Madam, – A non-consultant hospital doctor (NCHD) staffing crisis exists in the health service.
We have noticed the number of applicants for some NCHD posts in this country has already dropped by 70 per cent over the past 18 months. This situation is going to be exacerbated by the HSE Medical Education, Training and Research committee’s decision to reduce the number of NCHD training posts here.
The Republic has become a less attractive place to work than the UK for non-EU doctors. This has arisen because of the expense of registering with the Medical Council and the fees for the professional competency exams facing non-EU doctors, and the decision not to recognise a similar UK exam in this country.
Services to patients are going to be severely curtailed and there are not enough senior doctors in the system to make up the deficit. We need non-EU doctors to help run the acute services in this country at present.
This medical staffing crisis affects all acute specialties, but emergency medicine is hit particularly severely. The staffing crisis will result in increased dependence on locums in emergency departments. Even if they could be found in sufficient numbers to staff departments, it would not be possible to provide locum doctors with the same training and induction as conventionally-appointed staff.
Over-reliance on locums will lead to an increase in medical adverse events (harm to patients) as doctors work in unfamiliar surroundings with unfamiliar staff.
Whether sufficient locums can be found or not (and locums are expensive) the crisis will lead to increasing demands on medical staff in understaffed and overcrowded departments. Doctors, whether they are consultants or NCHDs, will be overworked, distracted and tired, and they will be more likely to make errors. Emergency departments around the country may also not be supported adequately by in-hospital acute specialties, as they too will be overworked and understaffed as a result of NCHD shortages.
There are other consequences to staff which are important but rank behind that of patient safety (which is the paramount concern). There is the likelihood that reconfiguration, a necessary planned reform for the health service and supported by most consultants in acute specialties, is going to be replaced by an unco-ordinated collapse of acute services.
Collapse is not reconfiguration. Frontline doctors fear they will be unable to maintain their high clinical standards, through the impossible clinical demands which will be placed upon them. They are also afraid they will be made answer for adverse events resulting from pressures and deficiencies that are not of their making.
The Irish Association for Emergency Medicine has asked for increased numbers of emergency medicine consultants to be appointed to reduce the reliance on NCHDs, but this takes time and the service should not be allowed to deteriorate pending their appointment. As it is, consultants are going to see the disintegration of units that they worked all their senior professional lives to build up. This is the case even in those units where they followed all the rules set down by the Royal Colleges, Medical Council and HSE with regard to supervision, training and the incorporation of NCHD posts on basic specialist training rotations.
How this medical staffing crisis has arisen is of secondary importance. Whether it was manufactured or happened inadvertently does not matter right now. What is most important is to focus on the fact that patients will suffer harm if this crisis is not acted upon urgently.
The health service should spare no effort in trying to find appropriate solutions.
Unfortunately July 1st, when the next junior hospital rotation begins, is not far away, and it will be challenging in such a short time to find those necessary solutions. – Yours, etc,