Paul Coghlan (Fine Gael)
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The Minister of State, Deputy Jim Daly, has arrived. It is a long way from Skibbereen but the good man is here. I call Senator Colm Burke. The floor is his.

Colm Burke (Fine Gael)
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I thank the Minister of State for attending to deal with this matter. I have raised this issue with regard to junior doctors consistently over the past four to five years.

In 2012, I conducted a survey of people doing their final medical examinations in Irish universities. It indicated that more than 60% of them did not intend to work in Ireland once they had finished their internship. A survey published in recent days indicates this number may very well have increased to 80%. While we have had various reports going back to 2003, including the MacCraith report and the second MacCraith report, which dealt with training for junior doctors, we do not seem to be making any progress.

I had to leave a meeting of the health committee with the Minister, Deputy Harris, to come here. The committee received a report on training and development in the HSE for the first six months of 2017, which showed we are underspending by approximately 36% on training and development. This concerns me because we want to retain junior doctors and we do not seem to be proactive in dealing with this. I made the point at the committee that the HSE has recruited more than 2,000 administrative and managerial staff in two years. We now have 17,000 managers and administrators in the HSE but, at the same time, we seem to have done nothing for the people working at the coal face, namely, junior doctors. We have a major problem with smaller hospitals, which are finding it extremely difficult to recruit senior house officers, registrars and senior registrars, particularly in places such as Letterkenny, Sligo, Castlebar, Clonmel, Waterford, Tralee and even Limerick. We need to address this issue, and it is for this reason I have tabled this question. We need major reform in how we provide for this category of personnel in the HSE at front-line level.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator who has been very consistent, dedicated and committed to this cause. I commend this and I thank him for raising this important issue. As a country, we invest considerable resources in training our non-consultant hospital doctors, NCHDs. As recently as Tuesday this week, a report published by the RCSI highlighted that more than 80% of trainee doctors have said that working conditions, training opportunities, and work-life balance are factors that would influence their decision to leave Ireland. Last Saturday, the Minister, Deputy Harris, attended for the second time the annual medical careers day, where he was struck by the enthusiasm of the students. It is vital that we continue to foster a positive attitude and support these medical students during their time in training.

National Doctors Training and Planning, NDTP, in the HSE funds postgraduate training for trainees through service level agreements with each individual training body for the various specialties. It also provides financial supports to NCHDs through two separate funding schemes for the costs involved in undertaking exams and courses. The first of these is the clinical course and exam refund scheme. NDTP provides funding of €450 for mandatory courses or exams undertaken in Ireland and €650 towards exams taken outside of Ireland. It is recognised though that sometimes the costs of courses or exams will exceed this amount. The second scheme is the higher specialist fund. This fund is available to higher specialist trainees, including GP registrars. In total there are approximately 1,500 of these trainees. Trainees are entitled to €500 per year of higher specialist training. This equates to €2,500 for those on a five year training programme. The total number of trainees is now more than 3,700 and this number has grown in recent years. In addition, the number of NCHDs who do not occupy training posts is growing. The total number of NCHDs has increased by more than 1,000, to approximately 6,000 in the past three years. While this increase is welcome, it must be recognised that the budget available to NDTP has to cover more trainees than previously.

The strategic review of medical training and career structure working group, chaired by Professor Brian MacCraith, published three reports in 2013 and 2014, and made 25 recommendations. The need to support NCHD training was highlighted by the group. I will mention some particular successes already achieved in implementing the MacCraith group’s recommendations, including the appointment of lead NCHDs. This role involves representing all NCHDs in their dealings with clinical directorates and hospital management. There is also the improvement of the work-life situation of NCHDs. The HSE has agreed to double the number of family-friendly training places over a three-year period, and the recruitment of additional NCHDs has meant significant reductions in working hours. The Department remains committed to the full implementation of the recommendations of the group. This includes recommendations relating directly to NCHD training needs and assisting in the recruitment and retention of key medical staff. On this basis, it was agreed earlier this year that management and the Irish Medical Organisation would undertake a review of the continuing education requirements of NCHDs. This review is due to commence in the near future and will be undertaken under the auspices of the Workplace Relations Commission. It is important that we continue to improve the working conditions of NCHDs and support their training needs to the maximum extent possible.

Colm Burke (Fine Gael)
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I thank the Minister of State. I fully accept a serious effort has been made with the MacCraith report, but I am very concerned that while the report set out a huge number of recommendations, it is not clarified how many of the 25 recommendations have been implemented. Perhaps we could get answers to this. I thought the MacCraith report would resolve many of the issues, but we are not resolving them and, in fact, we are going backwards. I am extremely concerned.

Another issue which has arisen to cause further problems is the number of doctors coming from abroad is not as plentiful as what it used to be because Ireland is no longer seen as an attractive training location for junior doctors from abroad. They have other choices such as Australia, Canada and New Zealand and we are not competing for them. We have a major challenge. If we want to reduce hospital waiting lists we need to have enough people at the front line to be able to do so. We have a problem with junior doctors, and because we have a problem with them we now also have a problem with recruiting consultants. This is something that needs to be given priority by the Department.

Jim Daly (Cork South West, Fine Gael)
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I undertake to get the Senator an update on the recommendations of the MacCraith report from the Department and furnish the Senator with a detailed update on how many recommendations were made, what actions have been taken, how many have been implemented and what steps have been taken to ensure the full enactment of all of the recommendations. I will do this without delay. I thank the Senator for his continued interest and help in this area.