By any standards, Ireland is very poorly provided with Consultants in Emergency Medicine. The number nationally is very far short of international comparators and therefore the decision of the Minister for Health, Stephen Donnelly TD, to fund an additional 50 Consultant in Emergency Medicine posts is very welcome. Particularly important is the suggestion that further posts will be funded in the future, which will allow the National Training Scheme to train sufficient doctors to take up these posts. Having fully trained specialists in Emergency Medicine looking after patients with emergency presentations will undoubtedly enhance the quality of care provided to these patients and ensure that the most ill and injured have access to Consultant level care more frequently than at present and earlier in their clinical course where the greatest benefit is to be had. It will also facilitate the training of the additional doctors on the training scheme that in turn will become the next generation of Consultants in Emergency Medicine.
In welcoming this positive development, the Association is particularly mindful that the most significant problem currently affecting clinical care in Emergency Departments (EDs) is the inability of a patient who requires hospital admission to be provided with a hospital bed in a timely fashion, resulting in unacceptable levels of ED crowding with inpatient boarders. As welcome as this initiative may therefore be, the appointment of additional Consultants in Emergency Medicine will not address this issue. It is imperative therefore that, in parallel, bed capacity is urgently created to improve the safety of patients in EDs. It is unfortunately but incontrovertibly true that crowded EDs and delays to hospital admission from the time of the decision to admit are each independent predictors of excess 14 day mortality. These stark realities will only be addressed by the provision of the necessary acute bed capacity to bring Ireland’s acute bed stock from its currently paltry 2.7/1000 of the population to the OECD average of 4.3/1000 population. The Association acknowledges that there has been the beginnings of an uplift in acute bed capacity over the past year but is strongly of the view that far greater ambition and urgency is required if the very serious clinical risk is to be addressed.
In an environment in which there are currently many hundreds of Consultant posts vacant nationally because of the very significant disparity in pay between established Consultants and those appointed since 2012, this worthy initiative may fail unless this salary inequality which makes Consultant posts in Ireland particularly unattractive compared with elsewhere in the developed world is addressed, and addressed urgently. The Association sees this as an issue that must be tackled so that the healthcare system benefits from the Minister’s initiative.