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Doctor in the House

When Dr Michael Harty walks around his Co Clare constituency, he sometimes bumps into former patients who express mixed feelings on meeting him.

“Patients will sometimes say to me, ‘We are sorry doctor that we voted for you, because now you are not here anymore’,” he laughs.

It is understandable that patients may miss their GP who had worked in Kilmihil village for more than three decades prior to winning a seat in the February 2016 General Election.

“Yeah, and I miss them too,” he says. “Particularly if I have heard about patients who I have looked after for years who have become ill. But this is what I chose to do.

“I have a long-term locum in my practice. It was a ‘No Doctor, No Village’ campaign, so one of the commitments I made to my patients was that I would ensure that the practice would continue while I was in the Dáil. I’m dependent on the long-term locum, who has worked out very well.”

The Medical Independent (MI) meets Dr Harty in his Leinster House office, where our interview is squeezed in between a Dáil vote that the Independent TD had to attend and his drive home to Co Clare, where he faces evening constituency work.

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Dr Michael Harty TD: ‘We need agreement on a contract'

He finds the commuting hard, he says, but when he meets his constituents they understand why he has made this unorthodox switch in careers.

 “It was a ‘No Doctor, No Village’ campaign but that was just a metaphor for ‘no post office, no village’; ‘no garda station, no village’; ‘no pub, no school, no shops’, basically the general decline of rural Ireland,” says Dr Harty.

“Certainly, if you take away a GP from a rural village, if they have a pharmacy, that pharmacy is not going to survive without the GP. Then the footfall for shops declines, the number of children in school declines. The general economic activity in the village is diminished if there isn’t a GP and a pharmacy in there. People understood it was a wider issue than just ‘no doctor’.”

Rural

In terms of rural general practice, Dr Harty foresees major changes occurring, no matter what transpires in the current GP contract talks.

“I cannot see rural single-handed practices surviving under this new contract, even with the changes in the rural practice allowance.

“That is just keeping those already there in practice. It’s a help, but it is not a game-changer,” he says. “There will be a need to network [rural] practices together, three or four villages or towns in proximity that will form a network. There may also have to be salaried GPs to attract people to isolated areas, maybe even inner city areas.

“There has to be innovation in this contract. It cannot be ‘one contract fits all’. Part-time GPs, job-sharing, contracted GPs, salaried, and subtle variations in that in relation to subsidies for support staff and for infrastructure. It has to be a very different contract.”

As reported in the last edition of MI, Dr Harty believes the NAGP and IMO should be treated as equals in contract negotiations by the Department of Health and HSE. 

He mentions the free GP care for under-sixes contract and warns that this should act as a cautionary tale.

“We need agreement on a contract. We saw what happened with the under-sixes. There was a belief, like I believed myself, that it was forced on me,” he says.

“I had no choice in the end but to sign. I held out as long as I could, but I was a lone voice in the end in my area. I could see patients drifting away. From a survival point of view, I had to sign the contract. But I don’t think it was the right way to produce a contract change. And if the new contract is to be delivered in that manner, I think it will be a disaster for general practice.”

A different life

Dr Harty’s mind may remain focused on the challenges facing rural general practice, however his daily life is now entirely different. Rather than the practice work and house calls in rural Co Clare, he is in and out of committee rooms, meetings and the Dáil chamber.

“Moving into the Dáil, there is a different level of communication. It is not so much a one-to-one, but the skills you have as a GP you can transfer to the skills you require to be a politician,” reflects Dr Harty on his new working life.

“In politics, you have to build up relationships. In general practice, I suppose you have built up relationships over 30 years, looking after third generations of the same families.

“Trying to build up relationships in the Dáil from scratch from being a new politician, that is a challenge. That is the secret of politics, trying to build up relationships with people, trying to get on with people. In politics, you are generally not going to achieve anything if you are not getting on with people.

“One of the main things I have learned in here, is that it is a long not a short game. So you have to keep at it, keep putting your point of view across and hopefully it will be listened to and stimulate action.”

Dr Harty came to the village of Kilmihil in 1984, having previously worked in Arklow, Co Wicklow, and Mulhuddart, north-west Dublin.

When he looks back at his early days in general practice, how does it compare to the challenges facing today’s GPs?

“The problem with general practice at the moment is the huge administrative burden that is placed on doctors,” he says.

“Young GPs are looking at [more established] GPs who are struggling with trying to balance staff and keeping the IT structure going and all the expenses that go into running a proper general practice. It’s a big struggle to make ends meet and to make a living out of it. It is not a 40-hour week.

“In my practice, my average was 65 hours a week. On the week you were on duty at the weekend, it was 80-to-85 hours. Young GPs are not going to do that. They are looking at the out-of-hours rota, and I suppose we as established GPs have grown into it.

“When we looked at the generation that we followed, we thought how did they work as dispensary doctors, delivering children out in the middle of nowhere and taking on huge responsibility and not being able to leave their geographic area.

“The competition that there was between GPs, that’s gone, which is great. When I came first to west Clare there was no rota. Gradually, rotas developed and the suspicion between practices were broken down.

“The new challenge now is, how do you make a living running a good practice, supplying quality service on the resources that we have? We have been hit by FEMPI.

“FEMPI has been the final blow to many practices; both financially and mentally, to GPs, they feel they have been dealt a severe blow and nobody is listening to them.”

HSE governance

The Co Clare TD is proud that he was one of the leading advocates for the establishment last year of the Oireachtas Future of Healthcare Committee. He now sits on that Committee.

He reveals that the governance of the HSE is one of the issues the members of the Committee are currently looking at, with little more than a month left before members are due to publish their all-party report.

“I have introduced the topic and I hope it will be a substantial part of one of the chapters of the [Committee’s final] report,” says Dr Harty.

“If we are expecting the HSE to have voluntary good governance, it is not going to happen. We have seen it with so many controversies.

“The most recent one, the ‘Grace’ case, where governance in the HSE seems to be non-existent when it comes to problems being identified. Not only is there no proper governance, the response is to deny and cover up and to denigrate the whistle-blowers.

“It seems to be now that the only way that we can find out about anything in our public service is to have a whistle-blower. Whistle-blowing is soon going to be the institutional method of finding out about something and that’s just completely unacceptable. So we must have governance that is underpinned by legislation.

“We have it in our clinical practice. If we don’t practice to the highest standard, we have to answer to the Medical Council and every doctor in the country is worried about the Medical Council. There is no ‘Medical Council’ for HSE management and I think that has to change.”

Echoing comments made to MI last month by the Chair of the Committee Deputy Róisín Shortall, Dr Harty is convinced the Committee will produce an agreed report by the deadline of 28 April.

“I think there will be all-party agreement on the report. The reason for that is, everybody realises what we are doing at the moment cannot work in the future. It is going to get more unworkable.

“There is an understanding that what we are doing is not sustainable. I think the Committee will have an agreement on the need for a new type of health service.”

Primary care

As has been previously reported, the Committee’s final report is expected to recommend a push towards primary care as the focus of the health service. Unsurprisingly, this is something that a GP like Dr Harty agrees with.

“The evidence is that we are going to have to move from a hospital-centred service to a primary care health service, because we have a changing population in terms of demographics,” he says.

“The hospital system is not going to be able to look after all those people: 99.9 per cent of people’s time is in the community [and] only a fraction of their time is spent in hospital.

“Yet hospitals consume 90 per cent of the budget. Of course, hospital services are absolutely necessary and there are capacity issues in the hospitals that need to be addressed. So we are not trying to in any way divert funds from hospital-based services. What we are saying is that community-based services need to be strengthened and developed to accommodate our chronic illness [patients] and our ageing population.

“If there is a properly resourced primary care service, many of the patients who are ending up in hospital or seeking hospital services can be looked after in the community, taking pressure off the hospital system.”

Brexit

Dr Harty is also heavily involved in the other health-based committee in Leinster House. In his role as Chair of the Oireachtas Committee on Health, many of the big health topics come across his desk.

Earlier this month, Department of Health officials briefed Committee members about ‘Brexit’.

“The Department did assure us they are on top of the situation,” says Dr Harty. “But it’s very difficult to give absolute assurance, because nobody knows what is going to happen with Brexit — whether it is going to be a Brexit with restrictions on freedom of travel, transfer of goods.

“They don’t know. We don’t know. We might find out in a couple of weeks’ time when Article 50 is triggered. They say they are looking at every scenario. That may well be the case. But it’s like having a story with 10 different endings: Which one are you going to choose, which direction is it going to go in?”

Dr Harty says the challenges will not only be with the more obvious all-island based services in rare diseases and other areas — there will also be problems in terms of education. “Irish students going to England, not just for medical education — is there going to be mutual recognition of qualifications? In relation to health services for Irish people living in England, will they still be able to have the same level of service after Brexit? And British citizens living in Ireland, will they still have the same access to health services that they have here [now]?

“There is a lot of uncertainty about how Brexit will affect all that. But it certainly is going to affect it. The problem is how to minimise that.”

New children’s hospital process ‘a mess’

The Co Clare TD has been looking closely at the saga around the largest infrastructural project in the history of the State.

Dr Harty thinks that when the new National Children’s Hospital is finally built, the health community will have to take stock and learn some serious lessons.

”I think the whole governance and whole decision-making process of it will be subject of an investigation in years to come,” he tells MI.

“It’s a complete mess. I think the whole process has been a mess. And that all comes back to [the point that] we need to have legislative governance in relation to how we make decisions in this health service, because expecting good governance without legislation is allowing what happened in relation to the  [new] Children’s Hospital.”

The Committee on Health that he chairs has heard from the National Paediatric Hospital Development Board and opponents of the St James’s site. The Development Board is due to attend the Committee again in the coming weeks to discuss the rising costs of the building.

“There is obviously a premium attached to building it on a brownfield site,” says Dr Harty. “That premium seems to be very large. It could be €300 or €400 million [more] than having it built on a greenfield site.

“That is a huge premium to have to pay for a location in an economy and a health service that is struggling to fund basic services. But I believe that the decision has been made and I don’t think that decision is going to be changed. I think people just want a paediatric hospital now.

“I think there would be immense frustration among medical circles and many parents if the site was to be the subject of discussion again and for it to delay the hospital by several years.”

So despite his concerns about the St James’s site, Dr Harty thinks the time for any big change of plan has passed.

“Whatever you think about the site, the delay has been appalling and now the cost is going to be appalling. My personal preference, if I was to start from scratch, is that a greenfield site would be the best option.

“No matter what you build, whether it is a house or store, in 10 years’ time it will be too small; that is just the way of things. There is room to squeeze in expansion in St James’s but if you have a greenfield site, you can expand north, south, east and west.”

Dr Harty on… the next General Election

“In fact, if we have a General Election tomorrow, I think the result might not be a whole lot different than the one we had. It might be a Fianna Fáil-led minority Government as opposed to a Fine Gael minority Government.”

A new GP contract

“Our graduates that we have now are thinking, ‘is there any point staying?’ So we need a contract that is meant to be a magnet to bring people home and to keep people here.”

IMO and NAGP parity in contract talks

“I am a member of both organisations. I have no axe to grind.  I’ve no interest in any internecine strife between the IMO and the NAGP. I don’t think we are going to get the best contract if only one body is involved in the negotiations and the other representative body has [only] a consultative role. I cannot see the logic in that.”

 

Medicinal cannabis

“There are huge problems around smoking cannabis… Medicinal products, medical extracts from cannabis, that is a different issue. I have a particular interest in making medicinal cannabis products available for patients. That should be pursued.”

 

His independence

“I wouldn’t join a party. I think if you are elected as an Independent TD, that [it] is your responsibility to be an Independent TD.”

 

Hospital Groups

“In the Groups, I think there needs to be equality and fairness so that the smaller hospitals are not starved of funds, compared to the larger hospitals who can dominate the Group.”

 

The new National Children’s Hospital

“I don’t think the decision can be changed, so we just have to get on with it. It is going to cost a lot more than if it had been built on a greenfield site. I think the whole governance and whole decision-making process of that will be subject of an investigation in years to come.”

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