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Fear further exodus of consultants will follow Sláintecare

30 May 2017

The IHCA is concerned that the Report from the Committee on the Future of Healthcare could cause an exodus of experienced consultants, which could prove “impossible to replace”.

Responding to the Sláintecare Report, IHCA President Dr Tom Ryan said that one of the adverse consequences of the report’s recommendations – which included removing private care from public hospitals – would be a consultant recruitment and retention crisis on an unprecedented scale.

The Committee has acknowledged that removing private care from public hospitals will be complex, and has therefore proposed an independent impact analysis of the separation of private practice from the public system with a view to identifying any “adverse and unintended consequences” that may arise. “Given the acknowledged need to increase capacity in the public system, it is important that any change should not have an adverse impact on the recruitment and retention of consultants and other health professionals in public hospitals,” the Oireachtas report states.

However, the IHCA believes that an exodus of existing high-calibre consultants would result, which would exacerbate the current crisis, whereby more than 400 permanent consultant posts remain unfilled on a permanent basis – a full 15 per cent of approved posts.

The proposal to cut €700 million annually in health insurance income to public hospitals as a result of the phased elimination of private care would not expand capacity – as suggested in the report – but in fact do the reverse, suggested Dr Ryan.

“There is a significant risk that the private income to public hospitals will be removed with little if any replacement funding, and that the public health system will be impoverished and risk a catastrophic failure during a future wintertime crisis as a consequence.”

The report envisages that the provision of private care by consultants in public hospitals will be eliminated over five years.

However, the Committee was of the view that the development of elective only hospitals in each Hospital Group could be an important counterbalance for consultants to private sector work, by creating “new opportunities for the development of their specialist skills through elective work in the public sector”.

593 additional consultants to be put in place from year four

Additional numbers of consultants will be required to meet population need, the Report later states, although further work would be needed to identify the specialties, numbers and locations of these new posts.

“Overall, the Committee has allowed for an additional 20 per cent (593) consultants to be put in place from year four, although some are included in area-specific costings, such as mental health and palliative care from year one. These will be additional posts; the filling of existing vacant posts is also an urgent requirement to ensure adequate staffing,” the report notes.

The Committee has allocated €119m for this increase in public hospital consultants, between years four and 10.

It also recommends that recruitment of hospital consultants and NCHDs should be to Hospital Groups rather than to individual hospitals, as part of meeting the medical staffing needs of smaller hospitals.

However, the Future of Healthcare report contains no “realistic solutions” to address the overwhelming shortage of hospital beds in the health service, the IHCA has charged.

To promote an environment where a single-tier system would evolve, the capacity of the public healthcare system would have to increase significantly, it stated. “The report has singularly failed to deal with this central issue. By failing to articulate the need for significant investment in the public health system, the unintended consequence of this report is that it will retard the subsequent development of an adequate public health system.”

The report earmarks €2.8 billion over 10 years to build up necessary capacity, expand entitlements and reduce the relatively high out-of-pocket costs experienced by the Irish public. A further €3bn ‘transitional fund’ is also included to support investment across the health service in areas such as infrastructure, e-health and expansion of training capacity. However, just €1.23bn of this is reserved for renovation and hospital bed capacity, over years one to six.

IHCA President Dr Tom Ryan described as “disappointing” this failure to include an annual commissioning plan to put the necessary acute hospital bed and other facilities in place to end a dependence on trolleys and continuously increasing waiting lists.

“Hoping to provide care to an increasing number of patients in the public health system without sufficient capacity is not a realistic strategy,’’ said the Consultant in Intensive Care and Anaesthesia at St James’s Hospital.

The report does not state how many additional beds the health service requires, but makes reference to the Department of Health’s ongoing bed capacity review, and recommends that that review should inform the detailed planning for the infrastructural investment provided for in the proposed transitional fund.

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