Colm Burke (Fine Gael)

I welcome the Minister of State. I also welcome the Bill, as it addresses the issue of medical staffing, a critical issue in the health service. I regret the fact, however, that the Bill is being expedited through the House. This is not the optimum state of affairs. However, considering the time issue involved it is, unfortunately, necessary. Despite this, I hope we will scrutinise the legislation rigorously.

It is important that we deal with this legislation today to make sure the shortage of non-consultant hospital doctors, NCHDs, is addressed as speedily as possible. The situation in which hospitals will find themselves next week is concerning. Our primary focus must be on patient care. It should go without saying that having a large number of vacancies in the junior doctor ranks of hospitals is not conducive to providing the highest level of patient care we can expect in the health service. Whatever contingency arrangements hospital management and clinical directors have planned cannot guarantee the level of patient care that having a full complement of staff would provide.

I commend the Minister's move in creating the new division, the supervised division. It is a creative short-term solution to the problem and will, I hope, be a successful and effective means of addressing the issue. It should boost recruitment efforts. I am sure the HSE has undertaken a significant recruitment campaign across India and Pakistan which I hope will result in enough doctors being found to fill the vacancies that have arisen. This is a timely measure that will address the immediate and pressing issue of the shortage of non-consultant hospital doctors who play a significant role in the delivery of medical care in the health system. They do an excellent job in difficult circumstances. The provisions of the Bill are concerned with the creation of this new grade of medical practitioner in the supervised division.

While this comprehensive and satisfactory legislation, I will raise a number of issues with the Minister later. On the whole, I have no issue with it. However, it is a shame that we are in a position where the legislation is necessary. The situation is unfortunate and wholly unsatisfactory. How was it allowed to develop? I do not wish to criticise any individual, but while the shortage of NCHDs appears to be a worldwide issue, one must ask why the problem was not addressed sooner by the Department of Health, the HSE, the Medical Council and the medical training bodies. As far back as November, The Irish Times reported a huge drop in applications for NCHD posts that were to fall vacant in January. The report quoted an internal HSE document that read, "Recruitment problems may result in significant gaps in service areas this year". It quoted another HSE memo that read, "The HSE national medical manpower managers are very concerned at the reduction in applications for NCHD posts ... The substantial reduction in the number of applications will lead to major difficulties in filling these posts". If this was such as issue approaching the January rotation, why was it not addressed earlier in order to prevent the situation in which we now find ourselves?

The shortage of NCHDs has been a recurring theme for several years, mainly due to the structure of the system in Ireland. I trust the Minister has every intention of reforming this area. I noted that he acted swiftly and decisively to deal with the issue, bringing in all stakeholders to find a solution to the problem. He deserves to be commended for the manner in which he acted on the issue. The current set-up is crying out for change. We spend hundreds of thousands of euro training medical practitioners and then do not provide them with adequate possibilities for further training and career advancement. It is most regrettable and sad. The health system must try to ensure NCHDs have clear career paths. In 2009 the Medical Independent reported that recent changes in the NCHD contract, increased workloads and the dire economic conditions in which the country found itself did not point to the country being an attractive place for young doctors to live and work.

The plight of NCHDs, particularly from outside Ireland, was brought to my attention during the week in an email that outlined how NCHDs found themselves in the position where they were considered too old and too experienced for participating in specialist training schemes. The email reads:

Like many of my contemporaries, I came to Ireland with high hopes and expectations. After all, we were starting a career in a western country, a country of equal opportunities and merit based progression. This was the kind of optimism I came to Ireland with, so I got stuck in, doing the rounds, learning from great teachers and working across the country's hospitals at the expense of separation from my beloved family.

Five years later he finds:

To the best of my knowledge, I have tried to up skill myself by sitting relevant professional exams, taking up any available opportunity for practical learning and making myself available for fixed term contracts rather than going for higher remunerating locum opportunities. I am therefore dismayed to realise that this is all there is to my medical career and I cannot help but loose all my motivation and give up on a system I put so much hope in.

I have worked with excellent doctors and individuals who would change things if they could and Ireland has trained me and become my home but it is with a great sense of regret that I begin to contemplate uprooting my family to seek progression elsewhere. I may not be 100% sure of what lies ahead, but I am certain I do not wish to remain stagnant for the rest of my medical career, relegated to the position of permanent hard worker while I watch new intakes that I will probably teach a few things move on to complete their training.

So, reluctantly, like many of my contemporaries who have moved on and moved up, I may have to seek my completion and fulfilment outside of this beautiful green country.

This is written by someone who had worked in this country for five years who now finds he does not have a place in the Irish system yet there is a shortage of doctors for filling certain posts. This raises serious question about how the system is structured and managed.

In 2009, Dr. Mick Molloy writing in the Irish Medical Times, flagged that the system then being put in place would cause problems and this is now coming home to roost. We need to look at the way we are dealing with this area. There is a need for a number of major reforms to ensure that we can make it attractive to doctors. Another issue with regard to the role of junior doctors is that with the reduction to 48 hours of their working time they are considering that other countries offer them the opportunity of a more structured training process. Instead of a six-month or 12-month contract they can be offered three-year contracts, not necessarily confined to one hospital but to a number of hospitals with a common training programme. I agree that the Minister's policy is the correct one in order to deal with the current issue but we need to look at how the system should be in five years time and in ten years time and how Irish medical graduates can absorb into the system to ensure they do not decide to leave the country within a year or two of qualification from the universities.

The Bill refers to a timescale of two years. There does not appear to be a provision to allow a person to come back into the system if for some reason his or her job terminates. I ask the Minister of State to clarify this proposal but I will revert to it later.