C&AG report - Persistent failures of management

The report of Comptroller and Auditor General John Purcell on the implementation of the 1997 contract of the Medical Consultants was published yesterday.

It makes timely reading, especially in view of the ongoing dispute with the consultants.

The report, which examined the implementation of the previous contract over the past 10 years, uncovered a number of deficiencies suggesting a difference of understanding between management and consultants in a number of areas. There is, for instance, a dispute about the agreed working week for consultants.

The Health Service Executive (HSE) contended that consultants were supposed to work 39 hours per week, including six hours of unschedulable activities, but the consultants insisted that they were contracted for only 33 hours a week. Mr Purcell expressed an understandable disappointment that this issue had not been resolved in the 10 years since the contract was signed.

The consultants were contracted to provide work schedules, but those were not updated over the years. After 10 years some bore little relationship to reality. As a result there was a distinct absence of records on which hospital managers could determine whether consultants were discharging their contractual commitments.

Even where managers believed that particular consultants were performing above and beyond the call of duty, there was no way of verifying this. The Comptroller and Auditor General found the lack of proper records particularly disturbing in the matter of consultants treating private patients in public hospitals, because there was no meaningful attempt to monitor the level of private practice of consultants.

In public hospitals 20% of beds were designed as private beds, but the report found that the level of private patients exceeded the 20% ratio in all categories of clinical activity. This brought the equity of the system into question, because less resources than those for which the public was ultimately paying were being applied to the treatment of public patients.

Distinct deficiencies were also found in the matter of clinical review to ensure the kind of medical abuses that occurred in Drogheda are not allowed to happen again. No central guidance was accorded with the result that whatever arrangements exist are merely implemented at a local level to varying standards.

The advent of the State Claims Agency has brought about a greater awareness of the importance of risk management. Some hospitals have taken proactive measures, but it will take a further three to five years to implement a comprehensive national plan.

Consultants do not come out of this report very well, but this should not be allowed to obscure greater deficiencies. The consultants were essentially allowed to interpret their existing contract as they saw fit.

The real story of this report has been the persistent failures of management. The managers largely only managed to dodge their responsibilities. Ultimately the report is a blistering indictment of managerial incompetence and indifference.