The coalface of a crisis

Departure gate: the Irish health service. Destination: overseas. These are the depressing details on the ‘boarding passes’ that NCHDs are currently being asked by their union to fill in to make the point clearly to Government that unless things change, there will be more NCHDs in our airports than in our hospitals.

As campaigns go, the symbolic departures screen is striking: NCHD shortage — ‘on schedule’; career planning — ‘delayed’; morale — ‘departed’; and a ‘final call’ on two-tier consultants. Our emergency departments (EDs) have always stood out in our two-tier health service for not allowing any patients to receive preferential or faster treatment. As the coalface of our acute service, they have also often felt the first brunt of any crisis.

While the current recruitment crisis in our EDs has been in gestation for several years, it would appear that the proposed pay cut for new-entrant consultants relative to their peers will only reduce the number of doctors pursuing a career in Emergency Medicine (EM) even further. Last week, utterances from the Irish Association for Emergency Medicine (IAEM) would suggest that such a ‘two-tier’ consultant body will result in unplanned closures or restricted hours at some of our major urban and regional EDs in 2013.

The Association warned the impact on middle-grade recruitment, which is already a major challenge, would be immediate, and this shortage would subsequently result in a further reduction in the number of applicants for consultant posts.

The Association believes the recent Ministerial decision to cut pay for new entrants threatens to cause large-scale emigration of EM doctors, which will impact on the very stability of the emergency care system.

But the recent Labour Relations Commission proposals also want EM consultants to participate in 24/7 rostering, based on UK and Australasian norms for specialist staff. But Ireland doesn’t come near the norm in terms of EM manpower, with some suggesting that it could take between five and seven years to implement such 24/7 cover. And while the LRC proposals accept that such rosters are “more onerous” , the only concession it would appear willing to give is that these consultants will not be required to participate in on-call or structured overtime. Why not consider a monetary incentive too?

Of course, the Government will be pinning much of its hopes to square the recruitment circle on the imminent ‘Smaller Hospitals Framework’, with the redesignation of many EDs to Local Injury Units, the rotation of NCHDs and consultants across the Hospital Group, and more support from duty GPs working in hospital Urgent Care Centres overnight, as well as senior nurses.

But will such a system be any more attractive?