Consultants’ voices must shape the future of Irish healthcare

Mr Jim Daly, IHCA CEO, argues why consultants need to be at the centre of decision-making and policy-setting to improve standards in patient care

As Ireland’s health service faces another pivotal period of reform, one truth stands out: The future of healthcare cannot be planned, resourced, or delivered without hospital consultants at the centre of the discussion. Consultants are not only senior clinicians; they are leaders of teams, advocates for patients, and custodians of standards of care. Their experience at the frontline of our hospitals provides insights that no strategy document or political aspiration can substitute.

Since taking up my role as CEO of the IHCA, I have seen first-hand the dedication and expertise that consultants bring every day to their hospital or service, often in very challenging environments.

Our hospitals are under sustained pressure. Waiting lists remain high, bed capacity lags behind comparable countries, and the demand for services continues to grow. These challenges cannot be solved by policy or resources alone. They demand collaboration and leadership, with clinicians guiding decisions at every level of the system.

This is why one of my central priorities as CEO is to ensure that the voice of the consultant is not only heard, but acted upon. We as an Association representing consultants are not setting out to be revered or feared, but rather regarded and respected as partners advocating for patients. Consultants need to be at the heart of decision-making and policy-setting when it comes to issues that affect patient care.

Moving beyond adversarial debate

The debate around healthcare in Ireland can sometimes feel combative – management against clinicians, government against professions. That framing is unhelpful. Patients do not benefit when the system is divided.

We need a culture where clinicians and policymakers work together with mutual respect. Consultants seek the tools and authority to do their jobs effectively in a system where governance reflects the realities of clinical care.

That is the position the IHCA is stepping into: As a  constructive partner, offering solutions, championing consultants, and always keeping patients at the centre.

Consultants as leaders

If our consultant leaders are to be accountable, they must also be empowered. It is not enough to have clinical input at the margins of governance. Consultants should be shaping strategy, influencing priorities, and leading change.

The clinical director model was designed with this in mind, but its potential is still to be fully realised. Consultants who take on leadership roles need clear authority, proper resourcing, and support. Otherwise, they are asked to carry accountability without the levers to make real improvements.

The voices we will hear at this year’s Annual Conference from clinical directors across Ireland will remind us that leadership is not an abstract concept. It is about navigating difficult choices, balancing competing needs, and ultimately doing right by patients.

Working together, building trust

The IHCA’s role is to ensure the consultant perspective is heard in these discussions and that it is offered constructively. That means engaging respectfully with Government, the HSE, and wider stakeholders, even when the conversations are challenging.

It also means looking inward and asking how we can better support consultants themselves. Leadership is demanding. Consultants need spaces where they can learn from peers, share challenges, and find encouragement. They need confidence that their Association is fighting their corner, while also helping them to thrive in their roles.

Focus on capacity and access

No conversation about the future of healthcare can avoid the question of physical capacity. Ireland continues to operate with far fewer acute hospital beds than required. The IHCA has welcomed the Acute Hospital Inpatient Bed Capacity Expansion Plan 2024–2031, which aims to open 3,378 new beds by 2031. But the reality is that up to 6,800 additional beds will be needed by 2040, and these must be distributed in line with regional demand.

Intensive care is a particular concern. Ireland has only 330 ICU beds. To meet even the minimum recommended target, this must rise to 579. To reach the Organisation for Economic Co-operation and Development average, it would need to exceed 900. Without this expansion, we will remain vulnerable to surges in demand and unable to provide the standards of care patients rightly expect.

Capacity also depends on theatres and diagnostics. The promised six surgical hubs and four new elective hospitals must be delivered without delay. Ireland’s stock of diagnostic equipment remains well below the European average, creating bottlenecks and adding to waiting times.

Driving efficiency

Building more capacity is only part of the solution. We must also use the resources we have more effectively. That means reforming processes and embracing digital innovation to improve patient flow and outcomes.

A prime example is the roll-out of electronic health records. This is a once-in-a-generation opportunity to transform the patient journey, reduce duplication, and increase efficiency. Consultants know better than anyone how fragmented records and outdated systems slow care and add frustration.

Process reform is equally important. The wider use of criteria-led discharge would help reduce blockages in bed capacity by allowing appropriate patients to be discharged more quickly. This approach is already proving successful in some hospitals and should become the norm.

And innovation has a role to play: Artificial intelligence-assisted triage, digital health services, and other digital tools can support consultants in delivering faster, more accurate care.

Tackling workforce shortages

None of these reforms will succeed without a strong workforce. Consultant numbers remain well below what is required to meet growing demand. Posts are approved too slowly and too many permanent positions remain unfilled.

Recruitment and retention must be a national priority. That means making consultant posts attractive in scope, as well as in reimbursement. Posts that include paired academic time, research opportunities, or service development remits can help attract the best candidates and keep them in the Irish system. The best thing that an employer can do is to give consultants the tools to do their job.

A shared path forward

At the core of these debates lies a simple principle: Improving care for patients is the goal we all share. The question is how best to achieve it. The answer must begin with those who deliver care every day. Consultants understand where the bottlenecks lie, where investment makes the greatest difference, and how reform can work in practice.

The IHCA will continue to make that case, not as a slogan, but as a principle for building a stronger health service. This year’s Annual Conference is not just a gathering; it is a signal of intent. In addition to being advocates for their patients, consultants will be leaders in shaping the system itself. That is how we will move from debate to delivery, from division to collaboration, and from frustration to progress.