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‘A sustainable plan is needed to stabilise recruitment and retention of consultants’

By Mindo - 11th Sep 2019

President of the IHCA Dr Donal O’Hanlon expresses concern about the continued gaps in care experienced in the Irish health service

The Association launched its social media campaign #CareCantWait in June to highlight the unacceptable delays in providing timely, high-quality hospital and mental healthcare which would not be tolerated in any comparable OECD country.  

We are alarmed at the inexorable increase in public hospital waiting lists that have occurred over the last four years. The root causes of our shamefully long waiting lists are a lack of capacity in the health service in terms of hospital beds and diagnostic resources and a lack of permanent consultants in the service.

As we all know and understand, if people are not assessed and their problems addressed quickly, they can often deteriorate, or a serious condition may not be diagnosed in a timely fashion.

We have analysed the figures for various regions and find that for many procedures, a patient’s length of time on the waiting list is a lottery, depending on her or his address.  There are variations in waiting times all over the country, depending on specialty. A critical issue facing the health service is the inability of the public hospitals to recruit sufficient numbers of highly-trained specialists who were willing to make a permanent career as a consultant in Ireland under the present terms and conditions.

We have had a considerable amount of engagement with the political parties and the Government on the critical issues of recruitment and retention of hospital consultants.  At this point, it has become clear to everyone that we have a major recruitment problem but so far, the necessary engagement to resolve it has not happened.

The bed capacity review did plan to increase the number of acute hospital beds by 2,600 over 10 years, but very little additional capacity has been delivered yet. The capital plan published last week does start the process of delivery but will only deliver 60 per cent of this yearly target. In the next few years, I feel it is vital that the increased capacity be delivered and this delivery needs to start happening over the next one-to-two years, given the record numbers treated as inpatients on trolleys, rather than being an aspiration over a 10-year time frame.

These problems are also evident in mental health services, where the shortage of consultants had led to many areas being covered by locums on short-term contracts. These individuals often do a good clinical job but unfortunately, the opportunity for continuity of care over a long period of time is lost to patients attending these mental health services.  This is unsatisfactory for patients and can lead to delays in management of their conditions and is inefficient for the service. In addition, the leadership and strategic guidance of the local consultant in developing the service is lost when a short-term locum leaves.

In many areas of the country, it has become extremely difficult to maintain a consultant presence on mental health teams. This is particularly evident in child and adolescent psychiatry, where some posts have been vacant for over a year. Various temporary arrangements have been put in place to try and provide a minimal service. Meanwhile, the recruitment of our highly-trained new consultants into the mental health service has stalled, due to their perception that they are undervalued and discriminated against in the Irish health service.

Often, many services are having to rely on experienced doctors without higher specialist status and there are concerns that some of this cohort of doctors do not have the comprehensive and wide-ranging training that fully-trained consultants brought to the care of their patients.

The problems in consultant staffing have become a matter of concern to the HSE and we eagerly await the official publication of the Murray report on medical manpower. The consultant staffing crisis is expected to worsen in the next three years, as a further 8 per cent of consultants approach the retirement age of 65. One wonders how they will be replaced, given that one-in-three posts advertised in recent years have not attracted a single qualified applicant.  We currently have 20 per cent of permanent posts which are not filled on a permanent basis. I would be concerned that in a few short years, it may approach 30 per cent — and that is assuming people work to 65, which is not a given and not as common as it used to be.

An even greater concern in the longer term is the fact that many of our graduates are emigrating after they complete their internship. In contrast to the situation in the past, many of these qualified doctors are going abroad without any intention to return home. This is because of the conditions in which they see established consultants working in the Irish health system and they are unwilling to take posts in a service that discriminates against new consultants in terms of pay.

Clearly, a sustainable plan is needed to stabilise recruitment and retention of consultants in the Irish health service, rather than the stop-start initiatives that we have had for the last decade. The essential first step in stabilising consultant manpower is for the Government to restore trust by reintroducing pay parity for more recently-appointed consultants.

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