Seanad debates

Wednesday, 13 March 2013

Adjournment Matters

Health Service Staffing

1:55 pm

Photo of Colm BurkeColm Burke (Fine Gael)
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The matter I wish to raise is a new agreement I discovered by accident which has been reached between the HSE and the universities in Pakistan. There is a need to bring the information into the public domain as we got no indication that this was happening. I raise the issue given that more than 200 people were brought in here in 2011 from India and Pakistan under the supervised division created for medical practice. We gave them two-year contracts either from July 2011 to June 2013 or from December-January 2011-12 up to 2014. Those two-year contracts will begin to expire at the end of June 2013. As I understand it, they will not be offered new posts.

I gave the example at the Joint Committee on Health and Children that of the six registrars in anaesthetics, five are employed by the HSE and the sixth is employed by an agency and has refused to take a post as a locum, in the knowledge that nobody else is prepared to accept the post as a locum. Therefore, the HSE is paying substantial money to employ through an agency. There are two senior house officers, SHOs, under the supervised division. I understand that when their two-year contract expires they cannot apply for the post of registrar, even though the people in the hospital have informed me they are suitably qualified. I am concerned at the lack of joined-up thinking in the HSE and the Department on the issue given that up to 250 people who have had the experience of working here for two years will be sent home.

I am concerned at the lack of consultation with the medical colleges and the HSE, in particular the Royal College of Surgeons and University of Limerick. The University of Limerick has many people from Canada who spend four years here doing their medical degree. They get the experience of working in Irish hospitals during the course of those four years and we are not prepared to offer them intern posts. Likewise, I understand the Royal College of Surgeons is not offering intern posts, although the students have been in the education process in Ireland for five years and have the experience of being students in Irish hospitals and are familiar with the way the system works. The HSE and the Department are not talking to those two institutions yet they are prepared to travel to Pakistan and employ people on two-year contracts. I seek clarification on the issue.

I put down a specific question to the HSE six months ago seeking the number of junior doctors who are on six-month contracts, the number on 12-month contracts, the number on two-year contracts and the number on three-year contracts and I cannot get that information. We need to look at this whole area which will be a disaster from June onwards unless the issue is tackled in a planned way. I am not convinced by the answers I got at the Joint Committee on Heath and Children on Tuesday, 5 March 2013. I am concerned from the Department and the HSE points of view that we are not dealing with the issue in a proper manner.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I am taking this Adjournment matter on behalf of the Minister for Health, Deputy James Reilly.

I thank the Senator for raising this important issue. A memorandum of understanding for a pilot exchange programme between the HSE and the College of Physicians and Surgeons of Pakistan was signed in November 2011. The programme is due to commence in July this year. Doctors who are currently enrolled in CPSP's postgraduate training programmes will spend two years gaining experience and training in Ireland. Participants will have their time accredited for training purposes by the CPSP and this will contribute to their career progression on return to Pakistan. This programme fulfils Ireland's obligations under the WHO Global Code for the Recruitment of Healthcare Workers. It will enable the up-skilling of doctors from Pakistan to the benefit of the health service there. The Senator has also raised non-consultant hospital doctors' employment contracts. There are approximately 4,900 NCHDs employed at any one time. Some 80% of these are training posts and the remainder are non-training or service posts. The duration of the contract held by an individual doctor is determined by factors which include the nature of training or service arrangements and whether the post involves rotation between sites.

I acknowledge that NCHDs fulfil a very important role in providing front-line care and wish to express my appreciation and that of the Minister for Health for the commitment and dedication of these doctors. However, for the most part these are doctors in training and we must ensure an appropriate balance between the provision of care by hospital consultants and NCHDs. It is important to state also that the issue of NCHDs' working-hours is one which the Minister is taking very seriously and plans are in hand to achieve substantial reductions in the number of hours these doctors must work. Entry to postgraduate training and continued participation in a multi-annual training scheme is determined by postgraduate training bodies. While an NCHD may have secured a place on a multi-annual scheme, the length of time that a doctor works in a particular site as part of that scheme may vary and he or she may choose to move between a range of different employers in the course of training. The contracts for training posts vary from a one-year contract for an intern to a contract of four to six years for a senior-specialist registrar. Senior house officers who participate in structured two or three-year training schemes may hold consecutive six-month or annual contracts, depending on whether they move location or change employer.

For a number of reasons, largely historical, the HSE operates several payrolls. Where an NCHD moves from one HSE payroll area to another or from the HSE to a voluntary provider, he or she must enter into a new employment contract. I accept that this is not ideal. The move to a shared services model in the coming years should address this issue and enable accurate data to be provided on the number of doctors who hold two-year contracts. I would like again to place on record the Government's appreciation of the major contribution which NCHDs make to the delivery of front-line care and our commitment to the achievement of compliance with the European working time directive by 2014.

2:05 pm

Photo of Colm BurkeColm Burke (Fine Gael)
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I very much appreciate the reply. It is specifically the Minister, Deputy Reilly's, area. I am still at a loss as to how we can offer two-year contracts to persons outside this country and we cannot get information about what two-year contracts are in existence with Irish graduates. I am at a loss as to how we can offer two-year contracts in this way when we cannot do the same with junior doctors.

On the 80% who are on training courses, I accept they are on training programmes but their contracts are still only six-months or 12-month contracts where it is not structured. They are on training programmes under the various different training colleges, but it is not structured. The specialist registrar programme is structured, but for those who are SHOs it is not structured. This is the reason we will lose a significant number of junior doctors over the next 12 months to two years. We must change the system.

We now face a situation where there is an added problem in that the number of those applying for consultant posts in Ireland has dropped, from an average of eight applicants per job to an average of two applicants per job, and this is a contributing factor. I ask that the Department would deal with this as a priority. I do not accept the answers being given to us by the HSE.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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The course on which the Minister is set is about changing the system. It is a big unwieldy system and it will take time to change.

On the information Senator Colm Burke is seeking, it is estimated there are on six-month contracts, approximately 2,000 senior house officers and registrars and some specialist registrars; on one-year contracts, 570 interns, approximately 300 senior house officers and registrars, and approximately 900 specialist registrars; on two-year contracts, some specialist registrars, 230 senior house officers and registrars on supervised divisions; on four-year contracts, 156 GP registrars; and on contracts of indefinite duration, approximately 600. As the Senator can see, it is an incredible amount of staff. I agree it is not ideal. The gaps, in terms of employment and delivery, are a significant issue for us and something about which we need far more certainty.

Photo of Colm BurkeColm Burke (Fine Gael)
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I thank the Minister of State.