Row over planned 24/7 consultant roles at National Children’s Hospital

The National Children's Hospital project has been hit by a new row over moves by the Health Service Executive to appoint consultants on contracts which for the first time could see them rostered to work in shifts over a 24-hour, seven-day week.

The move is being opposed by the Irish Medical Organisation (IMO) which represents specialists and non-consultant doctors who would apply for such posts.

Up to now, consultants have generally been required to work across a day running from 8am to 8pm. The IMO argues that any change to this would have to involve national negotiations and could not be implemented by just one hospital.

The HSE said that following a recommendation from its consultant appointments advisory committee, it had approved 12 new consultant posts for the Children’s Hospital Group – six in paediatric emergency medicine, four in general paediatrics and two in paediatric radiology.

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It said the posts were needed to facilitate the opening of a planned children's out-patients and urgent care centre at Connolly hospital in Blanchardstown next year. The facility will serve as a satellite centre for the €1 billion National Children's Hospital, which is due to open on a site at St James's Hospital in 2022.

The HSE said the 2016 National Model of Care for Paediatric Healthcare Services and the National Emergency Medicine Programme recommended consultant-delivered services “whereby patients and their families have greater contact with senior clinical decision-makers, resulting in less admissions to hospital, higher satisfaction by patients and families and more effective and efficient management of illnesses.

Public service agreements

“It is anticipated that an increase in consultant-delivered services would involve working outside the standard 8am-8pm working pattern and in that regard the consultant contract has, since 2012, provided for 5/7 and 24/7 working in line with the flexibilities provided by the public service agreements.”

The HSE said that while any work pattern requiring consultants to rotate through attendance at set times could be described as a shift, the details of the hours required for the new paediatric posts had not yet been decided.

“Intensive research has been carried out on this area of service need and quality,” it said. “The best patient outcomes come from a consultant-delivered service thereby ensuring senior clinical decision-makers are available on-site in a structured and planned way for a higher portion of the day and during the peak times patients present for treatment. The majority of attendees at paediatric emergency departments attend within the hours being discussed.”

The HSE said that at this point in time the Children’s Hospital Group had not identified a specific requirement for other consultant specialties to work outside the traditional 8am-8pm shift pattern.

“However, should such a need be identified in the future there would be intensive consultation and engagement with the staff and their representatives.”

The IMO said it fully supported the development of the National Children’s Hospital and cared deeply about patients and their families. However, it said it was “disappointed” that the posts approved hold open the possibility of the introduction of consultant shift work.

"Given the multiplicity of issues involved in the operation of the current consultant contract, only national negotiations will be sufficient to address and resolve all matters," it said, adding that it was ready to engage with the Department of Health and the HSE on the matter.