The Irish Health Service gosh where to begin?
VI Declaration: I am a consultant in 2 of Dublins largest hospitals. I trained and worked in the NHS for 10 years before joining the Irish Healthcare system in 2003. I’ve been a consultant for 4 years.
By way of defense of me and my coligues when choosing a carear in medicine the barriers to entry are high. You have to be motivated and very committed. it starts at school. you are interested in science and caring for patients I began like may others volunteering in hospitals and working for the St John ambulance. Once you get to med School the focus is all on pure learning Anatomy, Physiology, Chemistry Biology etc before moving on to the practical arts of the Practice of medicine. The next 10-15 years are very long hours and per hour very little pay. my first year the pay structure was full pay for the first 40 hours, half pay for the next 32 hours and then nothing after that. Ie you wer paid for the first 72 hours. Our average hours were 90 pw the longest week I worked was 128 hours which included a 56 hour shift. The gross pay worked out at about £1.20 per hour. Once you get on to the higher specialist training it is all about your speciality and you and your family make sacrifices to pursue that training often moving over seas. By the end of it you are a very well trained doctor in your specialist area focussed on clinical excellence, most of us tag on a management course to tick the box prior to the consultant interview but by that stage almost none of us have any experience of or interest in management.
@Txirimiri by the end of this its not surprising many of us my self included (Pin you saved my life and a fortune) are a bit one dimensional.
The best roll for a consultant is; adequately resource them and point them at the patient. Most of us would be happy to full fill that roll to the full. But we work within one of the most obstructive, unionised institutions where no one can be sacked for anything.
For avoidance of doubt I have zero sympathy for anyone who doesn’t discharge their contract in full. For the record I dont admit any private patients to public hospitals.
The consultant contract requires 37 hours of programmed monitor-able audit-able work + on call. After I’ve discharged my contract I still have some free time (remember I’ve never been required to work so few hours in a week) so I do some private work after my public commitments.
I have a very good example of the public vs private system.
I work with Surgeon A doing cases B in the public hospital one after noon each week. We rarely are able to do more than 3 cases per week together in the time available in the public hospital and cases are often canceled at short notice. There are days when I go in and my whole list has been canceled no one has informed me and there is nothing for me to do but drink coffe and as a certain song goes “chat up the nurses and be generally subversive”.
I work with the same Surgeon A doing the same cases B in a private hospital. We regularly do 12-16 cases in the same time that we manage to do 3 in the public.
Its the whole f@*king system top to bottom. No accountability at any point and no incentive to do any better. Tiny examples as to why: in the public, only the porters are allowed to move the patient from the bed to the table and table to bed at the start and end on an operation. If we muck in because they are late, delayed elsewhere etc it becomes a union issue. One day I changed the 13 amp fuse on a plug because we needed the machine to start a case, it nearly resulted in a hospital wide strike by the electrical engineers. If the list finishes early the nurses get re-deployed to the wards which they hate therefore the list always expands to fill the time available regardless of the workload. Consultants are forced into management to sort out and improve shit like this because we want to work but its a mess and we hate it, its not what we are trained to do and its sole destroying.
In the private hospital, people get sacked, time is money, if the porter isn’t there even the radiologist mucks in and moves the patient of the bed. If we are quick and efficient we get to go home early. If the list is canceled we all either dont come in or get to go home and dont get paid.
It would be nice to scrap the whole public service and start again.
The health service is like an old plane fixing it and changing things is like trying to repair it while it flies along.
A&E is a mess. The biggest problem is work load. It’s used as a GP service. This is intolerable and no amount of tinkering will fix it. There should be better out of hours service and personally I think all GP care should be free. This would overnight fix the A&E problem.
When you become a consultant you see lots of small changes that would improve the service. I identified a minor change that would save our hospital 60K pa in its drug budget. When implemented it would have actually reduced infection risks for the patient and slightly improved care and make zero difference to everyone else’s practice. No brainer right?
It took me 2 years to implement this minor change, I had to talk to he head of every feckin imaginable department and it felt like wading uphill through treacle. The change made no difference to me personally so the resistance to change was truly unbelievable. Another very minor change in our departments practice bringing us unto date with what many other hospitals were doing 20 years ago caused unbelievable resistance from the nurses that resulted in us doing weekly and in my opinion completely unnecessary training courses for 8 weeks a waste of everyones time.
When you think what it would take to actually implement a major practice change the mind boggles! I’m worn down by it already, why bother. I’d just prefer to get on with what I’m good at .
Please dont think I’m blaming Nurses or Porters for the problems thats not the case its at every level in the organisation including my own and some of my erstwhile collages give the rest a bad name.
Its not so bad, every day people are treated people get sick and get well 70% or more of it works very well. From my management coures I recall our spend vs health benefits or activity or something is not bad when compared internationally (perhaps some of the chartists can help support or refute that)
Its customary to end these rants with something positive or a suggestion on how to over night improve the system so Ill not do a Morgan Kelly and leave you with the suicide icon so here goes TI’s quick fix heath service:
- Make GP care Free to all would instantly ease pressure on A&E
- Make 24hr GP access mandatory every where in the state by way of GP CO-operatives again would help A&E
- Allow staff to benefit from improved efficiencies otherwise who cares what it costs or how quick you get your work done. (let them go home early or spend the saving in their own department)
- Dont deploy consultants in managerial postions they are clinicians through and through and crap at management in most cases
- Allow people to get sacked from the public service
- Come down like a ton of brick on consultants not discharging their full public contract (IMHO this would be a handful)
- Sick with one health care system ie full National health system or fully private. The bastard version gets the worst of both
edit changed a do to dont