Health services - Overtime culture out of control

VERY considerable progress has been made in the last three years in controlling overtime costs for hospital registrars and in the wider health services but still more needs to be done.

Three years ago the Health Service Executive paid an unsustainable €219 million but in the first six months of this year that figure was less than a quarter of that — €51m — but it still hit the €2m mark every week. Under the scheme 15 hospital doctors more than doubled their salaries of around €80,000 by earning €100,000 extra in overtime last year. At least one registrar was paid over €130,000 in overtime alone.

The doctors are not alone. More than 100 paramedics earn over €6 million in overtime, sick leave cover and annual leave cover. This, in some instances, quadruples basic pay. The HSE has confirmed that 107 paramedics, advanced paramedics and supervisors each receive over €100,000 a year.

It is unimaginable that this is the best use of increasingly scarce resources or that doctors or emergency staff working so many extra hours are physically or mentally capable of delivering proper care and attention to patients. Such long hours in such demanding circumstances are, as anyone who has had to deal with an exhausted and sleepy registrar will confirm, a risk to the patients and to the doctors.

This is recognised by the European Working Time Directive which obliges the HSE to limit the number of hours worked by hospital doctors. This is being achieved through changes in work practices.

Difficulties in finalising the employment contracts of nearly 200 junior doctors from overseas early this year may delay change and savings. However, the fact that overtime was factored into the contracts offered to those doctors by the HSE suggests that the overtime as standard practice is more institutionalised than might be prudent.

Health Minister Dr James Reilly has been vocal in his determination to confront these issues but he may find it easier to talk about it than to resolve it.

Figures published yesterday about waiting times in Dublin hospitals cannot have been an occasion for celebration either and in so many ways defy belief, especially as we imagine ourselves a modern, caring society.

Over 60,000 people are on outpatient waiting lists to see consultants at hospitals in Dublin. The figures, published by The Irish Times, show some patients were waiting for up to two-and-a-half years for initial appointments. Patients who wish to see a specialist in dermatology or endocrinology, or visit the Beaumont Hospital’s diabetic clinic, wait up to 30 months. Figures show Beaumont Hospital, the national centre for neurosurgery and neurology, had almost 13,000 people waiting to see specialists at the end of April.

These figures are scandalous and underline the great anxiety caused by escalating health insurance costs for those lucky enough to still be able to afford them and the fear and apprehension felt by anyone dependent on public health services.

The task of reforming our health services and the creation of a single, universal system is one of the objectives this Government has set itself. Let us hope they succeed because waiting lists and utterly excessive overtime bills are just two of the many issues that define our current system as dysfunctional.