Colm Burke (Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after "That" and substitute:

"the Bill be read a second time this day six months, following the proposed publication of findings by the Department of Public Expenditure and Reform arising from its review of barriers to extended participation in the public service workforce, up to and including the current age of entitlement to the contributory state pension."

I thank the Minister of State for taking time to deal with this matter and I thank Senator Swanick for the work he has done on this Bill. As someone who has tabled a number of Private Members' Bills here, I am only too well aware of the amount of work that has to be done in preparing any such legislation. I know the Senator consulted with quite a number of people.

When it was first suggested, I had concerns about the Bill in respect of people who might be holding on to a position and resisting change. I have seen that happen in hospitals over the years. In fairness to Senator Swanick, he has dealt with that issue with the requirement for joint consent. I have also seen management pushing very innovative people - good consultants - out when they should not be pushed out. I agree that there must be agreement. I accept that there must be agreement on both sides, from both the consultant and the employer, that the person can stay on. This is welcome legislation and I believe it needs to be given very careful consideration and taken on board.

What Senator Swanick said about the shortage of people is interesting. I was just reading this morning that there is a shortage of 100,000 people in Finland at the moment for various jobs because of a lack of job skills, not just in the area of medicine but in respect of employment overall. With regard to medicine, it is an issue that there is not just competition in one's own country to try to get employees, but in a world market. That is not going to change.

This morning I met with the HSE about this whole issue - about forward planning in the health care sector. I have very much been highlighting medical recruitment over the last five or six years. I was delighted to see that the HSE has now established one database for the entire country, into which it is putting all of the information from each and every hospital, so that it knows how many consultants are in each hospital, what their role is and what department they work in. It also has the consultants' date of birth so that it knows when they are likely to retire.

If we go back prior to the HSE, it is interesting that Comhairle na nOspidéal seemed to have had a mechanism to advertise posts before they became vacant. Once the HSE was formed we appear to have fallen down on that and, as a result, when a post becomes vacant it remains vacant for anything up to two years and there are locums in place for a period of time. The new system the HSE has put in place is a step in the right direction, but it is also important that the HSE gets the full co-operation of all hospitals at national level.

When talking about medical consultants, it is interesting how the system has changed. For instance, in 1984 there was one consultant in the entire country in accident and emergency medicine. There are now 88. The number of consultants in 1984 for the entire country was 1,085. I do not have up-to-date figure to the end of 2016, only those for 2015, but at the end of 2015 there were 2,891 consultants. There has been quite an increase.

Part of that increase is because of the sub-specialisation that has gone on in each area, whether in maternity, paediatrics, orthopaedics or surgery. That sub-specialisation within categories is why, in fairness to Senator Swanick, this Bill is important. There might be two consultants in the entire country who specialise in a particular area. To get a replacement for them would be quite difficult.

This Bill is welcome. We need to continue with forward planning and in respect of how we deal with our junior doctors. I was delighted to hear from the HSE this morning that there is a change in the trend of junior doctors feeling an urgency to leave this country and that we are putting in place a better system for training and retaining junior doctors. We have a lot of work left to do on that area however. We need to make sure that, even if people do go away, there are enough incentives to bring them back again.

One of the other issues that we need to look at, and which it is extremely important we look at, is that we have introduced a salary scale where the same salary applies in one area of the country compared with another. A person might be in Letterkenny on what is called a one-in-two call or a one-in-three call, which means that the person is on call all day, every day, five days a week. If it is a one-in-three call such people are on every third night and every third weekend.If a person works in Dublin, he or she might be on a one-in-eight call, which means that he or she works one night out of eight, five days a week and one weekend in eight. There is a huge difference. There is an argument that inadequate account is taken of the pressures on consultants working in smaller hospitals such as those in Letterkenny, Sligo, Tralee, Waterford or Kilkenny. It is something we need to keep in mind. When we look at the position in other countries, we see the need to be flexible. We must continue to look at different ways of operating the system. What Senator Keith Swanick is proposing in the Bill is retaining people with a specialisation that may not otherwise be available. We also need to look at providing other incentives. In particular, we must try to keep staff in smaller hospitals. For instance, someone working in a smaller hospital is entitled to go back to Dublin to take up a job because there is more of an opportunity to specialise in the area in which he or she is working. That is an important issue at which we need to look.

We need to make sure there is sufficient forward planning for junior doctors. One of the other issues I have raised on quite a number of occasions is that of co-operation with other jurisdictions in the provision of medical training. For instance, if there is a five-year programme of specialised training, two of the years could be spent outside the country in order that people will not feel that because they left the country, the door has been closed to them. There are a lot of challenges in the health care sector and there is a growing and ageing population. We need to plan for that change in demographics. I, therefore, welcome the legislation.