Press Release

Government Announces €200 million package of reforms of Medical Education and Training

The Tánaiste and Minister for Health and Children, Mary Harney, T.D. and the Minister for Education and Science, Mary Hanafin, T.D. today announced details of a €200 million Government initiative for major reform of medical education and training from undergraduate level through to postgraduate specialist training.

At under-graduate level, the reforms will involve:

  • a more than doubling of the number of medical places for Irish and EU students over a four year period from 305 to 725,
  • the introduction of a new graduate entry programme for medicine from 2007 as part of the overall expansion of places,
  • curriculum and clinical training developments aimed at enhancing the quality of undergraduate medical education,
  • the development of a new aptitude test for selection for graduate entry to medicine,
  • devising proposals for a new selection mechanism for entry to undergraduate medicine to involve a combination of CAO points and suitability test performance from 2008 at the earliest,
  • the creation of new academic clinician posts to be jointly funded by the education and health sectors.

At post-graduate level, the reforms will include:

  • improved retention of graduates from Irish medical schools through a range of measures to enhance the quality and attractiveness of postgraduate specialist training;
  • phasing out NCHD posts with limited training value within a feasible and realistic timeframe;
  • better workforce planning to align the numbers of doctors in training with projected consultant vacancies;
  • inclusion in the Medical Practitioners Bill, of provisions to assign appropriate medical education and training functions to the HSE and, where appropriate, the Medical and Dental Councils;
  • implementing the Training Principles to be Incorporated into new Working Arrangements for Doctors in Training;
  • the development of research in the health sector.

New oversight structures will also be put in place by both Ministers to achieve improved governance and accountability in the joint delivery of medical education across both education and health settings.

The two Ministers made the announcement at the publication in Dublin today of two reports on the reform of medical education at undergraduate and postgraduate levels.

These two reports make a series of comprehensive recommendations for the development and reform of medical education.

“The two Reports represent the most significant review of the medical education and training field ever undertaken in Ireland. It points the way forward for a more co-ordinated approach and acknowledges that medical education and training doesn’t stop when a person is qualified, but is a lifelong commitment.” the Tánaiste said. “Together these Reports provide an integrated implementation strategy to enhance and modernise medical education and training across the continuum from undergraduate education through to specialist training. The aim is to ensure that we have a sufficient number of highly trained doctors to service the needs of the growing population in Ireland. They will underpin the wider health reform programme including the shift from a consultant-led to a consultant-provided service and an increasing emphasis on doctors, nurses and other health professionals working in multidisciplinary teams”

Minister Hanafin said the quality of medical education and training is an issue of significant national importance. “Irish doctors have enjoyed a long-standing international reputation for excellence. It is imperative that our education and training system is sufficiently resourced and developed to maintain that reputation for quality as we seek to meet the significant demands of the future. It is essential that it responds to the manpower needs of a health system that is itself undergoing significant reform and development.

We must respond to the needs of medical students and aspiring medical students in opening up opportunities for entry to medicine and in ensuring that the quality of the education they receive keeps pace with best international standards. I am delighted that in publishing these reports today, the Tanaiste and I are in a position to announce a comprehensive Government response to their recommendations.” Minister Hanafin said.

The Ministers announced immediate plans to begin implementing the programme of reform in 2006. A Joint Inter-Department Steering Group will now be put in place to oversee the programme. A sum of €4 million is being provided under the Education Vote in 2006 to allow for an additional 70 EU places places in undergraduate medicine from this Autumn.

Eight new Academic Clinician posts will also be created this year and a programme of curriculum reform will be commenced. The Higher Education Authority are also to immediately issue a call for proposals for the provision of new graduate entry programmes from 2007. A sum of €3.2 million is being provided under the Health Vote to commence modernisation of the postgraduate curriculum, meet costs associated with the new Academic Clinicians and allow for an increase in the number of flexible training posts.

An indicative provision of €6.5 million in 2006 has been provided for in the Capital Investment Framework for the HSE in respect of the implementation of the Buttimer Report. Overall Capital requirements in the undergraduate and postgraduate areas will be the subject of detailed appraisal of existing infrastructure and future needs.

Background Notes

Health service reform

The reform of the health system has gathered pace with the establishment of the Health Service Executive (HSE) and the changed role of the Department of Health and Children. These changes will significantly alter the environment in which the postgraduate medical education and training system will operate.

Significant attention has been given in the past few years to reforming medical education and training. Many factors have led to evaluating our medical education and training systems and promote a reform agenda, such as:

  • the need to retain our graduates and to align the numbers of doctors in training with projected increased consultant numbers in order to provide a consultant-provided service;
  • the implications of complying with the European Working Time Directive as regards the working hours of doctors in training;
  • the development of research in the health sector;
  • the opportunity to modernise and enhance our medical education and training programmes including availing of new technologies;
  • the need for improved governance and accountability; and,
  • the wider health reform programme which, among other things, promotes an increasing emphasis on doctors, nurses and other health professionals working in multidisciplinary teams.

The health service is dependant on both the quality and quantity of doctors trained in Ireland. Currently, there is higher demand for doctors than supply worldwide, so we must ensure that enough doctors are suitably trained to meet the requirements of the Irish health service and that optimum value for money is achieved. The reform of the health services, increasing population and use of new technologies requires doctors to be trained to meet these changing needs. Quality in education and research is a key marker of a quality service and a powerful motivator for doctors educated in Ireland to train and work in Ireland.

The reform of health service structures provides an opportunity to enhance medical education and training and research within the health service. The quality of the service provided to Irish patients is strongly influenced by the quality of the education and training of the doctors and other professionals delivering that service. As medical education and training is intertwined with service provision in our hospitals, reforms to the health service will change how we deliver and organise medical education and training.

The reports published today involve a comprehensive evaluation of the provision of medical education and training and how that training can best be delivered to prepare our doctors to meet the health needs of the 21st century.

A programme of action has been set out that will reform the current system of medical education and training; and enable doctors to be trained in an improved training system from undergraduate education to specialist training. This will help to ensure that patients will be seen by a doctor who has the skills, training and experience to diagnose, treat and plan their care.

The Fottrell Report

The Fottrell Report has made recommendations on increasing the number of EU places in undergraduate medical education, a course curriculum in the Medical Schools, graduate entry programmes, accreditation processes for clinical training sites, increasing the number of academic clinicians and other issues relating to the organisation and delivery of undergraduate medical education and training.

The Buttimer Report

The Buttimer Report has focussed primarily on postgraduate medical education and training and has made recommendations on increasing consultant numbers with a corresponding decrease in the numbers of doctors in training, phasing out NCHD posts with limited training value, the role of universities/medical schools, graduate retention, governance, skills deficits, primary health care and research.

The reforms will include:

  • improved retention of graduates from Irish medical schools through a range of measures to enhance the quality and attractiveness of postgraduate specialist training;
  • phasing out NCHD posts with limited training value within a feasible and realistic timeframe;
  • better workforce planning to align the numbers of doctors in training with projected consultant vacancies;
  • inclusion in the Medical Practitioners Bill, of provisions to assign appropriate medical education and training functions to the HSE and, where appropriate, the Medical and Dental Councils;
  • implementing the Training Principles to be Incorporated into new Working Arrangements for Doctors in Training;
  • the development of research in the health sector;
  • improved governance and accountability; and,
  • will underpin the wider health reform programme including the shift from a consultant-led to a consultant-provided service and an increasing emphasis on doctors, nurses and other health professionals working in multidisciplinary teams.

Costs and implementation

An integrated implementation strategy has been developed and funding has been provided in the 2006 Estimates to commence the reform programme in both undergraduate and postgraduate medical education and training. The funding allocated to the HSE in 2006 for implementation of the Fottrell and Buttimer Reports is €9.7 million:

  1. €6.5 million capital investment in postgraduate education and training facilities following a detailed analysis of existing capacity and specific needs.
  2. €3.2 million revenue funding will be allocated to fund important initiatives in postgraduate medical education and training including, additional academic clinicians, expansion of the flexible training scheme, further development of competence-based training and other new training modules, career advice and mentoring structures etc.

The recommendations in the Reports (individually and combined) will form a programme requiring implementation over a period of years, and which will be critical to the successful reform of medical education in both the undergraduate and postgraduate sectors. They will assist in bringing about a more streamlined career structure, with a continuum from undergraduate training through postgraduate training and on to specialist/consultant level. These improvements will enhance significantly our capacity to retain doctors within the Irish health service and to attract those doctors abroad back to Ireland.

Implementation of the reports will help to ensure that value for money for investment in medical education and training will be enhanced and the following benefits will be realised:

  • Quality assurance – properly-trained doctors will provide best care to patients.
  • Structural reforms in both undergraduate and postgraduate medical education and training.
  • Move towards self-sufficiency in medical staffing.
  • Alignment of training numbers with projected vacancies should streamline postgraduate training and may facilitate younger progression to consultancy.
  • Economic dividend of improved research environment / knowledge economy.
  • Informal early warning mechanism regarding service quality via training inspections / NCHD post approval process.
  • Graduate entry system, which it is hoped can be introduced from 2007 will further diversify and enrich the pool of prospective doctors.
  • Planned, well-aligned, workforce numbers and ratios in medicine.

New oversight structures will also be put in place by both Ministers to achieve improved governance and accountability in the joint delivery of medical education across both education and health settings.

Proposals to increase the number of consultants

The Report of the National Task Force on Medical Staffing, published in 2003, recommended the adoption of a consultant-provided model of acute service delivery in place of the present largely consultant-led and NCHD-provided model and significant increases in the number of hospital consultants in tandem with corresponding reductions in the numbers of non-consultant hospital doctors.

The European Working Time Directive (EWTD): With the implementation of the EWTD, the working hours for doctors in training will be reduced – i.e. since 1 August 2004 average working hours are, under the Directive, capped at 58 hours on-call on-site per week, and are set to reduce further (to 56 hours from 2007 and 48 hours from 2009). The implementation of the Directive also means better provisions for breaks during the working day and minimum continuous rest periods.

Undergraduate Medical Places

  • In 1978, the intake of EU undergraduates to Irish medical schools was ‘capped’ at 305 per annum.
  • In 2003/4, the annual intake of students was 782, of whom 305(39%) were EU and 477 (61%) were non-EU in origin.