Changes demanded of consultants make no sense


MINISTER FOR Health James Reilly has controversially and unfairly insisted upon further work practice reforms from medical consultants in addition to immediately reducing newly appointed consultants’ pay by 30 per cent.

In doing so he stated that the people of Ireland demanded and expected the implementation of the proposals regarding consultants set out last month by the Labour Relations Commission.

Rather than unfair unilateral proposals, however, the people of Ireland demand and expect that the Government and Ministers work fairly and effectively to provide value for money. This is not apparent in the Minister’s performance to date.

Changing the work practices of consultants without addressing other more relevant issues within the health service makes no sense. Consultants are an extremely hard-working, dedicated and flexible group.

In my hospital, the absentee rate for medics is 0.4 per cent compared to up to 5 per cent in general in the health service; in other words doctors go to work day and night and at weekends, even when ill. Every day, consultants look after patients in overcrowded clinics until late evening, battle to treat patients in overcrowded emergency departments, struggle to admit patients for elective surgery and fight for their patients to get necessary investigations and treatments.

Every night, consultants are called for advice on critically ill babies or elderly patients, perform emergency life-saving surgery or organ transplant surgery, insert cardiac stents for acute heart attacks or administer clot-busting drugs for stroke.

Every weekend, unpaid and unrostered consultants are in hospitals looking after their patients. This is because doctors take their professional responsibility to their patients seriously and care about their patients. They frequently work way beyond their contracted 37 hours per week.

Furthermore, administrative support is frequently fragmented or non-existent, with many consultants typing letters or reports. We are often asked to write repeated business cases to maintain pressurised services, never mind develop new services to match the many wonderful medical and scientific advances.

If the Minister’s sole purpose is to save money, why is it that all public servants earning over €100,000 per year, including the newly appointed Minister of State for Health, do not also have their salaries cut? I suspect many public servants earning over €100,000, including the much-criticised medical consultants, would accept a salary cut in the interests of the country. However, it seems this Government is unable or unwilling to tackle the “elephant in the room”– the Croke Park agreement.

If the Government had the courage of its convictions, it would look beyond the medical consultant contract and salary by urgently addressing the overall costs of the service.

Bureaucrats outnumber doctors six-to-one and many problems in the health service are due to top-heavy administration and management within the Department of Health and the Health Service Executive.

James Reilly also claims there is a general consensus among consultants that the LRC “deal” was reasonable. This is a baseless statement and there is no such consensus.

It is important to note that the 2008 consultant contract was never honoured and consultants took a 12-15 per cent cut in salary in 2010, with a further cut in 2011 leading to a net paycut of 22-25 per cent (not including the universal social charge or pension levies). The Minister’s proposal to change the contract again and decrease the salary by a further 30 per cent will be the death knell for the academic hospital consultant in Ireland.

Many consultants return to Ireland in their late 30s with 15 years of postgraduate training. They bring international experience and expertise. They will now stay abroad because of the restrictive inward-looking contract and non-competitive salary on offer.

Ireland has already lost Prof Bill Powderly, head of UCD’s medical school, and Prof Dermot Kelleher, dean of medicine at Trinity College, both of whom have well-funded research and international reputations. This pattern is set to continue. In addition to working long hours for the care of their patients, the vast majority of medical consultants educate students, nursing staff and paramedics; act as advocates for their patients; develop programmes and bring research grants to employ doctors and scientists; host international meetings, bringing income into Ireland; promote fundraising; and assist with administration including the developing HSE clinical programmes.

Notably, the Minister for Health has acknowledged that flexible work practices by consultants saved 70,000 bed days and €90 million for the HSE. Encouraging this entrepreneurial spirit is what is needed. This latest iteration of the consultant contract will suffocate it. Consultants remain ultimately responsible for patient care. They, not managers, are sued when things go wrong. This huge responsibility is shouldered by consultants but their authority to ensure patients are safely treated is being eroded. This heralds grim prospects for the health of Irish citizens.

Prof Tim Lynch is a consultant neurologist and is clinical director of the Dublin Neurological Institute at the Mater hospital.

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