Dáil Éireann Debate, Thursday - 13 February 2014
11. Deputy Charlie McConalogue asked the Minister for Health the steps he has taken to address the shortage of non-consultant hospital doctors at Letterkenny General Hospital, County Donegal; and if he will make a statement on the matter. [6842/14]
Amharc ar fhreagraWhat steps is the Minister taking to address the shortage of non-consultant hospital doctors in Letterkenny General Hospital in County Donegal?
I thank the Deputy for the question. The number of non-consultant hospital doctors, NCHDs, in the public health system has increased by more than 200 in recent years and now exceeds 4,900. However, there are international shortages of NCHDs in certain categories and specialties. There are also some hospitals, such as Letterkenny, to which it has been difficult to attract NCHDs, for a range of reasons including training opportunities and rural location. We must live with this fact and do everything we can to address it.
Letterkenny General Hospital had an NCHD complement of 105 whole-time equivalents prior to the drive to support implementation of the European working time directive. To facilitate the implementation of the directive, it has received approval to employ a further 16 whole-time equivalents, increasing the total approved NCHD complement to 121.
Since July 2013, there have been ongoing efforts to recruit doctors for the January 2014 intake of NCHDs to ensure recruitment of all 121 whole-time equivalents. Unfortunately, due to national and international shortages of NCHDs, Letterkenny General Hospital, as of 11 February, has 26.5 vacant posts.
However, 14 of these posts are covered by agency locum non-consultant hospital doctors employed on a temporary basis to ensure continuation of service delivery at the hospital. Efforts are continuing to recruit additional NCHDs to the existing vacant posts.
Particular difficulties are being experienced in Letterkenny General Hospital regarding the recruitment of NCHDs in general medicine, and this is replicated in many hospitals nationally. There at 8.5 whole-time equivalent posts vacant in the general medicine specialty, comprising 7.5 registrar and one senior house officer posts. The recruitment and retention of non-consultant hospital doctors is required to support service delivery, address reliance on agency locums and facilitate the achievement of compliance with the European working time directive.
Last summer I set up a group under the chairmanship of Professor Brian MacCraith to undertake a strategic review of medical training and career structure.
Additional information not given on the floor of the House
The group is to make recommendations aimed at improving the retention of medical graduates in the public health system, planning for future service needs and achieving the maximum benefit from investment in medical education and training. The group provided an interim report in December 2013 with a focus on training. It is examining career structures and pathways following training with a view to submitting a report by the end of March 2014. In addition, the HSE is considering the establishment of a new service grade of non-consultant hospital doctor. The establishment of the hospital groups will also assist hospitals such as Letterkenny as the revised structures will facilitate the use of resources across the group. Indeed, the current shortages at Letterkenny are being considered in the context of the NCHD resources available to the west and north-west hospital group.
I thank the Minister for his reply. He has referred to national and international shortages in the supply of non-consultant hospital doctors. He has stated that shortages are particularly acute in regional and more peripheral hospitals such as Letterkenny General Hospital. His response is that this is something with which we must live. His response does not provide specific solutions which is what I asked for in my question. He has outlined that where there should be 121 NCHD posts in Letterkenny General Hospital. Currently 26.5 posts are vacant, with 14 being filled by agency doctors, no doubt at a more significant cost than the full-time posts.
The hospital normally had ten medical registrars but currently there are 8.5 posts. To comply with the working time directive, that number needs to increase to 15 posts. On many days recently there were significant backlogs in the accident and emergency department with people on trolleys, and neither Sligo nor Altnagelvin were able to take the overflow. The public had to live with that difficulty
I will come back to the Deputy.
It is not acceptable that the medium-term solution is that we must continue to live with it.
I must call the Minister.
I will finish on this point. I ask the Minister to elaborate on what steps he can take to address that situation to ensure it does not continue for the next few years.
As the Deputy has acknowledged, we have approved more posts for Letterkenny. The reality is there is a difficulty in recruiting but we continue to recruit actively and to use agency locums to ensure we provide a safe service for the people of Letterkenny. I congratulate the staff of Letterkenny General Hospital and the wider hospital group which provided support from Galway from Bill Maher and his team and the board. I also acknowledge the help from Altnagelvin during the flooding. The unit is fit to re-open and we look forward to seeing the Deputy at the opening. Letterkenny General Hospital is a critical part of our health service and it will be supported. I have no doubt we will be able to attract more doctors to Letterkenny by means of rotation within the hospital group. This is one of the benefits of the hospital group because staff will not be recruited to work in Letterkenny specifically but will be recruited for the north-west hospital group and will go on rotation between the hospitals during the course of their training. This system will also make available to Letterkenny and the people of Donegal a greater level of expertise than was the case heretofore.
I concur with the Minister and I thank him for his comments about the staff. What they and the management of the hospital have achieved has been heroic and amazing. The flooding of the hospital was one of the biggest disasters at any hospital in the history of the State. The accident and emergency department at Letterkenny General Hospital is the seventh busiest in the country, which shows the demands on the service. The hospital has had difficulty in recruiting the staff it needs and the numbers of staff which have been approved. This demonstrates the job of work faced by the hospital in dealing with its daily workload. We need to have solutions from the Minister. He has outlined that the number of NCHD posts has been increased to 126, but the real difficulty is in recruitment. The Minister has indicated there may be potential for rotation in the new hospital group. Whether the solution is in the system of rotation or else international recruitment in the medium term until there is more supply from this country, we need to see solutions quickly. We cannot continue with the current situation because it will mean more delays in the accident and emergency department which is unacceptable for patients in Donegal.
The Deputy will be aware from earlier responses to questions that the model of care needs to change in both hospitals and in general practice. We need to move away from this episodic illness approach to a system of prevention and chronic illness management in primary care. The Minister of State, Deputy Alex White, is dealing with this aspect and he is in consultation with the GP organisations, for which I thank him. It is the case that NCHDs are doing work that could just as well be done by other health care professionals. I alluded to the skill mix where nurses are performing duties which health care assistants could undertake, doctors are doing work that advanced nurse practitioners could undertake, and both professions are doing work that would be better done by physiotherapists or speech and language therapists or other allied health care professionals. We must address this by innovative ways of using the resources available to us, which in my view will be more cost-effective and result in better outcomes for patients and would also be more rewarding for the professionals involved.
