HEART BEAT: We are approaching a significant date for hospital medicine in Ireland. August 1st is supposed to be the implementation date of the European Working Time Directive, (EWTD). This will restrict the number of hours to be worked by non-consultant hospital doctors to 58 per week. The status of consultant hospital doctors remains unclear.
I read with some incredulity that a spokesperson for the Health Services Employers' Agency (HSEA) that there was no way the country could be compliant with the directive by August 1st. The blame for this is being laid squarely on the shoulders of the NCHD's by administrators and politicians alike. Many of these people know better. Alas the culture of blaming somebody else is strong in our society. We were told that one of the reasons for Hanley was the inevitability of complying with the directive, quite apart from the desirability of having larger units; thus in theory concentrating expertise and effecting economies of scale. Remember Hanley, government policy no less! Remember likewise Prospectus and Brennan. Not too much has been heard of these reports since the local and European elections. I wonder why? It would appear to the cynical that in the words the French politician Ledru Rollin "There goes the mob. I am their leader I must follow them" Clearly our unruly Irish mob wanted a different direction, so forget the reports.
This is a very important topic and will unfold over the next few weeks. I alluded to this in my earlier articles in this series and pointed out the impossibility of achieving such reduction in working hours by the target date. I am sad but not surprised that our so called administrators ever even thought that it was possible.
Furthermore, that they thought that such change, which will adversely affect patient care. and the training of our future practitioners. could be achieved without the co-operation and agreement of NCHD's and Consultants.
Consultation and agreement however do not seem to be the order of the day, clearly evidenced in the decentralisation issue Arrogant certainty, albeit uninformed, knows best, those opposing are powerful self interest groups. Meanwhile the patients still wait on the trolleys.
What is truly alarming and shocking about all of this, is that the EWTD did not spring up unannounced overnight. We have only had 10 years to prepare for this moment! Wile our European neighbours grappled with the problem, we as usual deferred its meaningful consideration. Judgement day we are told is inevitable, and it surely is upon us now. Somebody who was obviously not a Boy Scout, is responsible for our lack of preparation.
I personally do not believe that those charged with effecting the change, actually understand what is involved. Leaving aside temporarily the effects on training of personnel, there are major implications for the delivery of 24 hour patient cover. The smaller the hospital, the bigger is the problem. It requires 8 doctors to work a rota providing 24 cover and based on a 58 hour working week. This allows for holidays, rest days, study days etc. It does not make allowance for the unexpected, like illness or family leave. Pushing around the pieces will not solve the problem. Differentiation of skills and specialties in medicine begins early and the blithe assumption of cross cover, from one specialty to the next, is fraught with danger, The orthopaedic registrar may not be the most appropriate person to deal with your heart attack and conversely the budding cardiologist may lack expertise in dealing with major trauma. More importantly the the patient may not be best pleased or served by such arrangements. The lawyers however may expect more business as the disruption of clinical teams undermines patient care, with subsequent increase in litigation, already unacceptably high. For specialist teams ,in cardiac surgery, neurosurgery, organ transplantation, etc. it will become impossible to provide full cover through the week.
In the distant past this was possible, because of the willingness to work long hours as part of career development and the acquisition of knowledge and experience, In the recent past such willingness, also had financial compensation freely negotiated, for the long hours worked. The system creaked occasionally but basically functioned. Now the numbers simply do not add up and those responsible for running the service do not even appear to grasp the complexities involved.
These are sad days indeed for Irish medicine. The grand ideas and strategies designed to provide us with a Rolls- Royce standard service, are apparently incapable of fixing the nuts and bolts of the bicycle service we in fact possess.
Hold your hats folks! The way things are going, we will all be walking soon.
Dr Maurice Neligan is a cardiac surgeon