Q: When is a plan not a plan? A: When the HSE is in charge of it
NOBODY believes that winter services in our hospitals will improve despite pledges
THE Health Service Executive’s plans to address the chronic shortage of hospital consultants were dismissed as ‘fantasy stuff’ this weekend as health chiefs were accused of laying out impossible recruitment targets.
The criticism comes amid growing fears that the lack of consultants will seriously hamper our hospitals’ ability to cope with a socalled ‘twin-demic’ of flu and Covid cases this winter.
The plan was criticised for, among other things, its suggestion that 51 new emergency department (ED) consultants will be hired, when recruitment takes at least 40 weeks by the admission of the HSE’s own National Director of the Acute Hospitals Division, Liam Woods.
And the HSE was also not able to say how many consultants have been hired in total since last year’s winter plan was published.
Retired consultant obstetrician, Dr Peter Boylan, warned the shortage of consultants – around 900 in total – will get worse without significant changes.
He said under-pressure GPs can’t get appointments for their patients because of the shortage of consultants and general hospitals, and the system goes ‘round and round in circles’.
Speaking to the Irish Mail on Sunday, Dr Boylan said: ‘A lot of these announcements [such as the winter plan] are complete fantasy stuff. There are announcements and then there are re-announcements, and consultants are just fed up and the non-consultant doctors are voting with their feet and voting with their air tickets, to Australia in particular.’
The Australian government launched a billboard campaign in Ireland this week encouraging Irish healthcare workers to make the move.
To address the shortfall, Dr Boylan called for the abolishment of the 30% pay cut for new consultin ants introduced 10 years ago, and better working conditions.
He said: ‘Consultants come back here from abroad, from world class institutions – a surgeon, say. And they find that they don’t have an operating list, they don’t have an office, they don’t have a secretary, and they’re kind of squeezed into a clinic.’
Echoing Dr Boylan’s criticisms, Social Democrats co-leader Róisín Shortall said the health system is ‘characterised by an endemic failure to plan’.
‘This is the key cause of the current debacle,’ she told the MoS.
‘There is no sense of urgency to deal with the scenario where consultants cannot be hired because working conditions are dire.’
Deputy Shortall said there is no planning to make sure there are enough consultants coming into the system, with doctors opting for a better work-life balance abroad.
She called for ‘far greater urgency at the top’ and said there needs to be a ‘move away from reviews and short-termism’.
‘They don’t need to reinvent the wheel, just create the sort of worklife balance where people want to stay,’ she added.
‘Extra money is consistently being provided but it can’t be spent because there are no staff.
‘That is the biggest problem facing the service.’
Professor Rob Landers, president of the Irish Hospital Consultants’ Association (IHCA), said the pledge to hire 51 ED consultants ‘will have no impact given the current average timeline of over 500 days to recruit a consultant’.
‘This means if any candidates are found, they may not even be in post to deliver on next year’s winter plan,’ Prof. Landers told the MoS.
He said the existing consultant shortage and the deficit of acute hospital beds means the current winter plan is ‘unlikely to make inroads in delivering the significant numbers required of both of these resources in the immediate period’.
The IHCA president added: ‘Record levels of emergency department [overcrowding] over the summer could get significantly worse as we face into a potential ‘twin-demic’ of flu combined with further expected Covid cases.’
And he said the 40% fewer consultants per capita in Ireland than the EU average was ‘the direct result of years of underinvestment our public hospitals and ongoing unsatisfactory working and contractual conditions’.
The HSE’s winter plan acknowledged ‘recruitment limitations’ and said the extra ED consultant posts ‘will be filled initially with locum [temporary] consultants to ensure full impact over the winter period’.
However, Professor Ronan Collins, a geriatrician at Tallaght University Hospital and the clinical lead of the Irish National Stroke Programme, questioned the feasibility of that strategy.
‘Even if they go looking for temporary or locum consultants, the doctors aren’t there,’ he said.
According to Prof.
Collins, he had been told he would get temporary help at his Tallaght clinic so he could focus on his national role, but it still hasn’t come.
‘I’ve been doing both jobs for the last two years,’ he revealed.
‘The money is there but the doctors aren’t. It’s been advertised several times and there’s nobody there. And that’s in a discipline which is probably easier to hire to than emergency medicine. So I’m very confident when I say that the doctors aren’t there.
‘There may be some doctors around locally who would come out of retirement or do locum but there’s not a lot of them there from my own experience. There’s a genuine shortage in terms of doctors at the moment.’
Labour health spokesperson Duncan Smith said it has become ‘increasingly clear as the coronavirus fog lifts, that we have a fundamental problem in recruitment to the HSE at every level from nurses to consultants’.
The Fingal TD said that while consultants’ pay seems ‘extraordinarily high’ to lay people, doctors can find higher salaries abroad and ‘the market dictates’.
Mr Smith told the MoS: ‘There is an utter lack of forward planning. Only that explains why we need a winter plan every year when what we actually need is a summer plan that works.
‘There is a culture of management, political and bureaucratic, that is not working. It requires fundamental change.’
Although the HSE could not tell the MoS how many consultants have been hired in the last year, it insisted its 2.5 year plan to hire 84 consultants in public health – the field that deals with disease prevention at a societal level – is on track. It said 32 of a targeted 34 public health consultants had been hired by the end of June, and that the next phase of recruitment is ‘in development’.
As these consultancy positions are newly created, many will have been filled by public health specialists already within the HSE, but are now in a higher pay band.
‘Consultants are just fed up’
‘The money is there but the doctors aren’t’