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Without meaningful engagement from health management on a new consultant contract, the experiences, sacrifices and learnings of the past year will have been squandered
It has been a long and difficult year, not least for those of us in healthcare. We are not clear of the pandemic yet – and will not be for some time – with the impact of the Delta variant to play out this summer and into autumn. But there is now a renewed focus on ‘life after Covid’ as our society cautiously re-opens and the Government moves towards a fresh budgetary year.
A simple return to ‘normal’ will not do. Forward planning is critical for Ireland’s health system; so, we need to build back and beyond to create a well-resourced, infrastructurally sound healthcare system that guarantees the prompt provision of cutting-edge treatment. A system that is ready for the next crisis, whether the attack is microbial or cyber in nature.
Tánaiste Leo Varadkar has signalled that the €4 billion in additional spending given to the health service to fight the pandemic should be retained permanently. This is potentially good news, but only if this investment is channelled effectively and sustainably.
Almost one million patients are on waiting lists and one-in-five permanent consultant posts remain unfilled. On top of that, the health service has been deeply affected by the blows of the pandemic and the recent cyberattack. It is now or never if we are to rebuild our health system in a sustainable way that delivers for our patients.
Fundamental to this is a solutions-oriented approach that takes account of reality. The recruitment and retention of hospital consultants remains an overwhelming blockage in the way of timely patient care.
The disastrous consequences of the 2012 decision to impose inequity on consultants taking up contracts remain. Growing pressures are pushing consultants and public hospitals to breaking point. Chronic consultant understaffing impedes innovation and progress, meaning patients, and the professionals eager to help them, lose out. That is why the current ongoing negotiations with the Department of Health and HSE on a draft proposed consultant contract are pivotal.
These negotiations, if properly structured, provide an opportunity to tackle long-standing challenges. If the parties do not grasp this opportunity at this crucial moment, the experiences, sacrifices, and learnings of the past year will have been squandered.
The response from consultant colleagues both at home and abroad shows just how important this moment is. Many have shared stories online explaining why they took the decision to leave Ireland and work in other health systems. They point towards the contractual conditions in Ireland and the resulting poorer working conditions due to vacancies and understaffed consultant teams they faced delivering hospital services in this country.
Prof Anne Doherty, a psychiatry colleague here in Ireland, very aptly described the issue recently: “The problem [in psychiatry], like with every other area of medicine, is that doctors go to other English-speaking countries, and because their services are functioning better than ours, it’s very difficult for them to decide to come home to Ireland to make the very difficult choices of who gets that one mental health bed when you have four who need it.”
This to me sums up the core of the moral injury inflicted on so many of us in the setting of ongoing capacity deficits: Trained to heal, but appointed to ration. For many of those either currently living or planning to move abroad, the decision is not an easy one.
Having trained for many years in Ireland, with a desire to work and care for Irish patients, the sense of having little choice but to leave for the benefit of not only one’s career, but also one’s family life and personal wellbeing, is difficult to reconcile. It is clear that predecessors of the current Minister for Health reneged on prior promises and failed to build trust with us. Many understandably believe Government cannot be trusted again.
So what do we do?
A fresh approach, intent on working with us in partnership to resolve the layered challenges we jointly face, can only come from collaborative working. Without this change how many more consultants will have to face that difficult decision to stay away?
Patient access, consultant recruitment and retention, public faith in the Department of Health’s effectiveness have all been damaged due to the lost decade in healthcare from the ongoing fallout from the breach of the 2008 contract. Can any of us afford to lose another decade?
The team approach during Covid-19 showed how effective we are when we work together with a shared purpose.
Gender disparity is often an uncomfortable topic to discuss. But it would be remiss of me not to highlight that the future consultant body will rely on a predominantly female workforce. Uncomfortable or not, we all have a responsibility, and the Government have a legal requirement, to consider the impact of any proposed terms on gender equality.
Younger female colleagues will shoulder the harder burden. It is they who will disproportionately bear the load of:
• Restricted practice limits;
• Extended rostered hours;
• Variable working patterns
As the pandemic highlighted all too clearly, women disproportionately shoulder the work of care in the home, be it children or caring for elderly relatives. The proposed contract pushes towards an untenable work/life balance.
All our consultant doctors should feel valued, respected, and professionally fulfilled, but the new proposal is simply a recipe for burnout. The contracts must take account of this demographic reality, including what it means for individual medical professionals and the people they treat.
Unlike the 2008 contract, where 80 per cent of existing consultants switched to the new contract, we know through consultation with members that this will not be repeated and in fact they are more likely to be driven into the independent sector, abroad or away from the profession.
The Minister, his Department, and health service management dictate those working conditions for us as consultants, we who provide critical services and have proven our worth during the global pandemic. Yet, these officials wouldn’t accept the conditions themselves or propose them to other civil or public service-wide officials and their unions.
It is prudent for all of us to ask why they propose such terms for hospital consultants. With 20 per cent of permanent posts vacant, and against the backdrop of severe global shortages in the aftermath of the pandemic, the proposals are the antithesis of what is required in hospital medicine to address the challenges and fill those much-needed posts.
While the contracts are not a silver bullet to Ireland’s hospital consultant crisis, they are an essential part of the solution to create a meaningful and constructive framework that addresses some of the key issues at the core of our health system today.
Those working abroad are a clear demonstration of how valuing expertise and input on medical and surgical healthcare policy and recruitment matters can generate an environment of cooperation and result in the retention of highly-trained specialists. These are people who have gone the extra mile time and time again – and will continue to do so.
This is the mindset we need to see from our Minister, Department and health service management if we are going to train, attract, and retain the specialists needed to tackle our massive backlogs and deliver high-quality, timely access to care for our patients.
The HSE has determined that to meet projected patient demand, we will need to rapidly increase consultant capacity across most specialties. Across all medical specialties, excluding public health and psychiatry, there is a need for an increase of 42 per cent, or 3,068 additional consultants, by 2028.
The conditions we provide for consultants will be key to helping meet this need. The recruitment and practice problems that the current proposed contract changes will give rise to, if not adjusted in the negotiations, are numerous.
If we are to find workable agreed solutions, these negotiations must be open, well-structured, and held fairly and transparently.
To drive this goal, the IHCA has proposed the appointment of a retired High Court judge to lead the negotiations. Such an appointment, agreed between negotiating parties, is a proven model. Moving promptly to appoint such an independent chair will lend to constructive, professionally chaired engagement, thereby enhancing the prospects of a meaningful outcome.
In my role as Vice President of the IHCA, I have been involved in these talks from the beginning. I am determined to ensure these negotiations create a pathway to engage with the Government and health service management on the issues and challenges that consultants and patients have jointly faced for years.
Our current situation demands no less.