Madam, - I was surprised and disappointed to see the Taoiseach reiterating to Dáil Éireann last Wednesday the myth that consultants in emergency medicine are not available after 5.30pm in accident and emergency departments and that this is the kernel of the current problems.
Firstly let me say that the contract offered to me by the Department of Health and Children details that I will provide 33 hours of scheduled service per week during the normal working day. I have a commitment for a further six "unschedulable" hours which, if they become more than infrequent, either must lead to a re-adjustment of my schedule to remove them, or an increase in my salary. Neither of these options has ever been availed of.
When I last kept a detailed diary of my working hours, I averaged, over a 15-month period, 46 hours per week, all essentially in the emergency department and the adjacent observation ward. I am not unique in this commitment to my patients and their needs, but am only one of many.
When the Taoiseach speaks of consultants not working extended days, he neglects to mention that contract negotiations have never been entered into to extend the working day. Even now, with much huffing and puffing from the Health Service Executive Employers Agency, no firm proposals have been made, and no pricing structure indicated, so negotiations appear to be bogged down.
The Taoiseach also neglects to mention that much of the work done by consultants cannot occur without the support of para-medical personnel who also have a contract which clearly states the normal working week, and which does not envisage them being present outside normal working hours, except on an on-call basis, with a fee per item of work when they are recalled. No contract negotiations for these staff members have taken place either.
Last week, as well as working a full week's schedule of 33-plus hours, I was "on call" for my department out of hours. There were no patients who needed me to return during the night at any stage, but I had to provide telephone advice to my staff on many occasions. There were, for instance, six calls between 11pm on Monday and 6am on Tuesday. At no stage did I leave the emergency department before 6pm that week.
On Saturday I was in the department from 10am until 5.30pm, and also did a ward round, discharging a number of in-patients and seeing some of the new emergency patients.
I personally supervised two stress ECG tests for patients admitted overnight, a service my consultant cardiologist tells me is not available outside normal working hours in the world-renowned Massachusetts General Hospital, where he worked before returning to Ireland. This enabled me to safely discharge these patients. Four years ago, such patients would have had daily ECGs and blood tests and remained in hospital for four to five days. During this seven-and-a-half hour period, my rate of pay for working on a Saturday was only 60 per cent of my normal rate.
On Sunday, I attended from 11am until 2.30pm and again discharged patients. I returned on Sunday evening to evaluate a patient at 9.30pm, after ultrasound and CT scans had been performed, I got home at 11.30pm. My call-out fee was two-thirds that of the radiographer. As the call extended to two hours, I am entitled to claim an enhanced fee, giving me a financial advantage over the radiographer of €11.21 (after 17 years as a consultant).
On Monday of last week, having arrived at work at 7.30 am, I left at approximately 7pm. On Tuesday, I arrived at 8am and left at 6.30pm. And this during a week when I am not "on-call" outside normal working hours.
The Government bluster is used to hide the fact that, for years, consultants in emergency medicine have been exploited by the health service. It took nine years of representations, after a formal application, to have a second consultant appointed to this department and a further three years to get a third; we have been waiting in vain since October 2001 for any response to our application for the appointment of a fourth consultant. All this at a time when the acuity of patients is increasing, the access block is worsening, it is taking longer and longer to get each new, critically ill patient onto a trolley to be assessed by a consultant, or by a trainee working under their supervision.
And now this final comment from the Taoiseach, adding insult to injury, that if "there are no consultants in accident and emergency departments after that time [ 5.30pm] you can see why there are problems". In February 2004, I activated the Major Emergency Plan within St James's Hospital. At that time, we had 41 in-patients "boarded" in the Emergency Department. We have reached this level again recently, having been in the mid-20s for months and the mid-30s for several weeks.
For the Tánaiste to say we are in a state of national emergency in this regard merely mirrors my own view of the situation expressed publicly two years ago.
Why has it taken this long for the message to seep through? And why is the Taoiseach still trying to blame the consultants?
- Yours, etc,
Dr PATRICK K PLUNKETT, Consultant in Emergency Medicine, St James's Hospital, Dublin 8.