Non-Consultant Hospital Doctors European Working Time Directive (EWTD)
The European Working Time Directive limits the working week to 48 hours and has applied to most Irish workers since 1998. On 1st August 2004, it will apply to NCHDs in the Irish health service and a phased reduction in working hours to 48 hours, beginning with a 58-hour limit, will be required from that date.
The challenge is how to implement the Directive without compromising patient care. This will require a significant change to NCHD working patterns. In this regard, management has proposed that the first step should be a move from an ‘office hours’ 9am to 5pm Monday to Friday roster to a working week, rostered over a 24-hour span seven days per week. This will include a combination of rostered and overtime working and the introduction of a new payment structure.
Generations of Non-Consultant Hospital Doctors (NCHDs) have highlighted their plight of long working hours which average 75 hours per week. Their trade union, the Irish Medical Organisation (IMO) campaigned vigorously and successfully some years ago in Brussels for the extension of the protections of the European Working Time Directive to NCHDs.
Extraordinarily, the IMO now poses the greatest single impediment to the required reduction being realised from 1 August 2004. By refusing to agree to any changes in the current 9am – 5pm Monday to Friday rostering system, doctors make it impossible for their employers to even commence a phased reduction in their working hours, thereby ensuring a continuation of the huge overtime earnings that doctors have become accustomed to – €50,000 on average per doctor a year, a €200m overtime bill for hospitals nationwide.
At the heart of this stand-off with the IMO is an unresolved dispute as to when a doctor would qualify for overtime payments in the future. The IMO´s position is that all hours outside the hours of 9am – 5pm Monday to Friday are overtime by definition, irrespective of whether the doctor has actually worked his/her 39 hours. The management position, on the other hand, is that in common with all other workers, doctors should qualify for overtime payments only after they have completed their 39 hours work, i.e. from the 40th hour onwards. Despite an agreement in July 2002 in the Labour Relations Commission (LRC) to have this matter investigated by the Labour Court and a date set for a hearing in September 2002, the IMO reneged on their agreement with the HSEA and pulled out of the scheduled Court hearing at the last moment. It is the failure to resolve this issue that is at the heart of the present impasse.
Another impediment to preparing the groundwork for implementing the Directive has been the non-participation of Hospital Consultants and NCHDs in the proposed joint implementation groups to design compliant rosters and the logistics of implementing these rosters. The Consultants´ non-cooperation is because of an ongoing dispute over medical indemnity.
In the meantime, significant preparatory work has been underway. The Hanly Report set out a detailed implementation plan for reducing NCHD hours. Since then, a national co-ordinator and support team have been appointed, draft rosters and hours recording systems developed and extensive work undertaken by health agencies at local level. Advice on safe, EWTD compliant rosters has been provided to the Department of Health & Children and health employers by the medical training bodies. The Medical Education& Training Group is set to issue training principles agreed with each training body. Management continues to work in partnership with the training bodies and the Medical Council and are absolutely committed to ensuring that medical training will continue to the highest
However, without the co-operation of the medical profession, it is well nigh impossible to arrive at the right solutions to the challenges posed by the Directive for the hospital service.