Consultants wary of HSE staff proposal

Hospital consultants have given a lukewarm response to a Health Service Executive (HSE) plan to create additional posts for hospitals that improve their accident and emergency (A&E) performance.

The HSE wants the appointment of 100 additional consultants under its new A&E winter initiative to facilitate significant changes in work practices for senior medical staff in hospitals.

However, the Irish Hospital Consultants Association (IHCA)warned last night that any changes in work practices could only come about as part of an overall agreed deal on a new contract for hospital consultants.

It said any attempt to force through change could lead it to consider its position in relation to the new posts. The IHCA said any proposal to provide more suitable and comfortable facilities for patients was welcome, but it remained sceptical.

The Irish Times revealed yesterday the HSE is to propose the appointment of an additional 100 consultants, on top of normal development funding, for hospitals that meet basic standards in relation to A&E services and which make substantial progress on new enhanced performance targets.

It is understood the HSE will tell hospitals in the days ahead it envisages the new appointments will allow the existing designated on-call consultants to be freed from other scheduled duties.

It will propose that the consultant on call would be able to take responsibility for all in-house patients, including new and existing admissions in their units. The consultants on call would also be responsible for the discharge of patients even admitted originally by another doctor.

The HSE also wants the new appointments to facilitate the provision of daily emergency outpatient clinics in designated specialties, particularly respiratory medicine and cardiology, aimed at reducing the need for patients to present at A&E.

The HSE is expected to suggest that the appointment of the additional 100 senior medical staff could provide for multiple consultant-delivered ward rounds each day including weekends.

The HSE believes the additional appointments could allow consultants on call to be available in A&E departments daily until 10pm. It also believes they could allow GPs have direct access to consultant services, in order to reduce attendance at A&E.

The HSE says the additional appointments could facilitate the provision of enhanced diagnostic services for GPs and services in the community.

The recent Tribal Secta reports on A&E services, commissioned by the HSE, criticised the lack of access of GPs and community services to diagnostic facilities and maintained this was one of the factors leading to over-crowding in A&E departments.

Under the HSE plan, hospitals will have to meet basic criteria before being considered for the new funding.

These include eliminating the practice of patients waiting on trolleys.

To qualify for the new posts, hospitals will also have to make substantial progress towards reaching new exceptional performance targets to be introduced for the winter period.