Martin publishes Report of National Task Force on Medical Staffing
Micheál Martin TD, Minister for Health and Children, has today (15 October 2003) published the Report of the National Task Force on Medical Staffing. The report sets out how to improve patient care by reducing the working hours of junior doctors (NCHDs), employing more consultants and reforming medical education and training. It concludes that a national reorganisation of acute hospital services is now necessary.
Under the European Working Time Directive (EWTD) the average working hours of NCHDs must fall to no more than 58 hours per week by August 2004 and to 48 hours per week by August 2009. At present, the average is 75 hours, and many NCHDs work significantly longer than this. The Task Force, chaired by Mr. David Hanly, was established to make recommendations on how best to reduce hours and introduce a patient-led, consultant-provided service.
The Report set outs a series of principles for the organisation and delivery of hospital services nationally while making detailed recommendations regarding the organisation of acute hospital services in two health board regions (the East Coast Area and Mid Western). It recommends that a national plan for the organisation of acute hospital services should now be developed. Among the Report´s recommendations are:
- Specific measures to reduce NCHD working hours to 58 hours per week by 1 August 2004, including new work patterns and redistribution of NCHD workload Consultants
- Increased number of consultants under a new contract to improve patient care and ensure better patient access to 24-hour consultant-provided services. Acute Hospitals
- Principles for the reorganisation of acute hospital services nationally
- Each hospital to function as part of a regional network with the full range of specialist services. Patients should only travel further for care which is best provided at “supra-regional” or “national” level.
- A major hospital providing full range of 24-hour emergency and trauma services in each of the two regions studied.
- Reconfiguration of Local Hospitals so that they provide the large majority of hospital care, outpatient care and diagnostic services for local populations
- Development of services in the community, ambulance services and appropriate minor injury and illness services in Local Hospitals
- Develop closer linkages with GPs and multi-disciplinary primary care teams in line with the Primary Care Strategy.
- Local Hospitals to operate as part of an integrated hospital network in their area
Education and Training
- Integration of the training functions currently scattered throughout numerous agencies.
- Mechanisms sufficiently independent of service pressures to ensure the training nature of all NCHD posts.
Welcoming its publication, the Minister confirmed that he would undertake the measures necessary to reduce NCHD hours in line with the timetable set by the EWTD. He said that he is committed to the principle of the Hanly recommendations and will work to progress their implementation in consultation with key stakeholders.
The Minister emphasised that the Government would not close any hospital, nor did the Task Force recommend the closure of any hospital.
The Minister endorsed the Task Force’s conclusion that a consultant-provided service is the only way to ensure high quality safe patient care while achieving compliance with the Directive. He signalled that there would need to be significant changes to the current consultant contract before additional consultants could be employed.
The Task Force also reviewed the experience of other countries where NCHDs work shorter hours. Mr Hanly said that “Based on the evidence of research, best practice and experiences here and elsewhere, we strongly recommend integrating the measures needed to reduce NCHD hours with the recruitment of more consultants, reforms in medical education and training and reorganisation of acute hospital care. This is the route to better patient care”.
The Minister said that he has now put a number of implementations steps in place. A national implementation group will work under the aegis of the Labour Relations Commission to reduce NCHD working hours while negotiations on a new consultant contract will proceed immediately. David Hanly will chair a small group to advise on a national hospital plan, in conjunction with the Department and, on its establishment, the National Hospitals Office.