Letters to the Editor: Unequal pay for hospital consultants is a false economy

Medical and surgical specialists abroad are looking on with interest as to whether the current Minister for Health and Taoiseach will honour pay  commitments and restore basic trust across the system

In a globalised medical labour market, where talented, highly trained young Irish hospital specialists can work with more attractive conditions elsewhere in the world, restoring pay parity is a major part of the solution to the consultant recruitment and retention crisis. 

Last week, an Irish Examiner editorial commented on a story first reported in The Irish Times about a hospital consultant working for the HSE who had been paid more than €640,000 last year. While we do not have the exact details of the payment, much of that sum was likely due to retrospective payments in line with a 2018 High Court settlement agreement with the HSE for contract breaches and/or for additional work carried out due to unfilled consultant posts.

The editorial, however, suggested that it “refuted” the arguments made by the Irish Hospital Consultants Association (IHCA) on “inadequate pay” for consultants, pointing to this example as its rationale. This misrepresents the IHCA’s position, which is that for the past decade the Government has imposed an additional 30% salary cut on consultants taking up contracts since October 2012.

This paper’s editorial was correct when it pointed out that in November 2020 there were 730 permanent consultant posts vacant or filled on a temporary basis. That number shows no sign of being tackled head on by the Government, even after the pandemic, which has visibly strained the healthcare system and its healthcare professionals to their absolute limits.

This is also despite the “unambiguous commitment” made by Health Minister Stephen Donnelly in October 2020 to remedy the consultant salary inequity and restore trust between consultant bodies and health service management.

The longer these posts go unfilled, the longer patients must wait for care. In many instances, their conditions and prognoses will deteriorate. The indirect costs of ongoing symptoms impacting on people’s quality of life and their ability to work can also be substantial.

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The loss of our highly trained specialists abroad has forced the HSE to employ agency-hired locum doctors at often twice the cost of permanent consultant staff. What was myopically believed to be a shrewd cost-saving mechanism is in fact the complete opposite. Expenditure on locum doctors, or “agency costs” increased from €36m in 2012 to €95m in 2020, which is a €59m per annum increase or two-and-a-half-fold expansion.

The reported payments to some individual consultants and temporary agency staff highlight the false economy of the additional 30% pay cut imposed on those contracted since 2012. That unilateral pay cut means consultants contracted after that date are paid less than their colleagues, despite doing the same job with the same responsibilities in public hospital and mental health services which are enormously overstretched due to severe capacity deficits. The resultant one-in-five permanent posts that can not be filled are the root cause of the growing unacceptable waiting lists.

Our public hospital system is desperately short of hospital consultants, beds and other facilities to treat patients on time. Almost a million people are on a waiting list to see a consultant, a number that will only increase further in the aftermath of the pandemic and is likely to grow consistently over time as the population ages and the incidence of lifestyle-related chronic illness increase.

We will need a significant increase in specialist medical, surgical, and diagnostic staff to treat these patients. Unfortunately, the reality is that our public hospitals currently are not seen as an attractive place to work.

It is understandable that Irish specialist consultants in Toronto or Melbourne or elsewhere abroad may not want to uproot their family to take up a new position that discriminates against them in an understaffed, poorly equipped hospital short on beds with a massive, growing waiting list and all the resulting stress and discomfort that causes patients and staff. It is at the very least understandable that young highly-trained specialists seek to start their careers elsewhere in the world, where bed shortages are rare, waiting lists are manageable, and better staffing ensures a semblance of a work-life balance.

The remuneration of hospital consultants must be competitive in the global market which is experiencing shortages. It must reflect the responsibilities of the job, which are especially onerous in public hospitals here because of decades of underinvestment. Consultants bear an exceptional degree of responsibility. They make life-sustaining decisions every day. Over the years, that pressure, combined with long, irregular hours and decades of professional training, takes a physical, psychological, and emotional toll. Burnout and early retirement are common.

In a globalised medical labour market, where talented, highly trained young Irish specialists can work with more attractive conditions elsewhere in the world, restoring pay parity is a major part of the solution to the consultant recruitment and retention crisis. 

Our public hospital and mental health services need to become more competitive and better equipped to fill the increasing number of vacant permanent consultant posts.

Following the publication of the draft Sláintecare contract, it is now essential that both sides engage in full negotiations of the proposed contract.

However, the failure of two successive governments to end pay inequity has significantly undermined trust and is driving our highly trained specialists away from our public hospitals.

Our medical and surgical specialists, who have emigrated over the past eight years, and those completing specialist training, now look on with interest as to whether the current Minister for Health and Taoiseach will honour their commitments and restore basic trust across the system. This is a key factor that is adversely delaying the timely provision of care to public hospital patients. If this is left unaddressed, Sláintecare will amount to little more than business as usual with a new logo — that’s bad for everyone.

Martin Varley

Secretary General

Irish Hospital Consultants Association

O’Malley, honesty went hand in hand

The late Des O’Malley was about the only politician that I ever felt totally in tune with, as a person one could depend on for honestly taking on the political demons in the corridors of Leinster House. God be with you Dessie, you leave us with little to cling to for the principles you displayed and pursued.

Tony Fagan

Enniscorthy, Co Wexford.

Not one to run with the hare...

Des O’Malley was a politician of great integrity for whom breaking the mould of Irish politics was more than just an empty cliché. Much will be written about the well-documented milestones of his career, such his response to the Arms Crisis, his consistently hard line against militant republicanism, his principled strand against Haugheyism, and the formation of the PDs.

But I’d like to pay tribute to the courage he showed in changing his attitude to the cruel practice of hare coursing.

In 1984, Alan Shatter TD (Fine Gael) had proposed a motion at the Oireachtas Joint Committee on Legislation calling for the abolition of hare coursing. The motion was defeated; thanks in no small part to Des O’ Malley’s passionate defence of the blood sport.

The late former minister and leader of the Progressive Democrats, Des OMalley, who is praised for doing a u-turn on his Dáil voting stance on a hare coursing ban. File picture: RollingNews.ie

Campaigners for the protection of the iconic Irish hare were disheartened by this setback, dismissing any further lobbying of Des O’Malley as a lost cause.

But then, in June 1993, hare coursing came before the Dáil again, this
time the subject of a private members bill moved by Independent TD Tony Gregory. To the astonishment of observers in the public galley, including me, Des O’Malley voted with Gregory to ban hare coursing. This was unexpected, not only because of his previous voting record on the issue, but due to the presence of several coursing and hunt clubs in his County Limerick constituency.

Coursing fans decried his stance as a u-turn. I prefer to think of it as a reminder that it’s never too late to do the right thing.

Coincidentally, a phrase he used in relation to a different political scenario could well be adapted by campaigners against coursing:

“Let the Hare Sit.”

John Fitzgerald

Kilkenny

Naval service beyond fixing

The naval service is now beyond fixing. If the outgoing chief of staff, who was himself a member of the naval service, was unable to get the Department of Defence to address the crisis, there is little hope the incoming chief can do any better. The remaining Naval personnel deserve better.

Jerry Cahill

Killeagh, Cork

Above and beyond call of duty

Regarding the article in the Irish Examiner (Simon Coveney to clarify future of ‘Post-94’ cohort of short-staffed Defence Forces, Tuesday, July 20) what about the personell that have gone above and beyond to meet their contract obligations?

Overseas, career courses, time away from home and families?

What is their reward for meeting their contract obligations?

Patrick Campbell

Main Street, Cavan

Digital cert? Hold the line please!

Regarding the Irish Examiner article on the delays on the Government’s digital Covid certificate helpline (People ‘on hold’ for hours as Covid cert helpline mired in difficulties) I was on hold on July 21 from 8.45 through to 10.45 with no answer.

Ross Hallock

Ennis, Co Clare