‘Cynics’ dictate delivery of health service

Dr Peader Gilligan

The Department of Public Expenditure and Reform, and not the Department of Health, is dictating the delivery of healthcare in Ireland, according to the outgoing president of the Irish Medical Organisation.

Peader Gilligan, an emergency medicine consultant at Beaumont Hospital, said the Department of Public Expenditure and Reform (DPER) had motives other than the optimisation of patient care and was exploiting divisions between rival medical organisations.

He said they were “the ultimate cynics” who know “the price of everything and the value of nothing”.

DPER failed to understand the changing health landscape and certain actions, such as paying consultants hired since October 2012 less than colleagues doing the same job, were driving doctors abroad, he said.

“I’m very clear that the Department of Health understands the fact that things have changed and that the recruitment environment has changed.

I’m not so confident that DPER understands the level of change that has taken place, and more concerning to me is, I’m not sure they’re as concerned about it as they should be.

The Department of Health said DPER “recognised earlier this week that there are issues to be addressed in relation to new entrants”, and that “consideration will need to be given to potential solutions which are in line with public sector pay policy and available budgets”.

“This will be a significant challenge,” the department said.

Dr Gilligan said it has become “increasingly apparent” to him while IMO president “that it’s DPER who are dictating the delivery of healthcare in this country, and for me, that’s wrong”.

“The Department of Health has within its remit the delivery of healthcare and the design of healthcare in Ireland, and my sense of it is that that’s being frustrated by the economics of the system,” he said.

Dr Gilligan said it was now a feature of the health service that consultants resign from their jobs, which would never have happened when he first qualified.

“When I took up my consultancy and I was talking to people about it, they said to me the one thing they could say with certainty is that nobody resigned from a consultant position in Ireland.

“The one thing I can now say with certainty is that there are resignations all over the country, particularly in child psychiatry and emergency medicine.”

Moreover, hospitals were being propped up by locum staff.

My understanding is that in Tralee, the hospital is dependant on locum agencies for 40% of its consultant body, which is very, very significant indeed.

Dr Gilligan said divisions between bodies such as the IMO and the National Association of General Practitioners (NAGP) were being exploited by DPER .

He said: “I suppose I was a little bit concerned when the NAGP formed because I felt it was dividing rather than helping to progress things on behalf of general practice, and I really think what needs to happen is that doctors collectively decide the direction of the health service in the best interests of patient care.”

Dr Gilligan was at the AGM of the IMO in Killarney, which continues today.

Among the motions carried was a call on Government to ensure social media companies based in the Republic are treated as publishing companies for the better protection of children.

Dr Matthew Sadlier, the psychiatrist who proposed the motion, said he had “often seen patients who would say the precipitant for their mental health crisis has been a social media post, that had it been published in a newspaper, it would have constituted libel or slander”.

If the social media companies weren’t making a profit from advertising revenue, you could call them neutral, he said, but they were, so it was difficult to see why different rules applied.

Dr Clive Kilgallen, a consultant histopathologist at Sligo University Hospital, proposed a motion calling for an additional 5,000 beds.

He said with current bed occupancy at “almost 100%”, patients couldn’t get admitted to hospital for elective procedures, including for tumour removal.

“It’s almost ground to a halt,” he said.

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