Thursday 20 June 2019

Colette Browne: 'It's easy for the Taoiseach to take pot-shots at HSE medics - but what is his solution to the real problem in health?'

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Colette Browne

Colette Browne

We have a crisis of recruitment within the Irish health service, so what does the Taoiseach decide to do? Attack those already toiling within the system.

Last week, after it was revealed the HSE had yet to sign off on its winter plan for this year, Leo Varadkar opted to engage in a mud-throwing exercise, flinging as much of it as possible around in the desperate hope some of it would stick.

The most extraordinary part of the Taoiseach's broadside against medical staff - who he alleged were taking inordinately long Christmas holidays, thereby contributing to hospital overcrowding - was not that he expressed the opinion.

Rather, it was the certainty with which he doubled down on the accusation, without being able to offer a single shred of evidence to back up his assertion.

So, even though medics are currently working in a system in which almost 500 permanent consultant posts are unfilled, and in which there is a shortage of at least 2,500 beds, Mr Varadkar insisted that rostering issues are to blame for an overcrowding crisis that usually reaches its nadir in January each year.

Mr Varadkar made his comments without being able to point to the exact numbers of doctors, nurses or diagnostic staff who allegedly avail of lengthy holidays during the festive season each year.

That's because he doesn't have that information.

The HSE doesn't possess it and neither does the Department of Health. Rostering is an issue that is dealt with internally within every hospital.

Defending his comments at the weekend, Mr Varadkar said his views were informed by his own experiences of working in hospitals between 2003 and 2007 rather than any hard data.

I hate to break it to the Taoiseach, but medics working in the health service back in those years would likely view it as a halcyon period compared to the Dickensian conditions they are forced to work in today.

In 2006, then health minister Mary Harney declared the trolley crisis a "national emergency" when 495 patients were left languishing on trolleys. Last March, this number reached a record 714. This winter, we have been warned up to 1,000 patients could be left on trolleys.

Clearly, the trolley crisis is not a crisis, or a national emergency, at all. It is, in fact, the norm - and has been for years.

And the answer is not to have every consultant, junior doctor and nurse in the country working 24-hour shifts seven days a week. The answer is quite simple - more staffing and more beds.

But, of course, admitting this would mean assigning blame for endemic failures within our health system to politicians - and the Government doesn't want to countenance that.

Instead of castigating doctors and nurses for the having the temerity to take a couple of days off over Christmas, what could the Taoiseach have done differently?

Mr Varadkar could simply have acknowledged the reality of the situation - that we have too few medical professionals and too few beds - and outlined a plan to credibly address this shortage.

Because this crisis in recruitment is not a new phenomenon. Between 2015 and 2017, the HSE was unable to fill up to a third of consultant posts. During that period, 39 advertised hospital consultant posts didn't receive a single application and a further 153 received only one or two.

These shortages, up to 20pc of consultant posts vacant, are even more stark when you consider that Ireland's number of medical specialists is already 40pc below the OECD average - 1.29 per 1,000 population compared to the OECD average of 2.14.

Mr Varadkar could also have explained what the Government intends to do about the fact that, according to former director general of the HSE Tony O'Brien, 80pc of doctors in smaller hospitals are not on a recognised training programme and that up to 40pc of consultants in these hospitals are not on the specialist register.

The Taoiseach could also - in response to recent revelations from the High Court that the HSE is hiring doctors who quite literally can't tell an elbow from an ankle - have outlined oversights within the recruitment process that will be introduced to safeguard patient safety.

This is especially important in circumstances where Ireland is increasingly reliant on hiring doctors who have not been trained in Ireland or the EU to prop up our system.

Currently, 40pc of doctors working in Ireland have trained outside the EU - one of the highest rates of overseas doctors working in a health service in the world.

Oftentimes, inclusion in training schemes and career progress that would be available in other countries is denied to these doctors, meaning there is little incentive to stick around.

The result is that these doctors typically provide locum cover or are engaged in short-term contracts, but their professional development is stymied by a system that views them as nothing more than a plug to fill a hole.

If doctors without the requisite level of training or competence are working in the Irish healthcare system, that is primarily the fault of those who recruit these doctors without doing a thorough enough interview or review of their references.

The best the Taoiseach could offer, in response to news last week that a junior doctor working in a maternity hospital was hired despite having no experience of examining a pregnant woman, was that it was "absolutely essential" that foreign- trained doctors had valid qualifications.

Sure, but most of us would have thought that was a pretty easy policy to police - so why isn't it being done?

Finally, the elephant in the room is the pay disparity that has developed since 2012, when the pay for new entrants to consultant posts was cut, with the result that, according to the Irish Medical Organisation, new entrants could soon be on up to €50,000 a year less than their longer-serving colleagues.

How can the HSE convince younger doctors to stay here - and help to fix our broken health care system - when they are discriminated against in their pay, with colleagues who were hired before them paid significantly more to do the same job?

It's easy for the Taoiseach to take pot- shots at medics in an effort to lay the blame for hundreds of patients on trolleys and 720,000 on waiting lists at their door.

But what is his answer to solving the recruitment crisis that is actually at the root of so many of the problems bedevilling our health service - not just during Christmas, but all year round?

Irish Independent

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