Wednesday, 11 December 2013
Non-Consultant Hospital Doctors Recruitment
I thank the Minister of State for coming to the House to take this matter. This matter relates to the junior doctor issue, a matter I have dealing with over the past two years. I am very concerned about the issue because of the 4,900 doctors employed in the health service, some 2,000 are on six-month only contracts. I eventually extracted this information from the HSE after approximately 18 months of seeking it.
Let me explain my concern. Junior doctors will start their job on 7 January and by 7 February they will start sitting interviews for jobs starting on 7 July. This is an unsatisfactory situation. There is no other employment system with a structure like this. This system causes uncertainty. We have a large number of qualified doctors leaving this country. The cost of producing 600 medical graduates per annum is approximately €90 million, because they are trained over a five year programme. Based on my figures and analysis, up to two-thirds of these graduates leave the country within 12 months of finishing. Many junior doctors are leaving once they have completed their intern year. In other words, €60 million of the investment made by taxpayers was spent on these doctors who have left.
I suggest we need to restructure the system. Will the Minister of State provide the up to date position in regard to the restructuring that was to occur? I understand the president of DCU was appointed to head up the group on this. What progress has been made and when are we likely to see an initial report and when are we likely to see changes in the contracts being offered to the junior doctors we are employing in our hospitals?
I thank Senator Burke for raising this important matter. Non-consultant hospital doctors, NCHDs, play a fundamental role in the provision of services in our hospitals. The Minister for Health, Deputy Reilly, is committed to improving their working conditions and to ensuring they can have suitable career pathways and job security within the Irish health system.
Approximately 80% of the 4,900 NCHDs working in the public system hold structured training posts while 20% hold service posts. At present the duration of the NCHDs' employment contracts are determined by the nature of their training arrangements, the location of their employment, whether they rotate between various sites and who their employers are.
The Minister wishes to see arrangements developed which will ensure NCHDs in training programmes are provided with certainty at the beginning of training schemes regarding the location of rotations over the course of a scheme and that those in non-training posts are given contracts of a duration that make their employment sustainable and attractive in the longer term. The establishment of the hospital groups framework will facilitate the development of these contracts. The fact that a significant proportion of our NCHDs are on six-month contracts brings a level of uncertainty to the filling of posts each January and July when the cyclical rotations occur. The Minister wants to end this uncertainty by ensuring our NCHDs want to work and develop their careers here and he is satisfied that the range of initiatives in train will achieve this.
In July this year the Minister set up a working group chaired by Professor Brian MacCraith, president of DCU, to carry out a strategic review of the medical training and career structure of NCHDs. The terms of reference of the review include making recommendations aimed at 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 Minister wishes to acknowledge the focus that Professor MacCraith and the members of this group have brought to their work within a tight timeframe.
During October and November the working group met a number of key stakeholders, including trainee doctors, the Medical Council, postgraduate training bodies and clinicians in senior management in the HSE. The group submitted its interim report to the Minister last week and he is very pleased with the findings, which include a number of practical recommendations that can be progressed quite quickly. The interim report will be published shortly. The group is now moving to stage two of its work with a view to submitting its final report to the Minister by June 2014.
The agreement reached between the HSE and the Irish Medical Organisation at the Labour Relations Court in October on addressing working hours and achieving compliance with the European working time directive specifically encompassed NCHD recruitment and retention. It reaffirms the commitment in the Haddington Road agreement to reviewing the NCHD career structure with the aim of further developing career and training pathways for all grades of NCHD to consultant and specialist level. It also identifies successful graduate recruitment and retention as key to achieving compliance with the working time directive. The Minister has identified the attainment of compliance as a key priority for HSE management. Reducing the hours many NCHDs are required to work will make working here more attractive. The Minister is determined that as part of the overall health reform programme we build a public health system that values the contribution and commitment of trainee doctors and we want to ensure this very talented workforce are offered a rewarding and satisfying career here in Ireland.
I thank the Minister of State for the reply and I appreciate the work being done by the Minister in the Department. I am a little concerned the final report will not be published until June 2014 and that an interim report will be published.
Nothing really seems to have changed for 2014. While I accept that implementing the working time directive is necessary and fundamental for the health service, we are running into a problem whereby we will not have junior doctors coming from abroad over the next 12 months to two years. There is clear evidence that the number is decreasing. By the end of the year the cost of those employed under agency contracts as opposed to HSE contracts will be approximately €50 million. Waiting until June for a final report will not deal with the issues for 2014. The information I have received is that there are concerns about posts being filled in January. I ask the Minister of State to convey this to the Department. I suggest the final report be brought forward from June. It will be too late then because it will not have dealt with those starting in July 2014 who will be offered contracts in April or May. The report should be published not later than 31 March. I am genuinely concerned that we will run into major problems.
I assure Senator Burke that I will bring his views and concerns to the attention of the Minister immediately. Perhaps I did not make clear that the interim report will be published shortly. The Minister is very pleased with the findings, which include a number of practical recommendations that can be progressed quite quickly. I hope some progress will be made.