Whether Sláintecare lives or dies is now in hands of the consultants

For the final 18 months of my medical career, I had the privilege of working in the HSE. When I was a hospital consultant, it would never have entered my mind that I could write a sentence like the last one.

Strangely, the HSE I worked in was not the HSE I had read about in the media or heard about in my former jobs. What shocked me most of all (as a medic with the usual anti-HSE antibodies) was the very positive attitude the people I was working with had to frontline healthcare workers, including consultants, and the genuine desire they had to work with their clinical colleagues to transform the system. Covid may have had something to do with this. So what if it had.

Of course, I hadn’t the heart to say to my HSE colleagues that this feeling is not reciprocated by the troops in the frontline trenches – but I guessed they knew that already. No doubt, some will say that this was Stockholm syndrome, or a post-midlife crisis, or that I was brainwashed, or that I was simply a poacher turned gamekeeper.

But my experience of working in the HSE was not like that. Instead, it was a reality check that I had not expected, and that gave me a newfound confidence in the capacity of our healthcare system to change for the better. Central to that confidence is Sláintecare.

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The vision of Sláintecare is to deliver a single-tier healthcare system in which access is based on need, and to recruit and retain the very best healthcare clinicians, managers and staff.

Key components of Sláintecare include the removal of private healthcare from public hospitals and implementing a new consultants’ contract that provides greater flexibility.

Ireland has 40 per cent fewer consultants than the EU average, 900 unfilled permanent consultant posts, and 900,000 patients on waiting lists to see a consultant.

Most consultants working in Ireland and abroad, and doctors who are training to be consultants, indicated recently that they will not take up the new Sláintecare contract. Unless the vast majority do, Sláintecare will be dead in the water.

All-party support

It should be borne in mind that the government’s Sláintecare policy has all-party support, and so it can be truly said to have the support of the people who vote and who pay the salaries of consultants.

In all new contract negotiations, neither employers nor employees get all they want. But having ground to a standstill after protracted deliberations, the contract negotiations are now over. In my view, the time has come for consultants to show leadership and don the green Sláintecare jersey.

Recently I read the diaries of Dr Kathleen Lynn. Lynn was a revolutionary, a pioneering doctor, a co-founder of St Ultan’s Hospital, and the medical officer of the Irish Citizen Army in the 1916 Rising. The thought struck me forcibly that if Lynn were here, she’d tell her consultant colleagues in no uncertain terms to “sign up!”

So, what are consultants getting in the new contract? For a basic salary of €209,915-€252,150 (on a six-point scale), they work a 37-hour week (on shifts that run from 8am to 10pm on Monday to Friday and from 8am to 6pm on Saturday) with additional remuneration for on-call duties and overtime.

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In addition, there is a choice of different work patterns (less than whole time, work sharing, compressed hours, flexible start and finish times) and support for continuous medical education, training and research. On top of this, there is an opportunity, after meeting their commitment to their public contract, to engage in off-site private practice.

So, what are the turn-offs for consultants? Chief among them is the fact that an employer can change the provisions in a consultant’s contract after appointment in relation to place of work, as well as the scope and role of the post. Other issues include the absence of limits on the number of late evenings, Saturdays, and on-call sessions that a consultant can be rostered to work, and concerns about not having the additional staff needed to support consultant posts.

To transform our hospitals there is an urgent need to have more consultant cover in the late evening, at night and at the weekend. Under Sláintecare, there will also be a need for services to evolve and reconfigure – and in certain circumstances for services to move from one hospital to another, and from hospitals into the community. This requires greater flexibility in consultant work practices.

The more consultants who take up new contracts, the less onerous these changes will be for any individual consultant. Consultants may also work in a private hospital after their duties in their public hospital are fulfilled. It’s interesting to note that while the prospect of working in a different private hospital is appealing, the prospect of moving to work in a different public hospital is not.

Capacity to change

With a significantly greater earning potential than taoisigh and ministers of health (who work incalculable hours) and every other healthcare worker in the system, the terms of their new contract, although far from perfect, cannot be considered unreasonable or unattractive.

During Covid, consultants (like other frontline workers) demonstrated an amazing capacity to change how they worked – including hours on duty, on-call rosters, even workplaces. If they bottled a fraction of this in their new contracts, consultants could run Sláintecare on it.

It’s also important to point out that consultants are now significantly involved in the senior-management teams of both hospitals and the HSE as clinical directors and in other roles, and, therefore, are uniquely positioned to both lead and implement Sláintecare at both operational and clinical levels. The days of us (healthcare workers) and them (HSE, Department of Health) need to go; we need to work as one team.

In trying to sum up what it might feel like to be a consultant if we pulled off the Sláintecare grand slam, the recent words of Johnny Sexton came to mind (with apologies to the Irish captain for the poetic licence): “It’s the best healthcare service you can work for. We are so proud to be Irish consultants.”

There’s no reason why this can’t happen. All we need are some Kathleen Lynns and Johnny Sextons.

Chris Fitzpatrick is a retired consultant obstetrician & gynaecologist, and former master of the Coombe Hospital – and a former medical lead for Covid-19 vaccinations and an acting clinical director in the HSE’s Dublin Midlands Hospital Group.