Opening Address by the Minister for Health to the Joint Committee on Health and Children

First of all let me say that I am pleased to advise the Committee that excellent progress has been made in filling vacant Non Consultant Hospital Doctor (NCHD) posts over the past three months. It should be noted that this is being achieved against a background of a general shortage of NCHDs affecting Western Europe. It important that these vacancies are filled having regard to service needs and achieving compliance with the European Working Time Directive.

As of 29th September, approximately 10 NCHD posts of the 190 identified as vacant by the HSE before the recruitment of doctors from India and Pakistan remain vacant. The decision to recruit from abroad was made due to an ongoing vacancy level of approximately 150 NCHDs and a significant number of additional vacancies anticipated in July 2011 arising from the cyclical rotation of posts. 259 NCHDs have been appointed from centralised recruitment and to date a further 231 doctors (Thursday 29th September) recruited in India and Pakistan for the July rotation.

Given the shortage of NCHDs over the last two years, the HSE developed a range of strategies and initiatives to maximise recruitment, including the development of a centralised recruitment process for service or non-training posts. All vacant service NCHD posts were advertised as ‘Professional Development Posts’ under 2 year contracts to one of the four HSE Areas, with a minimum of 6 months in a regional centre and participation in a Professional Development Scheme under the relevant postgraduate training body. Notwithstanding these measures, about 150 posts remained vacant and it was decided to undertake a recruitment campaign in India and Pakistan.

I introduced legislation on 8th July to amend the Medical Practitioners Act 2007 to facilitate the registration of these doctors, which allowed for the creation of a new ‘Supervised Division’ on the Medical Register. Registration in the Supervised Division means that a person is registered for a period not exceeding two years in an identified post approved by the Medical Council and subject to supervision by the employer in line with criteria set down by the Medical Council.

The Medical Council then introduced new rules for the Supervised Division and with co-operation from the Medical Schools and Postgraduate Training Bodies organised specialty specific examinations for the candidates. 236 candidates were successful and as of 29th September 231 of these, which I have already alluded to, have been registered on the Supervised Division. More will be registered in the coming days. Approximately 80 additional doctors are expected to sit further assessments for the Supervised Division and if successful will be offered employment.

These doctors are making significant contributions to vacancies which existed in areas such as anaesthetics, paediatrics, emergency medicine and general surgery, delivering a safe, effective service to patients. In addition, they are reducing the HSE reliance on agency staff, reducing overtime costs, improving the quality of the service and ensuring further compliance with the European Working Time Directive.

You may be aware that the Commission issued a Reasoned Opinion on 29 September 2011 concerning failure by Ireland to fully implement the European Working Time Directive in respect of doctors in training (NCHDs). Under Article 258 of the Treaty, the Commission has invited Ireland to take the necessary measures to comply with this Opinion within two months of receipt. The Opinion states that, while Irish law provides for limits to doctors’ working time, in practice public hospitals often do not apply the rules to doctors in training or other non-consultant hospital doctors.

I am committed to achieving compliance at the earliest possible date and recognise that the working hours of NCHDs must be reduced and rest breaks granted in accordance with the provisions of the Directive. Obviously progress on compliance has been hindered given the shortage of NCHDs experienced over the past two years. However, it is also necessary to appreciate that the recent recruitment initiative will not in itself deliver EWTD compliance. Compliance will require significant changes in the manner in which hospital services are organised and delivered, particularly in smaller hospitals, where the numbers of NCHDs do not support EWTD compliant rosters, and to the manner in which hospitals rely on NCHDs.

At a more general level can I remind the Committee that Government policy in relation to medical education and training in Ireland is guided primarily by the Report of the Undergraduate Medical Education and Training Group (Fottrell Report, 2006), and the Report of the Postgraduate Medical Education and Training Group (Buttimer Report, 2006).

Both Reports represented a significant review of medical education and training carried out in Ireland and made a series of comprehensive recommendations for its development and reform. The recommendations formed a multi-annual programme requiring implementation over a period of years leading to the successful reform of medical education in both the undergraduate and postgraduate sectors. They also provided a comprehensive evaluation of the provision of medical education and training and how it can best be delivered to prepare doctors in Ireland to meet the health needs of the 21st century.

Many of the significant recommendations of the Buttimer Report on postgraduate medical education and training were implemented through the Medical Practitioners Act 2007. These include the assignment of appropriate medical education and training functions to the HSE and the Medical Council; better workforce planning by the HSE to align the number of doctors in training with projected consultant vacancies based on the staffing needs of the service; and the restructuring of the register of medical practitioners.

A joint Health/Education ‘Inter-Departmental Policy Steering Group on Medical Education and Training’ has responsibility for the on-going development of strategy and policy on medical education and training and continues to co-ordinate and progress implementation of Government policy based on the recommendation of the Fottrell and Buttimer reports.

Officials of my Department and the Department of Education and Skills are currently reviewing the extent to which both reports have been implemented. My Department is assessing the adequacy of the current medical education and training work programme and overall direction in meeting the policy requirements and health sector service needs.

Government policy in this area is that we should move from a consultant led health service to a consultant delivered service. This, of course, would require a significant increase in the number of hospital consultants and a corresponding reduction in the current reliance on NCHDs. However, it will be appreciated that the current economic climate will impact on the extent to which this can be achieved.

Against this background, and having regard to the recent shortage of NCHDs, I have asked my Department to develop proposals regarding the creation of a new associate specialist grade of non consultant hospital doctor.

In the UK, a Specialty Doctor Grade has been established. Initially these doctors deliver routine and emergency clinical care under the supervision of a consultant, but with time take on more responsibility. Doctors at the top end of the grade work with only indirect supervision. At all levels the specialty doctor is part of a team led by a consultant and takes part in all of the activities of their specialty including teaching students and junior doctors.