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Solving consultant crisis key to improving health service

Dr Gabrielle Colleran outlines the negative impact the consultant recruitment and retention crisis is having across the healthcare system

We stand at the fork in the road: A health system on the brink. Our waiting lists are the longest in the OECD. Approximately, 500,000 people are waiting for a consultant appointment. The Irish hospital system has the lowest number of specialist consultants in the OECD. Some 20 per cent of our posts are empty. If we continue to haemorrhage our talent, if our specialist consultants continue to leave Ireland to go and work permanently in health systems where they will be better valued and experience better training opportunities, pay and conditions than here, we will not be able to meet the challenges of our aging population.

I think Irish people are jaded from the health system. More specifically, I think they are becoming immune to negative stories about trolley numbers and lack of timely access. It has reached a point where some of the public, the politicians and indeed some policymakers think that health is a black hole where good money goes to be badly spent.

We as doctors just can’t accept this point of view. I believe that we, as a nation, can go from where we are now, with the worst waiting lists in the OECD to the best access in a period of seven-to-10 years, with many of the gains in access frontloaded if appropriately funded. To achieve this takes more than GPs, NCHDs and consultants working together. It will take a cohesive collaborative approach between politicians, policymakers, Department of Health, HSE, doctors and all allied medical staff with the patient central and patient impact at the core.

Of course, any discussion of improved access and reversing waiting lists is a moot point unless we see real engagement that tackles the consultant recruitment and retention crisis. With the lowest consultant numbers in Europe being compounded by the 20 per cent empty posts, most consultants spend their time firefighting to mitigate risk for patients. This is not the basis for a standard of high quality care or timely access and it’s a credit to the calibre of consultant practising in Ireland that patient satisfaction with care was 84 per cent last year.

Access is, however, an entirely different story. There just aren’t enough consultants in the system to see patients in a timely fashion. And so elective patients wait. And wait. And wait. Many get worse. Some can buy access to the private sector. However, paediatrics, obstetrics, trauma, stroke, myocardial infarctions, most emergency presentations (especially outside of ‘9-to-5’) rely on a robust public hospital with the staffing and physical capacity to provide timely care.

Our population is aging. Currently, one person in eight is over 65. That drops to one-in-six by 2030. We need to act quickly to stabilise the system, fill the empty posts, and address the waiting lists. Separate from the National Treatment Purchase Fund, we need to look at more insourcing in our public hospitals as risk mitigation until our access approaches a level where 80 per cent of people are seen within six weeks and 97 per cent within three months. These are achievable targets with appropriate investment. It is a given that one of the most basic things that must happen is pay parity for consultants. The unilateral additional 30 per cent cut that was applied to newly-appointed consultants since October 2012 has never been shown to save money. Instead, it has decimated patient access to consultant care and resulted in the current recruitment and retention crisis.

After we show the NCHDs that they will be valued equally to their colleagues if they chose to practice as specialist consultants, where to then? There were lots of valuable insights from the recent Medical Intelligence Workforce Report, which was published by the Irish Medical Council in April 2019. It is clear that all doctors want to work in healthcare systems that work for patients. They want to be part of an excellent system which affords them opportunities to learn, grow, develop, and lead, while also allowing them adequate time for rest, sleep, exercise, and personal activities. This fosters an inclusive, civil, diverse, respectful culture where doctors not only stay, but flourish. It is clear that the consultant shortages with resultant overwork, tight-call rosters, clinical risk, lack of adequate time for research, and teaching and the basics such as enough sleep, exercise, and personal time have a negative impact across the system, including on other staff. NCHDs, being transitory, are particularly vulnerable to bullying and we as consultants and clinical leaders must support them especially, as well as supporting each other.

Our new HSE Director General Mr Paul Reid is just finishing his first week as I submit this article. His success is all our success. As clinicians, we need to rally behind him to help him meet the challenges of what is probably the most demanding job in the Irish public service.

To finish on a positive note, we are training more medical students than anywhere else in the OECD. To quote Dr Rita Doyle, President of the Medical Council, interns are the “jewels in the crown”. That is a great foundation stone to start securing the medical pipeline of NCHDs, GPs and consultants into the future.

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