. For example, an NCHD working more than a 24-hour shift is now relatively unusual. The residence at St. James' Hospital where doctors on call used to sleep overnight was demolished a few weeks ago because doctors in that hospital no longer have to sleep overnight. Even though we are not yet in compliance with the working time directive, we are getting closer every year. Pay is important and it is particularly important in the case of consultants. I know the Deputy is a great believer in income equality and that everyone should earn the same. Certainly if his policies were implemented we would have no consultants in this country or very few. That is just one example of where income equality is not always in the public interest.

Paul Murphy (Dublin South West, Socialist Party)
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Like in Cuba which has the highest number of doctors--------

Leo Varadkar (Dublin West, Fine Gael)
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They are working in hotels in Cuba. I have been there.