Desmond O’Neill: Striking doctors and a cruel cut

Desmond O'NeillThe strike was so much more straightforward in 1987. I was then a trainee member of the Council of the Irish Medical Organization and our task was to change an overtime rate of half of the hourly rate to one of at least time and a quarter, thereby removing the employer incentive for virtually limitless overtime.

Even in the somewhat less relaxed professional climate of the time, most consultants were sympathetic, the public even more so, and apart from special cases, the strike was all-out for 24 hours – and successful.

Reel on 26 years, and the situation is significantly more challenging. For the junior doctors (termed non-consultant hospital doctors (NCHDs) in the Irish health service, the climate has been progressively soured in the last five years by significant cuts in pay, increases in taxes, removal of a formerly generous CPD allowance which covered diploma fees and more, and major difficulties in getting payment for modest amounts of unrostered overtime in many hospitals.

In addition, failure to implement hospital reforms mooted in successive reports from 1968 to 2003 has left a large number of relatively small hospitals with insufficient staff to implement more humane rosters and provide cover, with consultant numbers thinly dispersed. Increasingly smaller numbers of Irish graduates wished to work in the system, particularly outside the larger urban centres (see more).

Perhaps the unkindest cut of all was the deeply unhappy decision by the general practitioner and businessman Minister for Health, Dr James Reilly, to cut the pay of incoming hospital consultants by 30%. This was a solo run by the minister just ahead of a confidence vote on his performance in the Irish parliament, and was announced immediately after, and separate to, an agreement between the consultants and Department of Health on increased flexibility on working arrangements. Indeed, the Irish Medical Organization had to undertake significant work with its members to explain that this action had nothing to do with the agreement.

While doctors across all disciplines have seen incomes cut significantly, this singling out of new consultants above and beyond these more general cuts has been particularly odious. In a system with no increments this leads to a financial apartheid between colleagues carrying out similar clinical duties. Senior Department of Health and health service personnel express dismay in private but not in public, and only one in five vacant consultant posts has been filled since then .

Dr Reilly has been controversial in many ways, including the dubious honour of being the first sitting Irish Cabinet Minister ever to appear in Stubb’s Gazette as a debt defaulter, and the mysterious insertion of two health centres in his constituency on a list of primary care centres needing development (see more). However, for the profession, and emerging trainees, this extension of what is widely viewed as anti-consultant chippiness into an assault on another branch of medicine is unprecedented and seen as a grave error which, sadly, he is unlikely to admit to and which is a source of both present and future harm.

Our NCHDs are now threatening strike action for a range of issues, including a maximum 24 hour roster, implementation of the European Working Time Directive (EWTD), and reversal of the extra pay cut for newly-recruited consultants. Without increased numbers of medical staff (as took place in the UK for implementation of EWTD) and significant reform of the hospitals, it is hard to see how the first two objectives can be achieved in the shorter term outside all but a tiny number of the largest hospitals.

In addition, the experience for trainees and trainers of the shift systems in the UK is widely perceived as very problematic in terms of rota gaps, continuity of care, and training. The Royal College of Physicians in Ireland has developed a somewhat tardy response to the Herculean challenge of combining humane hours with continuity of care and training.

Minister Reilly is also attempting to by-pass both the Irish Medical Organization (despite being its former president and a GP member of its Council around the time of the 1987 strike) and the training bodies by asking the President of Dublin City University to chair a forum for trainees only. His comments that he wanted to create a space in which non-consultant doctors could give their thoughts “without intimidation from people at the top” or “fear of consequence for them” is sadly revealing of a mindset moored in atavistic perceptions of consultants, and it is hoped that our NCHDs will have more nous than to get engaged in this diversionary exercise.

So, as our trainees review what looks like an unsatisfactory response from the Irish health service to the threat of industrial action, the thoughts and wishes of their consultant colleagues are fully supportive and hope that they will be savvy enough to hold out for a package which realistically meets the needs of safety, care and training, supported by an adequate CPD allowance and restoration of parity with their colleagues should they decide on a career as a consultant.

Desmond O’Neill is a consultant physician in geriatric and stroke medicine and immediate past president of the European Union Geriatric Medicine Society.