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The failure to invest in essential acute hospital services and the blatant breach of the 2008 Consultants Contract combined with the persistent discrimination against new-entrant consultants have seriously undermined the capacity of our acute hospital services.
They represent serious mistakes by the State, which will adversely impact on services for decades to come unless rectified.
Overwhelming capacity deficits
The Association has repeatedly highlighted the extreme capacity deficits in our acute hospital services. The Capacity Review and the National Development Plan (NDP), published earlier this year, acknowledged the deficits, but there is a lack of urgency in addressing them.
The NDP provides €10.9 billion in funding for capacity expansion between 2018 and 2027, including an additional 2,600 acute hospital beds and 4,500 long-stay beds. The replacement of equipment and the extension of facilities have also been funded in the Plan.
Mr Martin Varley
The more recently published Sláintecare Implementation Strategy is less specific and over a longer time period. Neither document contains the required commitments on when the much-needed beds will be provided. This is a major concern as the unacceptable number of patients being treated on trolleys and the growing waiting lists confirm that the additional beds are absolutely required without delay. Similar problems exist concerning ICU beds. The HSE Prospectus Report in 2009 recommended a 45 per cent increase by 2010 and doubling by 2020. Today we have fewer ICU beds than in 2009.
Ireland’s acute hospital capacity is significantly below the EU average, therefore if the State fails to increase the capacity urgently, it will be condemning the population to ever-deteriorating acute hospital services. This, after decades of insufficient capital funding, would be irresponsible in the extreme.
Recruitment and retention crisis
The State has driven and continues to drive highly trained specialists abroad to work in health services where they are valued, where they are not discriminated against, and where they are provided with facilities to treat patients. The result is a prolonged and deepening consultant recruitment and retention crisis.
The fact that about 700 IHCA members had to take High Court proceedings to vindicate their contractual rights highlights the State’s disregard for them. The High Court settlement in June is an important and essential development, but it does not represent the full solution.
Our hospitals are increasingly uncompetitive in recruiting and retaining the number of consultants required. They are in a serious crisis with nearly 20 per cent of the permanent consultant posts vacant or filled on a temporary basis through agencies and otherwise. The State’s discrimination against new consultants is preventing the filling of over 500 permanent consultant posts. On a population basis, Ireland has one of the lowest numbers of hospital consultants in the OECD, at approximately half the OECD average. It is clear that the Irish population and patients can ill afford to have nearly 20 per cent of the approved permanent consultant posts unfilled. This represents a false economy from both financial and patient care perspectives, with steeply increasing waiting lists due to a shortage of consultants and growing medical agency costs which exceed €100 million per annum.
Over the past three years the health service has failed to fill up to one-third of the consultant posts advertised by the Public Appointments Service. During those three years, 39 advertised hospital consultant posts received no applicants and a further 153 received only between one and two applicants. This is having a severe impact on practically all medical and surgical specialties and hospitals throughout the country. Unfilled posts in 2017 include the following: Medicine (9), psychiatry (9), obstetrics /gynaecology (4), geriatrics (3), emergency medicine (3), pathology (4), radiology (3), paediatrics (2), and gastroenterology (2).
These developments contrast sharply with the situation that pertained prior to 2008. Any employer knows that you will no longer be an employer of choice if you breach contract terms and discriminate against new appointees. It is unacceptable that the State, of all employers, has persisted with such behaviour.
It is illogical that the State continues to perpetuate extreme levels of discrimination against new-entrant consultants given the growing number of vacant consultant posts and increasing patient demand for care. There is up to a 57 per cent salary differential between newly-appointed consultants and their colleagues appointed prior to October 2012. This discrimination must be ended without delay if our health service is to attract back highly trained specialists who have gone abroad. This is especially relevant as hospitals are paying agency doctors up to three times the salary they are paying new-entrant consultants.
Furthermore, it is of even greater concern that approximately 80 such doctors who have been appointed since March 2008 to temporary consultant posts are not on the Medical Council specialist register and, therefore, are not in a position to practise as specialists. This is a basic requirement to be appointed to a consultant post.
Given the improving economic situation, there is an opportunity and a pressing need for the State to end the discrimination against new-entrant consultants and fill the vacant posts. This makes sense on every level.