The country needs to increase significantly the number of medical specialists working in the health system to meet the demands ahead as there are about 250 posts currently fully vacant and “far too many” others filled on a non-permanent basis, the Minister for Health has said.
Addressing the annual conference of the Irish Hospital Consultants Association (IHCA) on Saturday, Stephen Donnelly said he wanted to see an agreement reached "within weeks" on a new Sláintecare contract that would see medical specialists treat only public patients in State hospitals. He said a new contract "had to be concluded" before the end of the year.
He said the key issue for consultants of pay equity for those appointed after autumn 2012 ,when lower salaries for new entrants were introduced, could be considered within the framework of the talks.
The Minister also said the number of people on waiting lists for treatment had been unacceptably high for years and had worsened as a result of the pandemic and the cyber attack on the HSE.
He said urgent action was needed and if success was to be achieved a co-ordinated effort across both the public and private system would be needed.
‘Must do things differently’
“We must do things differently than we have in the past. We must innovate and we must be bold and disruptive in our thinking.”
IHCA president Prof Alan Irvine said it was not a typographical error in letters being sent to parents offering scans for their children in 14 years' time. He said some public hospitals were offering appointments in 2035.
The Minister said the introduction of the public-only contract – which is a key element of the Sláintecare reform programme – would “form an important part of our progress towards universal healthcare”.
He accepted there had been “a rocky start” and ” a bad start” to the talks on a new hospital consultant contract when they began in the early summer.
However, he said he had intervened and listened to the concerns raised by representative bodies and doctors.
“Several issues were dealt with which had caused understandable frustration. And the issue of pay equity can be considered within the framework of the talks.”
The Minister said that achieving universal healthcare in Ireland was "one of the most important projects of our time".
“While getting there is difficult, the concept itself is very simple – timely access to affordable high quality care,” he said.
“We all know that we’re not even close to that right now. Girls and boys, women and men, waiting sometimes years to see a consultant, to wait again to get a scan, to wait again to have a procedure. In one of the wealthiest countries on Earth this is completely unacceptable.”
Prof Susan Smith, a professor in general practice at the Royal College of Surgeons in Ireland (RSCI) said while discussions around Sláintecare had been focused on contracts, the reforms were about providing “access to universal healthcare”.
Prof Smith, who is also a General Practitioner in Inchicore, Dublin 8, said she “hopes” the planned reforms survived the current setbacks. “I hope that they can sort out the challenges that are being faced, I strongly believe it will just take political will to make this happen,” she said.
Strategy after strategy
Mr Donnelly said that as part of the Government’s plans for investing in clinical quality he wanted to move away from “from the chronic implementation deficit disorder that has often blighted our health service”.
He said this involved in the past unveiling strategy after strategy but not funding them.
The Minister said significant sums had been provided this year to implement various development strategies in areas such as cancer and maternity which had been under-funded for years.
The Minister said Ireland fared poorly in providing timely access to care which was another another key element of universal healthcare.
He said work was under way to modernise and add permanent capacity to the country’s public health system as well as tackling waiting lists.
Mr Donnelly said he had secured Government agreement to add an additional 117 additional critical care beds, bringing the national total to 446 beds.
He said he wanted to develop new critical care facilities at five prioritised sites - Beaumont, St James's, the Mater, St Vincent's University and Cork University Hospital - to incorporate new and existing capacity.
Mr Donnelly said there were 6,000 more permanent staff working in the health service than there were in summer last year including 1,400 more nurses and midwives and 1,200 health and social care professionals.
However he acknowledged there were “significant recruitment and retention issues in respect of consultants, particularly in certain specialties and locations”.
He said progress was being made “but it is not happening as quickly as I would like”.
“In the past five years over 700 additional consultant posts have been filled, with just over half of that in the past two years. While some of these were permanent hires, many were also fixed term or specified purpose contracts.
“A significant proportion of consultant posts have been filled on this basis for many years, though the level has increased. Data from the HSE indicates that approximately 250 posts are not filled.”
Prof Irvine said the pay equality issue was a core element for the IHCA in the negotiations with the Department of Health. He said there was a direct line between vacant posts and waiting lists.
Backs to the wall
He said 18 months after the start of the pandemic healthcare staff still had their backs to the wall. He said waiting lists were growing and the number of vacant consultant posts increasing. He said “reform had been usurped by resignations” and it appeared that “the centre seemed unwilling to loosen its grip”.
The conference heard that hospital staff were presenting with increased stress as a result of “enduring” the last 18 months of the Covid-19 pandemic.
Prof Colette Cowan, chief executive of University Limerick Hospitals Group (ULHG), said healthcare staff were “very aware that winter was coming”, but added hospitals “would manage through it as we always do”.
At present hospital staff were “usually in a state of permanent white water,” trying to balance competing demands, she told those present.
Prof Cowan said terms and working conditions for consultants were “as important” as salary, when it came to recruiting and retaining specialists.
