Sir, – You report (News, July 12th) that the number of outpatients seen per consultant has fallen by nearly 30 per cent since 2016. Without more detailed analysis, a statistic measuring the number of outpatients seen per consultant is an entirely inappropriate measure of efficiency or quality of patient care. In fact, a decrease in this measure is an inevitable outcome of the move to more consultant-provided care. This is because it ignores the outpatient work done by the majority of our non-consultant hospital doctors, known as NCHDs. For example, a team of three doctors, of whom only one is a consultant, has an additional consultant appointed, with no increase in NCHDs. The number of doctors has increased by a third, and the number of patients seen will increase likely by more than that due to better productivity. But the number of patients seen per consultant falls.
A more consultant-provided service is policy since at least the Hanly report of more than two decades ago. A measure that perversely punishes hospitals for beginning to achieve that will ensure that it never happens.
Furthermore, as a measure of quality, number of patients seen is extremely crude and provides an incentive to list all referred patients for clinic visit, when it is increasingly recognised that alternatives, such as advice and guidance provided to primary care by letter, telephone or online methods, or assessments by specialist nurses, physiotherapists and others, are more appropriate and sustainable responses to many types of referrals. – Yours, etc,
Dr GERARD CROTTY,
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Consultant haematologist,
Tullamore,
Co Offaly.
Sir, – Your news report of July 12th paints an alarming picture of declining consultant productivity in our hospitals and Minister for Health Stephen Donnelly is right to focus consultant recruitment on hospitals where consultants are doing their job effectively.
There is clearly a culture of prioritising private over public among some hospital consultants, so to do anything other than what the Minister proposes would serve only to prolong the waiting list misery of the 50 per cent of our population who cannot afford private healthcare.
It could be illuminating to look separately at the productivity of the 2,000 consultants who have signed up to the new contract and are receiving a package worth up to €300,000 to see public patients only. As this cohort now accounts for more than half of all consultants, one would hope they are performing a little better than average. – Yours, etc,
CORMAC O’CARROLL,
Salzburg,
Austria.
Sir, – Ruary Martin (Letters, July 13th), in his response to (“Hospitals falling behind in performance face exclusion from funding for new consultants”, News, July 11th), makes the valid point that when things go wrong in the health service, it is clinicians (usually consultants) who are called to account before inquiries, not administrative managers. Regulatory bodies are often well funded and staffed and are quick to point out failures to meet their regulatory standards, despite the challenges healthcare staff face. When the HSE introduces a recruitment embargo, there is limited media attention to what an arbitrary mechanism this is to ensure spending remains within budgets. It does not focus on value for money, best clinical outcomes or helping to keep patients well. – Yours, etc,
FRANK BROWNE,
Templeogue,
Dublin 16.