Public health agreement long overdue, but welcome

The IMO’s annual general meeting (AGM), held on 17 April, was unlike any other in the Organisation’s history. Instead of the opulent surroundings of the Europe Hotel in Killarney (to where the conference returned in 2018 due to popular demand), the AGM was held virtually. In addition to speeches and presentations, it featured video interviews with doctors and pre-recorded segments by Minister for Health Stephen Donnelly and HSE CEO Mr Paul Reid. Over the last year, such virtual events have become a staple of the medical conference calendar. It was an AGM for the times we live in.

It is fitting that the new President of the IMO, Dr Ina Kelly, works in public health. If IMO members ratify the recent agreement between the Department of Health, the HSE, and the Organisation, Dr Kelly’s current working title of ‘public health specialist’ will finally be consigned to history. Under the proposed deal, the Department of Health and HSE have agreed to recognise public health specialists as consultants as part of a broad reform of the area. Such recognition has been a long time in coming.

A review by Crowe Horwath recommended the public health specialists be awarded consultant status. However, this review was only published in 2018 after a long delay. That the group be recognised as consultants was also a recommendation in the Scally Report, which was also published in 2018. Talks began between the IMO and health management on this issue, but progress was not easily achieved.

Although the Covid-19 crisis shone a spotlight on the essential work done by public health specialists like never before, there appeared a reluctance to confer on public health specialists the title which they deserved. At a meeting with the Department of Health and the HSE in September 2020, the IMO said it was told that the Department of Public Expenditure and Reform was withholding approval for the revised terms of the new consultant contract and stalling progress on the required legislative changes.

Strike action was proposed, but a ballot on the matter was delayed as a result of the severity of the pandemic. When the ballot was held in November, members voted overwhelmingly in favour of strike action, which was to take place in January. That too was postponed, again because of the huge surge in Covid-19 cases at the beginning of the year.

Public health specialists were caught in an unenviable position – between fighting for essential resources and status and continuing to protect the public from the worst health crisis in recent memory. On the Government and health management side, however, a failure to support a more fit-for-purpose public health infrastructure at a time of such a devastating global pandemic would have been a damning dereliction of duty.

Aside from the issue of consultant status, public health requires serious investment in more staff and better IT systems. It is to be hoped that the proposed agreement will form the basis of putting public health in Ireland on a more stable and sustainable footing, both now and into the future. While these reforms should have happened years ago, the deal is a huge stride forward for the specialty.