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EUROPE’S HIGHEST COURT looks set to rule that Ireland has breached the European Working Time Directive in relation to Non-Consultant Hospital Doctors (NCHDs).
An Advocate General at the European Court of Justice published an opinion on the matter this morning, noting that the government is incorrect in thinking that some aspects of the junior doctors’ roles – namely training – are outside the scope of the rules.
The Irish Medical Organisation (IMO) complained to the European Commission in March 2012 over the excessive hours worked by NCHDs. Although today’s decision is not a ruling, the AG’s opinions lead to final judgements in 80% of cases that come before the ECJ.
The EU Working Time Directive governs the number of hours that EU citizens can legally work, and also outlines minimum rest periods. Today’s opinion makes clear that the hours of training undertaken by junior doctors should be included in their ‘working hours’, even if they are not on call while it is taking place. The opinion explained:
Irrespective of whether training takes place at a hospital or on the premises of the training body, what is important is that NCHDs are required to remain during those training hours in a place that they are not free to choose, but which depends on the training programme that they are required to follow. That obligation for NCHDs to be physically present in a particular place for their training hours constitutes a constraint which prevents them from freely engaging in their personal activities.
The opinion has been welcomed by the Irish Medical Organisation, which organised a strike of NCHDs in 2013 to protest against shifts that lasted longer than 24 hours.
Assistant Director of Industrial Relations at the IMO, Eric Young, says the decision is a wake-up call for the Irish government.
For years they have forced NCHDs to work excessive hours and that has caused immense hardship and helped create the morale crisis which is forcing young doctors to emigrate from Ireland.
“One of the difficulties we’ve had is that it has been very, very difficult to get the government to implement its responsibilities on the European Working Time Directive,” he told RTÉ.
“We had to organise a strike in 2013 to press it into action. When the strike was concluded, we put an agreement in place which provided for full implementation of EU WTD by the end of 2014. Sadly, we’ve fallen very short of that.
The difficulty from our point of view now is that there are 230 doctors working more than 24 hours. In terms of a 48-hour working week, a lot of improvement has been made but a third of doctors are still over the legal limit.
“There is substantial progress but under the agreement, they were mean to be eliminated by 2014. They still haven’t been eliminated.”
Overworked
The IMO believes there are still 230 NCHDs in over 21 hospitals working over 24 hours and there remain some who are forced to work 32 hour shifts.
“Up to 33% of NCHDs are routinely required to work in excess of the legal 48 hour limit which must be urgently addressed. Removal of the protected training time will make this situation worse,” Young added.
“Nobody can defend a doctor working multiples of hours, late into the night and early morning, little or no sleep, no food, no rest. That’s not sustainable and not a model of healthcare that I can support,” Oireachtas health committee chair Jerry Buttimer told TheJournal.ie today, noting that the EU Working Directive must be adhered to.
A recent study found that 90% of Irish medical students are considering emigration after they qualify with career opportunities, working conditions and lifestyle cited as the main reasons.
A full judgement is expected before the summer. If it upholds the opinion, fines of millions of euro could be imposed on the State, according to the IMO. Sinn Féin has put this figure at anything as high as €100 million.
In a statement issued this afternoon, the Department of Health acknowledged that the EWTD has not been fully implemented.
However, it claimed that “good progress” had been made.
“We are committed to the full implementation of the EWTD,” Minister Leo Varadkar said. “As a demonstration of that commitment, we have hired 400 additional NCHDs in the last two years and are close to eliminating shifts of longer than 24 hours. Reducing average working times to 48 hours or less per week remains a challenge, particularly in smaller hospitals.
“It’s important to acknowledge that this is an opinion, not a final judgment. Agreement was reached with the IMO in the High Court settlement of 2010, that protected training time did not count as working time. However, that position is now in question pending the final judgment by the European Court of Justice.”
The Department claims that data from the HSE shows that the average number of working hours for NCHDs has reduced from 60 hours in 2009 to 51 hours at the end of last year.
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And about time too.
Why do we not have more medical graduates coming out of the colleges?
We are always told that there is a shortage of consultants and overworked Junior Doctors.
Why are there so few consultant positions and if there were more JD’s being trained surely this would help?
I think it’s more a problem with keeping doctors in the country as opposed to producing enough. Even if many more graduates were coming through the medical schools (at a significant cost to Ireland) they would likely react to the problems faced by current NCHDs in the same way and emigrate to better conditions. As to more consultant posts – the HSE are having significant trouble filling the currently available posts. Basically doctor jobs in the irish system are seen by many doctors as unattractive compared to what’s on offer elsewhere.
the reason is a constant percentage of Irish graduates are emigrating all the time and foreign doctors are not allowed training at all, even if seat remain vacant. so net result is less trained doctors.
Its catch 22. The graduates emigrate because of better working conditions abroad but for every one going the service gets worse for those within.
The HSE should prioritise a mass recruitment of at least 250 JD’s and the universities should drop the points requirements for the medical courses. An immediate injection of fresh blood is now urgent.
Wont be popular but I would pay more tax if it was red fenced for improving front line health professionals numbers.
Points are determined by demand/places. Only way to drop points is to allow more places but is there not a blocker on that happening?
There was a recent study done by NUIG that showed that the emigration of JD’s and Med Grads is due to lack of promotion and career development opportunities in the main.
Good, I hope they are fined a absolute fortune for this. It’s an ongoing disgrace.
The problem with that is they’d be happy to pay a fine every week if it meant they could carry on regardless, after all its our taxes that’ll pay it.
We’ve been hearing about this for years now yet nothing has changed, this isn’t something that has suddenly been imposed upon this government by Europe. Time and time again, government after government has made promise after promise to junior doctors only to procrastinate and outright lie. It’s become painfully obvious at this stage that they will only address this issue when forced to do so, even then nobody really expects miracles from an Irish government.
I’d say the IMO might give the gov a bit of a handout here considering their former chief had a pension package of close to 25 million ………!
I worked in an industry were both the employees and employers could be fined thousands for breaking the WTD,Not to mention the impact it has on road safety.
Yet there is a government/agency body breaking these rules,Anyone who has ever worked shift or excessive hours knows that the body cannot take it and eventually shuts down.
Fatigue is just if not more dangerous than being under the influence of drink & drugs,If the mgmt cannot put a roster together they should be shown the door.
Leo Varadkar as Minister of Health has this to say:
“We the Government are doing everything in our power to protect fishing rights in our waters and protect small fisheries against the invasion of super trawlers”.
I hope they take the Irish Govt to the cleaners. The Govt have fought this indefensible case for years knowing full well they were wrong.
The fine is paid by the taxpayers, so we lose… again and again and again.
Concur with most of the above.
Medical professionals always went abroad to gain expertise in specialities, some with a view to coming home to work here/ some notThey would intern here work as SHO, go abroad for a while and return with the expertise and contribute to the society that gave them their education
It’s enriching to have a health system formed with people from different backgrounds but not a setting where Irish health workers are in a small minority
Spare a thought for those who want to stay here advancing their careers knowing that they will never earn what they deserve and won’t get much kudos from the general public either The permanent departure of any well educated young citizen is not only a loss economically but socially and culturally People studying Medicine have had a high academic standard including Irish language skills never again to be utilised
Ar gach aon leibhéil is náireach é “Na coinníolachaí oibre ” tá ann le fada agus faoi láthair
The HSE is clearly overworking its junior doctors.
And yet it has not changed its policy.
Doctors should be on. 35 hour week!
Some years ago I had to go to hospital on Sunday morning to have stitches taken out!
I had to be seen by a doctor before the nurse could take out the stitches.
The doctor was asleep! He had only 4 hours sleep in 2 days.
When I met the doctor 2 hours later he was very tired. A lovely person who clearly was overworked !
Time for policy change.
No wonder our junior doctors want to emigrate !
Government needs to address these serious issues!
No wonder he’s tired. Why would someone have their stitches out on a Sunday?
Interesting to see that most of comments here are supportive of change and penned by people who are awake during the night (myself included) and are mostly using names that they are not hiding behind
If I thought that repeating myself ad nauseum on this issue would influence future practice I would sit neaworsr the keyboard morning, noon and night but as a vehicle for any reasonable debate or discussion i fear “airtime” would win out to postings from contributors such as
DONT CARE
BORED
MEATMASHER and many more much worse with destructive remarks and foul language.Lets hope change can be achieved by more campaigning that doesn’t involve moaning about the cost( a valid consideration)and happens soon
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