Inniu, tá na dochtúirí sóisearacha imithe ar stailc agus mar gheall ar seo, tá cinntí i dtaobh na mílte daoine curtha ar ceal.

The Government is in breach of the EU's working time directive. It is not alone in this. Deputy Martin was in breach of this EU law when he was Minister with responsibility for health, as was Mary Harney and as is the current Minister for Health, Deputy Reilly.

The Deputy has been in breach of a few laws himself.

The directive stipulates that junior doctors must not work more than 48 hours a week on average. It also requires them to have a minimum of 11 hours rest between shifts. Instead, some of them work as many as 90 hours a week. That is not just bad for doctors because, today, 12,000 outpatient appointments and 3,000 operations have been cancelled.

The working time directive is not a new EU directive; it has been in place since 2000. In 2009, the EU criticised the Fianna Fáil-led Government, and in 2011, it criticised the current Government. Deputy Martin, as Minister with responsibility for health, did nothing.

Not true.

Mary Harney, as Minister with responsibility for health, did nothing, and the current Minister for Health is doing nothing.

Deputy Martin set up three committees, or was it six committees?

I am sure the Taoiseach will agree that no doctor wants to put the well-being of patients at risk, but the failure of the Government to address this issue is putting patient safety at risk. Will the Taoiseach commit to implementing the working time directive fully to ensure junior doctors work safe hours? If so, when does he intend to do this?

I notice that Sinn Féin published its budget proposals earlier. Those included a third higher income tax rate of 48% giving a top tax rate of 59%, including the universal social charge. That means there probably would not be a higher earning doctor left in the country or anybody else when meaningful discussions are held about what that proposal actually means.

Do not worry. Take the time to study it.

This is the report that the party leader to the left of Deputy Adams produced in 2001. It was the report of the national joint steering group on the working hours of non-consultant hospital doctors which cost €254,000 and about which nothing was done.

He is not the Taoiseach.

It has gone on for 14 years without this matter being attended to. It is a fact that Ireland is committed along with the European Commission to the achievement of compliance by the end of 2014. Targets for implementation here were not met by previous Ministers, including Deputy Martin. The Minister for Health is determined to end this and to have it implemented in full by the end of next year, ending 14 years of inactivity.

Yesterday, I met a number of patients whose operations and treatments were cancelled today. There is much anger out there about this. It is very regrettable and will clearly result in a reduction in planned patient treatments. I understand that cancellations will arise in about 7,000 outpatient appointments, 500 day case and 200 inpatient cases. What is all this about? It is about the range of sanctions people want imposed on hospitals.

I understand there is great range of disagreement about what is involved here. Proposals have been tabled in this regard by both the HSE and the IMO. As with any industrial relations dispute, negotiations between the two sides are always the way to achieve a proper resolution. I call on the IMO to re-engage with the LRC process, which is the way to do this, and to desist from any further disruption to services, which is a cause of great distress to patients today.

It is absolutely desirable that doctors enjoy reasonable and proper working conditions. I assure the IMO and junior doctors in hospital that this Government, unlike previous Governments, remains fully committed to and has made serious progress in achieving compliance with the working time directive. In the first half of 2013, 35% of all NCHDs were compliant with the 48-hour week, particularly in specialist areas. I am informed that virtually all non-consultant hospital doctors in radiology, pathology, emergency medicine and psychiatry are fully compliant. The specialities in which compliance has still to be achieved are generally obstetrics, paediatrics, anaesthesiology, surgery and medicine. Average weekly working hours for all NCHDs were 52.4 hours as of July 2013. The Minister and the HSE are now focused on reducing this figure to 48 hours in compliance with the directive. We hope to have that achieved fully by the end of 2014. As the Deputy can see, significant progress has been made here.

Before I sit down, I again appeal to the IMO. The way to resolve this is through the Labour Relations Commission. There are two sets of issues tabled here and that is where the process should end. I appeal to the doctors to go back to the LRC and sort this out in the interests of acquiring proper working conditions but even more in the interests of their patients today, tomorrow and every other day.

I am delighted that the Taoiseach has our budget proposals. I would like him to study them. Feel free to plagiarise them. They are proof that there is a fair way to adjust the deficit.

You might study them yourselves.

If the Government can do it with fairness, it can do it by taking the burden off lower and middle-income families. The crux of the strike involving the junior doctors is the issue of patient safety. It is at the core. What the IMO is saying is that there are no sanctions for those hospitals that are not complying. That is what the IMO wants. The Taoiseach is appealing to the IMO to go forward to the Labour Relations Commission and that is fair enough but would he not ask the Minister to intervene directly to ensure juniors doctors work safe hours and patients get the treatment they deserve? It is fair comment to say that Deputy Martin was in breach of the directive but the Government and the Minister are in breach of this directive.

The Government, and the Minister in particular, have a track record of breaking Government commitments. The Minister promised to abolish prescription charges for medical card holders when in opposition. In office, he increased them. He failed to deliver the programme for Government commitment to free GP care for people with long-term illnesses. He has failed thus far to reduce hospital waiting lists. Like Mary Harney and Deputy Martin, he is great at promises but appalling at delivery. Will the Taoiseach instruct or ask the Minister to intervene directly in this junior doctors' strike?

I have already made the point to Deputy Adams that the Minister's track record since he became Minister for Health has been such that he has reduced the working hours for NCHDs on average to 52.4 hours per week in July 2013.

I will give Deputy Martin the report again.

Deputy Adams asked a question and he is entitled to a reply.

Previous studies have shown that in 2009, average hours worked for all NCHDs were 60 hours per week. It is now down to 52.4. HSE data from 2012 indicated that on average, NCHDs worked 54 hours per week and data for the first six months of this year show an average of 52.4 hours per week. I understand that the number of NCHDs working shifts in excess of 24 hours decreased from 58% in March 2013 to 34% in August. That is progress but we must implement the directive in full by the end of next year.

The establishment of the hospital groups will also empower hospitals to co-operate and share NCHDs when scarcities arise and that will further reduce NCHD hours. In addition, the Minister set up a group chaired by the president of DCU to carry out a strategic review of the medical training and career structures of NCHDs with a view to retention of the number of graduates in the public health system. An interim report on that will be produced in November 2013.

I mentioned the scale of reductions in terms of patient services because of this. It is already Government policy that those waiting longest should be prioritised and the IMO has confirmed, as the Deputy is aware, that same level of staffing as is normally provided on Sundays will be in place. Following discussions at the LRC over recent weeks, a joint IMO-HSE verification and implementation process has been proposed. This has already begun and will continue through October. Actions to change rosters and revise work practices identified during that process will be implemented in November. Implementation and achievement of a maximum 24-hour shift would then be jointly verified by the HSE and the IMO.

After 14 years of doing nothing, the Minister has brought this to a point where, on average, working hours are 52.4 and where we hope that by the end of next year, the working time directive will be implemented in all hospitals. As I pointed out to Deputy Adams, some specialist areas are already fully compliant and discussions are ongoing about the others. Let me repeat that Sinn Féin's proposal to have a top rate of 59% with the USC will drive every worker, business and entrepreneur out of the country.

You are already driving them out.

Sinn Féin actually mentioned that the current VAT rate in the hospitality sector should be retained but it never bothered to say who was going to pay for it.

Twenty years ago, a doctor told me that if I had to go into hospital, I should make sure I asked for a second opinion.

Twenty years ago, he said the doctor might have been on his or her feet for up to two days. This morning on my way to the Dáil I stopped by St. Vincent's hospital to speak to some of the non-consultant doctors who are currently on strike. They told much the same story as I was told 20 years ago. We all know they do not want more money. They told me that if their proposal to shorten their working week is accepted, their overall pay will fall. When I asked them what kind of duties they might perform after spending 36 hours working flat out in a hospital, they said they may have to perform a lumbar puncture or resuscitate patients in the emergency department. They told me about colleagues who had fallen asleep in operating theatres. I do not know if the Taoiseach ever worked 36 hours in a row, although I imagine he has. Having worked that long myself, I know I am not fit to change a light bulb after 36 hours. Several months ago there was consternation when we sat in the Dáil until 5 a.m. Somebody pointed out that at 5 a.m., when everybody was blind with tiredness, we were only halfway through the shift of a non-consultant hospital doctor. Two of the doctors' colleagues tragically committed suicide in the last year. More than half of our newly qualified non-consultant hospital doctors are leaving the country. Those who remained have finally mobilised, for which I say "fair play".

The crisis was not created by this Government but it presents it with an opportunity to get this right. Does the Taoiseach accept the need not only to limit the working shift to a maximum of 24 hours but also to impose binding sanctions on the HSE? The doctors believe there is a lack of credibility, accountability and trust on the part of the HSE. There has been a breakdown in trust and, therefore, they want binding sanctions. Will the Taoiseach stand over a guarantee to the non-consultant hospital doctors to the effect that binding sanctions which the HSE cannot ignore will be introduced as part of the package?

First, the strike should end. This is why I say to Deputy Donnelly, as someone who spoke to doctors this morning, that it is critical the Labour Relations Commission is able to engage with the HSE and the non-consultant hospital doctors, NCHDs. That is where it will be addressed and the only people who really suffer as a consequence of it not being addressed there are patients and outpatients waiting for treatment.

I agree that the situation 20 years ago was as the Deputy described. Over the last 14 years there was no real movement on the issue because of a failure to put in place a process to address it. In fairness to the Minister for Health, Deputy Reilly, who is also dealing with all the other problems and challenges in the health services, he has brought the issue to the point at which significant progress is being made.

Perhaps while Deputy Donnelly is on his way home he might ask the doctors why NCHDs in radiology, pathology, emergency medicine and psychiatry are fully compliant but those working in obstetrics, pediatrics, anaesthesia and surgery are not. Why is it that some specialties are fully compliant in hospitals all over the country whereas others to not appear to be compliant?

Is the Taoiseach blaming the doctors?

Is that a case of managers not being able to manage or is it because of staff shortages?

Ask the Minister for Health.

Deputy Donnelly made a valid point. The way to address this is to take the propositions by the doctors and the HSE back to the Labour Relations Commission. There are two propositions on sanctions on the table and if there is a difference of opinion, surely they can arrive at a workable compromise that will see the directive fully implemented by the end of next year and will not distress patients further. Yesterday I met two patients who had been fasting all day while waiting for treatment today only to find that their treatments were called off. It is distressing for people. The answer lies in the tried and trusted negotiation process of the Labour Relations Commission.

The Government is supposed to be in charge.

Two propositions are on the table. They should go back to the commission to sort out the issue.

That has not worked for them.

Everybody here is interested in seeing that the directive is fully implemented. The Minister set a target for the end of next year and he has made significant progress in that regard, despite 14 years of inactivity.

I thank the Taoiseach for his answer. He asked why there is no consistency and why some parts of the HSE are compliant. It may be due to medical procedural reasons of which I am not aware but it is an interesting question because it brings to the attention of Dáil Éireann the fact that while today's strike is nominally about whether sanctions should be applied - personally I think they should - it is also symptomatic of a malaise in the HSE. The HSE appears to be an organisation with little transparency and huge inconsistencies in how medical professionals and patients are treated. We all know it is not subject to meaningful parliamentary oversight and it is immune from parliamentary questions. There is a significant cultural issue which the Government could begin to address. However, this will require root and branch reform which opens up professional bureaucrats, some of whom are excellent and others are not so excellent, makes what they do transparent and, critically, makes them ultimately accountable to this House. Does the Taoiseach agree that we have a major issue and, ideally, an opportunity in regard to increasing transparency and accountability in the HSE?

On today's strike, does the Taoiseach agree with the thrust of the demand for binding sanctions? Essentially the doctors are agreeing to negotiate but they no longer trust the HSE. If the deal on the table is a promise by the HSE that it will not make them work longer than 24 hours, does he accept it is reasonable that the doctors no longer accept that promise and, therefore, will he support their call for some form of binding sanction? Perhaps it will not be the specific sanction they seek but there should be some form of binding sanction on the hospitals and the HSE.

In respect of transparency in the HSE, no more than any other organisation, agency or Department that is clearly a given. This is why the Minister for Health wants to transfer responsibility for the Vote back to the Department of Health so that it is answerable to this House. Deputy Donnelly will be aware that when an Estimate is concluded in respect of the budget and when the Minister for Health signs off on it with the Minister for Public Expenditure and Reform, it is then necessary for the HSE and the Department to produce a plan or strategy to deal with it. In some cases in the past, these have not corresponded with the Estimate that was actually produced. It is a given that there will be proper transparency.

In respect of sanctions, they are never going to work unless there is a measure of agreement between doctors and managers in a hospital. I do not have the details on all the reasons why some hospitals are compliant and others are not but I understand there are two propositions on the table, from the HSE and the doctors, respectively, on sanctions. That is the point of difference. There is the question of whether they are binding in the way the doctors are speaking about or, to take another form of sanction, a manager's job is to manage and doctors perform a critical public service for the good and health of our people. The place to address this is at the Labour Relations Commission rather than across the airwaves. It is a tried and tested forum and I would say to the NCHDs and the HSE this matter has to be resolved. It can and will be resolved through the forum of the Labour Relations Commission. The invitation has been made to both sides. The propositions are on the table and surely it is possible to work out a solution rather than leave people distressed and put out because of the situation that obtains at present.

I do hope that, following the Deputy's valid question, this will be responded to in a positive fashion and it is to be hoped it can be resolved, understanding that we want to get to a point at the end of next year where the working time directive is fully implemented in respect of all the doctors and all the hospitals, as it should have been many years ago.