Marcella Corcoran Kennedy (Offaly, Fine Gael) | Oireachtas source

I thank Senator Swanick and his colleagues for introducing the Bill and acknowledge the contributions of the Senators to the debate. It gives us an opportunity to discuss the issue of retirement age for those working not only in the health service but also in the wider public service. It is recognised that recruitment and retention of health professionals is an issue. There are recruitment and retention issues in the global health workforce as a whole. The issue is not exclusive to Ireland. The Department of Health is, in principle, in favour of the upward adjustment in the compulsory retirement age in the interests of workforce planning for the health sector. However, the Bill as drafted requires careful scrutiny and further refinement to allow its objectives to be met effectively. I will take this opportunity to outline, in no particular order of importance, some issues in respect of the Bill as currently drafted which require careful consideration.

There is no definition of "critical health professionals" in the Bill. However, the explanatory memorandum, as referred to earlier, states the Bill will apply to "key nursing, medical and consultant personnel within the public health system". It is silent on other health professionals such as therapy grades and whether they would meet the definition of "critical health professional". I am sure there are speech and language therapists and physiotherapists who would strongly view their role as being critical, and this would need further development as a concept.

It could be argued that the provisions of the Bill are potentially discriminatory. They appear to propose preferential terms and conditions for specific cohorts of health professionals employed within an organisation purely on the grounds of their professions. This seems unfair and would need to be considered further. The Bill also states that it is intended to apply to organisations funded by the Department of Health, all organisations funded by the HSE under section 38 of the Health Act 2004 and all other health and disability providers. This provision is very broad. It seems to include employees of agencies funded under section 39 of the Health Act. These employees, however, are not public servants. Neither the Department of Health nor the HSE has any role in determining the retirement of staff in agencies funded under section 39 of the Health Act.

Insufficient detail is provided in the Bill as to how the proposed "dual consent" process would work in practice between both parties, namely, the employer and the employee. This would need further scrutiny and explanation as it is not at all clear how it would work in practice. There are potential legal implications to what is proposed in the Bill if it were to result in a unilateral change in the terms and conditions of certain employees as set out in their original contracts of employment. There would also be implications surrounding the legislation for pension schemes. It is not clear how the provisions of the Bill would affect the labour market. For example, how would it affect young health professionals starting out if potential retirees instead worked on? Finally, I am of the view that it would be essential for all cost implications to be assessed properly before the Bill makes any further progress. In so far as the information has been provided, we need further clarity.

I will now consider the broader picture of the health sector and the public sector in general. We have heard the challenges the health service is facing in terms of recruitment and retention of professionals such as doctors, nurses and midwives. I am pleased to say we are emerging from a period of cost-cutting measures, including a moratorium on recruitment. We have turned the corner and recruitment is under way in the public health sector to resource and develop our services. At the same time, we must acknowledge that there are challenges in Ireland and internationally in recruiting some specialties of nurses, doctors and consultants. This difficulty is being experienced by other English-speaking countries, including the UK, Australia and Canada. Notwithstanding this, the staffing numbers at the end of January 2017 for the health services stood at 107,251 whole-time equivalents. This compares with 96,582 in January 2014, which is an increase of 10,669 whole-time equivalents.

I will outline the current position regarding the recruitment and retention of consultants, non-consultant hospital doctors and nurses as these are the main health professions on which the Bill appears to focus. We have seen an increase of 300 consultants in the public health system from January 2014 to January 2017. Ireland is experiencing challenges in recruiting some specialties. This is an international phenomenon and these specialties have traditionally been difficult to fill. There is recognition that consultant recruitment must continue to be prioritised in line with Government policy. Efforts continue to fill the consultant vacancies. The HSE has changed its consultant recruitment process and has developed a new simplified consultant application form. Work is under way to introduce a system of work planning and an individualised induction programme for consultants on appointment. I am confident that all these efforts will help in the consultant appointment process. The number of non-consultant hospital doctors employed by the HSE at the end of January 2017 was 6,020. This shows an increase of 215 since January 2016, an increase of 1,037 since January 2014 and an increase of 1,341 in the past decade. This is primarily a result of measures being implemented to achieve compliance with the European working time directive while moving towards consultant-delivered care. We are training the consultants of the future and the number of training places has been maximised. I recognise that the recruitment and retention of medical doctors who graduate and are trained in Ireland is important to the effective functioning of the Irish health service and is in keeping with our obligations under the World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel. In July 2013, a working group, chaired by Professor Brian MacCraith, president of Dublin City University, was established to carry out a strategic review to examine and make high-level recommendations relating to training and career pathways for doctors with a view to improving graduate retention in the public health system, planning for future service needs and realising maximum benefit from investment in medical education and training. The working group completed its work in June 2014 and, in all, submitted three reports and made 25 recommendations. The reports address a range of barriers and issues relating to the recruitment and retention of doctors in the Irish public health system. There have been several positive developments arising from the recommendations of the strategic review working group. These will have a positive impact on the quality of the training experience, and the working lives of trainee doctors. For example, many trainees now have predefined rotations at the start of their training schemes with reduced paperwork for each rotation and the HSE has developed an online national employment record. I also regard the implementation of the lead non-consultant hospital doctors, NCHDs, initiative at national level as a very important step. This role provides an opportunity for NCHDs to participate in discussions and decision-making regarding matters that affect them, the day-to-day running of hospitals, and allows them propose suggestions to enhance patient care to hospital management and clinical directors.

Progress has also been made on a number of other fronts, as a result of the group’s work. Revised pay scales for new entrant consultants have been implemented, and there is significant scope to recognise previous experience and qualifications. The HSE has agreed to treble the number of family-friendly NCHD positions and 32 trainees are due to commence flexible training in July 2017. We have seen some really good progress in terms of working hours of trainee doctors, and those working in non-training posts. We have made progress in reducing the numbers of NCHDs working over 48 hours per week to 17% of the cohort and we are committed to continuing with this progress. Another positive development, which will also address issues around recruitment and retention for NCHDs, is the restoration of the living out allowance for those appointed since 2012, which will be incorporated into the basic salary of these doctors from 1 July 2017.

Recruitment of additional nurses has been the focus of considerable ongoing activity by the HSE and voluntary hospitals. The Bring Them Home campaign to support the recruitment of Irish nurses abroad brought almost 100 additional nurses into the system and this campaign continues. The message is reaching the Irish abroad that Ireland is recruiting again and several initiatives are in progress to provide career development, training opportunities and improved pay.

The HSE has continuous open recruitment campaigns in place to ensure that all eligible applicants for nursing posts can apply at any time to work in hospitals throughout the country. The HSE is keeping these campaigns rolling. This means that they are left open for any new applicants who come on stream and hold interviews when they have sufficient applicants. The HSE ran a recruitment campaign for nurses and midwives from 28 to 30 December 2016. A total of 220 attended the event and 115 nursing and midwifery candidates were deemed successful and placed on a panel following interview. There was a careers open day for nurses and midwives last week at Dr. Steevens' Hospital. This was the second in a series of careers day events for nurses throughout 2017. The HSE is running recruitment campaigns aimed specifically at recruiting staff nurses for emergency departments. As part of the recent management proposals to the nursing unions, the HSE committed to offering permanent posts to degree programme graduates and full-time permanent contracts to those in temporary posts. The executive is also focused on converting agency staffing to permanent posts.

Retention of the nursing staff employed by the HSE also needs to be addressed and this is recognised. The HSE is analysing the data from exit interviews from nursing and midwifery disciplines to identify trends and will survey new starters to identify areas of improvement in orientation. The Irish Nurses and Midwives Organisation, INMO, is balloting on a range of initiatives designed to retain nursing and midwifery staff, including: extensive education and personal development opportunities for nurses and midwives to upskill; a pilot pre-retirement initiative as a method of retraining experienced nursing and midwifery staff; 127 promotional posts for staff nurses or midwives to clinical nurse midwife manager 1 level; and consideration in the upcoming pay talks of the restoration of a number of allowances for new entrant nurses. Providing an improved working environment will, we hope, encourage our nursing and midwifery staff to stay and may even encourage those who have emigrated to return.

I have outlined some of the work taking place in the HSE to recruit and retain health workers. I acknowledge that the spirit of this Bill is also intended to help by keeping experienced health professionals employed in the public health service past retirement. It is not at all clear that there is a high demand among health sector professionals to remain on or return to work having retired. I am aware that there are a small number of individual cases, some of whom have made representations to the Department of Health seeking to remain on in employment. In general, however, following initial inquiries, my sense is that the opposite may be the case for the majority of health professionals currently employed. We know that there are already schemes in place which allow certain professions to retire early. In the recent talks with the INMO, its proposals included a pre-retirement initiative whereby nurses and midwives could reduce their working hours in advance of retirement age. Many nurses, due primarily to the physical nature of their work, have, at their own request, moved off clinical work as they near retirement age. Consultants who retire and wish to return to work in the public health service are treated as new entrants and are subject to abatement of their pensions. Of those who retire, the HSE estimates that fewer than 5% return and, typically, that would be for less than a year. However, issues around the arrangements in place for retired public servants and whether continuing to work is an attractive proposition, are more appropriate to the Department of Public Expenditure and Reform. Indeed, I understand that barriers to ensuring extended participation in the public service workforce are being examined in a review being led by that Department.

The terms and conditions of employees in the public service are generally a matter for the Minister for Public Expenditure and Reform. While the Bill, as drafted, refers only to certain health professionals, it needs to be examined in the context of work being undertaken by the Department of Public Expenditure and Reform. That Department is reviewing the current statutory and operational considerations that give rise to barriers to extended participation in the public service workforce. This includes looking at the current and planned age of entitlement to the contributory State pension. The Department of Health, among others, is involved in this review and its officials have already held an initial meeting with their colleagues in the Department of Public Expenditure and Reform. I understand that this work is expected to be completed in the second quarter of this year.

In light of all of the arguments that I have put forward and the fact that this Department of Public Expenditure and Reform review will make recommendations which will apply to all public servants, not just certain health professionals, I strongly recommend that the House agree to the amendment I have proposed and await the conclusion of this review and its resulting recommendations. I welcome Senator Swanick's co-operation and agreement that we would allow time for the publication of the review which is already under way given the importance of this issue and its potential implications for the entire public service.