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‘The most significant opportunity is to fully staff our consultant teams by restoring parity for new consultants’

Secretary General of the IHCA Mr Martin Varley outlines the capacity deficits in the health service and what the Association’s  #CareCantWait campaign aims to achieve

Our hospital services are in a state of crisis because we have so many vacant consultant posts, insufficient bed capacity and a lack of other facilities. These factors have resulted in delayed care for an estimated one million people who currently are on a myriad of waiting lists. It is widely acknowledged that delayed care results in poorer outcomes, longer, more costly hospital lengths-of-stay and unnecessary suffering and stress for patients.

NTPF waiting lists had more than 564,000 people awaiting an outpatient appointment with a consultant in July. This is the highest number on record. It represents an increase of 48,000 (9.4 per cent) since the start of the year and an increase of over 200,000 in the past five years. Inpatient and day case waiting lists for surgery totalled over 68,000 at the end of July, 54 per cent more than the same month in 2012.  The cost of NTPF outsourcing, an attempt to contain the growing waiting lists, which are at record levels, has increased by over €75 million in recent years.

Medical agency costs have increased by €57 million per annum, more than a two-fold increase, compared with 2012, when then Health Minister James Reilly imposed the unilateral salary cut on new consultants. In addition, the cost of State Claims Agency adverse outcome payments increased by €184 million between 2013 and 2018. It is clear that the large number of unfilled permanent consultant posts and the extremely overstretched acute hospital situation are contributing to adverse patient outcomes due to delays in treatment and longer waiting lists.

Based on the above facts, it is abundantly clear, without the need for a detailed in-depth cost-benefit analysis, that the Government has been implementing a failed policy in discriminating against new consultants since 2012. It is a false economy, not just financially, but also from the perspective of patient care and acute hospital service delivery.

The IHCA is convinced that the restoration of pay parity for new consultants, to ensure that we can fill all our permanent posts, will be better than cost-neutral when a full analysis of patient benefits and the savings are taken into account.

The Association has been highlighting the critical capacity problems that have pertained in our hospitals for years; the inability of our hospitals to recruit and retain consultants; the lack of beds and other facilities; and the knock-on delays in providing timely care to patients.

Around one-fifth of our permanent consultant posts are vacant or filled on a temporary basis. Our hospitals can ill afford to have around 500 permanent posts unfilled, especially as the country has 42 per cent fewer consultants than the EU average.

The Public Service Pay Commission reported to Minister Paschal Donohoe in September 2018, confirming that there is a general difficulty in recruiting consultants and that the settlement of the 2008 consultant contract High Court cases had exacerbated the inequitable pay differential.  The report recommended that the Government should resolve the pay inequity issue for all new consultants appointed since 2012.

The root cause of the high number of consultant vacancies is the failure of Government to restore pay parity for new consultants appointed since October 2012, despite the recommendations in the Public Service Pay Commission report.

The number of patients treated on trolleys will remain unacceptably high until consultant staff levels are increased and additional hospital beds are opened.  These fundamental capacity deficits are the key causes of the overcrowding and delays in providing care to patients.

There is a clear requirement to accelerate the commissioning plan to urgently put in place the 2,600 additional acute hospital beds committed to in last year’s Government National Development Plan.

The mid-year Medical Council report, Your Training Counts, confirmed that Government policy towards new-entrant consultants was driving our highly-trained doctors and consultants abroad. About three-quarters of the respondents to the Medical Council survey who said they were considering practising medicine abroad confirmed they were doing so because of the discriminatory salary terms in Ireland.

In conclusion, opportunities exist on a number of fronts to improve the delivery of acute care throughout our hospitals but there is an unacceptable complacency at Government level to put the obvious solutions in place. The most significant opportunity is to fully staff our consultant teams by restoring parity for new consultants. Without this, the vacancies and waiting lists will continue to grow to the detriment of patients and hospital services.

Since early June, the Association’s #CareCantWait campaign has been continuously and effectively highlighting the unending examples of patient care concerns that exist. This is essential to ensure that the adverse consequences are made public on a continuous basis, thereby ensuring the political imperative to have the problems resolved. The Government’s complacency to date and its failure to resolve the deteriorating consultant recruitment crisis is progressively destroying the basic fabric of our acute hospital services.

The Association and its consultant members will continue to build on the momentum of the #CareCantWait campaign and related publicity by continuing to highlight the adverse impact on patient care of the vacancies and under-resourcing so that they are resolved. Consultants and doctors are required by the Medical Council Guide to Professional Conduct and Ethics to advocate externally and publicly in such cases. This is essential because the Government is continuing to ignore these significant problems. Now is the time to act before irreparable damage is done to all public hospital and mental health services and the care they provide to patients now and in the future. The IHCA is ready to engage to resolve the problems with the Government, relevant Ministers and officials and this must happen sooner rather than later.

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