The previous two speakers were admirably brief but, as the Chair might expect, I will not be.
It says a lot that when the new Minister for Health and Children went into the Department he immediately had to set up an industrial relations initiative. It is extraordinary that the health service employers have had a nurses' strike and have just, perhaps, averted a non-consultant hospital doctors' strike. I asked on the Order of Business this morning if we could find out what has happened to home helps who appear to be in difficulty again with the health service employers. People who were paid ridiculous sums, such as £3 per hour, for keeping the elderly in their homes will now be granted £6.50 per hour, but apparently some difficulties have arisen with the health service employers. Someone has got to be in charge of the health service employers. If it is not the Minister for Health and Children we should be told.
I was saddened on the last occasion I raised this topic in Private Members' time two weeks ago when the Minister said we could not require statutory health boards to be independent and at the same time expect him to do something. He has overall charge of the health services and if we cannot look to him for help, to whom can we look?
No progress has been made on the negotiations with the consultants. The Minister of State will say the medical manpower report is due shortly but we had the Tierney report five years ago which seemed very good. The medical manpower report will not be agreed shortly because the Irish Hospital Consultants Association has not agreed the sub-consultant grade, nor will it. The Department may want it but it has been a dismal failure in Great Britain. Why would we want to introduce something here which has been such a failure there? Let him introduce sessional consultants, part-time consultants if he wishes, but he must get rid of the notion that this sub-consultant grade, which in many cases would take the place of additional consultants, would be a great help. I hope the Minister of State, Deputy Moffatt, will convey these views to the Minister, Deputy Martin.
Non-EU doctors here have been treated disgracefully for many years. They have been the backbone of the health service, particularly outside Dublin, Cork, Galway and Limerick. They have run the county hospitals of Ireland. They came here for training which they did not get. This is the reason the Medical Council acted in 1996. I have been raising this matter since 1997 and advised that this day would come. Now it has come. The previous Minister for Health and Children took no notice of what I said. The Medical Council said it had to do something because of the lack of training in various county hospitals. That is due to a lack of consultants. Naas General Hospital has one anaesthetist consultant on duty at a time. It shares consultants with Tallaght Hospital. Naturally it could not make an agreement in regard to the training of anaesthetists there, so how could the casualty department take it on?
There are two obstetricians working here single handed. They are the last two in either the United Kingdom or this island. There are nine hospitals which have two consultants. The Institute of Obstetricians has said, while there is six months to go, it will not sanction training posts in those hospitals. What preparations are in hand for this eventuality? It is incredibly disappointing.
Another shabby practice for non-EU doctors was that if they left the country to go to, say, a seminar in London they were charged for a re-entry visa. One Russian told me he had to pay £50. Was that not a great way of encouraging non-EU doctors to keep up our medical staffing? It is no wonder they have left. When the Medical Council made its regulations it also said that non-EU doctors had to do an examination before they could become accredited to work here. This was fair. However, in the past they did not have to do an exam. They could work here without doing an exam, while to work in Great Britain they had to have an exam. The cost of coming here was prohibitive for them. Instead of 200 or 300 coming every year only ten to 20 came. Given that I have raised this matter so many times I do not know why I am even discussing it again. This was bound to happen. Here we are on 30 June and the crisis will start on 1 July.
While the inadequacy of the training programmes will not be addressed by £10 million, that sum is welcome. We have got to have consultants who have time for training. They are the individuals who train these people but they are running ragged from trying to keep the health service in operation. We are 1,000 consultants short of the number needed to get us up to Scottish levels. I do not think anyone has said the Scottish levels are excessive.
Senator Glynn said the other day there was a rheumatology programme in the Midland Health Board. I asked him afterwards who was the rheumatologist. He then explained that it was the hope of the Midland Health Board to have a rheumatology programme. The Midland Health Board deserves three to four rheumatologists but there are only about ten in the country. It is utterly ridiculous that there is such under representation of people in medial specialties, in particular neurologists. How many times have I told the House we have 11 when we should have 35?
Senator Chambers called for a policy on strokes and more action on them. How can we have any action without some neurologists? On the issue of rheumatologists, do we not have arthritis in this country? Then there is the most serious problem of ophthalmology. The Lions Club pays for people from the Midlands Health Board, who have been on the waiting list for over two years, to come to Dublin overnight so that they can have day surgery for cataracts. While the country is supposed to be awash with money and the Minister for Finance is telling us to party this is what is being done to those who are blind.
There was the recent scandal about the 78 year old locum who had been working as a pathologist in Letterkenny Hospital and Tralee General Hospital. It was a minor miracle that we were able to get a 78 year old to work anywhere. There are more consultant singlehanded posts in the country than proper set-ups. How can these people get even a day off if they do not manage to get a consultant from somewhere? I agree there should be some regulations regarding who can be appointed to consultant posts. As my colleague, Professor Sean McCann, wrote to The Irish Times, how would you feel if you were told that a 78 year old locum pilot was flying you across the Atlantic? Not too happy, I would imagine. We were fortunate to get somebody to take these positions. Not only are there far too few consultants on the ground but when anything happens we are in a dire situation.
The Medical Council sees what is happening with the General Medical Council in England. It is not supposed to be in charge of staffing but rather standards. It cannot be held responsible for a decrease in staffing if it is trying to raise standards.
Whenever there is a problem here there are angry patients and their public representatives are also angry. I was very upset this morning when Senator Liam Fitzgerald said on the Order of Business that he would like a course held on communication and an improvement in manners, although he was kind enough to say bedside manners, for consultants. When I raised this with him subsequently he did have cause for complaint. I suggest that those who are working in the hospitals are working on the run and under ridiculous conditions. Senator Glynn has said he cannot understand how the junior hospital doctors have managed to give a service in some situations, and he has seen the problems in the psychiatric services which are acute. He has not spoken much about the shortage of non-consultant hospital doctors but it is an important issue. The position with consultants is very bad. At certain times there would not even be an office into which one could take a patient to try to speak to them about something private; everything would take place in the middle of a clinic. I can understand Senator Fitzgerald's annoyance with the complaints that have been made to him and I will certainly take them up.
There have been such scandals in Great Britain that members of the General Medical Council yesterday took the serious step of voting for the disbanding of the body because they felt that as a regulatory body it had not been vigilant enough regarding members. They were right. We have only to look at the heart operations which for years were carried out on babies in Bristol where there was a totally unacceptable mortality rate. For several years the anaesthetist who pointed out the deficiencies in the service was not well supported by his own discipline. Indeed, he emigrated to Australia for a more peaceful, if not better, medical life because he believed his prospects of promotion would be diminished in Great Britain because of his whistle blowing. Perhaps there is something to be said for the criticisms of patients that people who work within the service are not fast enough to criticise colleagues.
The General Medical Council now has serious problems because of Dr. Shipman, who killed goodness knows how many people, and Dr. Ledward, whom women say mutilated them over his 18 years of operating. He is now able to work in Ireland as a pharmacist and could well be working as a locum pharmacist. The Pharmacy Acts contain no provision for a fitness to practise committee. Would that not be a new issue to tackle in the autumn? There were other consultants and general practitioners in England who did serious damage before their paths were arrested.
The key to solving the problem in this area is the appointment of more consultants to ensure training in posts where there is currently none. The Minister of State concluded his speech by saying, "With the full co-operation of all concerned and a commitment to making the best use of available resources, the effect on services can be minimised." What does he mean by that? I would have thought that all we can do is consolidate services. Navan, Cavan, Monaghan and Drogheda have serious problems regarding anaesthetists. The Minister of State, Deputy Moffatt, will be aware that it is unsafe to run a casualty department without anaesthetic cover. People should be told that certain hospitals are closed for accidents and emergencies until the situation is sorted out.
We are now in the holiday season, which means there will be locums in hospitals who are not familiar with those hospitals. I am aware that efforts are being made to recruit abroad and that the Internet is being used to search for German doctors, for example. However, the Department will have to assess them and ensure they speak adequate English. It will take some time for the accreditation processes to be completed.
There has been a terrible lack of a sense of urgency in the Department of Health and Children in the last few years. It takes at least a year in the voluntary hospitals and longer in local authority hospitals to fill a consultant appointment. Why does this process begin at the time the resident consultant is retiring? Why does it not begin a couple of years prior to that? That is what happens in most health services and in some it is considered desirable for the incoming consultant to work for six months with the consultant who is in place. That system could be introduced immediately. One need only look at the age range of employees and start filling the replacement posts at once.
A total of £10 million is being spent on the waiting list initiative. Who will operate on the patients? Surgeons from different hospitals have contacted me to tell me, for example, "I played golf on Monday to deal with my anger; I had to cancel my list because no anaesthetist was available." In another hospital, one of the major teaching hospitals in Dublin which shall be nameless, there is such a shortage of anaesthetists that, to ensure fairness, the surgeons operate a rota to determine who will have to cancel a list. Is this any way to run a health service?
Introducing legislation such as this is like running a health service with bits of Elastoplast. I cannot welcome it because I do not believe it will do any good. I doubt that any of the non-EU doctors, who might have been induced to stay if they had been approached three or six months ago, are still in the country. Why stay here if one knows one will be treated in this manner?
