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A generation of specialists will be lost unless consultant recruitment crisis is addressed

Our acute hospital and mental health services have suffered from decades of chronic under-investment. The health service has a much lower number of inpatient beds per capita in comparison to the average of the OECD countries.

There are growing demographic pressures. In the last decade the population served by the hospital system has increased by 12 per cent and is expected to increase by a further 4 per cent by 2021. The portion of the population over 65 is expected to grow more rapidly.

The challenges facing the healthcare system have a clear and growing impact on the care of patients. There is an increased number of patients being treated after hospital admission on trolleys this summer and this can be expected to become even more common in the winter months. The numbers on waiting lists for essential care are growing. This month 514,000 people are on waiting lists for consultant outpatient appointments and over 74,000 patients are awaiting surgical appointments.

Sláintecare

The Sláintecare Implementation Strategy, published in August, fails to provide real solutions for these capacity deficits in our acute hospital and mental health services. The Strategy’s proposal to introduce 2,600 new beds over the next 15 years fails to address the very urgent needs of patients who, in this year, need access to care in our acute hospitals. We need a clear year-by-year strategy for the delivery of increased capacity starting this year.

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Dr Donal O’Hanlon

Currently, the health service is unable to attract sufficient suitably qualified candidates for consultant posts. In contrast to the situation in the past, there are much fewer candidates interested in vacant posts in recent years. During the three years 2015 to 2017, over one-third of the posts advertised received between zero or one application and over half received between zero to two applications. Fewer candidates are presenting for interview for posts and from 2015 to 2017 the health service has failed to fill up to one-third of the consultant posts advertised by the Public Appointments Service.

Over 500 consultant posts are not filled on a permanent basis throughout the country’s acute hospital and mental health services. This represents a serious crisis with nearly 20 per cent of consultant posts that cannot be filled on a permanent basis.

Survey

The IHCA survey of over 300 recently-appointed consultant members carried out in July confirmed that our acute hospital and mental health services face an escalating and unprecedented consultant recruitment and retention crisis. This is due to ongoing discrimination by the State and health service employers against new-entrant hospital consultants. Respondents to the survey confirmed that the lower salary terms are having an adverse impact on the delivery of patient care due to the large number of consultant posts that are unfilled or filled on a temporary basis. Of equal concern, over 70 per cent of the new-entrant consultants have confirmed that they will seriously consider resigning from their public hospital posts unless the discriminatory salary terms imposed on them by the State are corrected. The survey has provided categorical evidence that our highly trained specialist consultants will not continue to work in our health services if the persistent discrimination against them continues. This is not surprising as there is currently up to a 57 per cent salary differential between newly-appointed consultants and their colleagues appointed prior to October 2012.

On a population basis, Ireland has one of the lowest number of hospital consultants in the OECD, at approximately half the OECD average. Our health services are uncompetitive in attracting and retaining consultants given the high levels of international demand for specialists and considering the terms and working conditions on offer in other countries. The Government must, without further delay, address the capacity issues that make posts unattractive and end the discrimination against new consultants. The failure to fill a third of the advertised consultant posts is having an adverse impact on practically all medical and surgical specialties and most hospitals throughout the country. The country has already lost a large percentage of the highly-trained specialists who qualified in the past decade. If the Government does not end the discrimination, in another decade we will have lost most of a generation of the specialists that we need. We have taken the exceptional action of outlining the stark realities in letters to the Taoiseach, Ministers for Health, Finance, Public Expenditure and Reform and the main political party leaders and spokespersons on health, finance and expenditure.

Our acute hospital and mental health services will increasingly fail our patients due to the large number of approved permanent consultant posts that cannot be filled as a consequence of the discriminatory salary cuts imposed by the State on new-entrant consultants.

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