Address by Micheál Martin T.D., Minister for Health and Children – National Task Force on Medical Staffing Inaugural Meeting

First of all, I want to say a very genuine “thank you” to each one of you and to the organisations you belong to for agreeing to participate in the National Task Force on Medical Staffing.

The two key Reports which will underpin your work – the Medical Manpower Forum Report and the Hanly Report on the working hours of non-consultant hospital doctors – have very significant implications right across the acute healthcare system. The recommended changes will affect not just hospital doctors, but also nurses, the health and social care professions, general practitioners, hospital and health board managers, the training bodies, my own Department and many more. I am therefore especially pleased that the membership of the Task Force is broadly representative of the many stakeholders involved in the healthcare system, and of the public interest. Without such broad representation, the Task Force would have very little hope of achieving its aims.

Your work as members of the Task Force will be critical to the success of the new Health Strategy and I hope you will be able to make a key contribution in relation to the two fundamental principles reflected in the title of the new Strategy: Quality and Fairness, as well as addressing some of the key national goals of the Strategy, which relate to responsive and appropriate care and high performance.

A key factor in achieving a fairer acute hospital service is timely access for each patient to fully trained doctors. We must therefore ensure that the number of trained doctors in our acute hospital system matches patient needs as closely as possible. That is why the Government has included in the Health Strategy a commitment to a significant increase in the number of consultants. The number and location of these additional consultants will be determined taking account of the advice provided by the Task Force, following your examination of the resource and cost implications that would arise if a consultant-provided hospital service were developed in place of the existing consultant-led system, as recommended in the Forum and Hanly Reports. The Strategy also includes a commitment to a significant expansion in the number of postgraduate places in medical colleges and undergraduate places, together with the provision of additional places on training schemes for specialist registrars.

The quality agenda places patient care at the centre of policy, requiring not just that we have the right number of staff but also the right people with the right training within the right work structures delivering care at the right time and in the right place. I am asking the Task Force to address the necessary education and training changes and to prepare a detailed implementation programme on workforce planning and restructuring to meet those challenges.

The third national goal identified in the Health Strategy is responsive and appropriate care. In this context, the Task Force will be concerned with helping in the development of a hospital system, and ultimately a health care system, which is structured to meet the needs of patients and clients, placing special emphasis on helping to develop a system in which appropriate care is delivered in the appropriate setting, and in which the patient is at the centre of planning our care delivery.

The work of the Task Force will also be closely related to the Strategy´s fourth national goal – that of high performance. This will require the Task Force to underpin all of its planning and decision making with an evidence-based approach.

When I became Minister for Health and Children over two years ago, the Medical Manpower Forum had already commenced its work, and there existed a significant body of literature produced over the past 30 years which addressed the need for changes in the structure and organisation of the medical workforce.

Following the Report of the Forum on Medical Manpower, the final piece of the policy jigsaw involved compliance with the EU Working Time Directive, which requires each member state to reduce the working hours of doctors in training to more acceptable, and indeed safer, levels within a specified, legally binding timeframe. This was addressed by a Joint HSEA and IMO Steering Group, chaired by David Hanly, set up with the support of my Department to examine the issues involved. The Forum Report and the Hanly Report were both submitted to me early in 2001, and subsequently published. The Government noted the recommendations regarding a consultant-provided service, and agreed that a Task Force should be set up to progress matters by examining the practicalities and potential costs of such a service.

In policy terms, therefore, the groundwork is done – your work is to put together a practical implementation programme within that policy framework, not to revisit or rewrite it.

Every analysis to date comes back to the same key point: we are over-dependent on junior doctors who, while still in training, are required to provide 24-hour, 7-day medical care, formally under the supervision of individual consultants. A number of factors affect consultants´ ability to be present on site on weekends, evenings and during the night. Patients in turn may have limited access to appropriate levels of senior clinical decision making, with implications for safety of diagnosis and treatment on the one hand and efficiency and cost-effectiveness on the other.

I am most anxious to progress the service improvements envisaged in both the Forum and Hanly Reports and I would ask the Task Force to focus on costing and developing a suitable model which best meets patient safety and quality concerns, as well as addressing cost-effectiveness.

There is general agreement on the key changes that need to be implemented. These include:

  • moving to a new model of acute healthcare provided directly by trained doctors rather than relying as we have in the past on doctors in training,
  • restructuring the working patterns of consultants, including provision for clinical teamwork,
  • assisting health boards and hospitals to achieve the significant reductions in the working hours of doctors in training in line with the EU Working Time Directive,
  • ensuring each NCHD is in a formal, structured training post and has real career opportunities,
  • identifying the other changes needed to update the framework for medical education and training in line with the new acute healthcare model and
  • linking the numbers of NCHDs in structured training posts to future workforce requirements.

While this policy consensus is a very helpful background to your work, it is important to recognise that the task you have undertaken is a difficult one. The problems to be addressed in preparing detailed implementation programmes to remodel hospital services, manage the phased reduction of working hours within deadline and address the educational and training requirements are neither simple nor self-contained. In fact, they are complex and interrelated. The solutions will also be complex: there is no “magic wand”. That is why we need to draw on all of your experience and expertise in a Task Force, and why the Task Force includes separate structures to focus on reducing NCHD Hours and on the Medical Education and Training implications. I am very pleased that David Hanly will draw on his previous experience to chair a Project Group on NCHD Working Hours and that Dr Jane Buttimer will chair a separate Project Group on Medical Education and Training.

In inviting you to contribute your expertise and experience, I am asking every individual member of the Task Force, including the representatives of my own Department, to contribute to the Task Force in the most objective, positive and cooperative manner possible, and to set aside sectoral or organisational agendas to the best of your ability. For my own part, to ensure that the Government and my Department will have the benefit of independent, objective advice, I deliberately established the Task Force on an independent basis separate from my Department and appointed David Hanly to act as its Independent Chairperson. In that context, I know that David Hanly is keen to work on the basis that all things are possible and that there should be no “sacred cows” – and he has my strong support in that approach.

The Task Force, crucially, is not and must not become an industrial relations negotiating forum, and I have asked both of the Chairpersons, Mr Hanly and Dr Buttimer, to ensure this does not occur. I would repeat that appeal to each of you as individual members of the Task Force. The changes you will recommend are likely to be very significant, and will of course be subject to negotiation. However, that must be a separate process.

The issues facing the Task Force are urgent. Hence the timescales are tight. I expect that every effort will be made by all interests represented within the Task Force to reach an early consensus on the new model and how it might best be rolled out. I would ask each of you to contribute in an open, frank manner and agree to work in an atmosphere which respects confidentiality within the Task Force. It behoves us all (myself and my Department included) to acknowledge the areas where improvements are needed and agree on how to remedy them. Your work in the Task Force is an historic opportunity to map out this path and contribute to the most fundamental changes for decades in how we deliver acute hospital services in Ireland, with the potential for very significant improvements for patients, whose interests must be placed right at the heart of your work in the Task Force.

Finally, I wish to thank Dr Jane Buttimer for accepting the role of Chair of the Medical Education and Training Group and to place on record my gratitude to David Hanly for agreeing to act as Independent Chair to the Task Force and as Chair of the NCHD Hours Group in continuance of his very significant work in the Joint Steering Group on NCHD hours.

Thank you once again for participating as members of the National Task Force on Medical Staffing – I wish you great success in addressing the complex and vital issues involved.