The new deal with consultants is good news for patients, but it could take years to implement all of the necessary changes, writes Eithne Donnellan, Health Correspondent.
Anyone who has ever had a family member with a recurring illness falling sick on a Friday afternoon or over an extended holiday period will have had that sinking feeling. There's the inevitable trip to hospital, knowing the patient will have to be admitted again and knowing that, upon admission, the patient is unlikely to be seen by a consultant or have a full range of tests until Monday morning at the earliest, or even Tuesday morning if it's a bank holiday weekend.
The experience is not just worrying for all who have to wait; it's also incredibly frustrating.
This system, which leaves many hospitals almost entirely dependent on junior doctors at weekends and which has been criticised ad nauseam in endless reports, may, however, finally be coming to an end thanks to a new deal with the organisation representing the majority of hospital consultants.
Under the agreement reached with the Irish Hospital Consultants Association (IHCA) on Thursday night, all consultants recruited in future will be appointed on the basis of new work contracts, which will also be offered to existing consultants already working in the Irish healthcare system.
The new contracts will ensure they are rostered to work not only for a longer week - up from 33 to 37 hours - but also for an extended day, from 8am to 8pm on weekdays and also for up to five hours on Saturdays, Sundays and bank holidays.
The consultants will be available at these times to see patients themselves, reducing the current over-dependence on junior doctors. This will allow for the introduction of the long talked-about consultant-provided as opposed to consultant-led service.
It means patients should be seen faster, admitted faster and discharged home as soon as medically ready, seven days a week.
Obviously, if patients are seen more swiftly by senior decision-makers and discharged as soon as they are fit, rather than left to hang around in an environment where hospital infections are rampant, the knock-on effects in terms of improving patient safety could be significant.
ANOTHER KEY BENEFIT for patients of the new working arrangements for consultants is the fact that outpatient clinics, where people are seen by specialists once referred by their GP, will start earlier in the morning and run on until later in the evening.
This, combined with the fact that there are promises to recruit around 2,000 extra consultants under the new contract, means more patients will be capable of being seen by senior decision-makers at the time of their first outpatient visit, rather than by a junior doctor, as often happens at present, after which they end up being called back several times before they finally get to see a consultant.
In addition, if more patients are seen every day in outpatient clinics that run on for longer, there will be the potential to reduce totally unacceptable outpatient waiting times. Last month, figures released under the Freedom of Information Act showed thousands of patients are currently waiting for outpatient appointments, with huge numbers waiting two, three and four years to be seen. Some are even waiting up to eight years.
In addition, it has been agreed between employers and the IHCA as part of the deal that patients referred to public hospitals for outpatient appointments and diagnostic tests such as X-rays or MRI scans will be put on one common waiting list, irrespective of whether they are public or private patients.
It means patients with private health insurance - which is now held by over half the population - won't be able to jump the queue for routine diagnostic tests in a public hospital. The result should be equity of access for all patients, which would be a major bonus for public patients.
But for private patients attending outpatients for routine tests in public hospitals, having to wait their turn effectively means they will have to wait longer to be seen than they do at present.
This new set-up would help prevent the recurrence of appalling tragedies such as that inflicted on Kilkenny woman Susie Long (41), who died last October after having waited seven months for her cancer to be diagnosed. In her case, her bowel cancer diagnosis was delayed because she was a public patient who was put on a lengthy outpatient waiting list for a vital colonoscopy. By contrast, she knew of a patient with private health insurance who was scheduled for the diagnostic test within three days.
The new working arrangements for consultants will also see them rostered to work in teams, which means that even if a patient's consultant is not in the hospital, another member of the team will be able to see them and discharge them if appropriate. Furthermore, these arrangements should ensure that if one doctor is underperforming or making mistakes, another doctor should be able to pick up on it fairly quickly.
In addition, the consultants entitled to do private practice will have their workload closely monitored to ensure they don't spend more than 20 per cent of their time on private patients, as has often happened in the past.
And the services consultants provide will be led and managed by fellow clinicians. These clinical directors, already in place in some hospitals, will be appointed to manage clinical services and budgets and to lead the development of services for patients.
OVERALL, PATIENTS WILL be the winners, says Minister for Health Mary Harney. And they should be, in the long run. But they are unlikely to notice any major changes in the short-term. The reality is that it could take years to appoint all the extra consultants promised and there will have to be negotiations with other health sector unions on a longer core working day for radiographers, hospital laboratory staff, porters, clerical officers and others if patients are to be able to have routine tests earlier in the morning and later in the evening when consultants working at those times order them. These negotiations with other unions could also be long and drawn out. After all, the talks with consultants were due to begin as far back as when Micheál Martin was minister for health, but they either failed to get off the ground or became derailed many times over the past few years.
It's not clear how much funding will be readily available this year to employ new consultants. A Health Service Executive circular distributed to hospital managers earlier this month in relation to staffing levels in the health service noted that individual services should examine the scope for additional consultant posts to be created in 2008 "on a cost-neutral basis through conversion of existing NCHD (non-consultant hospital doctor) posts to consultant posts".
It's true that many NCHDs, or so-called junior doctors, earn large salaries when overtime is taken into account, but none would earn the €240,000 now on offer for consultants signing up to contracts to work only with public patients, and few if any would earn the €220,000 on offer for those taking up contracts that entitle them to do some private practice while working in public hospitals.
Therefore, employing new consultants will not be cost-neutral. Where the extra money required for them will come from, in a tighter economic climate, is at this moment unclear.
SENIOR DOCTORS CURRENTLY in the system point to other factors that could delay benefits accruing to patients from the deal. They say hospital capacity will have to expand if they are to be allowed deliver all the extra services they will be capable of delivering over an extended working day. They point out, for example, that a lack of long-term facilities in the community at present means many patients fit for discharge cannot be released from hospital when they should be.
Free theatre sessions, not to mention beds, are already in short supply at many hospitals.
Finbarr Fitzpatrick, secretary general of the IHCA, said the revised contract will be only one of the key arrangements in how we reform the delivery of our hospital services.
"Similar arrangements must be made with other key groups within hospitals and the question of capacity must also be addressed," he said.
The agreement with the IHCA, which represents up to 1,700 consultants, is expected to be accepted in due course by the Irish Medical Organisation, which represents around 800 consultants. It pulled out of talks the day before the deal was clinched.
Patients, be they public or private, will reap the benefits in time if all sides accept what is proposed. But for those with private health insurance it would probably be wise not to cancel your subscription just yet.