Written Answers. - Hospital Doctors.

Tuesday, 15 June 1999

Dáil Éireann Debate
Vol. 506 No. 2

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  216.  Mr. Haughey  Information on Seán Haughey  Zoom on Seán Haughey   asked the Minister for Health and Children  Information on Brian Cowen  Zoom on Brian Cowen   the position regarding the hours worked by junior doctors, having regard to the recent EU Council meeting; and if he will make a statement on the matter. [14922/99]

Minister for Health and Children (Mr. Cowen): Information on Brian Cowen  Zoom on Brian Cowen  It is the responsibility of local hospital management to roster non-consultant hospital doctors taking into account the nature of the clinical service to be provided. The basic working week of all NCHDs is 39 hours. However, they are liable to be rostered to work up to an average of 65 hours per week. The 65 hour week was implemented in 1989 following a Labour Court recommendation and in consultation with the Irish Medical Organisation which represents the interests of NCHDs. A mechanism has been introduced to monitor and control working hours of NCHDs as part of the revised terms and conditions of the NCHD contract of employment effective from 1 January 1997. The first stage of the mechanism, was introduced on 1 July 1995 and the complete four stage mechanism, to resolve any breach of the Labour Court recommendation has been in place since 1 January 1997. I am not aware that there has been any use made of this mechanism to date.

The Deputy will be aware that trainee doctors, along with several other groups, were excluded from the provisions of the original working time [362] directive adopted by the EU in 1993. Following adoption of the 1993 directive the European Commission embarked on a consultative exercise with the sectors concerned and the member states on how a broadly similar level of protection to that provided by the 1993 directive, could be afforded to the excluded groups while taking account of the specific requirements of the industries and services concerned. In the case of hospitals this involved attempting to balance the need for reasonable working hours for doctors while recognising the 24 hour nature of hospital services and the need to guarantee continuity of care for patients. In Ireland's case we needed a framework which would allow us to move from our present position of having a maximum working week of 65 hours for junior doctors to the 48 hours contained in the 1993 directive. My Department has been concerned to achieve this in a manner which would not endanger patients and which would not throw the entire medical workforce career structure into chaos by recruiting large numbers of trainee doctors for whom there would be no reasonable prospect of securing career posts. The Deputy will be aware that the future structure of hospital medical staffing is already being looked at by the medical manpower forum.

The European Commission published its proposals for an amending directive to the 1993 directive in November 1998. The Commission's proposals have been the subject of discussion in a social questions working group under the aegis of the Labour and Social Affairs Council. A significant number of the member states felt that the commissions' proposals were impractical and could not be implemented in the timescale proposed. The German presidency then had to work on compromise proposals which might be acceptable to a majority of the member states. These proposals involved a total transition period of 12 years with a gradual reduction in maximum weekly working hours to 48 hours over the period. The United Kingdom proposed a 13 year transition period to reach the objective. In the interests of securing unanimity at the council this proposal was accepted.

I have to point out that we have progressively reduced hospital doctors' working hours over the years. The 65 hour week was introduced in 1989-90 at considerable cost resulting in the recruitment at the time of over 400 additional doctors. The number of junior doctors has continued to grow since then. This growth has resulted in a serious imbalance between the number of these trainee posts and the number of consultant posts. I established the medical manpower forum to address this and associated medical manpower issues. The forum is taking full account of the need to reduce working hours in its deliberations. However, we have to be realistic in how we approach this complex problem. What we have sought from these negotiations is a practical framework to implement the 48 hour week. I believe that we now have a set of proposals which [363] will allow us to reduce doctors' hours in an orderly and progressive fashion without jeopardising standards of patient care or damaging young doctors' reasonable career expectations.

What was agreed at the council meeting on 25 May 1999 now goes to the European Parliament for consideration. The eventual final content of the directive is a matter for negotiation between the council and the parliament. I do not believe that we need to await the final outcome of the EU's deliberations on the draft directive to begin to put in place the preparatory process required to implement the primary provisions of the legislation. In that regard it is necessary to establish the facts on the ground.

Accordingly, it has been proposed following a recent meeting between representatives from my Department, the Health Service Employers Agency and the Irish Medical Organisation that a study should be undertaken which would look at the hours worked by NCHDs. When the findings of the study and the outcome of the medical manpower forum's deliberations are available, it is intended to reach agreement on how to reduce NCHD working hours in a manner that benefits doctors and patients.

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