John Crown (Independent) | Oireachtas source

Cuirim fáilte roimh an Aire. I give the Minister a great big welcome and thank him for coming to the House. I know this is an issue he has dealt with very constructively before. In introducing the Bill today we are not in any sense trying to undermine anything he might wish to do independently to implement it in spirit, if not in all of the specifics. We would hope that this Bill, if passed, would give the Minister additional equipment for making sure that it happened.

The Bill we are introducing today, my fifth in the current Seanad, is one that seeks to end mandatory age-based retirement in the health service, a practice which I believe has had multiple negative effects on the service and which is a major contributor to an ever-worsening womanpower and manpower crisis in the health system. How did the idea that workers should have to retire, or should retire, at 65 originally arise? Credit is usually given to Otto von Bismarck, the Iron Chancellor, the unifier of Germany, who counter intuitively in terms of his historical reputation introduced many progressive social reforms and social policies in Germany. For example, he developed what I believe is the finest health system in the world, the current German health system, still the best, and he also introduced the first concept of an old age pension.

In Bismarck's time the average age of death of a German was approximately the early 40s so only a very hardy minority, a rugged minority, achieved the recommended retirement age of 70 in 1889 when he first introduced the pension. As the Minister is aware, in Ireland the average age of death is not thankfully in the mid-40s, it is about 81. If an Irish person is alive now at the age of 65, on average he or she will live approximately 20 more years, give or take a few years. It has been estimated that many current middle aged people will reach a demographic where they will, if alive at 65, have a 50% chance of reaching to 90. In Bismarck's time if one was alive at 65, on average one lived approximately two years longer. Sixty-five year olds are also physiologically younger than they used to be.

The current system forces healthy, physiologically young 65 year olds to retire with no regard to their health, competence, experience or, critically - the Minister will be aware of this - their dispensability to the health system. Is this good policy? Are we so flush with trained, experienced staff that we can afford to offload them involuntarily? The Minister will be aware that the answer to this is a resounding "No". We have the lowest number of career level specialists per head of population in the OECD for nearly every specialty in which records are kept. To take hospital medicine as an example, historically a near throng of incredibly bright young trainees were waiting in Boston, London, New York, Chicago, Edinburgh and other leading centres to apply in a very competitive environment for the odd rare consultant job which arose at home. This did give us the best trained - I say this bar none - cohort of senior specialists in Europe.

I acknowledge the Minister's efforts and those of his predecessor, Dr. James Reilly, to redress this long festering problem on both of their watches. The Minister attempted to do it by increasing the number of consultants at a time of great recession. They both deserve credit for that. The Minister's on-the-job learning curve in this effort has been steep. He knows now how difficult it is to attract the same number and the same calibre of trainees for jobs as we did historically, even for this relatively modest expansion, to say nothing of the kind of expansion which would bring us up to international guidelines. The result, as the Minister is well aware, is many unfilled posts and incredibly in a country where a consultant post was considered an extraordinary ultimate career achievement for people after, typically, a total of 18 years of training following the leaving certificate, one eighth of the jobs are not even applied for. That is an extraordinary change in the demographic and in the market for these jobs. As a result the jobs are also filled by locum tenensconsultants. I have to be honest, in many or most cases these are very fine, well-trained and competent doctors who in difficult circumstances make a decision, usually from abroad, to come and work in Ireland in a health system which is not always the most pleasant one in which to work. I would not in any sense want to decry the efforts that these, usually, very fine people make but they often are lacking something of the excellence of the quality of people who would have been forged in the crucible of the very rigorous Irish career structure and would have applied for the jobs. In addition, the very notion that somebody's position is impermanent is not good from the point of view of continuity or quality of care.

What this means is that all too often somebody who is highly-trained, internationally-trained, often a research leader in his or her field is being mandatorily replaced with somebody of lesser credential. Is this good public policy? In addition, it makes no economic sense to pay a salary and a pension simultaneously in respect of one position when the pensioner did not want to retire and is doing the job to a high and excellent standard. What amount of time remains?