Agreement reached on junior doctors’ working hours

Non-consultant hospital doctors in Ireland have accepted an agreement to resolve a dispute over working hours. The Irish Medical Organisation and the Health Service Executive signed a deal to ensure no doctor would have to work a single shift longer than 24 hours. However, on 20 November 2013 the European Commission referred Ireland to the European Court of Justice for breaching the European Working Time Directive over its treatment of hospital doctors.

Background

During the summer of 2013, the Irish Medical Organisation (IMO) announced it was to ballot members on industrial action. It was part of the union’s lengthy campaign for reduced working hours for junior doctors – known in Ireland as non-consultant hospital doctors (NCHD)

Following the ballot, 3,000 NCHDs took part in a one-day strike in October 2013. They wanted to highlight what the IMO claimed were ‘dangerously long’ working hours for junior doctors. The union said they were often expected to accept shifts in excess of 24 hours and 100-hour working weeks.

The union said this was in breach of their contracts and of the European Working Time Directive which obliges Ireland to adhere to maximum working hours.

Sides reach a tentative agreement

In October 2013, the IMO’s NCHD committee recommended that members accepted proposals that emerged from intensive talks between the union and the Health Service Executive (HSE) at the Labour Relations Commission (LRC).

The proposed agreement was accepted by IMO members in November 2013, averting a possible further two days of strike action. However, the IMO Director of Industrial Relations, Steve Tweed, warned: ‘Any failure by the HSE to meet the deadlines contained in the proposals will see a prompt escalation of this campaign and a return to industrial action.’

The agreement included an undertaking by management that by 14 January 2014 no doctor would work a single shift longer than 24 hours, and that all hospitals would be fully compliant with working time restrictions by the end of 2014. It states that ‘resource availability will not be a constraint’ and health service management ‘will prioritise resource allocation to achieve full EWTD compliance in 2014’.

Monitoring and verification

The agreement commits the parties to jointly ensuring that the working patterns of NCHDs comply with the European Working Time Directive by January 2014. It will be achieved through agreed monitoring arrangements, high-level accountability and the prospect of significant financial sanctions for hospitals that do not comply.

A national group will be set up to oversee verification and implementation of the agreement and joint verification and implementation will start immediately for each acute hospital. Moves to change rosters and revise work practices were due to commence during November 2013.

Sanctions

If a hospital breaches the new agreement, a financial sanction can be imposed, but only in a way that does not affect patient care. There is a scale of financial sanctions for different sizes of hospitals, and the fines will be levied fortnightly until compliance is achieved.

Hospitals will be divided into three bands, and there is an annual maximum fine for each band:

  • Band 1 Hospital – sanctions up to €650,000;
  • Band 2 Hospital – sanctions up to €350,000;
  • Band 3 Hospital – sanctions up to €225,000.

Under the agreement, monitoring of hospitals’ compliance with the new working hours for NCHDs was due to begin in November 2013, and penalties could be imposed from December 2013 onwards for failure to comply during the previous month.

When a hospital fails to keep NCHD hours within the agree limits, both parties will regard this as an emergency situation and will convene a meeting of the local validation group within 10 days.

It is also possible for individual managers responsible for any breaches of the agreement to be penalised. Penalties include:

  • reassigning management authority to a different staff member;
  • formal recording of poor performance as part of the performance management process;
  • formal consideration of the extent to which an individual manager/clinician should be held accountable in instances of non-compliance.

Ireland referred to Court of Justice

Meanwhile, on 20 November 2013, the European Commission referred Ireland to the European Court of Justice (ECJ) for breaching the European Working Time Directive in its treatment of NCHDs.

In a statement, the Commission said:

There are still numerous cases where junior doctors are regularly required to work continuous 36-hour shifts, to work over 100 hours in a single week and 70–75 hours per week on average, and to continue working without adequate breaks for rest or sleep… The Commission became aware of the infringement following national reports highlighting the lack of compliance, and after receiving a complaint from an Irish doctors’ organisation. The Commission already requested Ireland on several occasions to take the necessary measures to ensure that the practice of public authorities complies with the Directive. While the Irish authorities have replied to those requests, the concrete progress made in practice is simply insufficient, given the excessive number of hours doctors are still required to work in Ireland.

Responding to the referral, IMO’s Steve Tweed said:

While we have recently agreed a roadmap with the HSE on the ending of the archaic practice of overworking NCHDs, we retain a degree of scepticism about the willingness of the HSE to enforce every aspect of that agreement. Therefore this EU move will help keep the pressure on the authorities to meet their obligations.

Ireland’s Health Minister, James Reilly, said he was ‘disappointed’ at the decision to refer Ireland to the ECJ. He said he would continue to prioritise the issue until full compliance is achieved.

Roisin Farrelly, IRN Publishing

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