Minister for Health takes consultants to task on hospital crowding   

Minister Jennifer Carroll MacNeill is already ruffling feathers as she steps into her new role

So, we have a new Minister for Health. And Jennifer Carroll MacNeill has certainly hit the ground running. Indeed, there are shades of Mary Harney in her no-nonsense approach.

From the medical profession’s perspective, how she responded to the hospital trolley congestion seen after the St Brigid’s Day bank holiday weekend was instructive.

Over the bank holiday, the number of people on trolleys in hospitals across Ireland rose from 253 on the Saturday morning to 617 on the Tuesday morning. The Health Minister noted how the “very high level of hospital congestion” on Tuesday 4 February “has not been seen since January 2023”.

As a result of this spike in trolley numbers, Minister Carroll MacNeill told RTÉ’s Morning Ireland she had requested detailed information on the number of admissions and discharges per hospital “to identify where the issues may be particularly pronounced”. This data revealed that 1,000 more patients were admitted than discharged.

The Minister stated this is “in large part connected to the presence of senior decision makers on site”. As a result, she requested an analysis of the consultants rostered over the bank holiday.

Minister Carroll MacNeill said the initial data, from around a third of hospitals, shows that just 10 per cent of consultants were rostered, either on-call or on-site.

“This is not enough,” the Minister said. Ouch! And her follow-up comment was equally punchy: “Of course, other senior decision makers to support consultants are needed, but clearly consultants are the clinical lead and indeed the cultural lead of every hospital.”

Doctors tuning in might have appreciated this unexpected nod to their role in shaping hospital culture – but the moment of warmth didn’t last long.

The Minister told listeners that around 60 per cent of hospital consultants have signed up to the public-only consultant contract, as part of which consultants can be asked to work 8am-10pm Monday to Friday and 8am-6pm Saturday as part of their core 37-hour, six-day week.

And if the public were in any doubt about the implications of this contractual fact, she spelled it out: “Normal patient flow and outpatient clinics on Saturdays should be occurring…. This data that I obtained in response to a very significant spike over the bank holiday weekend has given me cause for concern.”

Asked what could be done based on the figures she had received, Minister Carroll MacNeill said she needed “much better data”.

“I will continue to bring this to Cabinet once I get that data and then I will bring the plan that there is for the bank holiday weekend – St Patrick’s Day, over Easter, May and June – because it’s about making sure that we’re using the tools that we have.”

She added that she has asked the HSE CEO Mr Bernard Gloster, “to do a much deeper dive on what is happening with the rotation of consultants and maximising the public consultant contract that we have.” The Minister said Mr Gloster will report back to provide a “full analysis of how consultants are being used and deployed and supported in our hospitals”.

IMO response

At the time of writing the IHCA had yet to respond to the Minister throwing down the gauntlet. The IMO said that consultants are not the obstacle to extending routine health services over the weekend, but serious investment in staffing and infrastructure, as well as a fundamental change in how hospital care is delivered, are required to support such a move.

Indeed, there are shades of Mary Harney in her no-nonsense approach

Prof Matthew Sadlier, Chair of the IMO consultant committee, said that, as most consultants have signed up to the new contract, it is evident there is an appetite amongst consultants to provide enhanced care over weekends. Which was an adroit response to the Morning Ireland presenter’s suggestion (during the Minister’s interview) that some consultants may simply not want to work on a Saturday.

INMO

But it was the Irish Nurses and Midwives Organisation that went toe to toe with the new Minister. Noting Minister Carroll MacNeill’s absence from a meeting of the emergency department taskforce, INMO General Secretary Ms Phil Ní Sheaghdha said that the Health Minister had been invited, but did not attend due to a diary clash.

“I don’t know what would be more important than the crisis in our emergency departments,” she stated.

I feel a bit of spice coming down the tracks on health, don’t you?