By Lloyd Mudiwa.

Gay Doctors Ireland (GDI) “fully expects” Dr James Reilly to support the Minister for Education in opposing a law that the organisation believes permits discrimination against lesbian, gay, bisexual and transgender (LGBT) employees.

GDI wants the removal of Section 37 of the Employment Equality Act 1998, which it claims allows religious hospitals and educational institutions to fire doctors based solely on their sexual orientation.

Section 37(1) states: “A religious, educational or medical institution which is under the direction or control of a body established for religious purposes or whose objectives include the provision of services in an environment which promotes certain religious values shall not be taken to discriminate against a person for the purposes of this Part or Part II if: (a) It gives more favourable treatment, on the religion ground, to an employee or a prospective employee over that person where it is reasonable to do so in order to maintain the religious ethos of the institution, or (b) It takes action which is reasonably necessary to prevent an employee or a prospective employee from undermining the religious ethos of the institution.”

GDI Chairperson Dr Conor Malone told IMT: “The Minister for Education, Ruairi Quinn, has called for its repeal and we fully expect that Dr James Reilly will support his Government colleague. We also hope the IMO and other medical associations will do their part to protect their members.”

Many other professional groups, including teachers’ unions like the Irish National Teachers’ Organisation, have criticised the legislation and called on the Government to amend the statute, he added.

The Equality Authority has also criticised the law, stating it had a “chilling effect” on employees.

Similar laws in Northern Ireland make it an island-wide problem.

Dr Malone commented: “Our members see this as a silent but very real threat, and it affects not just doctors but also nurses, teachers and other vital public servants. We’re not aware of any doctor who has been dismissed under cover of this legislation, but there are concerns that it has been or could be used to block promotion or even to avoid hiring someone.”

GDI discussed the law at a recent general meeting where delegates passed a unanimous motion “unequivocally rejecting” it.

According to Dr Malone, religious bodies run many Irish hospitals, so there was a “very real anxiety” that this could be used against LGBT staff.

“It’s shameful to think that an employer could fire someone simply because of their family life. At a time when the health system is crying out for NCHDs to stay and finish their training, it’s just another reason for young, talented doctors to consider going abroad where they won’t face this blatant discrimination.”

lloyd.mudiwa@imt.ie

By Dara Gantly.

A new co-op-run Community Intervention Team (CIT) covering the Carlow and Kilkenny area, officially launched last Friday by Minister for the Environment Phil Hogan, has already carried out more than 800 patient interventions since commencing in mid-September.

Currently covering a population of some 130,148, plans are already in train to roll out the service throughout the South East, initially to the Waterford area.

The Caredoc CIT model is the first of its kind in the country, as it is managed by the Caredoc out-of-hours GP co-op, in close co-operation with local consultants and the HSE, to facilitate early discharge and prevent unnecessary hospital admissions.

According to Caredoc Medical Director Dr Frank Bradbury, evidenced-based clinical algorithms were developed by the CIT working group, which included consultants at St Luke’s and the Caredoc clinical governance team, which assist hospital doctors, nurses and therapy staff in identifying patients that are suitable for early discharge. “Patients can then be treated by the CIT for up to 72 hours, or longer if deemed clinically appropriate,” said Dr Bradbury.

The service has been praised by local Kilkenny Consultant Geriatrician Dr Rory McGovern, who said it was an excellent example of “enhanced co-operation” between primary and secondary care. “It is a further step towards creating the seamless interface between community-based healthcare providers and the hospital multidisciplinary team,” said Dr McGovern.

Dorcas Collier, CIT Operational Manager, explained that for many health needs in the past, which would have required a patient being referred to the emergency department, the Caredoc CIT nurses can now deliver the appropriate care in the community: “The knock-on effect creates further HSE savings in relation to patient transportation costs from care of the elderly units and a reduction in the number of patients presenting at accident and emergency.”

dara.gantly@imt.ie

By Gary Culliton.

Continued understaffing of the middle-grade medical tier will place in jeopardy the recent success of the reforms undertaken by the Special Delivery Unit (SDU), a new report has claimed.

A survey carried out by the Irish Association for Emergency Medicine (IAEM) of emergency departments (EDs) has identified an “unsafe deficit” and “persistent ongoing vacancies within EDs”, with the resultant expensive locum requirements.

The Association has just completed a census of medical staffing within EDs across the country, which took into account the effects of the recent HSE India and Pakistan recruitment drive. Whilst recruitment to the more junior SHO grade has been successful, with all vacancies filled (36 of these are filled from the India and Pakistan recruitment), there still remains an “unsafe deficit” within the more senior middle-grade or Registrar in Emergency Medicine tier. Only 71 per cent (108/152) of these positions are filled — four from the India/Pakistan recruitment — and almost one in three of these more senior positions required expensive temporary agency staff to fill them, the IAEM stated.

Those hospitals with EDs where 50 per cent or more of middle-grade doctor positions remained unfilled and which were continuously reliant on agency staff included: Temple Street; Connolly Hospital, Blanchardstown; Galway University Hospital; University Hospital, Limerick; Mayo General; Naas; Letterkenny; and Our Lady’s Hospital, Navan.

The continued reliance on locum senior medical staff in EDs in Ireland is not only expensive but is “potentially detrimental” to standards of clinical governance and “risk avoidance” in patient care, the IAEM added.

The Association has urged an immediate government focus on potential strategies to ensure that the medical staffing of EDs is secured. In the longer term, this is dependant on significant consultant expansion. However, in the short-term, the IAEM believes this requires a stable middle-grade tier that should consist of doctors of senior trainee status to ensure there are adequate trainees to go on to become consultants in emergency medicine and a regularised staff grade position.

gary.culliton@imt.ie

By Lloyd Mudiwa.

Five more hospitals will shortly become part of the National Integrated Medical Imaging System (NIMIS), Irish Medical Times reports.

“Four hospitals are now live with the system and by year end the number will have risen to nine,” Prof Neil O’Hare, NIMIS Project Lead, said.

The four hospitals now live include Sligo General and Waterford Regional and in Dublin, both Beaumont and the Mater. Prof O’Hare told IMT that the system would also go live shortly in five hospitals in the North East.

“This fact belies the huge amount of work that has been undertaken by the local NIMIS teams, the national team, the supplier McKesson and other suppliers and HSE employees to bring the project to the point where we are now in a rapid implementation phase with on average of two hospitals going live with the system each month,” said Prof O’Hare.

The NIMIS project, he added, was now providing real patient benefits and efficiencies in those hospitals where it was live: “The system provides capabilities and tools to the clinical staff heretofore not available or only available on stand-alone computers.”

Prof O’Hare said this includes electronic ordering for imaging procedures, voice recognition for the rapid generation of radiology reports, and high-end 3D processing capabilities to help radiologists, surgeons and others to report on diagnostic tests or help in surgical planning. Cross-site reporting capabilities, and the rapid provision of radiology reports to clinical staff and GPs, were other benefits.

lloyd.mudiwa@imt.ie

By Gary Culliton.

Five consultant appointments approved by the Consultant Applications Advisory Committee (CAAC) were not accepted as Type C positions at last week’s meeting of another committee tasked with deciding whether hospital consultants can work privately off-campus.

A number of posts have been examined by the Type C Committee and IMT understands further information is now being sought.

The consultant contract states that there can be up to 700 Type C contract holders, including new Type C contracts, B* (B star) contracts or the old Buckley Category 2 contracts. According to HSE figures, there are currently approximately 500 of these posts in existence.

Amid reported difficulties in filling some vacancies, the IHCA believed that consultants should have a facility whereby — through off-site private practice — they could generate a “combined income between their private practice and their salary”.

An application for a Type C consultant post at Dublin’s Mater Hospital was approved in December by the CAAC. The Mater is seeking to make the Consultant Cardiologist post attractive to specialists abroad, and stated that via off-site private practice, Type C consultants could generate a higher level of combined income.

The IHCA has charged that up until now there has been “foot-dragging and ideological opposition” in relation to Type C appointments.

gary.culliton@imt.ie

George McNeice, IMO CEO

By Lloyd Mudiwa.

The Department of Health has declined to respond to a charge by the IMO that the Government’s claims that the union has frustrated efforts to implement the European Working Time Directive (EWTD) for NCHDs were off the mark.

The claims were contained in a Government report sent to the European Commission recently, committing Ireland to achieving compliance with the Directive within three years.

In a letter dated January 20 to Paddy Barrett, National HR, Department of Health, the IMO demanded that the Department immediately send a letter of clarification to the Commission retracting the “patent inaccuracies” with regard to the stance taken by IMO.

A spokesperson for the Department of Health told Irish Medical Times: “We can confirm receipt of the correspondence from the IMO and the issues raised are receiving consideration and the Department has no further comment to make at this time.”

In the letter, IMO CEO George McNeice took particular offence to the claim in the report that there had not been meaningful change in rostering arrangements due to ongoing negotiations with the doctors’ representative body.

He also took issue with the Department’s charge that the trade union initiated legal action in March 2009 in order to prevent the HSE from acting to implement the EWTD.

Regarding rostering arrangements, McNeice said this was presented as a statement of fact when it “clearly was not the case”. The IMO, he pointed out, had long campaigned for appropriate reductions in working hours for NCHDs and all rostering arrangements to allow for training to be delivered satisfactorily, provide for a safe level of medical care, allow for sufficient handover time and meet the requirements of the Directive and the 48-hour week.

On the legal action, McNeice commented: “This statement [that the IMO instituted legal action to prevent the implementation of the Directive] is clearly nonsensical and I am surprised, to say the least, that it would be included in the document submitted to the Commission.

“The fact of the matter is that the IMO instituted proceedings not to prevent the HSE acting to implement the EWTD, but to ensure that the HSE introduced rosters, which were in compliance with the EWTD.”

lloyd.mudiwa@imt.ie

Pictured L to R: Paula O’Connor, Dietitian Manager; Claire Moreau, Senior Dietitian, Richmond ICU; Carmel O’Hanlon, Clinical Specialist Dietitian, General ICU; Dr Rory Dwyer, ICU Consultant; Ina Dineen, Clinical Nurse Manager 2, Richmond ICU; Dr James O’Rourke, ICU Consultant; and Niamh Duggan, Clinical Nurse Manager 2, General ICU

By Gary Culliton.

Beaumont Hospital’s Richmond Neurosurgical Intensive Care Unit (ICU) has been ranked fourth and the hospital’s General ICU ninth in a survey of nutritional practices and outcomes among 183 intensive care units worldwide.

Beaumont is the second Irish hospital to achieve success in this international survey, with Cork University Hospital ICU achieving a top-10 ranking in 2008.

The multidisciplinary teams working in Beaumont Hospital’s two ICUs were the only European teams to receive the ‘Best of the Best’ accolade, reserved for those achieving a top-10 ranking in the survey.

The International Nutrition Survey is co-ordinated by the Clinical Evaluation Research Unit at Kingston General Hospital in Ontario, Canada. The results were announced recently at the Clinical Nutrition Week of the American Society for Parenteral and Enteral Nutrition, which was held this year in Orlando, Florida.

Commenting on the hospital’s performance, Beaumont’s Dietitian Manager Paula O’Connor said: “We first participated in this important international survey in 2007, with the specific intention of benchmarking ourselves against comparable ICUs worldwide. Our aim has been to learn as much as we can about best practice from our peers. Our success in the 2011 survey, with two of our ICUs ranking in the top 10, shows that this focus has been of direct benefit to our patients.”

The prevalence of malnutrition is high in ICUs generally, which can have a negative impact on clinical outcomes. Providing patients with the right nutrition, however, improves wound healing, boosts the immune system and helps the gut work more effectively.

gary.culliton@imt.ie

Beaumont Hospital ED

By Lloyd Mudiwa.

Beaumont Hospital’s report turn-around time (TAT), which is considered a key performance indicator by the Irish Faculty of Radiologists, has decreased to a mark which would have been nigh impossible prior to the implementation of the National Integrated Medical Imaging System (NIMIS).

HSE NIMIS Project Lead Prof Neil O’Hare told IMT: “Without a doubt the most striking benefit realised is the decrease in report turn-around time”.

Prof O’Hare said within four weeks of the implementation of the system, TAT for all reports has decreased to less than 18 hours. “This is a figure which would have been nearly impossible to achieve in the film-based environment,” he commented.

He added that within days of the system going live, NIMIS eased the care pathway for many patients from the first two hospitals, Sligo General and Beaumont, to have it installed.

He said a radiologist based in Sligo was able to receive a second opinion from a Beaumont neuroradiologist, which became part of the patient’s record within minutes, and there was no longer a need for Beaumont to take fresh images and reports for Sligo patients transferred into their care.

The scale of the Beaumont NIMIS project could not be underestimated, Prof O’Hare said, adding that making the hospital filmless and paper-light “overnight” was “certainly no simple task”.

“Many hospitals throughout the country and across the world have already installed their second- and third-generation Picture Archive and Communication Systems (PACS). The move from conventional film into the digital world, however, is a bigger leap and this is what has been achieved at Beaumont.”

Prof O’Hare said a number of challenges had to be addressed as nearly every process that involved radiology in Beaumont pre-PACS was based on either paper cards or x-ray film.

lloyd.mudiwa@imt.ie

By Lloyd Mudiwa.

The Faculty of Occupational Medicine, RCPI, is in the running to host the 2018 International Commission on Occupational Health (ICOH) Congress in Dublin. The Faculty’s bid made the shortlist, along with one other submission from Marrakech, Morocco.

The ICOH Congress is a global Occupational Health event, held every three years, that attracts more than 2,000 occupational health professionals from around the world. It was last held in Dublin in 1984.

The Faculty of Occupational Medicine submitted its bid to host the 2018 Congress in December. The theme of their bid is ‘From Ireland to the World — Uniting Occupational Health Professionals in Ireland in 2018 to Promote the Health of the Worker Internationally’. The proposed venue is the Convention Centre, Dublin.

Dr Martin Hogan, Dean of the Faculty of Occupational Medicine, and members of the local organising committee will travel to Mexico next month to make a final presentation at the 2012 ICOH Congress in Cancun. Members of the ICOH will then choose by secret ballot which of the two shortlisted countries will host the 2018 congress.

Results will be announced at the ICOH General Assembly on March 23.

lloyd.mudiwa@imt.ie

By Gary Culliton.

The HSE is developing standard national eligibility criteria to ensure more uniform provision of patient transport schemes. In addition, the procurement process for non-emergency transport provision, which has produced significant savings to date in the East, is now underway elsewhere.

If the criteria for private transport use in the East and Midlands were applied nationally, the HSE said it would anticipate savings of up to €10 million this year, or nearly 25 per cent of the total patient transport budget.

However, this would mean the withdrawal of some taxi services in the West and South East and would be difficult, with claims that access to health services would be reduced. As disability criteria are more consistent, there is likely to be a lesser effect on this patient group.

Further efficiencies in the HSE transport service may require a reduction in services, particularly non-emergency patient transport, the Executive has indicated. The HSE patient transport spending has been reduced from €56.8 million in 2008 to a targeted €42.5 million in 2011. Efficiencies to date have been achieved through new procurement arrangements and a tighter focus on when such support is actually required.

Non-emergency transport comprised over half of patient transport costs. It included both HSE and private services — taxis, minibuses and contracted ambulances. While the HSE has no statutory obligations in this area, it provides transport services or support where appropriate for patients, sometimes with staff, to access services, depending on resources and clinical need.

There is significant regional variation in the provision of non-emergency transport. In the East and Midlands, strict criteria apply and patients are not provided with transport to hospital appointments, unless there is specific hardship. Provision is more widespread in the West and South East.

A HSE policy document has been approved by the HSE Board, which sets out rules for making decisions on patient transport services, including the circumstances in which a service should and should not be provided and funded by the HSE. The new approach will involve “clear accountability and commissioning arrangements”, as well as patient needs assessment, a national booking and information management system, and separate emergency and non-emergency scheduling.

There are to be dedicated vehicles, such as intermediate care vehicles, and patient own-transport incentives such as lower parking charges or travel allowances.

Volunteer driver schemes are already operating in some rural areas.

gary.culliton@imt.ie