Dáil debates
Thursday, 18 May 2017
Topical Issue Debate
Hospital Consultant Recruitment
6:20 pm
Jack Chambers (Dublin West, Fianna Fail)
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We have a number of Ministers in the Department of Health. Is the Minister of State taking the question?
Damien English (Meath West, Fine Gael)
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I am, yes.
Jack Chambers (Dublin West, Fianna Fail)
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It is unfortunate that he has been delegated that duty when there are a number of Ministers of State, as well as the Minister for Health, who could respond on an important matter that has been brought to the attention of the public this week, namely, that non-specialist doctors are being appointed as consultants.
In recent years we have seen a massive recruitment crisis in health care, primarily due to the failure by the current and previous Government to keep our graduates in the country and in training schemes. However, it appears that the solution from the Health Service Executive, HSE, and the Department of Health was to appoint people as consultants when they were not part of specialist training schemes. That has considerable consequences for patient safety and patient care. To be clear, the HSE's own definition of a consultant is defined as a registered medical or dental practitioner who, by reason of his or her training, skill and expertise, is in a designated specialty, is consulted by other registered medical practitioners and has a continuing clinical and professional responsibility to the patients under his or her care.
We know that under the Medical Practitioners Act 2007, consultants must be part of specialist training schemes to be the very definition of a consultant. However, we know, from good authority from people on the ground, that the Government and the HSE have appointed people to positions for which they are not actually qualified and where they are not in the specialised training schemes. That has massive consequences for patient safety.
Were the Minister of State running the Department of Transport, Tourism and Sport and had he responsibility for airlines and pilots, would he be happy to have a captain flying a plane who did not have a licence for that position? As I think his answer would be "No", why is it good enough for the Government and the HSE to allow people to be appointed to consultant positions when they are not on specialist training schemes and do not meet the definition the State has upheld? It has considerable consequences for patient safety for those with complex medical conditions. They have presented with an enormous problem in their lives and are told the consultant in whatever hospital is addressing that matter but under the definition of the State, that consultant is not a consultant because he or she is not part of specialist training schemes. It is a form of deception. It is misleading patients but is also undermining the training of other junior doctors within our hospital system because if the lead clinician or consultant is not actually a consultant and is not part of a specialist training scheme leading a particular clinical team, that undermines the training and recruitment process for the other junior doctors who may be part of specialist training schemes.
The fact that the Government has employed people permanently when they are not consultants as defined by the HSE is a massive issue of ethics. It breaches the Medical Practitioners Act 2007 and it breaches the consultant contract. It is fundamental, therefore, that the Minister of State gives an explanation, even though it is not his line Department, as to how this has occurred. Is he happy that clinical safety will be upheld and can he provide certainty to the House that this practice is not systemic because we have it on good authority that this is the case?
Were the Minister of State heading up the Department of Transport, Tourism and Sport, he would not be happy for pilots to fly planes when they are not licensed to do so. That is what is happening at present in the health service, and it is very unfortunate that neither the Minister for Health nor any Minister of State in that Department is present because this is a massive issue of clinical safety. Clearly, it is not important enough for them to show up and I am disappointed by that.
Damien English (Meath West, Fine Gael)
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I am here to answer the question raised by Deputy Jack Chambers. The Minister, Deputy Harris, had hoped to be present but as the Deputy is aware, the timing of this moved quite a bit today. It is normal practice for the Minister or one of his Ministers of State to cover these issues, and the Deputy knows that. To be fair, there is no point in him trying to go down that road because it is not believable.
Jack Chambers (Dublin West, Fianna Fail)
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One of them should be here.
Damien English (Meath West, Fine Gael)
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Generally, they are here as often as possible.
I am taking the matter on behalf of the Minister, Deputy Harris. I want to thank the Deputy for raising it and giving me the opportunity to provide clarification.
I want to be clear, on behalf of the Minister for Health, that he expects the HSE to comply with statutory and policy requirements when filling consultant posts. He also recognises that the HSE has done an amount of work in the past year to ensure that is the case. However, it is recognised that there are limited circumstances where an experienced doctor, usually a senior registrar who would not be on the specialist register, may cover for an absent consultant. That is to ensure senior medical coverage and the provision of safe, quality care. The HSE has stated that this only occurs as a final option in emergency circumstances.
I wish to emphasise that any doctor who occupies a consultant post, even if he or she is not on the specialist register, would still hold a medical licence. It is similar to what the Deputy said about the pilot licence. They still hold a medical licence, and the Deputy should not try to give the impression that they do not-----
Jack Chambers (Dublin West, Fianna Fail)
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They do not hold a licence for the specialist training regime.
Damien English (Meath West, Fine Gael)
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-----and would be on a division of the Medical Council register. They are also fully qualified to practise medicine.
At a national level, health policy remains the development of a consultant provided service as per the report of the national task force on medical staffing, the Hanly report, and the reports of the strategic review of medical training and career structures, that is, the MacCraith reports of 2013 and 2014. The HSE has also been focused on improving the recruitment and appointment process for consultant posts. A high-level committee, appointed by the director general of the HSE, was tasked with analysing the current operational and administrative barriers to the efficient creation, approval of and recruitment to consultant posts in 2016. Having reviewed processes around successful consultant recruitment, 33 findings were identified and related actions for implementation developed. These are set out in a HSE document entitled Towards Successful Consultant Recruitment, Appointment and Retention, which was published in February 2017.
One of the findings of the committee specifically relates to this issue of providing services by those who are appropriately qualified. The finding stated that the HSE should ensure that "measures are adopted to cease the poor employment practice which gives rise to contracts of indefinite duration and risk to the public arising from provision of services by persons who are not appropriately qualified". It also set out a series of actions the HSE should take to address this issue. These require the HSE to review the extent to which permanent posts have been created or filled in breach of appropriate sanction; to act as a matter of urgency to enforce existing regulatory requirements; and that sanctions are implemented for non-compliance with qualifications. The executive should also clarify the scope of practice of the individuals referenced above and related designation as "consultants". It should also work with the Department of Health, the Medical Council and representative bodies to examine the use of the term "consultant" in regard to the specialist division. The timeline given for carrying out these actions is by the end of June 2017. The Minister, Deputy Harris, is confident that once these actions are implemented, they will help to address the issues raised by the Deputy.
I will conclude by noting that the number of consultants employed by the HSE at the end of March 2017 now stands at 2,881. That is an increase of an additional 122 whole-time equivalent posts since March 2016. It is also an increase of almost 700 in the past decade. I can assure the Deputy that the Government remains committed to continuing to increase the number of consultants and to the delivery of a consultant-led service.
Jack Chambers (Dublin West, Fianna Fail)
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With due respect, the Minister of State did not answer the question. In terms of a statutory framework, he said that all clinicians have a licence to practice. They do, but if the Minister reads the Medical Practitioners Act, he will see that it splits medical practitioners into two fields. There is the general licensing but then there is the specialist training licence regime. The Government has appointed consultants, pretending they are specialist registered consultants who have gone through that scheme, when they have not. That is what has happened here.
We know it is not in limited or emergency circumstances. We know it has happened on a systemic basis as a permanent solution to the recruitment crisis. Therefore, the analogy of the pilot who does not have a licence on the plane is very accurate because consultants whom the Government has appointed are practising as specialist, trained consultants when they are not such consultants. That is a fundamental breach of trust, ethics and the core principles of clinical practice. It raises serious issues concerning patient safety and care.
When patients believe consultants are properly trained and qualified to do the job when in fact they have not gone through the full specialist training scheme, it is a massive issue of trust, care and clinical outcomes. When the consultants have not the experience and have not gone through the specialist scheme, it has an impact on clinical safety. That is why we have rigorous, proper schemes through the various clinical faculties across medicine.
The Minister of State needs to explain this and also address it. It is important not to quote gross numbers about consultants. This is about the people who have been appointed who are not on specialist training schemes. That the Minister of State has not addressed my specific question shows this has happened. It is important that it be addressed.
6:30 pm
Damien English (Meath West, Fine Gael)
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I will be as brief as I possibly can. I did answer the question in detail and I explained to the Deputy all that has been done. The high level working groups have tried to address this and any concerns the Deputy has and deal with the process.
We recognise that there are approximately 300 consultant posts that are difficult to fill due to geographical location or the nature of the speciality. Many consultants trained in Ireland are much sought after in other English-speaking countries. Some of the posts are filled on a locum or temporary contract basis. In a small number of cases, some people filling the posts are entitled to contracts of indefinite duration. As I said, that can be an issue. Where a highly specialised skill is required, a person who is not capable of doing the job would not be offered the consultant post. I want to be clear about that. The Deputy is asking me whether what he describes is common practice. All I can say to him is that in order to ensure senior medical coverage and the provision of safe, quality care, the HSE has stated that what was described occurs only as a final option in emergency circumstances. That is what we are trying to achieve. When I quoted figures on consultants it was just to remind the Deputy that in times of plenty there were 800 fewer consultants.