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The significant and worrying trend of emigration of all grades of doctors, but particularly NCHDs, from the Irish public health service has been consistently highlighted by the IMO and the NCHD Committee. While Government and the HSE continue to bury their heads in the sand and ignore the root causes of doctors leaving, the IMO, supported by research from the RCSI and the Medical Council, have highlighted the key problems — NCHDs want and deserve better working conditions.
One of the most startling quotes from the RCSI study is: “Emigration is a matter of self preservation… the working conditions are killing us slowly.”
There is no escaping the fact that what is needed is a new NCHD contract.
In Autumn 2015, the IMO NCHD Committee embarked on a major listening and engagement exercise with NCHDs around the country through the IMO ‘Have Your Say’ campaign. The objective of this campaign was to listen to our members and give them a voice on what they would like to see in a new contract, while still fighting for basic entitlements under the existing one. Common threads kept appearing which will form priorities for a new NCHD contract, including issues such as access to training, leave cover and assistance with the costs of practising medicine. The NCHD Committee is now working to put together a programme for change and will launch this at the national NCHD meeting at this week’s AGM.
The general lack of respect by the HSE towards its employees has been well documented but what is more worrying in terms of NCHDs is the consistent and blatant breaching of current contractual entitlements.
NCHDs in University Hospital Limerick were forced to threaten industrial action after their employer had not paid interns for hours worked. A similar case against the National Rehabilitation Hospital, Dun Laoghaire, is currently working its way through the industrial relations process. This is just over 12 months after a threatened strike over pay in Cork University Hospital was narrowly averted.
It beggars belief that hospitals still think it is acceptable not to pay NCHDs correctly. It is perhaps a measure of long-standing systemic disrespect for NCHDs. Each year the IMO deals with individual cases for NCHDs where the employer refuses to honour contractual terms. Without the IMO, many of these doctors would be left at a serious disadvantage.
Why would anyone be encouraged to work in a system that effectively punishes you the harder and longer you work?
The lack of respect and the devaluing of the profession are also reflected by the HSE’s attitude towards the NCHD Living Out Allowance. The IMO has been forced to take legal action to restore this allowance after its unilateral removal by Government. All contracts must be honoured and honoured in full and it is ridiculous that the Government and the HSE are prepared to waste taxpayers’ money on costly and lengthy court proceedings in an effort to withhold monies owed.
It is clear these types of action have had a negative impact on NCHD morale. Studies have shown 63-80 per cent of NCHDs are contemplating leaving the country, while 88 per cent of Irish medical students are either contemplating or definitely leaving Ireland after graduation. A study by Dr Niamh Humphries of the RCSI found that the principal reasons for Irish medical graduates to leave the country were working conditions, followed by training and career progression.
The unilateral 30 per cent pay reduction for new consultants in 2012 had a devastating impact on both NCHD and consultant morale and resulted in approximately 300 vacant consultant posts. The actual number of currently vacant posts remains a subject of debate. A new pay scale was agreed in January 2015 and the IMO continues to work on the Incremental Credit Committee established under that agreement to ensure new consultants are treated fairly. This can only be seen as a first step in a process to restore full parity of pay. Anything less is not acceptable.
The NCHD Committee also continues to engage with the Strategic Review Group on career structure to ensure the recommendations of Prof Brian MacCraith are implemented in full. By ensuring a proper career structure is in place, the issue of retaining trainees in the Irish public health service can be addressed.
There has been ongoing work on implementation of the European Working Time Directive (EWTD) throughout the year. The European Court of Justice ruling that Ireland was not in breach of the EWTD was hugely disappointing for NCHDs, however, this has not slowed the work of the national verification group. Joint HSE-IMO site visits have been extremely useful in identifying problem areas and ensuring hospitals work to meet their requirements under the law. In particular, the work of local NCHD representatives in this area has been invaluable.
All of these processes form the unglamorous part of the NCHD Committee’s work, which will continue throughout 2016 as it lays the groundwork for a new contract. It is to be hoped that a new Government will address these issues with the IMO in a positive and constructive manner and help break the cycle of despair and negativity engendered after successive austerity governments.