The current staff crises in the health services can hardly have come as a surprise to those charged with responsibility for the area. Manpower planning studies have been conducted at many levels for several decades. As far back as the 1970s, there was a consensus that our hospitals required more consultants if the needs of patients were to be met and the training of non-consultant hospital doctors (themselves the future consultants and general practitioners) was to be sustained. The haphazard nature of career paths for both doctors and nurses in the State's health services - which might persuade skilled and caring personnel to remain within the service - has been piously noted for years. Report after report, recommendation after recommendation, from working party after working party, have been received, apparently agreed between all parties, and left to gather dust.
Few would claim that manpower planning in health services can be an accurate science. The variability of patient demand is far too great to allow for precision in calculating optimal staff numbers in all the various disciplines involved in all circumstances. But certain general principles can inform planning proposals on the recruitment and retention of health care staff. These include the proportionality of one discipline as against another; the ratio of consultant to non-consultant hospital doctors; the relativities of medical and nursing staff in hospitals and the minimal numbers of members of each discipline in relatively small hospital units.
It might have been thought, for instance, that the days of a hospital consultant working alone in his or her discipline in a general hospital which purports to provide any kind of emergency service, or to maintain younger doctors in quasi-training posts for post-graduate experience, were long over. Not so, it seems, from the current crisis in such as obstetric and anaesthetic (even surgical) posts in some hospitals around the country.
The problem lies not in the amount of work done with a view to planning staffing levels in Irish hospitals. It lies in the failure to implement the bulk of the recommendations made and apparently agreed. Some consultants are not blameless in the failure to create many new consultant posts. Additionally, there has been a decline in the necessary trust between healthcare personnel and the Department of Health which has occurred over many years because of what has been perceived as parsimony on the part of the Department and the health boards in their administration of the health services. It is as if the central and local authorities were acting as agents of the Department of Finance rather than facilitators and developers of the best possible service for patients - surely their primary purpose in the State.
The recommendations of the Medical Manpower Forum set up in 1998 by the then Minister for Health, Mr Brian Cowen, is eagerly awaited, not just for what it may say, but because the practice of non-implementation of health manpower recommendations has been current for several governmental administrations for decades past. Meanwhile, crucial manpower deficiencies must be remedied on an ad-hoc basis with great urgency if patients' needs are not to be further postponed and dedicated professional staff are not to be further stressed into leaving the services in which they were once proud to be providing patient care. The difficulties in recruiting and retaining health-care staff will increase with the imminent beefing-up of the British National Health Service promised by the Labour Government there.