Seanad Éireann debate -
Tuesday, 4 Apr 2017

Vol. 251 No. 4

Critical Health Professionals Bill 2017: Second Stage

Senator Keith Swanick

I move: "That the Bill be now read a Second Time."

Cuirim fáilte roimh an Aire Stáit, an Teachta Corcaran Kennedy, as a bheith anseo inniu. I mo thuairim féin agus i dtuairim mo pháirtí, Fianna Fáil, tá an Bille seo an-tábhachtach agus ba mhaith liom buíochas a ghabháil le mo pháirtí Fianna Fáil agus ár Seanadóirí. Freisin, fuair mé go leor tacaíochta leis an mBille ó dhaoine sa tseirbhís sláinte agus ó roinnt comhairleoirí. Is mór an onóir dom ar son Fhianna Fáil an Bille seo a chur chun tosaigh sa Seanad. Ocht seachtain ó shin, i rith díospóireacht eile anseo, labhair roinnt Seanadóirí i bhfabhar an rúin, Seanadóirí Devine agus Conway-Walsh ar son Shinn Féin agus Seanadóir Reilly ar son Fhine Gael san áireamh. Bhí mé an-sásta leis an tacaíocht ó Seanadóir Marie-Louise O’Donnell freisin.

Tá na fadhbanna leis an tseirbhís sláinte níos tábhachtaí ná aon fhadhb eile agus tá an fhadhb níos measa anois ná riamh.

It goes without saying that the problems with the health service are the most important problems we face in Ireland today. Unfortunately many of these problems are getting worse with time, not better. It genuinely gives me no pleasure in saying this, but it is an important backdrop to this legislation and the thinking behind it. It is important to acknowledge the huge interest shown in this Bill by fellow Senators, and it demonstrates to me the determination from Members to be constructive and solution driven, for our health system here in Ireland. The Minister of State, Deputy Corcoran Kennedy, and her officials are all most welcome and I look forward to hearing her thoughts on the issues which this Bill raises.

I acknowledge the support from Senators on all sides of the Chamber for what is contained in this Bill. As Members and the Minister of State will recall, I attempted to introduce a series of amendments to the Health (Miscellaneous Provisions) Bill 2016 when it was before us two months ago. Unfortunately, the ruling was that the amendments were out of order as they involved a potential charge on the Exchequer. It was on that basis that I produced a new Bill, the Critical Health Professionals Bill 2017, which contains exactly the same provisions as the previous amendments that I had proposed. I am very grateful for the public support expressed by Senators Reilly, Devine, Conway-Walsh, Wilson and Marie-Louise O’Donnell, and by the numerous other Senators who spoke to me after that debate, urging me to continue to pursue the matter through a Private Members' Bill. Senators Mark Daly and Robbie Gallagher kindly co-signed the Bill to get it to where we are now, and I thank them for that, as I do Councillor Damien O’Reilly of Fianna Fáil from Dunboyne in County Meath who has played an important role in helping to get this legislation to the floor of Seanad Éireann.

When I spoke about this issue previously in the House, I welcomed Dr. Enda Shanahan to the Public Gallery. His insights, research and dedication to this issue are an inspiration to us all. He is a man whom the laws of this land forced to retire from the public health system due to an arbitrary date. When we met here a number of months ago, his research and his folder of notes on the matter were a sight to behold, and he quietly encouraged me that day to keep the flag flying on this issue. I salute Dr. Shanahan for his service to this State in the public health system and my only regret is that he is unable, unfortunately, to benefit from the changes planned under this Bill as he has retired from the public health service.

This Bill is designed to address the situation of mandatory retirement for critical health professionals within the public health system. It is one part of a range of solutions that can be addressed easily, and I am very grateful for the time which the Minister for Health, Deputy Simon Harris, spent with me going through the various aspects of this Bill. He is to be commended on the interest that he has shown in this, and he has informed me that he wants to see this Bill move along speedily through the legislative process, if at all possible. There are too many times when critical health professionals within the Health Service are forced to retire due to their age and no other reason. This Bill sets out to change that while at the same time seeking to address chronic staffing problems in the health service.

An interesting question was raised with me about this Bill. What category of professional within the health service is a critical health professional as outlined in the Bill? This is a really important question and I am happy to inform the House that I have addressed that specific issue in section 2 which requires that the Minister introduce procedures by regulation that can set out the category of health professionals to whom this would apply. It is worth noting that the global shortage of health professionals is unlikely to change any time soon. There is however a compelling logic in allowing the Minister for Health to renew or revise periodically the categories of health professionals that are covered by the Act. This is similar to how certain aspects of employment legislation operate, such as the employment permits legislation which governs the critical skills employment permits, as well as the highly skilled eligible occupations list operated by the Department of Jobs, Enterprise and Innovation.

I am conscious that this legislation has to be workable, and while I have very strong personal and professional views about the arbitrary retirement age as it exists, I know that there is an urgency to the issue I seek to address. There is little point in introducing legislation to this Chamber that has no hope of being enacted. In the previous Seanad, the former Senator, Professor John Crown, did great work on this very topic, and I suggest that Members review that debate in 2015 if they wish to get a deep understanding of where he was coming from with his legislative proposal. His Bill was entitled the Longer Healthy Living Bill and was supported through Second Stage in Seanad Éireann by Fianna Fáil, Sinn Féin, the Labour Party, Fine Gael and the Independent Senators. I know Professor Crown is critical of an aspect of this Bill as proposed, specifically with regard to the dual consent provision. I will explain why I have included a dual consent provision, because this is central to this Bill being able to make an immediate impact, which I hope will ensure it does not get bogged down in legal or contractual challenges.

I believe mandatory retirement is an archaic system, but in the absence of a more formalised system in its place, we must tread carefully. This Bill could have gone further, but upon careful examination of the law, I have chosen to deal with the issue in this manner. Under this Bill, as proposed, the option for an employee to retire is not affected and nobody will be required to work past their retirement age unless they wish to do so. This is the first part of the dual consent process. The second element of this process required under this proposed legislation would mean that both the employee and the employer would have to consent to an extension past the mandatory retirement age. In having this provision, it allows both parties to contract out the new arrangements and does nothing to impact upon the legal rights of others.

In addition to the Bill presented in 2015 by former Senator Crown, this is an area where a lot of legislation has been proposed. In the previous Oireachtas, the Employment Equality (Abolition of Mandatory Retirement Age) Bill 2014 was put forward by Deputy Anne Ferris from the Labour Party. Just a few weeks ago, the Dáil had a Second Stage debate on a Bill sponsored by Deputy John Brady from Sinn Fein, called the Employment Equality (Abolition of Mandatory Retirement Age) Bill 2016. From what I could see from this Bill from Deputy Brady, it is worthwhile and Fianna Fáil supported it in the Dáil. Separate to that, my Fianna Fáil colleagues, Deputies Willie O’Dea and Mary Butler, have also produced an important Bill, namely, the Employment Equality (Amendment) Bill 2016. They too have engaged widely on the matter and have been very clear in their desire to see change in this area.

I highlight these other Bills to outline to the House the exact difference with this Bill. It is, I believe, one that could have a very immediate impact on the crisis in our health system. During the debate on this issue in February in Dáil Éireann, the Minister of State, Deputy Stanton, illustrated that the Sinn Féin Bill would involve unilaterally setting aside the retirement provisions of most existing employment contracts and would have serious implications for public sector employment, pensions policy and the wider labour market. These are all things that can be addressed, I am sure, to strengthen that Bill as it goes to Committee Stage. It does, however, highlight the legal minefield that exists in this area.

The reason I have chosen the dual consent model is to navigate the complexity of Article 15.5.1° of Bunreacht na hÉireann. The Constitution precludes the Oireachtas from declaring unlawful acts which were not so at the date of their commission. It would certainly give ample opportunity for substantive legal challenge as the Bill in the Dáil, as I understand it, appears to apply retrospectively to pre-existing contracts of employment. I am no constitutional lawyer, but I am certain that the Attorney General will have something to say about that.

In the previous Oireachtas, the Committee on Justice, Defence and Equality examined in detail the broader issue of mandatory retirement, and it received incredible submissions and presentations from the public on the matter. I want to read again a passage from Dr. Enda Shanahan's formal contribution and testimony to that Oireachtas committee. In November 2015 he said:

Two years ago I was compelled to retire from the health service where I worked as a specialist hospital doctor. I wrote to management, [then Minister for Public Expenditure and Reform, Deputy Brendan Howlin] and to [then Minister for Health, Deputy James Reilly], indicating that I was able and willing to keep working in the public health sector after age 65. I explained that I was physically fit - still running all distances up to and including marathons - and medically fit for purpose as certified by the Medical Council continuous professional development process ... The answer was that retirement was mandatory on reaching age 65.

At no point was any objective effort made to assess my suitability to continue working. I was retired purely because of a date in the calendar.

I will now take Members through each section of the Bill. Section 1 is a standard section setting out the various definitions used in the Bill. The key element of section 2 would allow the Minister for Health to introduce regulations to allow critical health professionals remain in their roles past the age at which they otherwise would be required to retire.

In practical terms, it would allow the mandatory retirement clause in the employment contract to be set aside, to allow health professionals to continue working under the same conditions they would otherwise have enjoyed had they not been required to retire at that age.

There are two parts to section 3. The option for an employee to retire is not affected by this legislation and nobody will be required to work past their retirement age, unless he or she wishes to do so. There is an important dual consent process required under the proposed legislation, which would mean that both the employee and the employer would have to consent to an extension past the mandatory retirement age.

Sections 4 to 6, inclusive, can be viewed together and they confirm that the same terms of conditions of employment would continue for staff, as set out in the conditions of employment.

Section 7 sets out that in order for health professionals to have their mandatory retirement age clause ignored, they would be required to inform the chief executive officer or the equivalent within their respective organisation, not less than three months before they reach their mandatory retirement age. This is to allow for management and the employee to engage constructively and formalise an agreement.

Section 8 has four parts. Part 1 specifies that the dual consent process to allow this to happen requires the written consent of both employee and employer. This written consent must be in place before the employee reaches the mandatory retirement age. Part 2 sets out that this agreement would include the timeframe permitted for an extension of employment, which may be up to two years initially and may be extended once, for a further two years, as long as the dual consent remains in place between both parties.

Part 3 states that these changes are not available to an individual who has previously availed of early or voluntary retirement. Part 4 is a practical section to make provisions so that if individuals who have availed of an extension of employment become unfit to work as per their work contract, they shall retire immediately under the terms of their employment.

Section 9 has two parts. Part 1 specifies that the legislation, if enacted, will apply to all organisations funded directly by the Department of Health, all organisations funded by the HSE, organisations funded under section 38 of the Health Act 2004, and all other health and disability service providers. In conjunction with the commencement of the Act, the Minister shall publish a list of all the organisations that the Act shall apply to. Importantly, it is provided that the Minister shall update the list to reflect any changes to organisations, including mergers, name changes and newly-established entities. Section 10 deals with the Title and commencement details.

I want to see this Bill become law, but I also want it to become good law and I know from speaking to the Minister, Deputy Harris, that he is committed to this also. In my career in medicine, I have encountered many highly-skilled consultants, doctors and nurses who did not want to retire but received a letter informing them that they were no longer of service to the State. This makes no sense to me. There have been too many instances where critical health professionals within the already overstretched health service have been forced to retire due to a date on their birth certificate and no other reason.

As a doctor I know that our current health system is embattled by staff shortages, shortage of senior consultants, not enough GPs, and a dearth of highly-qualified specialist nursing staff. Therefore, we need to do something, as the status quo is not working. This Bill is one step in the right direction in helping to erase those problems.

Senator Aidan Davitt

I am delighted to second Senator Swanick's Bill.

Senator Colm Burke

I move amendment No. 1:

To delete all words after "That" and substitute:

"the Bill be read a second time this day six months, following the proposed publication of findings by the Department of Public Expenditure and Reform arising from its review of barriers to extended participation in the public service workforce, up to and including the current age of entitlement to the contributory state pension."

I thank the Minister of State for taking time to deal with this matter and I thank Senator Swanick for the work he has done on this Bill. As someone who has tabled a number of Private Members' Bills here, I am only too well aware of the amount of work that has to be done in preparing any such legislation. I know the Senator consulted with quite a number of people.

When it was first suggested, I had concerns about the Bill in respect of people who might be holding on to a position and resisting change. I have seen that happen in hospitals over the years. In fairness to Senator Swanick, he has dealt with that issue with the requirement for joint consent. I have also seen management pushing very innovative people - good consultants - out when they should not be pushed out. I agree that there must be agreement. I accept that there must be agreement on both sides, from both the consultant and the employer, that the person can stay on. This is welcome legislation and I believe it needs to be given very careful consideration and taken on board.

What Senator Swanick said about the shortage of people is interesting. I was just reading this morning that there is a shortage of 100,000 people in Finland at the moment for various jobs because of a lack of job skills, not just in the area of medicine but in respect of employment overall. With regard to medicine, it is an issue that there is not just competition in one's own country to try to get employees, but in a world market. That is not going to change.

This morning I met the HSE about this whole issue - about forward planning in the health care sector. I have very much been highlighting medical recruitment over the last five or six years. I was delighted to see that the HSE has now established one database for the entire country, into which it is putting all of the information from each and every hospital, so that it knows how many consultants are in each hospital, what their role is and what department they work in. It also has the consultants' date of birth so that it knows when they are likely to retire.

If we go back prior to the HSE, it is interesting that Comhairle na nOspidéal seemed to have had a mechanism to advertise posts before they became vacant. Once the HSE was formed we appear to have fallen down on that and, as a result, when a post becomes vacant it remains vacant for anything up to two years and there are locums in place for a period of time. The new system the HSE has put in place is a step in the right direction, but it is also important that the HSE gets the full co-operation of all hospitals at national level.

When talking about medical consultants, it is interesting how the system has changed. For instance, in 1984 there was one consultant in the entire country in accident and emergency medicine. There are now 88. The number of consultants in 1984 for the entire country was 1,085. I do not have the up-to-date figure to the end of 2016, only those for 2015, but at the end of 2015 there were 2,891 consultants. There has been quite an increase.

Part of that increase is because of the sub-specialisation that has gone on in each area, whether in maternity, paediatrics, orthopaedics or surgery. That sub-specialisation within categories is why, in fairness to Senator Swanick, this Bill is important. There might be two consultants in the entire country who specialise in a particular area. To get a replacement for them would be quite difficult.

This Bill is welcome. We need to continue with forward planning and in respect of how we deal with our junior doctors. I was delighted to hear from the HSE this morning that there is a change in the trend of junior doctors feeling an urgency to leave this country and that we are putting in place a better system for training and retaining junior doctors. We have a lot of work left to do on that area however. We need to make sure that, even if people do go away, there are enough incentives to bring them back again.

One of the other issues that we need to look at, and which it is extremely important we look at, is that we have introduced a salary scale where the same salary applies in one area of the country compared with another. A person might be in Letterkenny on what is called a one-in-two call or a one-in-three call, which means that the person is on call all day, every day, five days a week. If it is a one-in-three call such people are on every third night and every third weekend.

If a person works in Dublin, he or she might be on a one-in-eight call, which means that he or she works one night out of eight, five days a week and one weekend in eight. There is a huge difference. There is an argument that inadequate account is taken of the pressures on consultants working in smaller hospitals such as those in Letterkenny, Sligo, Tralee, Waterford or Kilkenny. It is something we need to keep in mind. When we look at the position in other countries, we see the need to be flexible. We must continue to look at different ways of operating the system. What Senator Swanick is proposing in the Bill is retaining people with a specialisation that may not otherwise be available. We also need to look at providing other incentives. In particular, we must try to keep staff in smaller hospitals. For instance, someone working in a smaller hospital is entitled to go back to Dublin to take up a job because there is more of an opportunity to specialise in the area in which he or she is working. That is an important issue at which we need to look.

We need to make sure there is sufficient forward planning for junior doctors. One of the other issues I have raised on quite a number of occasions is that of co-operation with other jurisdictions in the provision of medical training. For instance, if there is a five-year programme of specialised training, two of the years could be spent outside the country in order that people will not feel that because they left the country, the door has been closed to them. There are a lot of challenges in the health care sector and there is a growing and ageing population. We need to plan for that change in demographics. I, therefore, welcome the legislation.

Senator Máire Devine

I welcome the Minister of State. I also welcome the Bill. It has been well written by Senator Swanick and founded in sound sentiments. It is wise morally and economically to allow people to continue working in the health care profession once they tick all of the boxes in meeting the criteria such as being fit for work and there being dual consensus. That is important. As we debated this issue in the House a while ago, I will not go into too much detail today.

Senator Swanick mentioned the Employment Equality (Abolition of Mandatory Retirement Age) Bill 2016 which was tabled by Sinn Féin in the Lower House and which we are waiting to proceed to Committee Stage. This Bill could be fast-tracked as it is a more narrow but focused Bill for health care professionals. Unfortunately, the amendment tabled by Senator Swanick's colleagues in Fine Gael seeks to delay it by six months, which is unfortunate. The health service is chaotic and its non-staffing is leading to the burnout of many professionals and compromises our duty of care. There is, however, a trend for doctors to think about remaining as opposed to leaving. A couple of days ago I met the chief nursing officer and, unfortunately, the trend is still for nurses to leave. A balance is needed between the recruitment and retention of junior staff at one end and, at the other, embracing senior staff to allow them to carry on and give the benefit of their experience to the health service to serve their up and coming successors.

We all know the mental, physical, emotional and economic benefits associated with work. It is our work ethic that gets us up in the morning and puts our feet on the ground and that gives us a purpose. I hope most of the time we actually enjoy what we do. Having a cut-off point of 65 years and saying to people who reach that age, "There is your hat," is cutting our nose off to spite our face, as we will lose experienced individuals. We must encourage older people to retain a very vibrant working life to contribute to society and not put them out to pasture. Sometimes, however, retirement is approached in that way. There must be an element of choice within our society. We all know what is best for us and should trust people to do what is best with their lives. In the past there were many inequalities in terms of adoption and in that women were forced to give up work. I believe there will be a watershed in the next generation and that we will be able to say we did well, that we looked at the issue of equality and did what was right. Our children and their children will thank us for making society a lot more democratic and equal in allowing people more choice.

I look forward to the Bill progressing. I reiterate the point that the six month delay is unfortunate, but it seems to be the Government's de rigueur response to most Bills. I wish Senator Keith Swanick the best of luck. I say, "Well done," to him and hope he continues to persevere with the Bill.

Senator Jerry Buttimer

I welcome the Minister of State, Deputy Marcella Corcoran Kennedy, to the Seanad and the opportunity to speak to the Bill. I commend Senator Keith Swanick for the work he has put into it, as well for its intent and import.

In a different era, once people reached a certain age, they were deemed to be beyond use. The aim of the Bill, agreed to by the Department, is to ensure a cohort of people who have a body of knowledge, practical experience and wisdom will not necessarily be lost. If we look at the legacy in the public service in the period from 2006 to 2014, a host of people were lost to it, resulting in a loss of competency and experience. People in some of the local authorities tell us that corporate wisdom and intellect have been lost. In this Bill Senator Keith Swanick is seeking to ensure people will not necessarily be put out to pasture, as some other Senators referred to it.

I am struck by the point made by Senator Colm Burke. In the previous Dáil I chaired the health committee. One of the issues we considered was recruiting staff in smaller hospitals and GPs in rural Ireland. As we tidy up this Bill and make it better - I do not mean to be negative - would it not empower and give the health system more oxygen if we were to move beyond the present structure and out of the silo in which we operate? The health care system is evolving and changing. Senator Keith Swanick has been a GP for many years and general practice has changed since he began. The hospital network has also changed. As we move towards the hospital group model and investing more in primary care services, the Bill becomes more relevant and a necessity. There is a need for the Department, the HSE and all interested bodies to sit down and engage on it.

Senator Máire Devine spoke about nurses. She is right.

Perhaps the one thing that has not changed is that the nursing burden is as heavy as it was. Having worked in a hospital, I am very cognisant of the huge amount of work done by nurses.

We need to plan forward, as Senator Colm Burke rightly said. It is a matter of having this kind of discussion on such a Bill to bring it to its next Stage. I am disappointed we could not do this as representatives on the all-party, non-Seanad Oireachtas Committee on the Future of Healthcare. It is all fine for some Senators to come to the House and be critical of Government, but when Government party Senators were willing to go on that all-party committee, we could not do it. This will set the roadmap for the future. This is why I was happy to put Senator Swanick's Bill on the Seanad clár so that we could have a debate in a non-adversarial, non-confrontational way about how our health system should, can and must look, which is about being flexible and changing.

The future of our health care is not just about staffing; it is also about policy. This is why the Minister deserves huge credit and praise for the pursuit of Healthy Ireland and the way in which we tackle obesity. We must have the alcohol Bill brought before the House and consider it in its totality so that we can go out beyond the spectre of the vested interests, go into the communities and see the differences it can make and the challenges we must overcome. The same goes for the Minister of State, Deputy McEntee, and the work we are doing on mental health.

Members have mentioned the issue of retention and recruitment, and it is important that our Health Service Executive and hospital groups are empowered in this regard. I am a very strong advocate of the hospital groups because they are about the sharing of knowledge, information and resources and ensuring we can get value for our patients. This is not about money, but the hospital that performs best will be able to retain and be that primary hospital group within the region.

Senator Colm Burke has always said at the Committee on Health and in this Chamber that we are now competing in a world market, and this is true. This means we must adapt and be flexible, and that is a matter of incentivising people to move back to Ireland, whether nurses, doctors or other health care professionals such as occupational therapists, OTs, or physiotherapists. We must give them opportunities to work in our country. However, equally, there is a cohort or group of people who do not necessarily want to retire. I have been very struck by what I have seen on my travels to North America where one meets many people aged over 70 who are still working and making a contribution. I do not want to live in an ageist society in which because people are a certain age, they must hang up their boots and stand down. That is a bad kind of society we live in because there are people who have contributions to make. My father spent all his life as a nurse. He is 80 years of age. He is still making a contribution as chairman of the board of management of a special needs school.

The Bill and, by extension, its component parts can help us to achieve what I have outlined. I commend Senator Swanick. I am happy to second Senator Colm Burke's amendment. I thank the Minister of State and the Minister, Deputy Harris, for not ruling the Bill out but giving it a further reading. This is important because the kind of politics in which we can engage by having this extended period leads to better legislation and better outcomes, and that is what we are about on this side of the House at least.

Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy)

I thank Senator Swanick and his colleagues for introducing the Bill and acknowledge the contributions of the Senators to the debate. It gives us an opportunity to discuss the issue of retirement age for those working not only in the health service but also in the wider public service. It is recognised that recruitment and retention of health professionals is an issue. There are recruitment and retention issues in the global health workforce as a whole. The issue is not exclusive to Ireland. The Department of Health is, in principle, in favour of the upward adjustment in the compulsory retirement age in the interests of workforce planning for the health sector. However, the Bill as drafted requires careful scrutiny and further refinement to allow its objectives to be met effectively. I will take this opportunity to outline, in no particular order of importance, some issues in respect of the Bill as currently drafted which require careful consideration.

There is no definition of "critical health professionals" in the Bill. However, the explanatory memorandum, as referred to earlier, states the Bill will apply to "key nursing, medical and consultant personnel within the public health system". It is silent on other health professionals such as therapy grades and whether they would meet the definition of "critical health professional". I am sure there are speech and language therapists and physiotherapists who would strongly view their role as being critical, and this would need further development as a concept.

It could be argued that the provisions of the Bill are potentially discriminatory. They appear to propose preferential terms and conditions for specific cohorts of health professionals employed within an organisation purely on the grounds of their professions. This seems unfair and would need to be considered further. The Bill also states that it is intended to apply to organisations funded by the Department of Health, all organisations funded by the HSE under section 38 of the Health Act 2004 and all other health and disability providers. This provision is very broad. It seems to include employees of agencies funded under section 39 of the Health Act. These employees, however, are not public servants. Neither the Department of Health nor the HSE has any role in determining the retirement of staff in agencies funded under section 39 of the Health Act.

Insufficient detail is provided in the Bill as to how the proposed "dual consent" process would work in practice between both parties, namely, the employer and the employee. This would need further scrutiny and explanation as it is not at all clear how it would work in practice. There are potential legal implications to what is proposed in the Bill if it were to result in a unilateral change in the terms and conditions of certain employees as set out in their original contracts of employment. There would also be implications surrounding the legislation for pension schemes. It is not clear how the provisions of the Bill would affect the labour market. For example, how would it affect young health professionals starting out if potential retirees instead worked on? Finally, I am of the view that it would be essential for all cost implications to be assessed properly before the Bill makes any further progress. In so far as the information has been provided, we need further clarity.

I will now consider the broader picture of the health sector and the public sector in general. We have heard the challenges the health service is facing in terms of recruitment and retention of professionals such as doctors, nurses and midwives. I am pleased to say we are emerging from a period of cost-cutting measures, including a moratorium on recruitment. We have turned the corner and recruitment is under way in the public health sector to resource and develop our services. At the same time, we must acknowledge that there are challenges in Ireland and internationally in recruiting some specialties of nurses, doctors and consultants. This difficulty is being experienced by other English-speaking countries, including the UK, Australia and Canada. Notwithstanding this, the staffing numbers at the end of January 2017 for the health services stood at 107,251 whole-time equivalents. This compares with 96,582 in January 2014, which is an increase of 10,669 whole-time equivalents.

I will outline the current position regarding the recruitment and retention of consultants, non-consultant hospital doctors and nurses as these are the main health professions on which the Bill appears to focus. We have seen an increase of 300 consultants in the public health system from January 2014 to January 2017. Ireland is experiencing challenges in recruiting some specialties. This is an international phenomenon and these specialties have traditionally been difficult to fill. There is recognition that consultant recruitment must continue to be prioritised in line with Government policy. Efforts continue to fill the consultant vacancies. The HSE has changed its consultant recruitment process and has developed a new simplified consultant application form. Work is under way to introduce a system of work planning and an individualised induction programme for consultants on appointment. I am confident that all these efforts will help in the consultant appointment process. The number of non-consultant hospital doctors employed by the HSE at the end of January 2017 was 6,020. This shows an increase of 215 since January 2016, an increase of 1,037 since January 2014 and an increase of 1,341 in the past decade. This is primarily a result of measures being implemented to achieve compliance with the European working time directive while moving towards consultant-delivered care. We are training the consultants of the future and the number of training places has been maximised. I recognise that the recruitment and retention of medical doctors who graduate and are trained in Ireland is important to the effective functioning of the Irish health service and is in keeping with our obligations under the World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel.

In July 2013, a working group, chaired by Professor Brian MacCraith, president of Dublin City University, was established to carry out a strategic review to examine and make high-level recommendations relating to training and career pathways for doctors with a view to improving graduate retention in the public health system, planning for future service needs and realising maximum benefit from investment in medical education and training. The working group completed its work in June 2014 and, in all, submitted three reports and made 25 recommendations. The reports address a range of barriers and issues relating to the recruitment and retention of doctors in the Irish public health system. There have been several positive developments arising from the recommendations of the strategic review working group. These will have a positive impact on the quality of the training experience, and the working lives of trainee doctors. For example, many trainees now have predefined rotations at the start of their training schemes with reduced paperwork for each rotation and the HSE has developed an online national employment record. I also regard the implementation of the lead non-consultant hospital doctors, NCHDs, initiative at national level as a very important step. This role provides an opportunity for NCHDs to participate in discussions and decision-making regarding matters that affect them, the day-to-day running of hospitals, and allows them propose suggestions to enhance patient care to hospital management and clinical directors.

Progress has also been made on a number of other fronts, as a result of the group’s work. Revised pay scales for new entrant consultants have been implemented, and there is significant scope to recognise previous experience and qualifications. The HSE has agreed to treble the number of family-friendly NCHD positions and 32 trainees are due to commence flexible training in July 2017. We have seen some really good progress in terms of working hours of trainee doctors, and those working in non-training posts. We have made progress in reducing the numbers of NCHDs working over 48 hours per week to 17% of the cohort and we are committed to continuing with this progress. Another positive development, which will also address issues around recruitment and retention for NCHDs, is the restoration of the living out allowance for those appointed since 2012, which will be incorporated into the basic salary of these doctors from 1 July 2017.

Recruitment of additional nurses has been the focus of considerable ongoing activity by the HSE and voluntary hospitals. The Bring Them Home campaign to support the recruitment of Irish nurses abroad brought almost 100 additional nurses into the system and this campaign continues. The message is reaching the Irish abroad that Ireland is recruiting again and several initiatives are in progress to provide career development, training opportunities and improved pay.

The HSE has continuous open recruitment campaigns in place to ensure that all eligible applicants for nursing posts can apply at any time to work in hospitals throughout the country. The HSE is keeping these campaigns rolling. This means that they are left open for any new applicants who come on stream and hold interviews when they have sufficient applicants. The HSE ran a recruitment campaign for nurses and midwives from 28 to 30 December 2016. A total of 220 attended the event and 115 nursing and midwifery candidates were deemed successful and placed on a panel following interview. There was a careers open day for nurses and midwives last week at Dr. Steevens' Hospital. This was the second in a series of careers day events for nurses throughout 2017. The HSE is running recruitment campaigns aimed specifically at recruiting staff nurses for emergency departments. As part of the recent management proposals to the nursing unions, the HSE committed to offering permanent posts to degree programme graduates and full-time permanent contracts to those in temporary posts. The executive is also focused on converting agency staffing to permanent posts.

Retention of the nursing staff employed by the HSE also needs to be addressed and this is recognised. The HSE is analysing the data from exit interviews from nursing and midwifery disciplines to identify trends and will survey new starters to identify areas of improvement in orientation. The Irish Nurses and Midwives Organisation, INMO, is balloting on a range of initiatives designed to retain nursing and midwifery staff, including: extensive education and personal development opportunities for nurses and midwives to upskill; a pilot pre-retirement initiative as a method of retraining experienced nursing and midwifery staff; 127 promotional posts for staff nurses or midwives to clinical nurse midwife manager 1 level; and consideration in the upcoming pay talks of the restoration of a number of allowances for new entrant nurses. Providing an improved working environment will, we hope, encourage our nursing and midwifery staff to stay and may even encourage those who have emigrated to return.

I have outlined some of the work taking place in the HSE to recruit and retain health workers. I acknowledge that the spirit of this Bill is also intended to help by keeping experienced health professionals employed in the public health service past retirement. It is not at all clear that there is a high demand among health sector professionals to remain on or return to work having retired. I am aware that there are a small number of individual cases, some of whom have made representations to the Department of Health seeking to remain on in employment. In general, however, following initial inquiries, my sense is that the opposite may be the case for the majority of health professionals currently employed. We know that there are already schemes in place which allow certain professions to retire early. In the recent talks with the INMO, its proposals included a pre-retirement initiative whereby nurses and midwives could reduce their working hours in advance of retirement age. Many nurses, due primarily to the physical nature of their work, have, at their own request, moved off clinical work as they near retirement age. Consultants who retire and wish to return to work in the public health service are treated as new entrants and are subject to abatement of their pensions. Of those who retire, the HSE estimates that fewer than 5% return and, typically, that would be for less than a year. However, issues around the arrangements in place for retired public servants and whether continuing to work is an attractive proposition, are more appropriate to the Department of Public Expenditure and Reform. Indeed, I understand that barriers to ensuring extended participation in the public service workforce are being examined in a review being led by that Department.

The terms and conditions of employees in the public service are generally a matter for the Minister for Public Expenditure and Reform. While the Bill, as drafted, refers only to certain health professionals, it needs to be examined in the context of work being undertaken by the Department of Public Expenditure and Reform. That Department is reviewing the current statutory and operational considerations that give rise to barriers to extended participation in the public service workforce. This includes looking at the current and planned age of entitlement to the contributory State pension. The Department of Health, among others, is involved in this review and its officials have already held an initial meeting with their colleagues in the Department of Public Expenditure and Reform. I understand that this work is expected to be completed in the second quarter of this year.

In light of all of the arguments that I have put forward and the fact that this Department of Public Expenditure and Reform review will make recommendations which will apply to all public servants, not just certain health professionals, I strongly recommend that the House agree to the amendment I have proposed and await the conclusion of this review and its resulting recommendations. I welcome Senator Swanick's co-operation and agreement that we would allow time for the publication of the review which is already under way given the importance of this issue and its potential implications for the entire public service.

Senator Keith Swanick

I thank Senator Davitt for seconding the Bill and I welcome everybody's comments. I acknowledge Senator Colm Burke's work in the health sector. This Bill is not confined to consultants although the Senator spoke extensively about them. It involves many health professionals. It is important to realise that this Bill will allow the Minister to revise and review periodically the categories of health professionals covered in the Act. That is included in the Bill. The dual consent is designed to navigate the complexity of Article 15.5.1°. The Constitution precludes the Oireachtas from declaring unlawful acts "which were not so at the date of their commission".

I also welcome Senator Devine's comments and acknowledge the balance she mentioned regarding the younger and older members of the health service. I fully condone her comments on equality in the health service and thank her for supporting the Bill. I value the sentiments expressed by Senator Buttimer. I know that he speaks from his experience as Chairman of the Oireachtas Joint Committee on Health. He acknowledged that we are losing practical knowledge and experience unnecessarily due to an arbitrary date in the calendar. I agree that it is a shame that Senators are not members of the Oireachtas Committee on the Future of Healthcare because we all want to achieve the same goal and improve the outcome for patients.

I welcome the Minister of State's comments. The last thing we want this Bill to do is be discriminatory in nature. We are trying to get over that hurdle. This is why I included in the Bill a provision that the Minister can periodically revise the categories included in the Bill, for example, therapists mentioned by the Minister of State, in the same way as applies with the employment permit legislation. Regarding the Minister of State's concerns about employees covered by the Bill and agencies that might be included under section 39 of the Health Act, I look forward to working with the Minister and the Department to clarify this matter in the coming months.

In respect of dual consent and contractual issues, it is important to realise that this Bill allows both parties - the employee and the employer - to contract out the new arrangements. There is nothing that will impact on the legal rights of others. From speaking to colleagues, I honestly believe that many health professionals would take up this offer if it was on the table. I look forward to the Bill coming before the House in six months.

Amendment agreed to.

Motion, as amended, agreed to.

An Leas-Chathaoirleach

When is it proposed to sit again?

Senator Colm Burke

At 10.30 a.m. tomorrow.

The Seanad adjourned at 7.30 p.m. until 10.30 a.m. on Wednesday, 5 April 2017.