Public Health Doctors Dispute
Mr. Gormley asked the Minister for Health and Children the steps, if any, he has taken to deal with the current strike by public health doctors; the implications this strike may have if there is a serious outbreak of SARS here; and if he will make a statement on the matter.
Minister for Health and Children (Mr. Martin): At the outset, a Cheann Comhairle, I wish to again state, on behalf of myself and my Government colleagues, our serious concern at the national strike action taken by public health doctors in pursuit of a 30% pay claim. I strongly urge the IMO to cease this unwarranted action, particularly in view of the recent agreement on a new national pay deal, Sustaining Progress, and to participate in the processes which are available to resolve this dispute.
I also wish to record that this claim has been lodged in relation to the current duties and responsibilities of these doctors and is separate to any pay increase that the Irish Medical Organisation has indicated that they will demand for the implementation of changed working practices that may be required in the future.
It is important to clarify the background to the current dispute, especially in view of the variety of selective historical accounts that are being circulated.
The Regional Public Health Function was established in 1994, comprising the grades of Director of Public Health, Specialist in Public Health, Senior Area Medical Officers and Area Medical Officers.
A full review of the public health function commenced in 1999 with the report of the Public Health Review Group (Brennan Group) issuing in April 2002. The IMO were equal partners and co-owners of this review process. The HSEA, the Department of Health and Children and the Health Boards accept the recommendations contained in the Brennan report. The report does, however reflect the diverging views between the parties on the issue of consultant status for Public Health Doctors. The Chairman’s role was that of facilitator to the working party and not that of an arbitrator. His comments in relation to the status of directors and specialists were no more than a personal view and as such had not the status of a recommendation. The only recommendations contained in the report were on those issues on which the parties were in agreement. It should also be noted that the Brennan report acknowledged that there might be a need to revisit its recommendations following the implementation of proposed changes recommended by the Health Strategy, entitled Quality and Fairness, and the Primary Care Strategy. Both of these strategies, and the forthcoming report on the Audit of Structures in the Health Service (Prospectus), will have significant implications for the future role of public health doctors and, as such, must be taken fully into account in any negotiations process.
In 2002, following extensive consideration of a detailed submission by the IMO the Public Service Benchmarking Body recommended increases for public health doctors ranging from 2.5% for a Specialist in Public Health Medicine to 14.2% for a Director of Public Health Medicine. In making these recommendations, the Benchmarking Body was determining the rate of pay which should apply to the various public health posts based on their duties and responsibilities as of the 30 June 2002. It is also important to note that these duties and responsibilities have not changed in the interim. The Benchmarking Body did acknowledge that it was not in a position to take account of the issues raised by the Public Health Review Group (Brennan Group) in relation to the restructuring of public health service provision.
The Health Strategy envisages a population health division being established in each health board, incorporating such areas as public health and health promotion units. These developments will obviously be influenced by the outcome of the restructuring proposals which are currently being finalised and must be central to any consideration of the future role and responsibilities of public health doctors. I feel it is necessary to reflect on the key issues at the heart of this industrial relations dispute.
The Irish Medical Organisation, the representative organisation for public health doctors, has lodged a claim for a 30% pay increase, in advance of any discussion or agreement on future changes in work practices arising from the negotiations on the Brennan report or that will be required under the Health and Primary Care Strategies or the Prospectus Report. This claim is in addition to increases of up to 14% which have been approved by the Public Service Benchmarking Body and the 7% increase which will be paid under the terms of the new National Pay Agreement, Sustaining Progress.
Contrary to IMO suggestions that the Department of Health and Children did not favour or support the intervention of the Labour Relations Commission, it should be noted that Department officials, as part of the management team, have attended a number of LRC hearings with the IMO. In the context of these discussions, management made a substantial offer to the IMO in an attempt to resolve this dispute. A cumulative increase of up to 25%, inclusive of the increases approved under benchmarking, has been rejected by the IMO. On top of this amount the public health doctors will receive a further 7% under the new national agreement. In monetary terms these increases would translate into very substantial amounts. The salary of Directors of Public Health will increase by €29,000, from €82,000 to €111,000 per annum, a cumulative increase of 35.39%.
The salary of public health specialists will increase by €17,000, from €78,000 to €95,000 per annum, a cumulative increase of 21.52%. The salary of senior area medical officers will increase by between €17,000 and €19,000, from between €55,000 and €63,000 to between €72,000 and €82,000 per annum, a cumulative increase of 30.41 %. The salary of area medical officers will increase by between €11,000 and €13,000, from between €48,000 and €56,000 to between €59,000 and €69,000 per annum, a cumulative increase of 22.11 %.
I put it to the House that increases of this magnitude do not warrant industrial action, let alone a national strike. I am sure that it will not go unnoticed that the potential increases themselves are in excess of the average annual industrial wage. Unfortunately, I am left with the impression that the IMO has a preference for strike action rather than mediation or resolution. It is unprecedented in the history of Irish industrial relations for any union to have refused to participate in proceedings in the Labour Relations Commission or the Labour Court in the weeks leading up to the strike.
Both the Health Service Employers Agency and my Department have written to the Irish Medical Organisation indicating their opposition to the current action and requesting the reconvening of talks at the Labour Relations Commission or a referral to the Labour Court. A management team, comprising officials from my Department, the Health Service Employers Agency and the health boards, held negotiations with the Irish Medical Organisation in the Labour Relations Commission on a number of occasions in recent months. I understand that the HSEA has accepted an invitation from the Labour Relations Commission to resume discussions and has urged the IMO to participate in this process. I have previously requested the Irish Medical Organisation to return to these negotiations or to accept my invitation to attend the Labour Court. Both of these offers have been refused by the IMO in the weeks leading up to the strike. I now again request the IMO to reconsider its position in this matter in an attempt to resolve the current impasse. Further ministerial intervention at this stage is neither appropriate nor necessary in view of the processes available to the IMO through normal industrial relations channels.
Talking about industrial relations practices and protocols brings me to another worrying aspect of this dispute - the difficulty in obtaining agreement to or clarification of the IMO arrangements for the provision of emergency cover by public health doctors during their strike. It is management’s firm belief that the IMO requirement that requests for emergency cover should be channelled by health board CEOs to the IMO national strike committee rather than being dealt with at local/regional level is most unsatisfactory. The refusal of the IMO to meet with management to discuss and clarify issues which arose at a previous meeting on emergency cover is unprecedented. Similarly, the weekend statement by the IMO that there would be further serious curtailment of the already severely limited emergency cover arrangements, the refusal to exempt any director of public health or the director of the national disease surveillance centre or to exclude the activation of major emergency plans from their restrictive requirements raises serious ethical, professional and public safety issues and calls into question the organisation’s motives in taking this approach.
Against this backdrop arrangements have been made to provide contingency planning arrangements at all levels within the Irish health care system. A national contingency planning group will assist and advise on any national issues in relation to emergency responses. This will cover issues related to the expert committees on SARS and biological threats. A national incident room has been established within the Department to liaise with the health boards and health authority and to monitor developments on a daily basis. Advice notices have been placed in the national press and these will be reviewed and reissued if appropriate.
The medical division within the Department of Health and Children is providing an advisory service to the broader health system and meeting international reporting requirements to bodies such as the World Health Organisation and the European Union. In relation to the issue of SARS, I established an expert group, in March, to monitor the situation as it developed and to provide advice in relation to the measures required to deal with this syndrome. Prior to this strike, the national disease surveillance centre (NDSC) and the Department of Health and Children developed protocols and guidance for hospitals and health professionals which described the syndrome and provided advice on how suspect cases should be managed. In addition, information for the public and health care workers as well as guidance for aircraft cabin and aircraft cleaning staff has also been provided. The health service agencies will continue to monitor developments in this area in line with the guidelines issued. In that regard, I have been advised that the Health Service Employers Agency has again written to the IMO in relation to emergency cover arrangements and, specifically, those applying to SARS. The HSEA has requested the IMO to restore the public health input in relation to SARS to normal levels, as an exceptional matter, and in recognition of the unique nature of the illness. A reply is awaited from the IMO in this regard.
Each health board and authority has nominated a senior official to co-ordinate contingency arrangements at regional level and details in this regard have been circulated to all health agencies and to the IMO. Local senior management are overseeing the arrangements necessary to ensure effective co-ordinating and response at local level.
I will finish by again urging the IMO and public health doctors, both collectively and individually, to reconsider the course of action which they have undertaken by initiating this unnecessary strike, to return to the Labour Relations Commission to continue negotiations or to seek a joint referral to the Labour Court. I can assure them that the Health Service Employers Agency is ready and willing to resume this process at the earliest opportunity.
Mr. Gormley: Does the Minister agree that public health doctors have been taken for granted for many years by the Department? In many ways they are the Cinderellas of the health service and it is wrong to approach this is by engaging in sabre rattling, as the Minister has done this evening. I understand positions are entrenched at the beginning but we must negotiate and find a solution.
The Minister talked about a cumulative increase of up to 25% then mentioned numerous times that those involved would receive €29,000 of an increase. Over what period will that take place?
The Minister outlined in this speech that the IMO stated at the weekend that there would be a further serious curtailment of the already severely limited emergency cover arrangements. That is causing disquiet. He then says we are adequately covered for SARS. How can the Minister square those two statements?
It appears that the health service has contingency plans in place. However, does the Minister agree that without the public health doctors, these plans are severely curtailed? Does he share my anxiety that if there is a SARS outbreak the country will not be adequately covered because of the strike and that therefore the onus is on him to resolve it as quickly as possible?
Mr. Martin: I did not go on strike.
Mr. Gormley: The Minister is being facetious.
Mr. Martin: It is a fair point. I share the Deputy’s concern about the SARS virus. The HSEA has contacted the IMO again today with a view to having it exempted from the strike action.
Ms McManus: The Minister got his pay increase without having to go on strike.
Mr. Martin: The virus is of sufficient gravity to merit that kind of response. I am not sabre rattling, but I have made the point that the health boards through the HSEA are available for discussions and negotiation. Industrial relations machinery is in place to deal with this issue.
I have been Minister for Health and Children for a little over three years. In my first months in office I had to deal with threatened strike action by junior doctors. It went to the wire. The following year GPs were involved in unrest and this year, public health doctors have taken strike action. It appears that the first recourse in these disputes is strike action.
Mr. Gormley: Will the Minister indicate why, if the proposed increased offer to the public health doctors is so good, they are refusing it? Does he consider it is merely a question of greed?
The WHO has described the SARS virus as one of seven pathogens with the potential to cause the next black death. If it is that serious, does the Minister accept it is his duty to resolve this problem as soon as possible?
Mr. Martin: Some of the questions have been asked a second or third time. With regard to the Special Olympics, I have made the point that in view of the world-wide nature and scale of the threat posed by the SARS virus, we are guided by the advice of experts in the WHO. The Special Olympics are due to commence next June. In the meantime the expert committee will continue take advice from the WHO. Closer to the date we may have to make decisions on the best way to proceed. At present, it is too early to make definitive decisions on that aspect.
The WHO is taking this crises very seriously and we owe it a significant debt of gratitude for the manner in which it has addressed this public health threat. To date, it has not issued any recommendations on travel restrictions or quarantine arrangements in respect of those travelling from the affected areas. We will continue to work with the WHO.
I understand that the expert committee has been informed that the alleged cases referred to yesterday are not being notified to the WHO as SARS cases as they do not fit the diagnostic criteria necessary to report them. That is welcome news. The expert committee is monitoring the SARS virus. Prior to the strike action, those involved in public health informed through the National Disease Surveillance Centre, gave advise and produced high quality and important work. There is now a deficiency in this area and I am very concerned about it. The HSEA has contacted the IMO requesting that the SARS virus be exempted from strike action, given the gravity of the issue in terms of a public health threat, across the world and to this country.
Regarding Deputy Ó Caoláin’s question, in terms of the directors of public health the levels start at about 82,000 and will go up to 111,000 over the next 20 months. The number of public health specialists will increase from 78,000 to 95,000, of senior area medical health personnel from 19,000 to 82,000 and of area medical officers from 59,000 to 69,000.
Caoimhghín Ó Caoláin: How do they compare?
Mr. Martin: I do not have the continental comparisons with me, but I am informed that our public health personnel are not directly comparable in terms of duties and the range of tasks they perform.