Some 24-hour health services may have to be curtailed to meet limits on doctors’ hours

Some health services which are currently operated on a 24-hour basis may have to be curtailed in future if European rules limiting doctors' working hours are to be implemented in full, Minister for Health Leo Varadkar has said.

In a wide-ranging speech to the Irish Medical Organisation’s annual conference in Kilkenny he also said that complying with the European Working Time directive could lead to greater roles being given to nurses and therapy staff.

He warned that while the issues surrounding the implementation of the rules on doctors’ working hours had been around for years, the bullet would soon have to be bitten.

“ I find it hard to see how the directive can be implemented without assigning an expanded scope of practice to nurses and therapists and remunerating them for it or how we can continue to provide 24- hour cover for all the services we currently do. These are not new issues but the bullet will have to be bitten and that will require leadership both political and professional if we are to meet our European obligations.”

The Minister told the IMO conference that without doubt the Irish health service was “ under-resourced”.

He said the evidence was there in relation to the ratio of doctors to population, the ratio of acute hospital beds per person, the number of specialists and the amount of money invested in primary care.

However he also argued that the resources that were available were not deployed as efficiently as they ought to be. He also said co-operation with change was not always as forthcoming as it might be and that doctors did not see as many patients as their counterparts abroad.

“Hospital beds are not used as efficiently as they should and average length of stay, day of surgery admission and day case rates vary inexplicably from place to place. According to the OECD, which has no axe to grind, Irish doctors see fewer patients on average than their peers. There might be good reasons for all of this but it is still not as it should be and we need to change it.”

The Minister also signalled that there will be no speedy implementation of universal health insurance - the cornerstone of the Government’s long-planned and long-delayed health service reform.

“On universal health insurance, I firmly believe that we need to make health insurance more affordable before we can make it universal.”

He said work in this areas which was being carried out by the ESRI and the Health Insurance Authority was nearing conclusion, and would allow the Government to develop a new road map to universal health insurance .

However he said it was clear that there was a lot of work still to be done such as the need for new financial systems in hospitals and embedding activity-based funding.

“It’s not something to be rushed. If we have learned anything from the mistakes of the past it is that all health reforms should be thought through and change-managed and project-managed properly.”

Mr Varadkar told the conference that while doctors had a responsibility to advocate on behalf of their patients, there can be a fine distinction between this and the under-mining of public confidence in services.

“There should be and will be no gagging clauses as long as I am Minister, and whistleblowers will be listened to. But I want a real partnership between all our groups, so that we can work together to address concerns and identify problems before they escalate, and stop things getting to the point of no return. Doctors are right to be advocates for patients and press for reforms, but at the same time none of us want to undermine public confidence in our health service.”

“It can be a very fine line, as sometimes fighting for one can lead to the other. When the line is crossed, we all end up weakened, trust is eroded, and confidence seeps from the system. In a real partnership everyone can advocate for improvements, but without undermining the very nature of the service we provide.”

Mr Varadkar also ruled out throwing money at waiting lists in a bid to reduce them in the run-in to the general election.

Earlier this week it was confirmed that the number of people awaiting out-patient appointments in hospitals had exceeded 400,000.

He said that some of the initiatives used in the past to reduce waiting lists “ are not to be followed and my strong preference is that we make maximum use of under-used capacity in our public hospitals, where it exists, and then turn to the private sector”.

The Minister also said legislation would be introduced later this year to establish the current group of children’s hospitals as a trust.