While there is an understandable focus on the massive cost overrun for the new national children’s hospital and what it says about how poorly managed our health service is, now is not the time to put buildings before people.
The most important asset in our health system is the people who work in it. For the patient, it is the level of personal care they receive from healthcare assistants to medical consultants that matters most. And it is the quality of these professionals that most determines a safe and successful illness outcome.
So what does the unprecedented number of simultaneous industrial disputes currently affecting healthcare tell us? With nurses, doctors and ambulance personnel all involved in separate disputes – but with a common theme – one thing is clear: a dysfunctional Department of Health is presiding over a public health system close to total collapse.
The Irish Nurses and Midwives Organisation says nurses and midwives are seeking to secure safe staffing levels in the health service. This requires making conditions more attractive in order to attract home the many nurses who emigrate following qualification, it says. The Psychiatric Nurses Association has withdrawn all overtime working in adult psychiatric services in response to the failure to engage with nurses on recruitment and retention. An escalation to a full withdrawal of services is promised.
General practitioners
Meanwhile hundreds of general practitioners closed their practices on Wednesday to mount a Dáil protest at the Government’s continued failure to honour promises made to fund development in primary care. The National Association of General Practitioners wants a reversal of a 30 per cent cut in grants imposed during the recession. It says young, newly-trained GPs are emigrating and older GPs are giving up and retiring early. Many practices can no longer take on any new patients because of doctor shortages and a decade of reduced funding. Delayed appointments are a new reality for existing patients.
The common theme across the industrial relations unrest in health is a failure to invest in people. A failure made worse by the amount of money frittered away on agency and locum staff. The Health Service Executive spent some €114.5 million on medical locums last year. Restoring pay parity for newly-appointed consultants – who earn up to 57 per cent less than colleagues with the same workload and responsibilities thanks to emergency measures introduced by former minister for health James Reilly – would cost €22.5 million per annum.
It means we have 40 per cent fewer hospital consultants than the OECD average and 20 per cent of posts lying empty. The gaps are partially filled by more than 450 locums and some 160 doctors employed as consultants who aren’t qualified as consultants.
Dr Gabrielle Colleran, a consultant paediatric radiologist at Temple Street and Holles Street hospitals and healthcare commentator says: “As long as we keep fielding half the consultant team we should have, as long as we are dependent on locums, as long as we are appointing non-qualified specialists to consultant posts we can expect to have significant issues with quality and safety.”
Noting that patients deserve better, she says: “We stand at the end of the lost decade in Irish healthcare. It’s clear to all, and most importantly to patients, that major reform is needed in both primary and secondary care.”
And not for the first time the president of the High Court this week urged the Department of Health to urgently address the “clear defects” in the processes used to recruit junior doctors in hospitals nationwide. Striking two non-consultant hospital doctors off the medical register, Mr Justice Peter Kelly said the department “must get a grip” on this pattern of defects, which has implications for patient safety, “sooner rather than later”. One of those struck off was an anaesthetic registrar who came to the attention of the Medical Council following an adverse outcome at Dublin’s Rotunda hospital.
Failure to invest
A series of similar High Court appearances is a bellwether for the continued failure to invest in people across the health service. It is emblematic of the “bottom-fishing” recruitment we have been reduced to.
What isn’t in doubt is that we need a new national children’s hospital. An overspend of at least half a billion euro on the project is a scandal. But we mustn’t allow this to divert our attention from the most pressing problem facing the health system. Yes, infrastructure is important in a revitalised health service but without high-calibre staff the new hospital risks becoming an empty white elephant.
Investing in people is the first step in turning the ship of health around. Quality recruitment will encourage healthcare professionals to return home (while saving money). They, in turn, will help create the fundamental culture change needed to detoxify our health service.
Dr Muiris Houston is the Irish Times health analyst