Secret HSE report: Patients at risk as consultant recruitment crisis intensifies

An unpublished report prepared by the HSE’s National Doctors Training and Planning Unit paints a damning picture, reporting that consultant recruitment in Ireland is 'in crisis'

Susan Mitchell

Deputy Editor and Health Editor @susmitchellsbp
16th June, 2019

Last August, the President of the High Court hit out at what he described as the HSE’s “scandalous”, “dangerous” and continuing practice of permitting non-specialist doctors to be appointed as consultants in hospitals and mental health services.

“The HSE appears to be a law unto itself in this regard,” Mr Justice Peter Kelly said, addindg that it “cannot be right” that a difficulty in recruiting doctors at consultant level was addressed even temporarily by appointing people he said were inadequately qualified for such posts.

He said the fact that such an approach had been adopted by the HSE, in breach of its own requirements for the last ten years, was nothing short of “scandalous”.

The judge had raised several issues with the Medical Council concerning the HSE’s practice when he cancelled he registration of Arjan Kumar Bhatia, a radiologist with an address at Drumcliffe in Sligo. Bhatia had been recruited by an agency to work as a locum consultant radiologist at Cavan General Hospital.

Writing for the Irish Times, Mary Carolan outlined how “Dr Bhatia worked at the Cavan hospital between June and September 2014. After the hospital raised concerns, the council’s fitness to practise committee found some 80 allegations involving 43 patients amounted cumulatively to poor professional performance, including failures concerning CT scanning, to see liver abscess, to recognise acute stroke, understating of cancer scans, and missed fractures”.

Bhatia had previously worked over a number of years in other Irish hospitals despite failing the examinations for the position of consultant radiologist, Kelly noted.

A number of such cases have come before the courts.

Dr Clive Kilgallen, chair of the Irish Medical Organisation’s consultant committee, said that, while it was clear that the HSE was breaching its own recruitment procedures by hiring non-specialists, the underlying problem was that the Irish health service was “not seen as an employer of choice for consultants”.

Now, a new report from within the HSE itself has highlighted the true scale and severity of the problems facing Irish hospitals and healthcare organisations.

Read the full report

The unpublished report was prepared by the HSE’s National Doctors Training and Planning Unit (NDTP) which is headed up by professor Frank Murray. It paints a damning picture, reporting that consultant recruitment in Ireland is “in crisis”.

It represents the first admission from the health service that what is now happening on a widespread basis in Irish hospitals and the resultant gaps in service is creating clear patient safety risks.

The report found that one in every 20 doctors now employed as a medical consultant by the health service was not on the specialist register, which ensures they have completed higher specialist training. Smaller and rural hospitals are worst affected, it said.

The report states that:

- The number of applicants for consultant posts in Ireland has fallen “dramatically. For many posts, there are no applicants, and for most posts, the number of applicants has fallen precipitously”

- Low demand for medical posts was “largely due to substantial medical emigration” and doctors are “leaving Ireland in huge numbers”

- In 2016, more doctors who qualified abroad than qualified in Ireland joined the Medical Council Register.

- Working as a trainee doctor or consultant in Ireland has “become unattractive”

- Limiting consultants’ ability to undertake private practice was a disincentive to take jobs

- The failure to produce more sustainable work rotas was making posts unattractive

- Many posts were unsupported appropriately by clinical teams.

The report said the recruitment process for consultants “was slow, fragmented, multi-step and distant from the needs of the recruiting site”. Since 2016, the average time to hire from the start of a campaign to the issuing of a contract was 658 days, or 22 months.

It said that this protracted recruitment process has “a critical negative impact” on effective consultant recruitment. All this, it said, has led to greater gaps in the provision of clinical services and a bigger reliance on non-specialist doctors.

Clive Kilgallen said the reliance on non-specialists was “driven by the totally unfair and discriminatory pay policy where government unilaterally decided to impose an additional 30 per cent cut over and above cuts that applied elsewhere in the public system to new consultants appointed after [the beginning of] October 2012.

“We warned at the time that this punitive action would have serious and damaging consequences on the ability of our health services to have enough consultants in post to provide timely and appropriate care to patients.”

The report’s stark findings emerge just after it was announced that the satellite centre for the National Children’s Hospital would not be able to open as originally planned due to a consultant shortage.

In a recent Dáil debate, Fianna Fáil health spokesperson Stephen Donnelly questioned why the government was doing next to nothing to address difficulties in recruiting and retaining medical consultants.

“Ireland is running out of doctors. We have the lowest level of hospital consultants in the OECD. At the same time, we have the highest waiting lists for patients – men, women and children – to see these doctors. These issues are linked,” he said, adding that the government “did not seem to be doing anything about it”.

Donnelly highlighted how newer recruits were on significantly lower salaries than medical consultants who were hired before 2012.

“Any doctor thinking of returning from Australia, America or elsewhere will end up earning between €60,000 and €90,000 less than colleagues who have the same experience and may have graduated from the same medical schools. As a result, doctors are not coming back,” he said.

Donnelly questioned how the government could find an additional €1 billion to build the National Children’s Hospital, which has spiralled in cost, but could not provide doctors doing the same job with equal pay.

“When it comes to certain things, there is an endless pot of money. My calculation is that the switch can be flipped. When our healthcare system is about to explode and half a million people are waiting to see a consultant, it can be done. Flipping that switch would cost approximately €25 million a year by comparison to an additional €1 billion for the children’s hospital,” he said.

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