Wednesday, 30 September 2015
Longer Healthy Living Bill 2015: Second Stage
Cuirim fáilte roimh an Aire. I give the Minister a great big welcome and thank him for coming to the House. I know this is an issue he has dealt with very constructively before. In introducing the Bill today we are not in any sense trying to undermine anything he might wish to do independently to implement it in spirit, if not in all of the specifics. We would hope that this Bill, if passed, would give the Minister additional equipment for making sure that it happened.
The Bill we are introducing today, my fifth in the current Seanad, is one that seeks to end mandatory age-based retirement in the health service, a practice which I believe has had multiple negative effects on the service and which is a major contributor to an ever-worsening womanpower and manpower crisis in the health system. How did the idea that workers should have to retire, or should retire, at 65 originally arise? Credit is usually given to Otto von Bismarck, the Iron Chancellor, the unifier of Germany, who counter intuitively in terms of his historical reputation introduced many progressive social reforms and social policies in Germany. For example, he developed what I believe is the finest health system in the world, the current German health system, still the best, and he also introduced the first concept of an old age pension.
In Bismarck's time the average age of death of a German was approximately the early 40s so only a very hardy minority, a rugged minority, achieved the recommended retirement age of 70 in 1889 when he first introduced the pension. As the Minister is aware, in Ireland the average age of death is not thankfully in the mid-40s, it is about 81. If an Irish person is alive now at the age of 65, on average he or she will live approximately 20 more years, give or take a few years. It has been estimated that many current middle aged people will reach a demographic where they will, if alive at 65, have a 50% chance of reaching to 90. In Bismarck's time if one was alive at 65, on average one lived approximately two years longer. Sixty-five year olds are also physiologically younger than they used to be.
The current system forces healthy, physiologically young 65 year olds to retire with no regard to their health, competence, experience or, critically - the Minister will be aware of this - their dispensability to the health system. Is this good policy? Are we so flush with trained, experienced staff that we can afford to offload them involuntarily? The Minister will be aware that the answer to this is a resounding "No". We have the lowest number of career level specialists per head of population in the OECD for nearly every specialty in which records are kept. To take hospital medicine as an example, historically a near throng of incredibly bright young trainees were waiting in Boston, London, New York, Chicago, Edinburgh and other leading centres to apply in a very competitive environment for the odd rare consultant job which arose at home. This did give us the best trained - I say this bar none - cohort of senior specialists in Europe.
I acknowledge the Minister's efforts and those of his predecessor, Dr. James Reilly, to redress this long festering problem on both of their watches. The Minister attempted to do it by increasing the number of consultants at a time of great recession. They both deserve credit for that. The Minister's on-the-job learning curve in this effort has been steep. He knows now how difficult it is to attract the same number and the same calibre of trainees for jobs as we did historically, even for this relatively modest expansion, to say nothing of the kind of expansion which would bring us up to international guidelines. The result, as the Minister is well aware, is many unfilled posts and incredibly in a country where a consultant post was considered an extraordinary ultimate career achievement for people after, typically, a total of 18 years of training following the leaving certificate, one eighth of the jobs are not even applied for. That is an extraordinary change in the demographic and in the market for these jobs. As a result the jobs are also filled by locum tenensconsultants. I have to be honest, in many or most cases these are very fine, well-trained and competent doctors who in difficult circumstances make a decision, usually from abroad, to come and work in Ireland in a health system which is not always the most pleasant one in which to work. I would not in any sense want to decry the efforts that these, usually, very fine people make but they often are lacking something of the excellence of the quality of people who would have been forged in the crucible of the very rigorous Irish career structure and would have applied for the jobs. In addition, the very notion that somebody's position is impermanent is not good from the point of view of continuity or quality of care.
What this means is that all too often somebody who is highly-trained, internationally-trained, often a research leader in his or her field is being mandatorily replaced with somebody of lesser credential. Is this good public policy? In addition, it makes no economic sense to pay a salary and a pension simultaneously in respect of one position when the pensioner did not want to retire and is doing the job to a high and excellent standard. What amount of time remains?
I can go to the long version of my speech. I am reminded of a couple of outstanding anecdotal examples, one of which shall remain nameless, a very famous surgeon who worked in St. Vincent's Hospital, who one day was running an academic department, performing operations, coming in at night-time to do emergency surgery, teaching medical students, preparing international research presentations and the next day he was told, because of the number on his birth certificate, he was surplus to requirements and the State required him to become a retiree. This was a person who could have worked for many more years, and has worked for many more years in other capacities.One of the Ireland's finest doctors is Professor Fergus Shanahan from UCC. In Ireland, we throw around the term "leading eminent international" but in his case it is true. He is absolutely in the world's front rank in his area. He has the type of curriculum vitae a journeyman researcher like me looks at enviously and wonders why I cannot be that good. This is the type of man, doctor and researcher we should try to keep in post. He is a world leader. He has built up from nothing a research laboratory which employs 200 people. He has published 500 papers. He has a national centre, but more importantly it is an internationally recognised centre. He has brought in substantial investment through foreign direct investment from eight companies. What he has brought into the country has doubled the investment the taxpayer has made through statutory grants to his unit over the years. When he heard me on the radio this morning, he came to me with a cri de coeur. He said there is no plan in place to replace him. This is a fit vigorous young man, and please God his health will be spared for many years, and the idea that he will have to walk away from this in three years' time is absurd. This is to say nothing of the 2,000 patients with inflammatory bowel diseases, one of the most complex illnesses in the world and a disease in which he has developed a truly international reputation, who will be left without their doctor.
Those of us who trained in North America had the experience of having godlike senior colleagues as career mentors. I am thinking of wonderful women and men such as Dr. James Holland in Mount Sinai Hospital who had a major role in developing the curative treatment for childhood leukaemia. He was my old boss and I had the great pleasure of going back to visit him a couple of years ago. At the time he was still seeing patients. I am sure he will not be offended if I give away his age, which is 89. He was not working five days a week but was seeing patients several days a week, maintaining his own practice, writing papers, still applying for research support and being a generally productive person. This is a somewhat extreme example, but many of our colleagues are fine people working in their late 60s and 70s and they find the idea that I would have to retire before they do, even though I am many years their junior, absolutely absurd.
The argument is sometimes advanced that we need this system to flush out the dead wood. It will be apparent that sometimes the wood dies in the 40s and the 50s. The wood does not only start dying at 65. Do we have a mechanism for flushing out the deadwood in the 40s and 50s? I am afraid we do not. A policy of getting rid of all 65 year olds in an attempt to get rid of the bad 65 year olds historically has had a term. It is called collective punishment. It means people who are quite capable of doing the job and who are 65 are being asked to give up the job they love and do not wish to give up because there are some bad 65 year olds out there. It is a way of getting rid of all of the wheat with the chaff.
I stress the Bill is not an attempt to end voluntary retirement. It is enough for many people to retire at 65 and they want to go. Does the Bill guarantee the ongoing rights of an increasingly enfeebled elderly doctor to practice beyond his or her period of competence and lucidity? No, it does not, because the Bill contains structures which allow the Minister, if alerted by a colleague, patient or any other interested party, to suspend a doctor in this situation pending an investigation of his or her competence and it grants the Minister legal protection to do so.
I made the proposals contained in the Bill to the Minister earlier in the year, and I must say he received them very graciously and positively and with the innovative thinking which I hope we will continue to see from him, something which is not often exhibited by people sitting in his chair. He put me in touch with the relevant officials in the Department, who in turn kindly met me and one of my colleagues and told us that as far as the Department is concerned this could be an administrative matter and there is no need to legislate on it. Without pointing any fingers at anybody, we have over the past year made several attempts to see whether this administrative matter was being advanced. In particular, we are aware that we are getting towards the end of this Oireachtas. Nothing has happened, so what we are doing today is making it easier for the Minister. This is an attempt to mandate what is at present an administrative option to arm the Minister with the legal authority to go to the officials in the Department and state he is following the law and that we will do this. This cannot be way down the list of priorities.
I will quote, perhaps provocatively, the great James Carville, President Clinton's adviser. If treacle is being poured out in an attempt to block this and people ask the Minister why he would want to do this, he can say it is because it is the law, stupid.
I welcome the Minister. It is an honour to second Senator Crown's Bill. To many people retirement is an alien concept. They rely on the income from work to sustain themselves and their families. Work defines them in their own mind and gives them their role in society. Some fear retirement and a loss of status. Where such people have skills which are not easily replaced, as Senator Crown has just been telling the House, we have the loss of their service to society plus pensions costs. Paying people through pensions not to work is a cost, and denying the public the services of those required to retire is a greater cost.
The Bill assumes an individual may be certified unfit to work as a result of a medical condition by a registered medical practitioner. It provides for an appeal process. Life expectancy in Ireland has increased by an estimated 15 years, as Senator Crown stated, since 1950 to 81 years. A girl born today will probably reach 100. Were she to take up the study of medicine it would mean 35 years of study, 30 years of showing that great knowledge to society as a whole and 35 years of compulsory retirement, as Senator Crown has said. Death rates have fallen very rapidly since 2000, and life expectancy is growing faster in Ireland than the rest of Europe with reductions in car accidents and smoking being cited as the likely causes.
There is no general compulsory retirement age in Ireland aside from some fairly limited industries and professions. To this degree, the advisers who told Senator Crown he was pushing an open door are correct. Unless it is set out in a contract of employment as well as accepted by custom and practice in that workplace, people cannot be forced to retire. The Equality Tribunal asked employers to justify objectively compulsory retirement and the examples of these objective justifications included opening opportunities in the labour market for persons seeking employment. Senator Crown has shown us this is not happening as some posts are never applied for and in many cases there are very few applications. The justifications also included establishing a balanced age structure. In the type of medicine Senator Crown described, experience is absolutely vital and is something one gains more of every day. It is not acquired by just taking courses in university, but through carrying out vital complicated operations. Another justification was encouraging the recruitment of young people and preventing disputes about the performance of older people. The performance aspects of older people are covered by Senator Crown's Bill. Other justifications are intergenerational fairness, preserving the dignity of older workers, which Senator Crown has covered, and motivation and dynamism through increased promotion prospects. Dynamism is not there because of the difficulty Senator Crown has mentioned. Nobody is being excluded from this as younger people do not apply. Another justification is to ensure vacancies become available to encourage recruitment and the promotion of younger people. We will need to do this anyway. There was also the desire to avoid capability issues and health and safety concerns for the public. Health and safety is promoted by Senator Crown's Bill because the experience of the people being forced to retire exceeds those who might be a locum. Literature by Barry Walsh at McDonald Solicitors and Reddy Charlton Solicitors mentions these factors. They are adequately responded to in Senator Crown's Bill.
Case law includes a case in the High Court in 2008 when the assistant Garda commissioner did not wish to retire at 60 but was compelled to do so because motivation and dynamism was needed through the increased prospects of promotion. These factors do not apply here. Senator Crown has identified an area where there is there a dearth of capabilities to replace those compelled to retire. No young persons apply to take up such posts. Patients are unfairly treated because of the specific skills shortages. The Bill accommodates the issue of capability and competence. In the absence of a general compulsory retirement age in Ireland, the sectoral approach in the Bill is the correct one.The proposer has a record of learning and experience in the profession covered in this Bill. Skills are acquired over many decades of postgraduate learning, networking with leading experts in the world and other experience. This is lost by enforcing early retirement.
Understandings of career and learning development change over time. For instance, maybe the 2008 decision about the senior police officer might not apply. Today we might reflect changes in policing methods in terms of greater use of scientific know-how, cold case groups, improvements in Garda training and perhaps less emphasis on physical fitness standards. Those factors might change in a particular case. Safety standards were cited in the case of electricity workers, as older workers might place customers at risk. That does not apply here as the older workers Senator Crown has described to the House are, in fact, safer. We could check insurance records and malpractice records if that proposition were doubted. The case is made here that experienced, highly qualified medical practitioners are a lower risk prospect than staff recruited on short-term contracts in a labour market with few applicants and heavy migration out of the country. I commend the Bill to the House.
I am covering for my colleague, our health spokesperson, Senator Colm Burke, who is attending to matters in Cork this evening. I welcome the Minister to the House and I welcome this Bill. I also heard Senator Crown explain this Bill on "Morning Ireland" this morning and I listened very attentively to his contribution. I could not but agree with him: it makes absolute sense. I am happy to inform the House that the Government will not be opposing this Bill. It will allow it go to Committee Stage, where it can be teased out in more detail.
It is a common-sense approach. We are dealing with a population that is aging significantly due to developments in the area of health, lifestyle choices and so on. People are living much longer than they would have been over the decades, and in future decades they will hopefully live longer still. The age at which people can claim the contributory old age pension will go up in the next four or five years from 66 to 68. The logical extension of this thinking is that we look outside the box and examine alternative ways of retaining expertise, particularly in the health service. As Senator Crown has rightly pointed out, the type of knowledge that some of our top consultants have is internationally required. Many eye surgeons and cancer experts lecture internationally on a regular basis. Their depth of knowledge and research are sought after all over the world, so why should these people be forced into retirement at 65? It is illogical.
This is something we would not necessarily think about on a daily basis, which is why people like Senator Crown make such a valued contribution to this House. As a result of his expertise and the fact that he works in the health service on a daily basis and has dedicated his career to this, he sees it at first hand. That is how the expertise he has brought to this House as an independent Senator can contribute to the legislative process.
A few years ago, an assistant Garda Commissioner, Martin Donnellan, took a case to the High Court on the basis that he was forced to retire from the Garda. I do not believe he was successful in that case, so if we were to introduce this legislation we should look at rolling it out to other aspects of life and other occupations. At the time, the case was made that certain detectives had built up enormous expertise in the investigation of crime in a particular area, whether it be drug-related, smuggling, or any of the various facets of crime. Why should that expertise be lost to the system if we are dealing with a perfectly healthy individual who has amassed that forensic knowledge over many years? The debate that will result from this Bill could happen in many other areas of the public service, and I would encourage this. I look forward to following the Bill in consultation with my colleagues and Senator Burke. I also look forward to hearing what the Minister has to say, because this is an innovative way of retaining expertise in the public service and in the health service.
I welcome the Minister to the House. I am sure he recalls the previous occasion he was here before the summer where we were debating the issue of organ donation and the requirement for a new pancreatic and kidney transplant surgeon on the retirement of Dr. David Hickey. Senator Crown's Bill highlights this as much as anything. That is another instance in which there was no succession planning, to use the legal term, for the transfer of knowledge - or, in this case, a wealth of knowledge - held by an individual to his successor. That is what this Bill does: it allows for the reality that people can now work longer, and those who have attained the knowledge need to have the time, space and planning put in place for them to pass that on.
As the Minister knows, the replacement for Dr. Hickey is coming over from Scotland. That is the information we have. We will be having a debate on the whole organ donation issue again, but there is a worry for those who are on the organ donor list regarding what happens when the person they have been dealing with throughout their illness is gone and they have not been introduced to the person who will replace him or her.
I am delighted to see that the Senators opposite are looking forward to Committee Stage of this Bill. Now that they are in a minority, we might just see Committee Stage, and we look forward to their amendments and their support on that Stage. This is a serious piece of legislation. Senators Crown and van Turnhout and I were dealing with another piece of legislation in the area of health. It is fortunate that what could be done within the Department by the Minister, as Senator Crown has outlined, is now being debated, to highlight the issue and to see whether the Minister will act to ensure that the corporate knowledge that is in our health service is retained and that the inter-generational transfer of knowledge will also be put on a structured footing. David Hickey is a great example of how that does not happen in the way it should. This is the proposal put before the House and the Department: that we have a structured approach to new areas of medicine that Irish doctors have specialised in, as Senator Crown has outlined, and which were not even imagined 30 years ago. It is for the people who pioneered that research and the development of that knowledge and are willing to transfer it to a successor over time that we should put in that structure now. There is no doubt that should have been done years ago, but we will now put it in place. If it requires legislation, so be it. I am delighted to see that the Government is not opposing the Bill and I hope that, rather than not opposing the Bill, it will support it and see it passed before the end of this Dáil term.
I welcome the Minister to the Chamber. We are not opposing the Bill, the intention of which is decent and sound and worth much consideration.We can speak only about the Bill before us. The Bill, as presented, requires additional work before it can be fully supported, and I look forward to discussing it on Committee Stage. The Minister might think about and redress some of my concerns. Does the Bill propose to exclude other employees across the public service, or is it confined to those who work in the health service? If so, by what logic do we include one specific group of workers and exclude the rest of the public service? A case can be made that if it applies to the health service, it should apply also to the wider public service. If not, it would not just be inequitable but would possibly stand contrary to agreed public service employment agreements, labour relations conventions and labour law. Unless it can be demonstrated that a unique set of circumstances exists within the health sector to confine the provisions of the Bill to the sector, we must rework it.
There might be concern that the Bill may create a third classification of worker, although it is not the intention of the Bill. There are employees who are required to retire at the end of their employment contract, generally at the age of 65. There are other employees whose employment terms are defined under the Public Service Superannuation (Miscellaneous Provisions) Act 2004. The Bill before us requires us to introduce a third category of worker whose employment terms are defined by it. We must examine it more closely and determine whether section 9(a), which allows for an individual to be declared unfit for work, introduces something we might not necessarily want to introduce. To classify a person as unfit for work due to his or her age is discriminatory because it is based on age-related criteria rather than health-related criteria and would introduce a direction we might not wish our industrial relations machinery to follow.
If we can demonstrate that certain unique conditions exist in the health sector that would confine the provisions of the Bill to the sector, it would be worthwhile specifying them. There is a precedent in the superannuation arrangements regarding the care of mental patients which specifies a particular category of health sector worker who is treated differently in employment law than other sectors. Section 9 introduces a category of employee who is to be treated differently. The reference to section 9 introduces this discrimination. The Bill, as proposed, would work as well without section 9. If we examine what the section is trying to achieve, we can find it is probably achieved without reference to it.
The Bill needs to have regard to the provisions of the Public Sector Superannuation (Miscellaneous Provisions) Act 2004, although the only Act referred to in the construction of the Bill is the Medical Practitioners Act 2007. We would benefit from considering the Public Sector Superannuation (Miscellaneous Provisions) Act 2004, particularly section 4(1)(b). We could ask some questions about how the section relates to workers. Would superannuation benefit be paid to an employee after he or she has reached the age of 65 or would the employee already have accrued his or her full entitlements at that stage? If there is a requirement for a further adaptation of the superannuation apparatus, we would need to be clear about how it would work and how it would be calculated. Schedule 1 of the Public Sector Superannuation (Miscellaneous Provisions) Act 2004 lists bodies which are not defined as public service bodies and to which the provisions of the Act do not apply, and we could have usefully applied the same criteria to the Bill before us.
Is there a concern that if we induce workers to stay in their posts at the top of their positions, generally speaking, after the age of 65, we would disincentivise younger staff from applying for these posts? I am thinking particularly of areas in which there are very few workers, for example medical consultants. Would we disincentivise younger doctors from moving into an area if they think they must wait another five, ten or 12 years for a consulting position in a particular specialty? I hope the Minister understands what I am trying to say. I look forward to discussing it further. It is very complicated. It is not as simple as proposed in the Bill. While I do not oppose the Bill, I look forward to amendments being tabled, and some rewording and redrafting to take my points into consideration.
I welcome the Minister. I commend Senator Crown on bringing forward a Bill that is worthy of support, and I support it. It is not the first time the Senator has brought forward legislation, which is what we are here to do, and I commend him on it. I also commend the Minister and the Government on accepting the Bill and allowing it to go to Committee Stage. Hopefully, it will reach Committee Stage before the next election. I support and acknowledge the Minister's support for the Bill, which is about choice. While some people will want to retire at the age of 65, or whatever the current retirement age is, others will want to continue to work, and they should have the choice. People should not be forced to retire, nor should they be forced to stay longer than they should. The Bill is a small step in the right direction.
The issue addressed in the Bill is happening not only in the health service but in other sectors. I have received many calls from people in the private sector whose contracts expire when they reach the age of 65 and who are not allowed to continue to work, even if they want to. As in the situations which Senator Crown is trying to remedy, they have no choice but to sign on, given that they will not receive their pensions until the age of 66. They receive jobseeker's benefit for nine months and then receive social welfare for a period, which is not right. It is not right that people who are aged 65, 66 or even 70 or 75 who are in very good health and do a very good job, who might be consultants, doctors, nurses or clerical assistants, are forced to leave their jobs due to an arbitrary age set by the Government. While the Minister might not like me to use the word "universal" when addressing health service issues, there seems to be universal support for it. If there is universal support for the principle, we must iron out whatever flaws are in the Bill, and take the opportunity of Committee Stage to do so.
One of the principal reasons the Senator brought forward the Bill is that while there are people who are able, bright and capable but who are being forced to retire, we have capacity issues in our hospitals. The Senator will know of an example in University Hospital Waterford, where a dermatologist was forced to retire and the post remained unfilled for a long time, as a result of which the waiting times increased. We have seen many similar situations. The Minister might already know that, last week, there was a bizarre and disgraceful situation in which ambulance drivers were directed to divert patients from University Hospital Waterford, which is the regional hospital, to smaller hospitals in Wexford and Tipperary due to capacity problems in the accident and emergency service. Can the Minister imagine the situation? It was confirmed by a senior consultant in the hospital. The Minister might shake his head-----
I am accepting that does happen. The Minister can be flippant about this issue if he wishes but a consultant who works in the hospital was on local radio yesterday and said that this happened not for the reasons given by the Minister, but because of capacity issues in the accident and emergency department. That is what happened and that is the Minister's fault. That is the responsibility of Government. He also said that it will continue to happen, over and over again, unless we address those capacity issues.
There are capacity issues in our public hospitals and the Minister knows that. He also knows that there are critical pressure points in some hospitals and in some specialties within those hospitals. There are problems with recruitment of consultants and junior doctors because of the number of front-line staff that were taken out of the health service in recent years. There is much work to be done to get things right in the public service and particularly in our public health service. This Bill represents one small step the Government could take, at least to allow those who want to continue to work to do so - people who are of a certain age but who are capable of continuing. In the spirit in which the Bill was brought forward, I acknowledge the Minister's support for it, in principle at least, and the fact that he is allowing it to progress to Committee Stage. I look forward to the Committee Stage debate on the Bill at some point. During that debate we can tease out any concerns the Minister or Senators may have. The Minister might also address some of the other issues I have raised in his response today.
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.
I want to make a number of points on the Bill. I welcome the opportunity to speak on the issue facilitated by Senator Crown and colleagues who put forward the Bill. The legislation serves a purpose, particularly in light of the fact that many regional hospitals struggle to either retain consultants who are about to retire or recruit new consultants. This is a particular issue in my own county of Donegal which has a number of consultant posts that are vacant. It has been extremely difficult to recruit new consultants to fill the posts which is probably due to the geographical location and other factors.
The Bill has merit. Ireland has an ageing population but so do all OECD countries. Demographics are also changing and there is a demand for increased health care across the western world. As a result of increased ageing and demand for health care we must allow people who have specialist expertise that they have built up over a long number of years an opportunity or option to remain in their positions.
The Minister has outlined his concerns and signalled his intention to table amendments at a later date. The general thrust of the Bill must be welcomed. I think the legislation is a good piece of work. All of the Senators will welcome a debate on the Government's amendments.
There are significant difficulties in the health service at the moment and I have mentioned consultant posts. A survey was carried out by the Irish College of General Practitioners as recently as May of this year. It outlined that there is a severe shortage of general practitioners and that the situation in Ireland is likely to get worse. The college outlined that 18 GP posts were vacant as of May of this year with some posts being vacant for up to three years, which is a particular issue in the west of Ireland. There are posts vacant in the Taoiseach's constituency in Mayo. Over 20% of GPs are over the age of 60 and almost one in three are over the age of 55. There is a difficulty because one in eight trained GPs plan to emigrate post qualification with 25% or thereabouts undecided. All of this is due to the fact that they can see that there are greater job opportunities abroad.Flexibility in that regard, allowing GPs to remain where they wish to do so and there are no obstacles, must be welcomed.
From a societal perspective, populations are ageing across the world and the health of individuals is improving, so why not allow people to work longer? I know the Minister's Department would have the most up-to-date departmental and OECD figures in that regard. If people are living longer, surely they should be allowed work longer if they wish to do so and if there are no obstacles from the employer side. It would serve both employer and employee well, and it would also help when we consider the pension crisis coming down the tracks. There are many advantages to allowing those with specialised expertise, in particular, remain in employment.
I hope the debate will not end today. A general election is on the horizon and it would be brilliant to see this piece of legislation adopted by the House, going through all Stages to Report Stage and beyond ahead of that election. I ask the Minister to facilitate that and I hope the Leader will do it as well, so Senator Crown's Bill can see the light of day, so to speak. There would be societal benefit from his ideas. It is only natural that no Minister could accept the Bill as it reads and there are caveats that would have to be addressed by the Department. That is understood. I hope it will not just sit here after being accepted today but rather that it will be moved forward, with the work brought to the Bill by Senator Crown and his colleagues fully recognised.
I welcome the Minister to the House and the introduction of Senator Crown's Longer Healthy Living Bill 2015. It sounds exciting to live longer and healthier. I agree that the issue of mandatory retirement at 65 must be debated at a national level, as the Minister has indicated. They say that 80 is the new 60, 60 is the new 40 and, as the Minister will be glad to know, 40 is the new 20. He has much to look forward to in the coming years. We are told that we are certainly living longer due to a healthier lifestyle and diet, etc., despite all the issues we have with obesity and other health problems. I recently read a piece from Professor Lynda Gratton from the London Business School who asked the question of whether a person would like to live to 100. If that is to happen, the person will have to work until he or she is 80. To do that, the person will have much to do to be organised.
It is appropriate to speak today of how in the past month I have been involved with a television series called "Super-Fit Seniors". It involves sportsmen who are between their mid 70s and late 80s who are still competing at a high level in their respective sports. One gentleman is a sailor who is 83, and he is still competing against men who are less than half his age and beating them. There is a 74-year-old Formula 2 motor car racing driver who competes against men younger than him, as well as an 85-year-old marathon runner who runs 60 miles per week. There is an 86-year-old rower who is competing in the world championships in the new year and who is still doing approximately 40 km per week in the boat. There is an 83-year-old cyclist who is riding 500 km per week and who only this past weekend had a wonderful race down the country, which I attended. There is a 70-year-old power lifter who is deadlifting half a tonne in weight and will soon be competing in the world championships.
That is not a promotion for the programme but I was quite impressed by these gentlemen. When I asked them about retiring, they told me it does not enter the equation whatsoever. It is not their philosophy to quit. They thrive in competition, not necessarily against others but against themselves. It is a psychological and physical competition, leading to mental stimulation that keeps them fresh, happier and feeling younger; it keeps them busy and gives them a good attitude in life. I loved one man's philosophy in particular, as he said that growing old is mandatory but growing up is optional. In essence, that is what this Bill is about. It is about whether retirement can be optional or mandatory. At the same time, we must remember that some people are looking forward to retiring at 65, and it is very important that there can be an opt-out. People cannot be forced against their will to retire.
I very much agree with Senator Crown that it would be an extraordinary benefit to retain the invaluable knowledge and experience of the older workforce. If those people are competent and willing to work after the current retirement age, why not allow this to happen? The only problem I have is that the Bill applies to the health sector and the various agencies alluded to by the Minister. My concern is whether this can cross to other public services and even the private sector. These issues must be addressed if we are to make this applicable to the health service.
I have some concerns regarding section 9 of the Bill and a person's fitness to remain in the workforce. There could be many occasions where a person, for one reason or another, could consider himself or herself fit to stay but colleagues or managers may think differently. I know the Bill outlines procedures in sections 10 to 13, inclusive, on examinations by medical practitioners, etc., but personality clashes could come into play, so the area requires careful consideration. Since 2004, the Public Service Superannuation (Miscellaneous Provisions) Act has, among other elements, removed the compulsory retirement age for certain categories of new entrants to the public service. Already, new entrants are not necessarily required to leave work on age grounds. This Act, however, does not deal with all those in the public service prior to 1 April 2004, and those employees are required to retire at 65, whether they want to or not. I also have a reservation in that if too many people choose to work beyond 65, it will affect the amount of jobs coming on-stream for graduates and school-leavers. Many people view this as unfair as, for example, retired teachers can come back to work to fill substitute or supervision roles while many young people and graduates are looking for work.
I note that the Minister agrees in principle with the Bill but many of the proposed provisions require very careful consideration and consultation will be required with the Departments of Public Expenditure and Reform, Jobs, Enterprise and Innovation, and Social Protection, as well as the HSE and other agencies outlined as being under the remit of the Department. In a survey from 2012 on whether retirement at 65 should be scrapped, 28% of people indicated it should be scrapped, 48% indicated it should not and 23% indicated they did not know. The question will be contentious and it will be interesting to see how this progresses through the House. I thank Senator Crown for bringing the Bill to the House.
I commend Senators Power, Crown and Barrett on bringing forward this Bill, which has certainly opened the debate on retirement age in this country. Funnily enough, when I first entered the Seanad, one of the first debates concerned a social welfare Bill where we proposed to increase retirement age to 67 and 68 by 2028. At that time, the Opposition gave out yards and said it was terrible to do this to people. Today, we are on a different footing. After that debate, I had a cup of tea in the bar and a man approached me who told me he found the debate interesting. He asked me if I knew his age and I said I did not. He told me he was 66 that day and he did not want to retire. He was a correspondent with The Irish Times, Mr. Jimmy Walsh, and he certainly did not want to retire. He worked for a number of years after that. It is interesting that he said he did not want to retire.There are many people who do not want to retire so we are faced with people who do not want the retirement age for the State pension to go up but we want the retirement age for the public sector to go up. This Bill will have implications for the health sector as it cannot just stop. That would leave it open for other sectors of the public sector immediately, such as teachers and their expertise, gardaí and other people who do not wish to retire. We cannot say it will not have implications because it will, and there are implications for the economy also. I agree that it is one way of trying to keep the expertise of consultants in the workplace. As a medical doctor the Minister knows that the lifespan of the career of a person working in medicine is shorter than the careers of others. By the time medics leave college and by the time they have trained up to become consultants it can take years, so their career life is shorter than others. The expertise of consultants in particular, who have seen and learned over the years, results in a wealth of knowledge in looking after and caring for people to extend lives. This is evident in the fact that people are living much longer than before. The Minister, having qualified and then becoming the boss as the Minister for Health, must have had the fastest promotion in history. That was certainly some jump. He knows, however, how many years it took to get his training and where he wanted to be. The least one would expect is a certain length of time in which to practise.
Senator Cullinane made reference to pensions. The State pension transition has been abolished. This moved the goalposts for people from being able to retire at the age of 65 to the age of 66 and the goalposts will move again to the age of 68. I have raised this issue previously in the House; that for those people who had to retire at the age of 65, there would be a shortfall until their State pension age whereby they could only claim jobseeker’s benefit for nine months. Senator Cullinane may not be aware but the Minister, Deputy Burton, did take the issue on board and brought in a special arrangement whereby people who had to retire at the age of 65 can draw the jobseeker's benefit until they are 66. However, what will happen when we go to the retirement ages of 67 and 68? Will the jobseeker’s benefit be extended then? I advocate that all contracts requiring people to retire at the age of 65 be extended to the State pension age, even if this means approaching the private sector and asking it to extend the contracts. It is not fair to say to people, “You have to leave your job.” These are people who have worked all their lives and they may have a few bob saved, and those savings could cripple them when it comes to their second year of jobseeker’s allowance. At that stage it is going to be means-tested against them. There is a big hole in this issue that needs to be addressed. I understand it may not come under the health brief, I believe it is more relevant to the enterprise and employment brief, but it has come up today under the Minister for Health's Department. I believe that the Departments of social welfare and enterprise and employment should come together to address this issue as it is going to cause problems.
Self-employed people may have no option but to work longer than the age of 66. No-one is going to tell them they cannot work past 66. Smaller self-employed businesses may have hit hard times during the recession and resorted to drawing jobseeker’s allowance as they would not be eligible for benefit. For some strange reason, a person who is self-employed and who accesses jobseeker’s allowance will not get any credited contributions for that period of time. Credited contributions are invaluable to people when it comes to pension age. People who may not realise it now will suffer big time because of the lack of those credits. This also relates to women who were affected by the marriage bar who will be crucified when it comes to their pension. They had no choice, even when working in the public sector. They were forced out of their jobs simply because they got married. The only women exempted from that were teachers. We have an obligation to look after those women.
I commend Senators Crown, Barrett and Power for this Bill. I welcome the Minister to the House. The situation referred to by Senator Moloney sounds like double punishment to me; marriage and then lack of a pension. I support the Longer Healthy Living Bill 2015. It seems nonsensical to have public servants in the areas of law and politics, and in other areas, who can work until they are asleep. In my time within the legal service I have experienced judges who were God knows what age - I would not mention any names and it does not mean to say that they would not read the transcripts that night - but I have often been in court where there is a very elderly judge who could be 80 years of age or beyond. Why should we have a situation where health care workers who are perfectly capable of doing their job are not in a position to stay on in that job?
There are people who would much rather retire, the earlier the better, and they may retire if they wish. The Bill proposes to address the issue of those who are employees of the Department of Health and all those who are employed by bodies directly funded by the Department of Health who are forced to retire. I believe there is no link between mandatory retirement age and preserved pension age, nor does this draft Bill serve to change the pension benefits or pension age. It should be noted however that any change to the existing pension arrangement could have significant cost implications, as alluded to by the Minister, and would in the first place, be a matter for the Department of Public Expenditure and Reform.
I am in favour of section 6 of the Bill which refers to a presumption that an individual is fit to work. This section states, "Any individual who seeks to have a mandatory retirement age clause ignored, under the regulations provided for by this Act, shall be assumed to be fit to work unless a registered medical practitioner has determined that they have become unfit to work as a result of the existence of a medical condition." I believe this to be a fair and equitable clause. I also strongly support section 8, otherwise known as the "grandfather clause" which states, "Any individual who attained the mandatory retirement age within two years of the commencement of this Act may apply to the Minister to have their employment reinitiated, under the same terms and conditions that were available to them, if they retired as a result of attaining that age." This clause would appear to be fair to those who have recently reached retirement age and I believe this could still be applied to other sectors such as the teaching profession.
We have heard much talk of how staffing poses one of the biggest challenges in the medical field. The HSE, the largest employer in the country, is obliged to provide health care for all conditions and illnesses and it is faced with unique challenges in retaining the professions and the specialist skills of a range of medical practitioners. Senators, including Senator Gilroy, have spoken about this at length and Senator Crown outlined specific areas of expertise where the HSE is losing employees because of this mandatory requirement, which seems totally nonsensical.
I will now turn to consultants. There are some specialties in which there are international shortages and in which posts have been traditionally difficult to fill. Shortages in specialties such as emergency medicine and psychiatry are a worldwide phenomenon and not specific to the Irish health services. My own mother was very upset at having to retire at the age of 65 but she still works privately. She really enjoyed her work and was missed in the service as she was head of the section when she retired.She missed it very much and was missed by the Mayo psychiatric services. It was sad to see her have to retire earlier than she had wanted to. I have a particular sympathy for where Senator Crown is coming from in regard to the Bill.
Sourcing successors can also take time, an issue which the Minister touched on, even where the retirement date of the occupant of a pivotal role is known. There are also some hospitals to which historically it has been difficult to attract applicants, in particular smaller hospitals. Notwithstanding these factors, it is appropriate that decisions, in limited circumstances, about the rehiring of retired medical staff are made by health service employers rather than driven by the employee's assessment of the situation.
Certain specialist nursing grades, particularly theatre nurses and nurses with particular specialist qualifications, are valuable resources that can be difficult to replace and forced retirement on attaining the retirement age can result in a significant resource loss to the system. In recent years, there have been particular difficulties in recruiting in this area. The national integrated strategic framework for health workforce planning will include representatives of the Departments of Health, Children and Youth Affairs, Education and Skills, Jobs, Enterprise and Innovation, Justice and Equality and Public Expenditure and Reform. The Higher Education Authority and SOLAS will also be involved with a range of HSE directorates. The working group will begin meeting early next year and submit the framework to the Minister by October 2016. The plan will include a high-level implementation plan and associated deliverables.
I agree in principle with the Bill and the comments that it is quite complicated and would have wider implications for Government policy in terms of public sector pay, pensions and workforce planning. Consultation will be required with relevant stakeholders, including the Departments of Public Expenditure and Reform, Jobs, Enterprise and Innovation, and Social Protection, and the HSE and other agencies under the remit of the Department. I am not necessarily in favour of limiting it solely to health service employees. There is no reason it could not be extended to the public sector. Given that agency doctors have been employed at a high cost to the health service, surely this would be a way of getting around that major cost in view of the shortage of available qualified personnel for the health service.
I thank the Minister for his courtesy and constructiveness in dealing with the Bill. I am grateful that he and his officials have decided not to oppose it but to allow it proceed to the next Stage which we hope to do, relatively quickly, giving everyone the opportunity to table the substantial Committee Stage amendments which are required.
In answer to a few specific points, such as the wider applicability of the Bill, I agree absolutely, I think there should be a policy not only throughout the public sector but in the private sector. We have to purge ourselves of the thinking which states that we can tell right now at what age people in the future should retire, not knowing anything about their health or competence, their lucidity, the prevailing circumstances and context of the sector in which they work at the time it is not rational. The simplest way to do it is to get rid of the concept altogether. I cannot honestly think of an exception in the public sector where we should say that, purely on grounds of age, a person should have to retire.
The question of the dead wood was raised. Again, what is being said is that our inability to get rid of young dead wood - it appears as if we are studying foresters here - should not first compound the problem by not getting rid of old dead wood. The problem is that it is forcing us to get rid of perfectly good, viable wood that just happens to be a little bit older. It is an incredibly blunt instrument, if the only way we can get rid of the one in ten bad actors at the age of 65 is to get rid of all people at the age of 65. That, clearly, is an issue that needs to be addressed.
The issue of blocking younger people was mentioned by some of my colleagues, that if we do not have mandatory retirement it imposes an unnecessary obstacle to talented young people coming through. Trust me, at every stage of my career I have encouraged young people and have tried to get new jobs made for them. I have tried to get them hired and I have tried to build careers. I would like to think that I have a reasonable reputation as a mentor in this regard. There is no part of me that would want to block young people from coming in. If the logic of it is that we have to get rid of older people in order to make jobs for younger people, why not bring in retirement at 45 years of age. That would be great, we could give everybody a job at 25 or 30 years. To me, there is no logic to that. Let us think this issue through. The existence of 65-year-olds in jobs is not what blocks 30-year-olds from getting jobs, it is economic inefficiency that blocks 30-year-olds from working in an environment which is adequately resourced to make jobs for them.
The US does not have mandatory retirement. Its economy is doing quite nicely and coming out of a very long recession. The unemployment rates in America have reduced quite a bit and it did not have to do this by enforcing mandatory retirement. It understood that one has to get rid of all the inefficiency in the economy that one can. It is fundamentally inefficient to pay two people for the same job. If the level of efficiency is increased in the system, the system will perform better. It will be better for the micro-economy of that sector and, ultimately, for the macro-economy if that kind of reform takes place everywhere. My own sense is that is a bad argument. In addition, there is something incredibly not just inefficient - it is way past inefficient - subversive to the health of an economy to have large numbers of dependent people in the economy. That is not the way it should be. The more people who are productive as opposed to being dependent, the better the economy will be. This is one quick way of taking some little slice out of our increasingly unbalanced productive to dependent ratio.
The double consent process, to which the Minister referred, that it must be in the gift of the employer to allow the person to stay on, is wrong. Why should it be in the gift of employers to let somebody work at 65 and not in their gift to let them work at 45? If the Minister intends to introduce a new regime where people in the public service could be fired, I would be all in favour of that but I do not think it should apply specifically to people in the health service at the age of 65. The logic that people only work when it is good for the system and good for their line managers to think that they can continue working should apply at every age group and across every sector of the public service. It is not something that should be confined to 65-year-old physiotherapists, nurses or doctors.
There is a lesson and a quick fix here. We know that the reform was put in place between 2004 and 2012, that somebody at some stage said, with the new contracts, mandatory age-based retirement is wrong. Therefore, why do we not extend it to the people who were in posts in 2004? It seems to me that if the positions are in place to allow those folks to have their pension rights in some sense rationalised for those who are not going to retire, why not do it for the folks who are that big demographic bulge for the years before and are not, as yet, retired? As a short-term measure, that would greatly improve the situation in which we find ourselves in terms of the staffing crisis in the health service. It is not radical, there is a precedent, it was done from 2004 until it was rolled back when a decision was made, it must be acknowledged, to incentivise people to take early retirement by hitting their pension if they remained post the full retirement age, which in retrospect is poor public policy. I know of a number of very fine doctors, researchers and others who said they would have to leave a couple of years earlier, otherwise their pensions would be affected.
We have had a very constructive debate. Earlier, I was not sure if the Bill would be accepted on this Stage but at least it would get the debate going, which it has done, but it has been even more constructive. I am conscious of the limited lifespan of this Oireachtas. I am going to give the Bill a very high priority and seek as much help as I can from colleagues on both sides of the House to win whatever mechanisms we can so that we will not have some nebulous "see you next Wednesday approach" when it gets to Committee Stage but will have a firm date, probably next month, so that we can make some attempt to progress it through the Oireachtas prior to its dissolution.
I thank the Minister and his officials for attending.