Taoiseach Leo Varadkar’s calls for nurses and hospital consultants not to take holidays in January will “go down like a lead balloon” with already overworked and overstretched frontline staff, according to a leading emergency medicine consultant.
Dr Chris Luke, who has been working in emergency medicine in Cork at Cork University Hospital (CUH) and the Mercy University Hospital (MUH) for 20 years, said Mr Varadkar's comments were likely to prove "particularly upsetting" for people working in emergency departments.
In the Dáil on Tuesday, during a debate on plans to deal with overcrowding in hospitals, Mr Varadkar said nurses and hospital consultants should not take holidays in early January. He has also called on the HSE not to sanction additional holidays for doctors and nurses over Christmas.
Dr Luke warned that forcing frontline staff to postpone their holidays will have an impact on the quality of care that they can provide, especially given the serious understaffing in the health service and, in particular, in emergency medicine.
"Leo Varadkar is talking about denying people their necessary R&R [rest and recuperation].The closer you are to the front line the more you need your R&R. It's the same as in any battlefield front – staff need their time out, particularly doctors and nurses in emergency departments where there are so few."
Dr Luke instanced the situation in Cork where he said there are approximately seven to eight emergency medicine consultants covering Cork University Hospital, the Mercy University Hospital as well as minor injury clinics at St Mary's in Gurranebraher, Mallow General Hospital and Bantry General Hospital.
“We’ve done our best here in Cork over the last 10 years to minimise the absence of senior staff from the shop floor at Christmas, but there are so few emergency medicine consultants. There will be just two permanent emergency medicine consultants in Cork within a few months and the others will be locums or part -time.”
International standards
Dr Luke said that with some 70,000 attendances annually at the emergency department at CUH, 35,000 at MUH, 15,000-20,000 at St Mary's Minor Injury Clinic and 10,000-15,000 at both Bantry and Mallow, international standards would suggest that Cork needs around 20 emergency medicine consultants.
“The British and Australian standards say there should be one consultant in emergency medicine for every 10,000 attendances and, on that basis, we should have 15-20 consultants in Cork city and county. But over the last 15 years, we managed to acquire seven or eight, some locums, some part-time.”
Dr Luke said that Mr Varadkar’s comments were particularly upsetting for people who are already foregoing annual leave to ensure the system can survive. He instanced his own experience at the MUH where he minimised his absences over Christmas for years to cover it on a part-time basis.
Christmas Day tends to be the quietest of the week, but then Christmas Eve is a peak
“Up until this year, I was running around to two hospitals which are permanently overcrowded and overstretched. The consultants are all working flat out so the idea that, once or twice a year, they should go without a standard break is particularly challenging.”
Dr Luke said one of the problems is that at Christmastime the capacity of almost all acute hospitals is reduced, with season shutdowns in areas such as radiography imaging as well as wards being closed. This meant the capacity of frontline staff in emergency departments to deal with the influx is further reduced.
‘Bedlam’
“Christmas Day tends to be the quietest of the week, but then Christmas Eve is a peak because people are rushing to get in before Christmas,” he said. “And St Stephen’s Day onwards is bedlam, and the busiest days of the year last year were the first two or three or four days after Christmas.”
He said if people are denied their leave and work over Christmas, “all you are doing is pushing their entitlement to take leave out into January”.
“Even giving extra goodwill at Christmas means that the doctors and nurses involved are even more rostered and burnt out – it’s not a viable solution.”
He said on one hand, the HSE is “promoting all this mindfulness stuff” and on the other hand they are resorting to “the floggings will continue until morale improves school of management which has been tried intermittently over the years but which we know doesn’t work”.
“That approach is going to have repercussions for recruitment and that is the issue – there are 500 consultant positions empty in the HSE and if people are already working flat out and now being asked to postpone their leave entitlements, it’s not going to help recruitment to fill those positions.”
