asked the Minister for Health if his attention has been drawn to the fact that the Royal Collage of Surgeons in Ireland is concerned that the new 65 hour working week introduced for non-consultant hospital doctors may provide inadequate time for the training of young surgeons, unless special arrangements are made locally to allow them to work longer on a voluntary basis; and his proposals in this regard.

5.

asked the Minister for Health if he will clarify the situation in relation to the implementation of a 65 hour working week for non-consultant hospital doctors as recommended by the Labour Court; if he is satisfied with the rostering arrangements with specific regard to the continuous number of hours being worked at one time; and whether the optimum level of patient care will apply in the implementation of such arrangements.

17.

asked the Minister for Health if his attention has been drawn to the serious concern about the long hours that junior hospital doctors have to work and the possible effect that these long hours could have on important medical decisions they are required to make; if he intends to take any steps to have the hours reduced; and if he will make a statement on the matter.

I propose to take Questions Nos. 3, 5 and 17 together.

The Labour Court, in Recommendation No. 11840, issued on 4 May 1988 recommended inter alia that, as a means of reducing the hours which non-consultant hospital doctors are required to work, the aim should be to ensure that all rosters are for not more than 65 hours per week on average. This recommendation was accepted by management and by the Irish Medical Organisation. This commits the Irish hospital system to significantly shorter working hours than is being aspired to in the UK hospital service.

Since the recommendation was issued, management, consultants and non-consultant hospital doctors at local level have engaged in discussions to draw up rosters which adequately reflect the service requirements in each hospital and in the light of the recommendations for the 65 hour week. Agreements have been reached in a number of areas and rosters implemented. Where disagreement has been recorded, a monitoring committee, consisting of representatives of management and the Irish Medical Organisation with an independent chairman have been examining such cases in detail and making appropriate recommendations.

I am satisfied that implementation of the Labour Court recommendation will result in a significant reduction in the hours being worked by non-consultant hospital doctors and a considerable improvement in the efficiency and effectiveness of medical care available in our hospitals.

I am aware of the views expressed by the Royal College of Surgeons in Ireland concerning the training implications of a 65 hour week for non-consultant hospital doctors. I would point out that the monitoring committee have, in a number of cases, recommended payment for hours in excess of 65 where there is agreement on all sides that the introduction of a 65 hour week would not be practical. I feel that this is a reasonably flexible approach and represents a realistic solution to the difficulties, which the college foresees in relation to surgical training.

I should like to ask the Minister if he has received a letter from the Royal College of Surgeons in Ireland drawing attention to the fact that this might seriously hinder the training of surgeons here and that the reciprocal arrangements which exist between the Royal College of Surgeons here and their counterpart in England and Scotland may be lost if we do not have sufficient time allocated to the training of surgeons.

I am aware of a letter from the president of the College of Surgeons. We are looking into the points raised in that letter to see what the implications are.

I should like to ask the Minister what he would regard as the maximum acceptable number of continuous hours a junior hospital doctor should work.

It would vary from job to job and the post a junior hospital doctor filled at a particular time. For example, a doctor working with a skin consultant would be able to work for longer hours than if he or she was with a busy surgeon. The hours would vary from time to time but, in principle, I would accept 65 hours as being a reasonable time. However, we have to have regard to the needs of patients and to the needs of the doctors for their own training purposes. With the variety of hospitals around the country the rostering cannot always be arranged on the basis of the 65-hour week.

Will it be possible for the Minister to give us some assurances that in the hospitals where different conditions prevail doctors will operate to some standard set by him as to the maximum acceptable number of hours, or points beyond which he feels are not acceptable? Will the Minister agree that there should be some reassurance to the public that the Minister is exercising control in regard to this?

I am satisfied that the monitoring committee will ensure that the hours worked are the appropriate hours in the circumstances. I would like to assure the public that I am satisfied that doctors are not working hours that would constitute a danger to the public. The hours worked by doctors are appropriate and there is no risk to the public.

Is the Minister aware that, in a recent inquest, this was a contributory factor? Therefore, I think the public would like to see the Minister respond in some way to ensure a national standard that the Minister feels would meet the need.

I would not want to comment on a specific case. I repeat that I am satisfied that the hours worked by doctors in this country do not create a risk for patients. Indeed, as regards junior hospital doctors, I should say the 65-hour week is the lowest in Europe. For example, in the United Kingdom they are going to have a trial period of 72 hours, reducing the number of hours doctors work there. I am satisfied that there is no risk to patients from the number of hours worked by doctors. Having said that, I am also satisfied that the monitoring committee will ensure that the hours worked by junior hospital doctors comply with the agreement reached within the Labour Court. But, in some cases, it may be necessary for doctors to work more than the 65 hours in order to meet patients' needs.