‘What patients deserve'

Row over hospital consultant hours

A Cavan consultant has warned that plans to put hospital consultants on Saturday rosters could ultimately leave patients with less, not more care.

“We cannot roster our way out of a capacity deficit,” warns Cavan-based Consultant Paediatrician Prof Nick van der Spek, as the national row over Saturday consultant cover intensifies.

The warning from the Irish Hospital Consultants Association (IHCA) member comes amid plans to extend consultant working hours, with the association calling on the Government and HSE to put the brakes on planned changes until hospitals have the staff and infrastructure to make them work.

Prof van der Spek insists consultants are not opposed to working Saturdays and some already do.

The problem, he says, is what happens when consultants are put on weekend rosters without the nurses, junior doctors, diagnostics, beds and wider hospital teams to support them.

“I want to be very clear from the outset: Consultants are willing to work Saturdays between 8am and 6pm. I myself am rostered to work Saturdays in Cavan General Hospital,” explains Prof van der Spek, who has 25 years’ experience as a Consultant Paediatrician.

Consultants in the main, he says, are also prepared to work the extended hours already included in their contracts, between 8am and 10pm during the week.

“Our concern is not about working these hours. It is about how extended working is implemented and whether the resources are provided to make it work for patients.”

The IHCA says properly resourced extended services could benefit patients.

“If properly resourced, providing more services after 5pm, and on Saturdays, could be a welcome development for patients and we at the IHCA are in support of this,” Prof van der Spek tells the Celt.

But he says there simply are not enough healthcare professionals employed at present to substantially increase current routine services without taking staff away from somewhere else.

“This is a national problem, but it would also very evident in my own hospital,” he says.

The Minister for Health has refuted claims by consultants that the new seven-day roster will create gaps in services.

Minister Jennifer Carroll MacNeill has said there are many different examples across the country of where the new rosters are being implemented successfully.

She said they are improving patient safety including through earlier discharges and lower trolley numbers.

Prof van der Spek’s warning is illustrated by a striking analogy previously used by IHCA President Professor Gabrielle Colleran, who said ‘consultant cover in Ireland is like a blanket over a patient in a hospital bed’.

She also described the proposed approach as “clinical and economic insanity”.

“If the blanket is already too short, pulling it up to cover the shoulders on Saturday simply leaves the feet exposed on Monday - precisely when patient demand is traditionally at its highest and the full hospital infrastructure is operating,” states Prof van der Spek. “That is the fundamental problem.”

And Cavan’s paediatric service, he says, shows just how stretched the system already is.

“Our blanket in paediatrics is already very short with just four permanent consultants and a temporary post instead of the absolute minimum of six, and similar capacity problems exist in other departments in our hospital and in hospitals throughout the country.”

The fear is that spreading the same limited number of consultants across more days will simply only serve to move the problem around.

“Ultimately, that risks providing less care rather than more - and nobody wants that: not patients, not consultants. I can’t speak on behalf of others responsible for running our health service.”

But consultants cannot operate as lone figures in a hospital, admits Prof van der Spek.

“A consultant needs a team,” he accepts. “You might describe the consultant as the captain of the ship, but a captain needs a crew. Without the crew, the ship cannot leave the harbour.”

Prof van der Spek points to paediatric clinics, where up to 30 children can be seen during the normal working week by multidisciplinary teams involving consultants, nurses, advanced nurse practitioners, healthcare assistants, junior doctors, administrative staff and other healthcare professionals.

“The consultant activity that would normally have taken place during the week would have to be reduced or cancelled,” he told the Celt, in order to balance the contractual hours.

“We would therefore be taking a highly productive consultant-led service away from a weekday, when the full hospital infrastructure is available, and replacing it with a less productive service on Saturday.”

Prof van der Spek adds: “We have not created additional capacity. We may actually have reduced it.”

He stresses that this is not currently happening in his own service, but it still illustrates “what could happen if extended working were imposed without providing the necessary supporting resources”.

Minister Carroll MacNeill had singled out Cavan General Hospital earlier this month in an interview with RTE when she said it was “almost inconceivable” that Emergency Department consultants would leave at 4pm on a Saturday.

Like the IHCA, Prof van der Spek’s message to the Minister and Government is straightforward: Fund the system before stretching it further.

“The solution is not complicated, although it requires investment.”

And that means more consultants and the teams needed to work alongside them.

“We want patients to receive faster, better and more efficient care. And we are willing to work the Saturdays and extended hours provided for in our contracts to help achieve that,” Prof van der Spek concludes.

“But extended working must create additional capacity, rather than simply moving existing capacity from Monday to Saturday. We cannot roster our way out of a capacity deficit. Give consultants the numbers, the teams and the infrastructure to do the job properly, and we will work with the health service to make extended working succeed. That is what our patients deserve.”