Recruitment needed to support weekend working

In June, following the controversy over private work at the Rotunda Hospital, it seemed clear that the implementation of the public-only consultant contract (POCC) would continue to receive political focus.

And so it has proved, with the roll-out of the POCC gaining increased attention in recent weeks.

Perhaps inevitably, in this context, tension between the consultants and the HSE and Government has risen.

The IMO recently responded to media reports of a HSE briefing to the Minister for Health Jennifer Carroll MacNeill, which suggested that consultant weekend work in three Health Regions remained too low.

The Organisation said any accusation that consultants are not working enough weekend shifts in public hospitals was a “fallacy”, which did not account for the current shortfall of doctors within the healthcare system.

Prof Mick Molloy, Chair of the IMO consultant committee, pointed out that every weekend, consultants “are working on call, carrying out ward rounds, reviewing and discharging patients, and responding to emergencies”.

Prof Molloy said that these duties are conducted in addition to the core hours worked from Monday to Friday.

“Rostering consultants for core hours on a Saturday means that they must take another day off during the week or this additional workday to be classed as overtime, which is not financially effective in the current constraints,” he said.

“In order for weekend core hour rostering and extended day core hour rostering to be effective, a whole-of-hospital approach is required. Using a consultant’s core hours for an outpatient clinic on a Saturday, rather than inpatient work on a Monday, is a poor use of resources.”

He argued that, where a consultant can have a full team, services, and infrastructure available on a Monday, but not on a Saturday, “it does not make sense to roster the consultant on a Saturday as there is less productivity.”

“This is why hospitals are in some cases slower to roster consultants on a Saturday,” according to Prof Molloy.

“The public-only consultant contract allows such rostering, but there is no recognition of the additional staff required to make a comprehensive six-day health service a practical reality.”

He pointed out that the Department of Health’s NCHD taskforce recommended a target ratio of 110 consultants per 100,000 of the population.

“In terms of whole-time equivalents, we are currently at 87.6 per 100,000,” stated Prof Molloy.

“These figures show the scale of the challenge that faces the health system. We cannot click our fingers and expect meaningful change when the entire health system – not just consultants – is still set up for weekday working. Those consultants who work weekends will be off midweek with no cover given our lack of doctors.”

The dispute over weekend working is not the only recent source of tension around consultant staffing.

Last month, the IHCA urged the HSE to lift an embargo on the appointment of 24 funded hospital consultant posts at Cork University Hospital (CUH).

The Association was giving its support to CUH CEO Ms Jennifer Kearney, who wrote to HSE South West appealing for a derogation for CUH from the current employment restrictions and the approval of a minimum of 172 priority posts.

Some 24 of these posts are for hospital consultants across a range of specialties.

“It is unacceptable that internal HSE administrative bottlenecks are overriding agreed and approved consultant appointments and forcing existing staff to try to maintain increasingly fragile services in the face of ever-increasing demand for hospital care,” according to IHCA CEO Mr Jim Daly.

“The embargo may also cause significant reputational damage to CUH and the wider HSE, at a time when the health service is seeking to attract consultants working abroad to return to Ireland. Put simply, the embargo on the appointment of consultants at CUH must be lifted immediately.”

Central to both the IMO’s and IHCA’s concerns is the need for additional consultant appointments.

Minister Carroll MacNeill sees the implementation of the POCC as key to achieving reform and efficiency across the service.

The recruitment of consultants, as well as other healthcare professionals, is essential not only for the potential benefits of the contract to be realised, but also for hospitals to be adequately and safely staffed.