Outpatient clinics that are open at night and a substantially better chance of being seen by a consultant are among the improvements in hospital services agreed yesterday by the Medical Manpower Forum.
The forum's recommendations could take years to implement, could cost more than half a billion pounds and would require detailed negotiations with health-service unions.
The success of the strategy will also depend on having sufficient nursing and other staff available. Today the Minister for Health and Children, Mr Martin, will announce a package of flexible working and training initiatives to attract back the thousands of nurses who have left hospital work.
Mr Martin said yesterday that the work of the forum represented "a major milestone for the health services". The Irish Hospital Consultants' Association said it hoped negotiations on a new contract could begin by March to allow for its implementation from October. The Irish Medical Organisation called for the publication of the report and for immediate negotiations.
The Medical Manpower Forum was established in May 1998.
As expected, the forum has come out in favour of replacing a substantial number of non-consultant hospital doctors (NCHDs) with consultants.
This is driven by the need to improve the career path for NCHDs by the continuing reduction in the number of hours worked by NCHDs and by the need to provide a better service to the public.
If the forum's strategy is implemented over the next five to seven years, the public can expect outpatient clinics which will be available before they go to work in the morning and after they finish work in the evening as well as during the day.
They can also expect that consultants will be on duty in the hospitals for 12 to 18 hours a day and in some cases around the clock. At any given time, there will be a far better chance that the doctor attending a patient will be a consultant.
The new arrangements are to be tested in a number of hospitals and a report on the results will be given to the Minister within six months.
The forum did not recommend the number of consultant posts to be created. The Irish Hospital Consultants' Association has been pressing for an extra 1,000 or so, which would roughly double the number of consultants in the public hospital service.
The cost of employing an extra consultant is estimated by the Department of Health and Children at about £800,000 a year when the cost of ancillary staff, drugs and medicines and the running costs of facilities are taken into account. In many cases, however, ancillary staff will already be in place, to some extent at least, so that the extra cost will be less than this.