‘Recruitment problems for LUH posts to get worse’

RECRUITMENT of consultants in Letterkenny University Hospital (LUH) is difficult in the best of times but, as a result of the proposed Sláintecare contract, it may become even worse.
Mr Peter O’Rourke, retired consultant orthopaedic surgeon, believes the proposed contract will lead to further vacant consultant posts, more trainees emigrating on completion of training, longer waiting lists and a detrimental effect on patient care.
Mr O’Rourke, who retired last year after a twenty-three year career in Donegal, expressed fears that the new Sláintecare contract will keep health professionals away from Letterkenny University Hospital.
“It’s always been a major struggle to get people to apply for jobs in Letterkenny but the advent of Sláintecare will make it harder,” he warned.
Currently Letterkenny provides general surgery, cancer surgery, urology and trauma and orthopaedic services. The lack of beds has resulted in the cancellation of many surgeries and patients are now being referred to private hospitals by the National Treatment Purchase Fund (NTPF) within a matter of weeks.
“The idea of setting up hospitals in Cork, Galway and Dublin to do planned surgery could, potentially, be the death-knell for surgery in places like Letterkenny,” Mr O’Rourke said.
“If planned surgery stops, then surgeons cannot be recruited and there will be no emergency surgery. If there is no emergency surgery then you cannot run an Emergency Department and this makes any hospital unviable.”
He highlighted a number of concerns with the Sláintecare contract which he feels will effectively ‘gag’ consultants by its prohibition of doctors advocating for patients or services, its ownership of any publications by doctors, and its ability to move doctors to different locations.
It comes as most recent figures show that one in four whole-time equivalent (WTE) consultant posts are vacant across “a range of medical and surgical specialties” at Letterkenny University Hospital (LUH).
There are currently 66 approved Consultant Posts at LUH of which 47 posts are filled on a permanent basis.
One of the posts which has yet to be filled is consultant orthopaedic surgeon – Mr O’Rourke’s former job.
“My job has been advertised and interviews are due to be held in the near future but that may be significantly delayed because Saolta is only offering the new contract which has yet to be agreed with the profession with its reduced salary scale and which denies you any private practice,” Mr O’Rourke said.
Sláintecare, which was launched in 2017, has promised to reform the Irish healthcare system by eradicating the two-tier divide between public and private healthcare and reducing waiting lists.
However, Mr O’Rourke believes that Sláintecare is never going to work in smaller, regional hospitals like Letterkenny.
“The whole premise of Sláintecare is that it will free up beds in public hospitals for people who are treated as private patients. In Letterkenny, recent figures show less than 10 per cent of private patients were planned admissions. The remaining 90% were emergencies which means that even if you stop private patients being treated the potential benefit to the public, regarding access to beds, is virtually zero in Letterkenny. The hospital loses income which the government must replace, the doctors lose incentive to work in public hospitals and the only beneficiaries are the private medical insurance providers.
“Also, if you introduce the new Saolta contract it won’t be a level playing field because people can go and work in voluntary hospitals like Vincent’s, the Mater and Beaumont in Dublin. There, very likely, you can also continue doing private practice in private hospitals while people working for the HSE won’t be able to do,” he explained.
“In reality, no Irish trained consultants will be interested in coming to work in Letterkenny,” he added.
Attracting consultants to LUH have been an ongoing problem. At present, there are consultant campaigns for the filling of permanent consultant positions in the following specialties: orthopaedics; obstetrics and gynaecology; microbiology; anaesthetics; nephrology; radiology; and geriatric medicine.
“Many of these posts have been occupied by locums for many years, but many of these doctors while very competent and provide a great service they would be ineligible to apply for the permanent posts.
“Service development is virtually impossible for locums, which is detrimental to the hospital and they are not incentivised as they do not have any long term commitment.
“There has been a disproportional focus on cancer services in Letterkenny. This, while important, has been at the expense of other services. As doctor approach retirement then if replacements cannot be recruited even the cancer services which already rely on locums will be in jeopardy,” he said.
Mr O’Rourke was the only applicant for his own job twenty five years ago so it’s always been difficult to get people to apply for jobs in Letterkenny.
What more can the Saolta Hospital Group do to entice more consultants to the North West and Letterkenny?
“There’s no silver bullet but the fact that they’re offering this new contract will only make it harder to appoint people to places like Letterkenny. It is the only hospital in the country where doctors do not have access to a private hospital,” he said.
Mr O’Rourke, who retired in December last, says he has ‘no axe to grind’ with the HSE.
“The X-Ray Department only has two permanent consultants at the moment. It has two retirees doing the breast clinic work, which has been the case for a number of years, because they couldn’t get a breast radiologist.
“It’s an extremely well resourced department with the best of facilities but getting people to work in Letterkenny is going to be extremely difficult. If they work anywhere else they have access to private hospitals with a significantly higher income.
“At the best of times there were few, if any, applicants for jobs in the obstetrics and gynaecology service while the Emergency Department – which had one new appointment recently – has had two vacant jobs for the past twelve years but never bothered advertising because no one ever applied.
“Some politicians, philosophically, are against private practice but I don’t think they understand how it will affect Donegal, disproportionately, compared with every other hospital,” he said.
Mr O’Rourke also renewed his call for the National Treatment Purchase Fund (NTPF) to be abolished. He believes that the funding it receives should be channelled into public rather than private hospitals.
“The Government has probably put more than a billion euro into the NTPF at this stage which is the only reason for the increasing number of private hospitals has developed and survived – money that could have been better used to create infrastructure in places like Letterkenny.
“Instead, the private hospitals are getting bigger and bigger and they’re looking more and more to public hospitals who train medical staff for the additional doctors and nurses they need,” he said.
The health reform envisaged by Sláintecare will mean nothing for many people in need of urgent treatment now, Mr O’Rourke believes.
“Surgery was cancelled almost on a daily basis in September at Letterkenny due to Covid and we’re not even into the winter yet.
“All of these things being planned as part of Sláintecare will crucify Letterkenny because if people aren’t able to do elective surgery then you can’t have an emergency service,” he warned.
Mr O’Rourke believes Letterkenny University Hospital will continue to struggle to attract permanent staff until the HSE takes “ownership and responsibility” and addresses ongoing critical shortage of hospital beds which is the only way to resolve the problem.

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