Fewer consultants mean longer wait times and greater patient safety risk

Access to acute hospital care in Ireland is getting worse, not better, and the figures bleakly bear this out.

Over 550,000 people are waiting to see a consultant, an 84% increase since the end of 2013. A significant 170,000 have been on a waiting list for more than 12 months. The number of elective surgeries carried out in public hospitals has halved since 2012 and, shockingly, more than 100,000 people are treated on trolleys every year. Sadly, this is the new normal.

These chronic, systemic problems are being compounded by the fact that Ireland’s population is ageing. Those aged 65 years of age and over make up 13% of our population but use 54% of hospital inpatient beds.

The older we get as a country, the more likely we are to develop chronic illnesses, such as heart disease, diabetes and arthritis, which require years (if not decades) of consistent and often expensive treatment.

A shortage of expertise

While the causes of these problems are myriad, arguably the most pressing is the lack of consultants, the senior doctors who have completed specialist training and have advanced expertise in one particular area of medicine.

Based on population size, Ireland has the lowest number of consultants in the EU—43% below the average, in fact. Currently, 1 in 5 of all consultant posts in Ireland’s public hospitals and mental health services—almost 500—are unfilled on a permanent basis. These vacancies attract few, and sometimes zero, applications.

Hospitals need consultants to operate, so to plug the gap, the HSE spends significant sums of money on agency, or “locum”, consultants, who are essentially freelance doctors that fill in for vacant yet critical roles on a short-term basis.

Consultant shortages are contributing to ever-growing HSE medical agency costs which have grown by €57 million, from €37 million in 2012 to €93 million in 2018—a 156% increase. The cost of hiring an agency consultant can be 2-3 times the cost of employing a permanent, full- time consultant. This spend on locums is a false economy.

Bad for patient health

The long-term shortage of consultants is putting patient safety at risk, too. In virtually every specialist field—cardiology, dermatology, gastroenterology, ophthalmology, urology, to name a few—Irish patients endure waiting times that are typically far longer than any other EU country. Disease does not operate to a schedule: the longer the wait, the more likely it is that a sick patient’s health will deteriorate. More advanced illnesses are more difficult and expensive to treat. Tragically, in some cases, months spent on the waiting list can be the difference between life and death.

Sometimes the wait isn’t the only factor detrimental to patient welfare. There are currently at least 100 doctors appointed in the past decade, who are not recognised as specialists by the Irish Medical Council, working in public hospital specialist consultant posts. This means that well-intentioned but less experienced doctors are making healthcare decisions as independent specialists that they are not registered to make. Accordingly, patient care and safety are being jeopardized and clinical risk is increased. This is a contributory factor behind a 100% increase in clinical indemnity claims between 2013 and 2017.

Addressing the cause

Irish doctors, consultant and non-consultant alike, are leaving the country in droves. Between 2015 and 2017, over 700 specialists stopped working in Ireland. The reason for this is clear: pay disparity and working conditions.

Hospitals in the United States, in Canada, in Australia and other countries to which our specialist consultants are emigrating offer more attractive terms and conditions and value our highly trained specialists.

The HSE’s front-line staff desperately want to deliver improved services to patients. They see first-hand how the unfilled consultant posts affect wait times and patient care. Many Irish doctors working abroad today want to work in Ireland but, understandably, the Government’s persistence in imposing less favourable terms on new consultants is delaying their homecoming and driving more of our doctors and specialists abroad to pursue their careers. Until these issues are addressed, the consultant brain drain will continue, posts will remain unfilled, and there will be no meaningful decrease in patient wait times.

The Government accepts that we have a problem in recruiting and retaining consultants in our public hospital system, yet there has not been any meaningful engagement to address the consultant shortage issue. Ignoring the problem doesn’t make it any less real for the hundreds of thousands of patients waiting for an appointment or treatment in our public hospitals. All who work in Irish healthcare are motivated to do the best for their patients, but care can’t wait.

It’s time for all stakeholders—the IHCA, Minister for Health Simon Harris, Minister for Finance and Public Expenditure and Reform, Paschal Donohue, their officials and the HSE—to work together to find the solution without further delay.

Support the IHCA campaign #CareCantWait.