The appointment of non-specialist doctors as practising consultants by the HSE is, as the president of the High Court observed, scandalous behaviour because it places the lives, health and welfare of patients in jeopardy. But it is not a new scandal. And it would be foolish to imaging the activity was not informally accepted by the Department of Health and by previous ministers.
Upholding a decision by the Medical Council to cancel the registration of a particular consultant, following a series of medical errors, Mr Justice Peter Kelly criticised the HSE, emphasised the importance of patient care and forwarded a copy of his judgment to Minister for Health Simon Harris, his department, related health organisations and the Attorney General. The doctor concerned had been employed for some years at a number of other hospitals, in spite of failing medical examinations. He was later appointed as a consultant by the HSE. That organisation, the judge said, "appeared to be a law unto itself".
The roots of improper appointments go back 10 years to when the Department of Health attempted to cut costs and change the nature of consultants’ contracts. An industrial dispute followed. At that time, the Royal College of Physicians of Ireland expressed concern that the HSE might, in response, appoint doctors who were not fully qualified as consultants. And so it came to pass. A loophole in legislation marginalised the regulator – in this case the Medical Council – and non-specialist doctors were appointed to consultant posts.
By last year, the number of unqualified consultants had risen to 128 – out of a total of 3,000 – and those individuals were practising in 20 acute hospitals. They included psychiatrists, surgeons, anaesthetists and obstetricians. And while the Medical Council expressed concern about patient safety, it only took action when formal complaints were made. The services most affected by unorthodox appointments included community health organisations and regional hospitals.
Medical practitioners are not blameless in all of this. In defending established contractual arrangements for consultants, they opposed new pay and recruitment processes. Subsequently, the Medical Council appeared to take a hands-off approach and the judge suggested it could have been more assertive in challenging questionable appointments.
The dysfunctional nature of the healthcare system has been exposed once again. It requires immediate attention. The departure of HSE director general Tony O'Brien will provide an opportunity to reorient the organisation, encourage early retirement by senior managers and introduce a system of accountability. It must be grasped. For too long, public health needs have been treated as less important than those of service providers.