Consultants and accountability

Sir, – With regard to the Prime Time report on the unacceptable performance of some medical consultants, I was not surprised by the findings, although the extent of the practice was alarming.

At one level it reflects yet again the poor moral compass of a sizeable few when it comes to professional behaviour, whether it is among our doctors, bankers, lawyers, gardaí, politicians or whoever.

It also seems that we are unable to police ourselves very effectively, perhaps as a result of being a small, contained country with relatively close-knit communities.

Calling out a colleague or whistleblowing, whether it is done by a working colleague or an administrator, does not happen without its social and personal consequences, as we have seen.


In these circumstances, self-regulation on its own is inadequate. It requires proper governance structures, oversight and accountability – sadly more bureaucracy to monitor staff performance rather than, as would better be the case in healthcare, monitoring better patient outcomes.

Recently I was asked to chair a committee of the HSE to try to meet the very real challenges of, and better regulate, the recruitment, appointment and retention of medical consultants.

The consultant contract and salaries were not part of the brief, although they are real issues that need to be addressed, particularly in terms of equity.

Instead we looked at the whole consultant appointment journey right from the time a hospital applied to appoint a consultant, through to the recruitment, appointment and subsequent management of that consultant. There can be no question that appointment practices heretofore had been shoddy, to say the least. It was not unusual that consultant applications by hospitals had not been carefully thought through.

It was also not unheard of for a new consultant appointee to arrive at his or her new post without any planning for their access to specialist sessions or the support staff they required.

For example, a surgeon might arrive with no operating theatre access. This kind of practice has created antipathy between consultants and management and hardly fosters institutional loyalty, giving, perhaps, one of the motives to escape to an alternative and better working environment.

I believe the committee has put in place a much better structure, with 38 clearly defined recommendations, agreed in principle by the unions.

Regarding the present behavioural controversy, the committee strongly advocated the need for a robust appraisals process whereby a hospital, its administrators or clinical directors assess the performance of consultants, at intervals, against their job description.

This is a two-way process in that it also allows consultants to hold hospitals to account if they have insufficient support to carry out their job as described.

Introducing appraisal will not be popular but it is common practice internationally and many of those in other businesses will be very surprised that it is not already an established part of our own regulatory process.

It is incumbent for the HSE to make these changes and for hospital management and clinical directors to be empowered to institute these processes.

Then the next question arises – quis custodiet ipsos custodies – who guards the guards themselves? This too needs to be done better. – Yours, etc,


(Retired Consultant

Surgeon and Former

President RCSI),

Bray, Co Wicklow.

Sir, – I wholeheartedly support any efforts to highlight deficiencies in health service provision and attempts to tackle them in a positive way.

In the interests of balance, I wonder is the Prime Time Investigates team planning to follow our consultant colleagues who work over and above their contractual obligations daily, with a level of commitment, dedication and responsibility far in excess of any measurable quantity. In my experience, the vast majority of the "troops" are available for deployment when off-duty, overnight or on holidays, if so needed. – Yours, etc,



Irish Surgical

Training Group,

Dublin 7.