ORAL QUESTION ON HOSPITAL STAFFING & SERVICES

30th June 2011 Oral Question on Hospital Staffing & Services

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8. Deputy Catherine Murphy asked the Minister for Health his plans for the development of a career path for doctors who have finished their training; the timeframe to which he is working; and if he will make a statement on the matter. [17862/11]

Deputy James Reilly: There is already a structured pathway in place for persons who have been awarded a basic medical qualification following completion of a course of study in one of the medical schools.

The first year of postgraduate medical training, the intern year, is undertaken in a teaching university hospital following which doctors can apply to commence training in the area of medicine in which they hope to specialise. They do this by either entering a basic specialist training programme and then a higher specialist training programme in the clinical specialties, public health, occupational health, microbiology, radiology and pathology or by entering a general practice training programme.

Basic specialist training, which generally takes two years to complete, involves working in a series of senior house officer posts in supervised clinical settings, which include structured training opportunities. Upon successful completion of their basic specialist training, doctors are eligible to apply for higher specialist training. However, as these posts are very competitive many doctors work as registrars, under the supervision of a consultant, for a year or two before progressing to higher specialist training.

Higher specialist training, at specialist registrar level, takes four to seven years and is overseen by the relevant postgraduate training body. It involves rotating through a number of supervised training posts across the breadth of the relevant specialty, undertaking in-house and external training activities and sitting a number of postgraduate training body membership examinations in that specialty.

Doctors who have successfully completed their higher specialist training are entitled to registration in the specialist division of the register of medical practitioners and are eligible to apply for a consultant post in their specialty.

Doctors who wish to become general practitioners must complete a GP training programme following completion of the intern year. This consists of two years at senior house officer level in supervised clinical posts, followed by two years at GP registrar level in a GP training practice. Formal training opportunities are provided throughout and trainees must sit the general practice membership examination.

I have asked my Department to consider the scope for the creation of a new hospital specialist grade which would make for a more appropriate and sustainable model of service provision. While consideration is at an early stage, it is envisaged that this would be a non-training post filled by doctors who have completed specialist training.

Additional information not given on the floor of the House.

In addition, I am setting up a group to carry out an immediate review of career structures and paths for non-consultant hospital doctor, NCHD, posts. This group, which will include the Department, the training colleges and other key stakeholders, will examine issues such as designation of training posts, career structures for NCHD service posts and working hours and conditions and is aiming to complete its work by the autumn. We will endeavour to match undergraduate numbers to consultants and GP numbers required and provide a clear career path.

Deputy Billy Kelleher: On a point of order, the Minister made——

An Ceann Comhairle: Please resume your seat.

Deputy Billy Kelleher: ——a very serious allegation——

An Ceann Comhairle: The Minister did not make any allegation against an individual——

Deputy Billy Kelleher: He made a very serious allegation across the floor of the House.

An Ceann Comhairle: Please resume your seat.

Deputy Billy Kelleher: The Minister——-

An Ceann Comhairle: If you do not resume your seat I will ask you to leave. Please resume your seat.

Deputy Billy Kelleher: The Minister should withdraw or substantiate that allegation.

An Ceann Comhairle: The Minister did not make an allegation against any individual.

Deputy Billy Kelleher: Is the Minister quite clear in stating that the previous regulator was interfered with in some way?

An Ceann Comhairle: If the Deputy does not resume his seat he will leave the House. Does he want me to name him?

Deputy Billy Kelleher: That is absolutely——

An Ceann Comhairle: Leave the House please.

Deputy Frank Feighan: I believe the financial regulator was interfered with and everybody in the House knows it.

An Ceann Comhairle: Deputy Feighan, do you mind?

Deputy Billy Kelleher: Substantiate it so.

Deputy Barry Cowen: By whom?

An Ceann Comhairle: This is Question Time. I ask Deputy Kelleher to leave the House.

Deputy Luke ‘Ming’ Flanagan: That was a good maiden speech.

Deputy Barry Cowen: Go outside the House and say it.

Deputy Billy Kelleher: Deflecting from Roscommon, that is all you are doing.

Deputy Barry Cowen: Step outside the House and say it if you have something to say.

Deputy Frank Feighan: Of course I will.

Deputy Derek Keating: We are elected to this House.

Deputy Luke ‘Ming’ Flanagan: Some of them would not have been if they told the truth before the election.

An Ceann Comhairle: Deputies, you are in a parliament. Please behave as if you are in a parliament.

Deputy Derek Keating: It was you and the likes of you who got us into this mess.

Deputy Barry Cowen: I did not interfere with any regulator.

Deputy Catherine Murphy: I thank the Minister for his reply.

Deputy Derek Keating: Deputy Cowen should be ashamed of himself.

Deputy Barry Cowen: I was not here, mate.

Deputy Catherine Murphy: I have listened to——

Deputy Derek Keating: I am a Deputy. How dare Deputy Cowen address me in that manner.

An Ceann Comhairle: I ask Deputy Keating to remain quiet also.

Deputy Catherine Murphy: ——speak about money following the patient.

Deputy Derek Keating: How dare he.

An Ceann Comhairle: I ask Deputy Keating to be quiet, please.

Deputy Catherine Murphy: For that to take place, there must be a sufficient number of consultants.

Deputy Derek Keating: I am leaving the Chamber in disgust at Deputy Cowen’s comment.

Deputy Catherine Murphy: I tabled the question because this topic will continue to crop up until an adequate structure is put in place. The inadequacy of the structure is clear from the continuing shortages we hear about in particular disciplines. Does the Minister believe the number of consultants is sufficient and the career path for medics is adequate to enable them to reach a point at which they are appointed consultants?

The Minister highlighted a number of issues related to Roscommon hospital. This week, I spoke to a person who is seeking admission to one of the large teaching hospitals. When I spoke to someone in the hospital in question I was informed that admissions, including serious cases, are being repeatedly rescheduled. When a resource is inadequate nationwide it has a knock-on effect. It is not a question of how quickly one can travel from one hospital to another. If the career path is not adequate and there are too few consultants, a logjam develops in the large hospitals and no one passes through the system.

An Ceann Comhairle: The Minister has one minute to reply.

Deputy James Reilly: I accept everything the Deputy said. I did not reach the end of my reply owing to time restrictions. I will not bother with the script and instead tell the Deputy what is the position. I am pleased that as a result of the terrible dark cloud of the shortage of non-consultant hospital doctors, the Medical Council and colleges have come forward and co-operated in an effort to have the issue resolved. Arising out of this, I have spoken to their representatives about creating a forum. I want to report by the autumn on how we will address manpower issues from the day a person starts as a medical student to the day he or she retires as a specialist or general practitioner. We need to create clear career paths and treat people with dignity. We should create a specialist position. At present, one in four of those who complete their specialist registrar training become consultants because jobs are available for them, while three out of four become deskilled and start to go backwards or leave the country because jobs are not available for them.

People have referred to indenture. It costs nearly €1 million to get someone to specialist registrar level at the end of training. For this reason, I want to create a new post of specialist who will be clinically autonomous, will only report to the clinical director and will ultimately become a full consultant. We should acknowledge that he or she has the clinical acumen, training and experience to work as an autonomous clinician. This will provide a clear career path and address much of the shortage being experienced in our hospitals.

An Ceann Comhairle: Before we move on to Question No. 9——

Deputy Caoimhghín Ó Caoláin: Is there an opportunity to ask a brief supplementary question?

An Ceann Comhairle: No, we are out of time. I stress again that, in accordance with Standing Orders presented to me, during ordinary questions the Minister has two minutes to reply and four minutes are available for supplementary questions, one minute for the person asking the question and one minute for the Minister to reply. In other words, four minutes are available for two supplementary questions and two replies. That is the position under Standing Orders. We have exceeded the time available on every single question.

Deputy Caoimhghín Ó Caoláin: Is there not a provision for other Deputies to——

An Ceann Comhairle: I ask Deputy Ó Caoláin to resume his seat for a moment, please. I am trying to get through Question Time and there are Deputies who have questions on the Order Paper.

Deputy Caoimhghín Ó Caoláin: Perhaps the Ceann Comhairle should have Question Time on the plinth.

An Ceann Comhairle: Deputy Ó Caoláin may ask his party’s Whip to propose changes at the Committee on Procedure and Privileges in order that Question Time can be dealt with in a different manner. I must deal with Question Time as provided for in Standing Orders. The Minister has two minutes to answer a question and four minutes are available for supplementary questions. That is the position as laid out before me. The replies supplied to Ministers are much too long and are over-running the two minutes available. As a result, I am required to interrupt.

Deputy Caoimhghín Ó Caoláin: The Ceann Comhairle exercised a little leniency earlier. Perhaps he could continue that pattern.

An Ceann Comhairle: If I allow eight or ten minutes for one question, other Deputies will not have their questions answered. The matter is that simple. I ask the Minister to reply to Question No. 9.

Deputy James Reilly: With due respect, I am trying to give comprehensive answers but I will expedite them. I respect what the Ceann Comhairle said and will speak more quickly if somewhat less distinctly.

An Ceann Comhairle: I must make the House aware of the position.

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Posted by admin on June 30, 2011. Filed under Healthcare,In the Dáil,Parliamentary Questions. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry