Monday 20 November 2017

Think the health service is bad now? Wait until July

As 'virtual wards' become a feature of our hospitals, John Crown fears virtual doctors may be the next step

Last week, a coroner referred to one of our best hospitals as a "dangerous place for anyone, let alone a patient". The facilities of this institution were so overstretched that the fine health professionals who work in it were forced to care for their unfortunate patients in "virtual wards", in other words, unequipped corridors and alcoves, when a real ward wasn't available.

If the coroner thinks that things are bad now, just wait until July, when the latest instalment of the medical manpower crisis will hit.

In July, Ireland, the country with the highest number of medical schools per head of population in Western Europe, will be so critically short of doctors to run our hospitals that emergency units may close.

We are now attempting to import medics from India and Pakistan, two of the most medically underserved countries in the world.

While most will be fine, dedicated young women and men, the basic laws of supply and demand inevitably mean that in this type of seller's market, standards can slip, as increasingly desperate and panicky buyers (the HSE) work out the calculus that any doctor is better than no doctor.

I'm worried that the HSE might decide to develop the "virtual ward" concept, employing virtual doctors, medical avatars who could perform surgery in operating theatres of dreams.

The crisis is a direct and inevitable consequence of the health policies of successive governments.

Non-consultant hospital doctors are trainee specialists. Why should it make any difference to the smooth running of a health service if trainees are hired or not?

These apprenticeships attract brilliant young women and men who have graduated from medical school after five or six years of gruelling study, and who are pursuing specialist careers, including the speciality of general practice.

However, the general practice and hospital consultant jobs that they are preparing for do not exist in sufficient numbers to absorb them and historically the great majority emigrate.

This would be understandable if there was a glut of specialists, but there is not. Ireland is so short of specialists that waiting lists are often measured not in months (which would be unacceptable in most countries) but in years. Private lists are shorter, but still unprecedentedly long by international standards.

While small specialist numbers are very good news from the point of view of medical incomes (and provide 100 per cent of the explanation for the report that one consultant made €1m from the VHI last year), it needs to be recognised that doctors and their professional organisations have been leading the clamour for increased appointments.

The people who have blocked these appointments over years were ministers of health and officials of the Department of Health and HSE. Instead of creating the appropriate number of career-level posts, they decided to maintain a pyramid-shaped career path, with many "trainees" (who are cheaper) at the base and a few consultants and GPs at the top.

The argument that this was necessary due to excessive consultant salaries doesn't wash. On the old contract with smaller salaries, and in the pre-Common Contract era when many consultants did their public work for minimal stipends, the jobs were still frozen by government.

Meanwhile, in a piece of detective work that would make Inspector Clousseau look like Sherlock Holmes, HIQA, the State agency charged with inspecting healthcare standards in Ireland, discovered that the reason why our Republic -- which again has the lowest number of specialists per head of population of any country in the western world -- also had the longest waiting list for an appointment to see these specialists, was due, not to the aforementioned shortage, but due to communications issues.

Health Minister James Reilly last week addressed the priority issue of doctors' dress codes. Apparently, we intimidate patients when we wear suits. Patients will apparently be reassured when we go tieless. All I can say is that in Leinster House, it's the tie-less ones that terrify me!

Minister, when you double the number of consultants, I'll give up my suit.

Senator John Crown is a consultant oncologist

Sunday Independent

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