Best practice must be resourced

Senior health managers are urging HSE action to ensure that best practice is resourced and spread rapidly and efficiently across the Irish health system. Maureen Browne reports.

Maureen Browne
Maureen Browne

Senior health managers are deeply concerned that the historical and current shortage of resources make it very difficult in some cases to implement the highest standards of good practice.

“Because of the cutbacks over the last five or six years, a culture of ‘make-do’ is growing up within the health services,” said one manager.   “We may not have all the resources we need to provide a service to the optimum level, but the attitude is that we have been doing it for years, thankfully nothing serious has happened and the alternative is not to provide any service or a reduced service.

“We are getting used to this climate, but it is not the way we should be working and it is giving rise to serious concerns. It makes no sense to me that we have people and committees working day and night to draw up best practice strategies and then we don’t have the resources to implement them in full and with the best will in the world we have to watch waiting lists grow and grow, which is very far from basic good practice.”

A colleague agreed saying that in the present climate managers were being forced to take very hard decisions. “There is enormous pressure to maintain or even extend services although we do not have the necessary resources,” he said. “We are asked to provide services for which we have neither the money nor the staff and we are all aware that having thousands of people on waiting lists must be unsafe. We do amazing work in our hospital, but that is just for the patients whom we manage to get in.”

There is enormous pressure to maintain or even extend services although we do not have the necessary resources

Another manager said that with so many consultant posts unfilled he is very worried about the whole questions of consultant locums. “You can very easily find yourself in the situation where you desperately need a long term locum and you cannot find anybody who is either on the specialist register or eligible to be on the specialist register, which is the basic criteria we are meant to adopt in the case of long term locum positions (for short term, senior registrars are allowed to act up). So what do we do? Shut down or significantly reduce a service or take on somebody in a locum capacity who is technically not qualified for the post but who seems to have good training and experience?”

The moratorium and the reductions in consultants and nurses salaries have made it extremely difficult to recruit and retain the numbers required for the current services. “Because consultants are autonomous, we can’t introduce a system of peer review, so it is very important that we recruit only those who are qualified for long term positions,” said one manager.

“Personally I know some wonderful locums, but I would still be happier taking on people according to the letter of the law and there is no doubt but that the shortage of consultants and nurses is resulting in problems in the services.”

A number of managers have suggested that the clinical staffing levels of the services should be monitored.   They point out that HIQA has a role in the cancer services with standards in terms of pathways, treatment times etc for patients suspected of having cancer. They would like to see this extended to other specialties.

“Realistically there is little point in setting treatment timeframes which there is no hope we will meet under the current circumstances,” said a manager.

Managers are also concerned that good practice is not spread around the system. They say we need a system which alerts all service providers to system failures which might affect them and shares with them new innovations and best practice.