Cash injection planned for health service, but changes will take time

Will it happen? Will we really be able to pop into the hospital for an out-patient appointment at 7 a.m

Will it happen? Will we really be able to pop into the hospital for an out-patient appointment at 7 a.m. on the way to work or at 7 p.m. on the way home?

Will the first doctor we see be a consultant, even if it's late and we're a public patient? Will the non-consultant hospital doctors (NCHDs) be fresh and rested, working a mere 48 hours a week?

Yesterday's announcement from the Government that talks can start on implementing the report of the Medical Manpower Forum holds out the prospect of some of these changes taking place gradually over the coming 10 years.

They should result in a better quality of service for hospital patients, who will be seen by fully-trained doctors. It also offers the prospect of out-patient clinics at more user-friendly times if, and it's a big if, hospitals can be weaned off giving lots of people the same appointment for the same doctor at the same time on the same day.

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The cost of providing this new, better service could be enormous. An extra consultant, including back-up staff, equipment, theatre work and so on, costs from £400,000 to £800,000 a year depending on whether you're getting the figure from the Irish Hospital Consultants' Association or the Department of Health and Children.

Multiply either of those figures by 1,000, which is the number of extra consultants the Irish Medical Organisation and the IHCA believe are needed, and the annual cost looks extremely high.

There is not a lot a consultant can do at 7 a.m. without administrative staff, nurses, NCHDs, radiographers, care assistants, porters and all the other people who go to make up a hospital service. This will also carry a cost.

There are other considerations.

To cover a particular post 24 hours a day, seven days a week, could require as many as five consultants, taking holidays and other contingencies into account.

Another difficulty is that a big increase in consultant numbers means more people competing for the same amount of private work. Indeed, if the public hospital service improves it could mean more people competing for less private work. This is likely to be on the minds of consultants at pay negotiations.

There is a hard road to be travelled by negotiators before the changes recommended by the forum are implemented.

That said, we can be fairly sure that our hospital services will move, slowly or otherwise, in the direction outlined by the forum. This is for two reasons, at least.

First, NCHDs will simply not tolerate a failure to move to the shorter working week demanded by the EU. Replacing them with increasing numbers of NCHDs may not be an option, with, for instance, Britain's National Health Service creating thousands of consultant posts which would attract frustrated "junior" doctors. Creating the extra consultant posts here may be the only way to retain doctors of quality in the system.

Second, the Medical Council has set itself on a course of improving the quality of training offered to NCHDs in Irish hospitals. It is clear that in many cases they are being used almost solely as a source of labour.

The Medical Council has begun to withdraw recognition for training purposes from some departments in some hospitals, and this is likely to continue. To keep recognition, and to keep attracting NCHDs, the system will need more consultants to be able to do the training and treat patients at the same time.

There is, however, one other ingredient needed to make it all work: beds. To appoint a consultant without giving him or her beds to put patients in is pointless unless we mean to extend the queues in the emergency departments.

A report on bed numbers is being prepared, and the Minister, Mr Martin, has suggested that about 2,000 more are needed in the system.

pomorain@irish-times.ie