A Memorandum of Understanding (MOU) concerning cooperation in the provision of health and personal social services and the regulation of the practise of medicine in Ireland was signed by the Health Service Executive (HSE) and the Irish Medical Council (IMC) in 2013, in the interest of service user safety and public protection.
Last night (13th December) a meeting of doctors was held to discuss the possibility of reforming what some, particularly those who have been under investigation by the IMC, have described as the current “dysfunctional” nature of Irish medical regulation, prompting the question; if this MoU is not yet being effected to the best of its ability, then where could it improve?
In October, Medical Council President Professor Freddie Wood, gave his welcoming address at the Medical Council’s conference ‘Enhancing the Culture of Patient Safety’ by highlighting the importance of practising a safety culture, while also acknowledging the need for mistakes, or “near misses”, as learning tools.
He stated that if a quarter of annual deaths of patients undergoing serious surgery could be reduced by managing close calls, or by learning from failure, then that would “provide huge extra resources, resources as we heard some weeks ago – particularly In intensive care- are limited”.
Professor Woods continued by stressing the importance of; “…knowing how much we do, how well we do it and what we do and using that information to continually assess and look at team improvement. All too often, individual doctors are blamed for a particular failure. We will see many times after investigation that the systems fails, or usually, that teamwork fails”.
However, although more recently speaking on behalf of the individual doctor, last year the IMC president criticised the fact that the council had received only one complaint from the HSE about a doctor in the previous year (2015).
In August 2016, he told the Irish Times that this was “a very low” reporting rate when compared to the UK and other countries, claiming that the number of complaints about doctors from the major public employers in other countries would probably be about 25 per cent of the total.
Earlier this year, Dr Marcus de Brun commented to IMN on how the current regulatory system is negatively affecting patients: “The Medical Council as it stands is operating to the detriment of public health. The reason we have such lengthy public waiting lists, I believe, is due to the highly defensive medicine being practised in this country.
“Out of fear of being brought before the Medical Council, doctors are unnecessarily referring patients on to cover themselves, and clogging up the system in the process. Something needs to change”.
The Secretary General of the Irish Hospital Consultants Association, Martin Varley, outlined to IMN how he believed the mechanisms of this MOU could be positively used to address obvious areas of common interest that impact upon patient safety and public protection.
He highlighted some of the most prevalent concerns for hospital consultants: “The IHCA believes one pressing area of common concern for patient safety and public protection that the HSE and Medical Council should urgently address is the appointment of locum and agency doctors who are not registered as specialists with the Medical Council to specialist consultant posts.
“These appointments are in breach of the HSE’s recruitment rules and the Medical Practitioners Act, 2007. The Act provides that a doctor who is not registered as a specialist with the Medical Council is not authorised to practise as an independent specialist or consultant”, he stressed.
The HSE’s National Doctors Training & Planning data confirms that 81 consultant post-holders appointed since March 2008 do not hold specialist division registration and of these, 27 posts are occupied by doctors who are working via an agency.
He also emphasised that the Doctors Integrated Management E-System (DIME) database is only 84 per cent complete, with the status of 16 per cent of consultants unknown and unmatched to clinical posts, meaning that the figure of non-specialists could be higher.
Furthermore, he stated that; “The data do not include information concerning the Medical Council registration status of consultants on contracts of less than one month. The appointment of doctors who are not on the specialist register to consultant positions is now affecting posts in 13 specialties throughout 20 acute hospitals and 10 mental health service areas, based on most recent information received by the Association from the HSE”.
Among the affected specialties he listed are obstetrics/gynaecology, general surgery, anaesthesia, several medical specialities, urology, orthopaedic surgery, radiology, emergency medicine, paediatrics, and all four psychiatry specialties.
The association stated: ”…it is unacceptable [that] doctors who do not have the essential specialist training, skills and expertise are purporting to treat patients as consultants in our acute health services. Appointing inadequately qualified doctors to specialist consultant posts breaches the most basic of contemporary international and national professional standards in healthcare”.
The association also highlighted that the appointment of non-specialist doctors who are not on the Medical Council’s specialist register to consultant posts poses a safety risk to patients, a risk that has been acknowledged by the HSE.
“In a response to a Parliamentary Question in May 2017, the HSE acknowledged that doctors appointed to consultant posts must be appropriately qualified and competent to perform the duties and functions of a consultant, with regard to the safe delivery of consultant services.
“To quote from the HSE’s response: ‘Breaches by an employer of the HSE’s regulatory requirements have significant implications for the organised and safe delivery of consultant services’
This practice is undermining the most basic standards of professionalism in our acute services. Furthermore, it is clear that this is occurring because of a lack of competitiveness in recruiting and retaining consultants”, the Secretary General asserted.