The need to value and respect our consultant workforce

Irish Medical Organisation, Annual General Meeting, Aviva Stadium, 28 May 2022.

Chair of the IMO consultant committee and incoming President Dr Clive Kilgallen outlines how the medical profession have been let down by successive Governments.

Covid-19 brought into sharp focus all the issues which, for over a decade, we in the IMO have been advocating for: The urgent need for significantly improved bed capacity and infrastructure; the crisis in medical workforce recruitment and retention; and the inherent dangers of longer and longer waiting lists.

Throughout this time, our proposals have been falling on deaf ears and we now are living with the consequences of misguided cuts to health budgets, the implementation of inequitably and inherently unfair pay policy for consultants and no serious sustainable effort to tackle the effects of a decade of underfunding. 

Political decisions have left our health service in a perilous state with a demoralised, overworked, and burnt-out workforce. Covid-19 and the HSE cyberattack have been devastating, presenting many challenges, which have taken their toll on the professional and personal lives of our members.

However, Covid did not make the political decisions that have brought us to this point. 

We can and must do better. This requires political will to even make a start on addressing the problems. No single contract can resolve the problems that beset our service, but a contract can, at least, be designed to retain and attract much needed consultants into our public health services.

Other jurisdictions are spectacularly successful at recruiting Irish consultants – why? Because they value, respect, support and enable them to have fulfilling careers. Successive Governments here, on the other hand, seem to adopt a position that consultants are the enemy and an obstacle.

Nothing could be further from the truth. Consultants have for many, many years advocated strongly for a first-class health service that delivers timely care to patients, for a service that actively enables consultants to be leaders in delivering care. Yet any solutions we propose are, at best, met with lip service. 

We now have more than 850 vacant posts. As the HSE recruitment struggles continue, what hope do we have of delivering upon the additional 2,000 consultants that will be required over the next five years. This crisis in our consultant workforce is a direct result of the unilateral 30 per cent pay cut imposed on our colleagues in 2012.

The inevitable consequences, which were entirely predictable, are dangerously high waiting lists, which now sit above 1.3 million; a service that is incapable of delivering timely care; and a workforce that has no trust in Government or confidence that anything will change for the better. 

It is, therefore, all the more unbelievable that the Government would produce a draft consultant contract that further exacerbated the problems and has been met with an overwhelmingly negative response from both consultants and trainees.

Not only are those consultants and trainees who are currently working in Ireland opposed to so many aspects of the proposals, but those working abroad have clearly indicated that they would not return on the basis of this draft contract. 

As always, the IMO is willing to engage with the Department of Health and the HSE on developing a contract that is capable of delivering a solution to recruitment issues, capable of enabling consultants to do their job and develop skills and capable of being implemented in a fair and equitable manner.

On behalf of consultants, we proactively engaged and proposed workable solutions to address the crisis and right the wrong that was imposed on our colleagues who took up consultant posts after October 2012. While those negotiations were suspended due to the departure of the independent Chair, it is very disappointing that the process has not restarted to date. 

However, in the meantime, the Government decided to further disrespect and potentially breach current agreements. The restoration of hours imposed during austerity is a key feature of the current public service agreement Building Momentum and we are appalled that any move would be made to exclude consultants from this process.

Consultants are already working significantly over and above their contracted hours and this is simply not acceptable. Similarly recent indications from Government that consultants may not be paid their contractual and legitimate final FEMPI restoration payment in July 2022 is yet another example of not honouring agreements already reached. We must be able to trust that agreements reached will be honoured. 

Reaching agreements and breaking those agreements have become an all too familiar response by Government and the HSE. We see the same happening to our NCHD colleagues, the very doctors we are depending on to keep the service going now and to be the consultants and medical leaders of the future. As consultants we are fully behind their campaign #StandingUp4NCHDs. 

Let there be no doubt that we are with them in this fight. Many of the current cohort of consultants engaged in industrial action as NCHDs; we know their struggles and it is more than disappointing to see it all happening again.

Our NCHDs look at our own working conditions and our own contract issues. Is it any wonder they choose to leave rather than pursue a consultant career here in Ireland? Will the Government never learn? 

You have to treat your employees with dignity and respect, honour agreements, allow them to do their jobs, and listen to them.