Madam, – Dr Chris Luke’s impassioned narrative about the medical staffing crisis in accident and emergency departments in particular and the health service in general makes for interesting reading (June 9th).
We have been here before, and I have witnessed such recruitment drives abroad to fill the junior doctor jobs in Irish hospitals. The phenomenon of home graduates leaving Ireland for better training and working conditions elsewhere, and international graduates like me coming to Ireland in the hope of getting trained, spans more than three decades.
The issues of medical staffing needs were thoroughly explored by the steering group on medical staffing (Hanly Group) as far back as the last century (1999-2000). I served on this group and the recommendations of this group (The Hanly Report) are still valid. The solution for the medical manpower crisis facing Irish health service is neither recruitment abroad nor indentured medical service for the home graduates.
The solution very much lies in the hands of senior clinicians such as Dr Luke and HSE managers by radically restructuring how patients requiring urgent and emergency care are managed and by whom.
Currently a patient with suspected appendicitis would be seen by a GP, an AE senior house officer, a surgical senior house officer and a surgical registrar before a decision is made for the final treatment plan. The same layers of care at varying levels of seniority are the crux of the problem. There is a lack of senior decision-making at the front line in a timely manner and this leads to overcrowding in AE departments, which then spreads to the whole hospital.
The AE crisis is often more to do with how efficiently or otherwise a hospital deals with patients presenting to it as urgent care cases. The suggestion of asking interns to serve in AE departments is not appropriate, as the solution is not assigning more junior doctors to the front line.
The solution is to employ fully trained and experienced doctors (consultants/specialists) to make timely and appropriate decisions 24 hours a day, seven days a week. These senior doctors should be supported by appropriate diagnostic and other consultant-provided services, with expanded working hours as negotiated under the now to be revised consultant contract. – Yours, etc,