Consultants are being asked to manage their colleagues without the authority or resources to do it effectively under the Sláintecare contract, a medical conference has heard.
Dr Ike Okafor told the Irish Hospital Consultants’ Association event in Kilkenny his experience of the clinical director role, intended to be a key one in the reformed public hospital structure, is that he had no power to sanction doctors and no budget to shape the environment in which they work.
“So I find the role has limited power, limited authority, it’s just about your ability to persuade people to do things,” he said, adding because “you have no budgetary or financial control, you don’t have the ability to manage risks in any meaningful way”.
Dr Okafor, a consultant in emergency medicine based at Temple Street, has been the clinical director at Children’s Health Ireland since January 2022.
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The role makes him the line manager for 130 consultants, while his section also includes 150 non-consultant hospital doctors (NCHDs). Dr Okafor said in instances where he felt disciplinary action was required, his only option was to lodge a complaint with more senior hospital managers.
Dr Amanda Burke, the national clinical lead for Camhs and youth mental health, was more positive about the role, but suggested clinical directors should have more strategic authority.
She raised issues, however, about the potential of disruption to structures in some mental health services as a result of the establishment of the HSE’s new regional structure. This, she said, “risks fragmenting governance, weakening accountability and undermining quality and safety”.
Speaking at the same event, Department of Health secretary general Robert Watt said Cabinet approval to proceed with the project to digitise the country’s health records will be sought by the Minister for Health over the coming weeks.
He said the new system would be a key element in changing the way the health system operates, making it more efficient, helping patients to be seen faster and improving outcomes.
“Demand for services is currently increasing at 3 to 4 per cent a year,” he said. “If it stayed at 4 per cent, in 18 years demand would have doubled, if it is 3 per cent it would be 24 years. But that’s not possible. We aren’t going to have 600,000 people or a budget of €50 billion or €55 billion. So we have to work differently.”
In the wake of suggestions by the Minister for Health Jennifer Carroll MacNeill, who did not attend the conference, that consultants need to be more productive, and comments by IHCA president Prof Gabrielle Colleran that they could only be expected to deliver the expected level of care when they had access to the required resources, he said he accepted the issue was a collective one.
But, he said, “we need to embrace change faster. We need to use data more efficiently. We need to use technology in a way that improves the patient experience.”
