Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I am pleased to have the opportunity to participate in this discussion on the Longer Healthy Living Bill, 2015. I thank Senators Crown, Barrett and Power for bringing this matter forward and acknowledge their work in writing this Bill. The issues raised in the Bill are worthy of national debate. Society is changing and so too is the way we work, and that is not particular to the health service. People are living longer and their overall health continues to improve. The notion of public servants being required to retire at a relatively young age by today’s standards, even where they may still have much to contribute and be keen to do so, is one that as a society we should revisit.

This Bill is timely in so far as the loss of highly qualified personnel who are still willing and able to fulfil key roles in our health service can sometimes exacerbate the workforce challenges we are experiencing. In 2013, the Government published the national positive ageing strategy. Objectives of the strategy include the development of a wide range of employment options, including options for gradual retirement for people as they age as well as addressing barriers to continued employment and training opportunities. Specific areas for action are age-friendly workplaces, contracts of employment, flexible work practices, gradual retirement and pre-retirement planning. These considerations must also be taken into account in developing an integrated approach to the transition between people’s working lives and their retirement.

It is important, however, to acknowledge that it suits many employees to retire when their contract of employment finishes or, indeed, before they reach the age of compulsory retirement. The pressures of increasingly stretched staffing resources of recent years have probably added to the push factor for some public servants and we all know of people who have decided to retire and pursue other interests while they still have the energy and good health to allow this. Equally, there is a growing number of people who would be happy to continue working beyond what has been traditionally regarded as retirement age.

In the health service, medical practitioners, including GPs, and also nurses, are among the specialist personnel who are often interested in continuing to practise beyond their official retirement age. It is time that as a society we look again at all the rules and regulations governing retirement from the workforce in order that the widest possible range of options are provided to people as they age. As with the Civil Service generally, the age profile of staff in my Department is currently weighted towards those in the latter third of their working life. Therefore, it is very important that we ensure the necessary succession arrangements are in place to replace those who will reach the end of their working life within the next decade. I am pleased that in the past year or so we have been able to recruit a number of new, generally younger staff, who bring additional capacity and skills to bear on the Department’s work. This injection of young blood along with the significant organisational change programme being led by the Secretary General will further enhance the Department’s capacity and effectiveness so that it can successfully discharge its important leadership and oversight role for the health service.

The Longer Healthy Living Bill as drafted refers to the Department of Health and bodies directly funded by the Department of Health such as the HSE, HIQA, the Health Products Regulatory Authority, Health Insurance Authority and the Irish Blood Transfusion Service. Taken together, the health family of organisations which come either directly or indirectly under the ambit of my Department account for about one third of all public service employment. The Bill as drafted does not include organisations funded by the HSE under section 38 of the Health Act 2004, which include voluntary hospitals like Beaumont, St. Vincent's, St. James's and the Mater as well as all of the children’s and maternity hospitals, among others. Nor does it include a range of major disability service providers. If the Bill is intended to encompass the public health service as a whole, its scope would have to be extended to cover all of these significant providers.

As Minister for Health, I do not set the terms and conditions for employees of my Department. They are a matter for my colleague, the Minister for Public Expenditure and Reform. Therefore, as far as the staff working in my Department are concerned, as well as those across all Departments, terms and conditions can only be altered if it is determined by Government that changes should be applied across the Civil Service as a whole and not just to one of 15 Departments. Changes have occurred in recent years as part of the reform of the public service in respect of, for example, sick leave and annual leave, with benefits in terms of standardisation as well as considerable savings to the public pay bill. To avoid any misunderstanding, I should also explain that it is generally those civil and public servants recruited prior to April 2004 who must retire at age 65. With certain exceptions, staff recruited between April 2004 and December 2012 do not have a mandatory retirement age, while those recruited since January 2013 are required to retire at age 70.

As Senators will be aware, there have been recent changes to the State pension age which mean that since January 2014 there is now a standard State pension age of 66 years. Further changes in the State pension age will come into effect in 2021 and 2028, when the State pension age will increase to 67 and 68 years respectively. It is important that in considering changes for retirement age we take account of changes in the State pension age and any changes to working and retirement policy will require the input of my fellow Ministers in the Departments of Social Protection and Public Expenditure and Reform.

As matters stands, mandatory retirement ages are commonplace in public service employment. These long-standing provisions reflect historic life and health expectations and also allow certainty for both employees and administrators. The existing mandatory retirement ages in the public service are objectively justified but the extent of litigation makes clear to me that this is an area that needs a great deal of detailed consideration with the assistance of expert advice.

I will point to a number of other issues raised by the Bill which the Senators may wish to address on Committee Stage. The Bill as proposed essentially gives employees the right to continue on working past their retirement age, whether their employer wants them to stay on or not. This is a provision that might be reconsidered. I would be very much in favour of employees staying on past their mandatory retirement age by mutual agreement, that is, if it is double voluntary. However, employees insisting that they stay on when their employer does not want them to or would prefer them to retire may be going too far. Of course, there may be people who are not physically or mentally fit, who are as some Senators put it, "dead wood", although I would not use the term myself. The fact that we cannot remove dead wood when people are in their 40s or 50s is not a good argument for saying that we should not remove dead wood when people are in their late 60s, 70s, 80s, 90s or even older.

We must also bear in mind the need to make space for new entrants and for promotion. The Senator is correct that for one in every eight recently advertised consultant posts there were no applicants. However, there were applicants for seven out of eight posts and perhaps those posts would not have been available had people decided to stay on past their retirement age. I would also point out that there are existing arrangements that allow people to stay on past their retirement age. People are regularly hired as locums to fill the posts they vacated and people with particular skills can be hired on a short-term contract basis, perhaps for a year or two.

I have particular difficulty with section 7 of the Bill which provides that an individual who wants to work past his or her retirement age must inform the Minister of this in writing. Currently there is no direct employment relationship between the Minister and any of the 100,000 people who work in our health service and I would have serious reservations about creating such a relationship. The only employment relationship that I have as a Minister is with my political staff, whose contracts are coterminous with mine. All Ministers are very busy people and the Minister for Health is no exception. I would have serious concerns about individual files on individual employees going to the Minister for decision. There would be all sorts of pitfalls and problems in that regard.It would be a major step backwards. Senator Crown mentioned Bismarck. The last person who had that kind of power was Tsar Nicholas of Russia where individual employment files went all the way to the Kremlin for him to sign off on them. Perhaps that aspect is something that may be reconsidered. Perhaps the CEO of the institution would be the right person rather than the Minister, in that regard.

Section 8 also includes a grandfather clause. It allows individuals who have reached the mandatory retirement age within two years of the start of the Act to apply to be re-instated two years after they have retired. I would have concerns about this measure. Let us take for example an assistant secretary general who retired two years ago. Under this Bill, he or she would be able to insist on being rehired. It would mean creating a job with a salary of nearly €200,000 for somebody who has decided to reinstate himself or herself who perhaps is not needed because the job has been filled. I ask the Senator to reconsider that aspect of the Bill on Committee Stage.

Another issue that arises is whether such persons could draw their full pension as well as a salary. I imagine that is not the case but the matter would have to be clarified so that abatement would occur. Another thing that would have to be considered would be somebody trying to return who has already availed of early retirement. There have been a number of very generous schemes that provided for early retirement. It would be a bit much if somebody were to avail of that scheme, take the early retirement package and then seek to be rehired again. A few people have tried to do so although they do not say it in their media pronouncements. I shall comment on the matter another time.

When it comes to the Department of Health, which is different from the HSE, there is a provision to allow people to stay on beyond their required retirement age based on hardship grounds. In addition, if an officer has specialist experience and expertise that is required by the Department, a business case can be made under existing rules to the Department of Public Expenditure and Reform for the person to stay on.

While I welcome the Bill, and the Government will not oppose it, I have given some consideration to possible approaches to retain expertise within the health service. The Bill, as drafted, requires further refinement to allow its objectives to be met effectively. The recruitment of medical staff and nursing staff is a particular challenge at present, and will continue to be so for the foreseeable future, as long as there is a 1.2 million shortage of health staff across the world. Many of our staff work in other parts of the world because they are so well trained and excellent but also because those countries are short of staff too. What we do all of the time in the western world is denude developing countries of their staff. There are a few rare countries that have a surplus of health care staff.

In terms of recruitment, there is an international shortage of consultants, doctors and nurses. The World Health Organization projects that the requirement for medical staff and the related shortfall will continue to increase significantly in the years ahead. Irish medical staff are trained to high standards and are much sought after in many English speaking countries and we, in turn, seek staff from overseas in places like eastern Europe, the United Kingdom, Australia, India, Pakistan, Sudan, Nigeria and the Middle East to mention just a few. Over 100 Australian doctors are registered in Ireland which is a fact that is not known by many people. We are endeavouring to reach self-sufficiency, for example, through the implementation of the Fottrell report on doctors and the nursing degree programme that now produces 1,500 graduate nurses a year. None the less, Ireland continues to have a high reliance on the foreign recruitment of clinical staff. In these circumstances, the option of postponement of retirement by some health service staff could relieve some of the staffing pressure in our health service.

On a related matter, my Department is establishing a cross-sectoral working group on health workforce planning. The working group will begin meeting early next year and will, among other things, conduct a high level examination of the current position of the health workforce in Ireland which will include looking at numbers, skills and competencies. Consideration will also be given to national and international policies, and developments and trends that are likely to influence the future shape of the health workforce. Preparatory work to support the development of the framework is under way and includes a review of what happens in other countries.

The recruitment problems that we are having in our health service are well known to everyone but perhaps the progress being made is not. It is worth putting some of that on record here today. As of 1 January the number of consultants fully employed in the health service has increased by a net 52. That means we have 52 more consultants on the payroll than we had on 1 January 2015. In total we have 114 more doctors on the payroll than we had on 1 January of last year and over 500 more nurses than we had this time last year. This progress has been achieved through a combination of people being employed, new posts and people being transferred from agencies and taking up proper contracts. The agency spend so far this year is down by €11 million on last year's figure which is good to see.

Since the Government came to office in 2011 the number of consultants has increased by 300 to 2,800. The Senator acknowledged that the improvement took place during a period of retrenchment. If we can increase the number during a period of retrenchment then we can do much more in the coming years during a period of growth. Perhaps we could aim to reach the OECD averages within a reasonable timeframe of six to ten years. It is largely due to the requirement to comply with the working time directive that we now have 5,500 NCHDs working in the public health service which is the highest figure ever. While nursing numbers are somewhat down, we have record numbers now of midwives, clinical nurse specialists and advanced nurse practitioners. That is another fact that is not well known and is rarely conveyed by the media.

So far this year the Nursing and Midwifery Board of Ireland has recorded a 122% increase in the number of nurses applying to be registered in Ireland. That figure includes nurses staying, nurses coming back and nurses who come from overseas. The increase is very significant. There are indications that the graduate nursing classes of this year intend to stay in the majority of cases which was not the case two years ago. The most recent survey of doctors in training is entitled Your Training Counts and will be published soon. It indicates that 80% of such doctors intend to stay and that half of the 20% who intend to leave wish to return.

The Government does not intend to oppose the passage of this Bill through the House and will not be doing so. The Bill represents a useful contribution to the national debate which I believe must continue as we work towards deciding how we, as a society, can most effectively marry the needs of the public service with people who work in it. In that vein, and in light of the comments I have made, I expect to propose substantive amendments to the Bill as it progresses which I hope will be constructively debated by Members.