Colm Burke (Fine Gael) | Oireachtas source

For monitoring to work there must be continuity within the management system. In my experience, the management system in the HSE is akin to a revolving door. I have spoken previously about a particular hospital in which there have been ten managers over a period of 18 years. When a manager becomes aware of a practice that is not appropriate and he or she moves to another job, it becomes the job of the new manager to take over the process. Do we have continuity in monitoring in HSE hospitals? In my experience, we have a revolving door in terms of responsibility in hospital administration in monitoring because staff are continually moving to other jobs. Has an analysis been undertaken of the average length of time spent at senior management level in HSE administration? The huge turnover of senior management staff in HSE hospitals is an issue that has not been looked at. As a result, other issues are falling through the cracks.

My second question is for the departmental officials. I am open to correction, but as I understand it, under the previous category B contract, consultants were required to work 11 three-hour sessions but under the current contract, they are required to work 39 hours and that where there are three or four consultants assigned to a particular department, each will be on-call on a one-in-three or one-in-four basis. In an area such as dermatology it is unlikely that a consultant would be called in as often as a consultant in the areas of cardiac, orthopaedic or maternity care. Perhaps the officials might provide data for the levels of on-call activity of consultants outside the 39-hour contract. We have a problem in recruiting consultants, particularly in small hospitals, because they are required to work 39 hours and be on-call on a one-in-three or one-in-four basis, including at weekends.

On admissions through emergency departments, I have heard consultants say their names have been recorded on the charts of private patients on admittance through the emergency department, even though they have never seen the patients. What is the policy in that regard? As I said, I have heard consultants say they do not know when a patient is admitted as a private patient and that it is often done in order that the hospital can charge private fees for a hospital bed. What are the rules in that regard? Is it the case that emergency departments automatically admit people as private patients? I have come across cases of people who have been admitted to a ward as the private patient of a consultant without that consultant having been made so aware. It is not that the consultants are claiming for the treatment of these patients but rather the hospitals claiming fees for the use of the hospital beds.

My final question is related to the many challenges we face in the health care sector. What percentage of elective surgery work is done in the private sector, on which we are so reliant because of the lack of access to the public sector? As mentioned by Mr. Woods, consultants who are looking for jobs want access to beds for patients, access to theatres and sufficient support staff. For example, a hospital might have ample theatre space and support staff but be unable to improve on the level of operation throughput because of the lack of intensive care beds. This is one area in which we face challenges. We are also experiencing problems in recruiting because consultants are choosing to work in facilities in which there is greater backup support and thus the opportunity to do more work.

They are some of the issues I have heard being raised by medical practitioners.

This has come back to me through general practitioners, GPs, too.