The recent news that the Department of Health was unable to comply with a European Commission ruling to provide measures by which they would ensure Ireland was meeting European Working Time Directive (EWTD) requirements for NCHD working hours came as no surprise.
Having requested and then receiving an extension to the original two month deadline, what was surprising is the level of detail in the plan, which aims to introduce the EWTD over 12, 24, and 36-month periods in various hospitals.
One of the main impediments to fulfilling the requirements of the EWTD, and this is alluded to in the Department’s plan, is the failure to progress reconfiguration, a process that had largely been halted since Dr James Reilly became Minister for Health and took the short, medium, and long term plans of the previous administration off the table.
The plan states that changes in the organisation of acute services which are required to achieve compliance in a number of hospital sites “need to be progressed”.
While some reorganisation of services has been undertaken in specific smaller hospitals, this has not been on the scale to satisfy legislative requirements regarding working time.
In busy hospitals where intake over a single weekend may exceed normal patient levels over a week, NCHDs are forced to work long hours, exceeding 60- 70 hours in some extreme cases.
Often, paperwork and management plans take up the bulk of this time.
The Minister has regularly expressed his dissatisfaction with the knowledge that NCHDs often act as “gofers” within hospitals, again wasting what he calls valuable and expensive time.
Minister Reilly stated just last week on Morning Ireland that he is “astonished” that interns are sent “scurrying around” hospitals as messengers and said that this is not the sort of work appropriate for staff on salaries of up to €40,000.
He has also previously stated that NCHDs are often carrying out tasks that are the domain of other health professionals, such as nursing staff, physiotherapists or phlebotomists.
He instead firmly advocates providing care at the “lowest level of complexity”.
Whether the Minister intends to address this from top down or bottom up is not clear, but what is clear is that these excessive hours and essentially unworkable rosters are one of the main reasons, along with the lack of sufficient and appropriate training, that interns are choosing to leave the Irish health service to work elsewhere.
Skiing in Canada and surfing in Australia are added perks but for many emigrant Irish-qualified doctors the main lure is structured training and realistic working hours.
They also seek the boon of a specialist appointment – something they may never achieve in Ireland.
In the recession of the 1980s, the “brain drain” that occurred due to the lack of job opportunities for the brightest of Irish graduates was one of the great tragedies of that recession.
With many of these highly qualified expats having returned during the boom years, another crisis is unfolding in this recession as emigration levels climb higher and higher each month.
The number of newly-qualified Irish doctors among these émigrés is significant.
This pressing issue must be addressed with the provision of a clearly defined career path for Irish medical graduates.
Minister Reilly promises the creation of a new specialist grade by year end, but this has been met with a very mixed reaction.
Defining the exact nature of the role will be a complex task and it may not provide enough of an incentive for NCHDs who are already convinced that the grass is greener.
