Sir, – It has been my experience when I worked as a consultant – and also importantly from my experience as a patient – that consultants (as one might expect) generally make diagnoses and decisions quicker than non-consultant hospital doctors; are less likely to order and to rely on diagnostic tests to treat patients; are less likely to admit patients to hospital; and are more likely to discharge patients home.
Consultants are undoubtedly under increased pressure at present given the number of vacant posts among their ranks. Like most healthcare workers, many are also worn out after three years of Covid.
Clearly consultants cannot magic up new beds that don’t exist in hospitals or in the community, and cannot compensate for deficits in nursing numbers or skill-mix.
Having said all that, consultants are the highest paid healthcare workers; on average they also earn considerably more than the Minister for Health (and the Taoiseach); they have also been negotiating a further increase in their salaries as part of the new Sláintecare contract, which will also include the facility to undertake private practice in private hospitals once their commitments in public hospitals are fulfilled.
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Given that many elective admissions are being postponed at present, and that the medical on-site staffing in our acute hospitals at night and at weekends is overwhelmingly made up of non-consultant doctors (some of whom are not even in training posts), it seems very reasonable in this crisis situation for the Minister for Health Stephen Donnelly to request consultants to provide additional on-site after hours services over the next few weeks, and for the reasons I have outlined above.
Clearly no one is suggesting that this is a solution to the current crisis in our hospitals, but it could be one of a number of important temporary sticking plasters to keep the system from falling apart in the short term.
In asking consultants to work longer hours, it would also be reasonable to anticipate that nurses and midwives would defer any industrial action they may decide to take (for undeniably justifiable reasons) until the acute phase of this chronic crisis is over.
Hospital management must also increase its after-hours presence and be seen supporting its staff at the coal face.
As part of any definitive solution which the Government must find and implement as a matter of urgency, which obviously must include increased capacity in primary care, step-down care, community-based and domiciliary services, as well as the creation of more hospital and intensive-care unit (ICU) beds, the segregation of elective and emergency care pathways, the recruitment and retention of nurses and other healthcare workers, and the replacement of non-training medical posts by advanced nurse practitioners, medical training posts, and consultants, there will be a need to include a greater on-site consultant presence in our acute hospitals after hours.
In seeking to fill vacant consultant posts, and in creating new posts, and in the context of the finalisation and the implementation of the new consultant contract, it will be essential to do what is needed to make this happen. – Yours, etc,
CHRIS FITZPATRICK,
(Retired consultant obstetrician/gynaecologist),
Dublin 6.
Sir, – The current health service deficits and the resulting chaos is forcing doctors and nurses to provide and accept poor standards of healthcare delivery to patients and this is creating unrest among members of the professions.
Such a situation is the very antithesis of their nursing and medical education, which is governed by EU directives and national standards, regulated through the university, the Medical Council and the Nursing and Midwifery Board of Ireland.
The content and outcomes of nursing and medical education is strong on patient advocacy, ethics, competence, safety and standards of care. The application of such principles to clinical practice in the current healthcare environment is alien to their work in healthcare, and is an affront to the decency of sick people. Following the efforts of doctors, nurses and other healthcare staff during the Covid pandemic, the expectation now being placed on them to continue to work in such conditions and beyond contractual arrangements may be a bridge too far. There is evidence of high absenteeism and sickness rates and difficulties with recruitment and retention. In particular, nurses are restless and those that leave are replaced by nurses who lack the same level of experience and confidence.
Each year, for many years, the country has had to risk-manage a health environment in crises and a trolley service. The lack of appropriate health planning for this predictable winter health crisis event places doctors and nurses in a position of risk-management and their frustration with politicians and health service planners is understandable. This winter has been the worst ever and now politicians and health planners must engage health service personnel and demonstrate immediate commitment to restructuring, and planning of healthcare, on a number of fronts, in order to see through this current crises.
We need new and dynamic recruitment strategy with rewards and incentives for existing health care staff.
We need short-term and long-term plans for the shortfall of 500 beds.
We need a commitment to restructuring the health service, including decisions about implementing Sláintecare.
We need a task force established to report on health service planning for care of elderly people. – Yours, etc,
SEAMUS COWMAN,
Professor (Emeritus),
RCSI College
of Medicine and
Health Sciences,
Dublin 2.
Sir, – As a retired nurse, listening to the crisis unfold in our emergency departments over Christmas and the new year, the thought occurred to me that most of the patients unfortunate enough to end up in emergency departments should not have had to resort to this. Elderly frail patients with respiratory conditions especially need good nursing care. This cannot be delivered in the ED; indeed EDs were never designed for this.
Talking to a friend whose daughter is a nurse in Australia, she tells me of the system which pertains in the health service there. The Hospital in the Home Team (HITH) treats such patients at home. A nurse sees the patient at home, takes bloods, deals with intravenous infusions, catheter care, home oxygen, nebulisers and even cancer care. The nurse liaises with the patient’s GP if medications need to be reviewed or the patient’s condition deteriorates. The patient avoids the stress and dangers of the ED and the ED avoids being overwhelmed and becoming a place of danger for the patient.
It seems to me that a radical rethink of our hospital-centric care needs to happen. Anything else is just tinkering around the edges. – Yours, etc,
MARY DINEEN,
Cork.
A chara, – Do we now have a overcrowding problem on the letters page?
I predict we won’t have space for all the letters on the healthcare crisis unless space is made for the overflow. – Is mise,
DERMOT O’ROURKE,
Lucan,
Co Dublin.