Kidney crisis the latest symptom of ailing health service

The embarrassing prospect of donated kidneys having to be sent abroad because of a lack of staff to harvest and transplant them here is only the latest symptom of the increasingly dire staff problems in the Irish health service.

Money is part of the issue, particularly since former minister for health Dr James Reilly cut the salary of new consultants by 30 per cent in 2012 and tried to cut starting salaries for nurses by introducing a graduate scheme for the profession.

Clipping the wings of high-flying consultants was popular and populist, given the context of the economic meltdown since 2008. The Government could legitimately argue it was also morally correct, given the levels of hardship being experienced by the less well paid. While well-intentioned, it now seems like an over-correction.

The cut was a blunt instrument that imposed the greatest suffering on new entrants and failed to take account of the huge demand for Irish-trained doctors in other western health systems.

Why, argued younger doctors, should I perform the same work as a more established colleague for far less money? And why should I accept, after my long years of training, a salary far lower than I could achieve in so many other health systems?

A starting salary of €109,000 for a consultant on a type B contract, which allows limited private work, might seem handsome, but not to doctors who have slogged 15 years through the training system at great personal expense and sacrifice and are prepared for long, antisocial hours.

The result is that hundreds of posts have become impossible to fill on a permanent or even a short-term basis. The widespread engagement of agency and locum staff has ended up costing millions. It isn’t just provincial hospitals that are finding it difficult to recruit staff; even positions at the cutting edge of medicine in the main teaching hospitals remain vacant.

Thus, as The Irish Times reported last year, two of Beaumont Hospital's 10 operating theatres remain closed at any one time due to a shortage of anaesthetists. The same hospital has twice tried to recruit qualified surgeons to join its renal transplant team, again without success.

It isn’t all about money; the working conditions in the Irish system are harder than elsewhere, and the level of frustration commensurately higher. The consultants in Beaumont are intensely frustrated that the surgical lists are regularly cancelled, leaving highly expensive equipment and the staff to use it effectively idle. The remaining four transplant surgeons have been providing cover in 24-hour block every four days, in addition to their regular daytime duties in the hospital.

The same thing is happening, to a less extent, in nursing. Here too, the quality of the workforce is being thinned out.

Moves are now afoot, in talks between the HSE and the Irish Medical Organisation, to reverse most of the 30 per cent salary cut.

Unfortunately, it will take years to unravel the damage done – so the problem will get worse before it gets better.