National Council Annual Report 2018/2019

Mr Martin Varley Secretary General 1 National Council

• National officers elected at the National Council annual meeting on 15 June 2019 • Membership of the National Council is on page 27 for ratification following this report • National Council Committees (pages 3, 4 & 5) • Council met on 11 occasions in the last year

2 2019 – 2020 National Council Name Specialty Hospital/Region Dr PJ Breen Anaesthesiology Retired Dr Roy Browne Psychiatry Phoenix Care Centre Dr Aine Burke Pathology Sligo University Hospital Dr Gabrielle Colleran Radiology Temple Street Dr Charles d’Adhemar Histopathology MRH Tullamore Dr Conall Dennedy Endocrinology University Hospital Dr Patrick Dillon Anaesthesiology Limerick Mr Joe Dowdall Vascular Surgery St Vincent’s Dr Laura Durcan Rheumatology Beaumont Mr Garrett Durkan Surgery – Urology UHG Mr Colm Fahy Surgery – ENT Galway Clinic Dr Clare Fallon Geriatrics MRH Mullingar Dr Orla Franklin Cardiology Crumlin Children’s Hospital Dr Sinead Harney Rheumatology Cork University Hospital Prof Alan Irvine Dermatology Crumlin Children’s Hospital Dr Paul Kelly Emergency Medicine Wexford General Dr Mary McCaffrey Obstetrics & Gynaecology Kerry University Hospital Dr Kieran Moore Psychiatry Crumlin Children’s Hospital Mr Maurice Neligan Trauma and Orthopaedics Beacon Hospital Dr Oisin O’Connell Respiratory Medicine Bon Secours, Cork Dr Donal O’Hanlon Psychiatry Naas Hospital Dr Conor O’Riordan Radiology St Luke’s Kilkenny Dr Ioannis Polyzois Oral Surgery Dental Hospital Dr Trip Prassad Diagnostic Radiology Navan Hospital Mr Peter Ryan Surgery – Urology Bon Secours, Cork Dr Tom Ryan Anaesthesiology St James’s Dr John Scully Anaesthesiology Dr Mike Staunton Anaesthesiology OLOL, Drogheda Dr Shona Tormey Surgery Limerick To be co-opted 3 National Officers

President Dr Donal O’Hanlon Naas General Hospital, Kildare Vice Presidents Dr Gabrielle Colleran Children’s University Hospital, Temple St Dr Laura Durcan Beaumont Hospital, Dublin Membership Secretary Dr Conor O’Riordan St Luke’s Hospital, Kilkenny Treasurer Prof Alan Irvine Our Lady’s Children’s Hospital, Crumlin

4 National Committees & Chairs

Focus Group National Officers and immediate past president, ex officio Finance Prof Alan Irvine

Legal Affairs Committee Dr Donal O’Hanlon

New Entrants Discrimination Committee Dr Donal O’Hanlon

New Entrants Working Group Dr Laura Durcan

Psychiatry Dr Kieran Moore Private Practice Committee Mr Garrett Durkan Full Time Private Practice Committee Mr Peter Ryan

Health Insurer Schedule Reviews National Officers & representatives 5 of relevant specialties Legal Affairs Committee

The committee, which is chaired by the President, oversees issues concerning breach of contract and its membership includes:

• Dr Donal O’Hanlon President • Professor Alan Irvine Treasurer • Dr P J Breen National Council Member • Dr Roy Browne National Council Member • Dr Thomas Ryan National Council Member • Dr Phyllis O’Sullivan Consultant Radiologist, St Luke’s Hospital, Kilkenny

6 New Entrant Discrimination Committee The Committee is chaired by the President and includes the following members:

• Dr Donal O’Hanlon President • Dr Gabrielle Colleran Vice President • Dr Laura Durcan Vice President • Prof Alan Irvine Treasurer • Dr Roy Browne Council Member • Dr Aine Burke Council Member • Dr Conall Dennedy Council Member • Dr Oisin O’Connell Council Member • Dr Thomas Ryan Council Member 7 New Entrant Working Group

The Committee is chaired by Dr Laura Durcan, Consultant Rheumatologist, Beaumont. The members of the Committee include:

• Dr David Bradley Consultant Neurologist St James’s Hospital • Dr Aine Burke Consultant Pathologist Sligo University Hospital • Dr Gabrielle Colleran Consultant Radiologist Temple Street Hospital • Dr Conall Dennedy Consultant Endocrinologist Galway University Hospital • Dr Jean Donnelly Consultant Paediatrician OLCH, Crumlin • Dr Brendan Doyle Consultant Pathologist Beaumont Hospital • Dr Laura Durcan Consultant Rheumatologist Beaumont Hospital • Dr Fiona Fenton Consultant Psychiatrist Mental Health Commission • Dr David Kevans Consultant Gastroenterologist St James’s Hospital • Dr Barry Moynihan Consultant Geriatrician Beaumont Hospital • Dr Donal O’Hanlon Consultant Psychiatrist Naas General Hospital • Dr Oisin O’Connell Consultant Respiratory Physician Bon Secours, Cork • Dr Noirin Russell Consultant Obstetrician/Gynaecologist Cork University Maternity Hospital • Dr Triona Walshe Consultant Radiologist Mayo University Hospital • Dr Sandra Walsh Consultant Paediatrician OLCH, Crumlin

8 Private Practice Committee The Private Practice Committee is chaired by Mr Garrett Durkan, Consultant Urologist, Galway University Hospital, and includes the following members: • Mr David Borton Consultant Orthopaedic Surgeon Hermitage Medical Clinic • Dr Eilis Cryan Consultant Gastroenterologist Bon Secours, Galway • Dr Pat Dillon Consultant Anaesthesiologist University Hospital Limerick • Mr Garrett Durkan Consultant Urologist Galway University Hospital • Mr Colm Fahy Consultant Otolaryngologist Galway Clinic • Prof Alan Irvine Consultant Dermatologist OLCH, Crumlin • Mr John Nee Consultant Surgeon Bon Secours, Galway • Mr Maurice Neligan Consultant Orthopaedic Surgeon Beacon Hospital • Prof John McElwain Consultant Orthopaedic Surgeon Blackrock Clinic • Dr Oisin O'Connell Consultant Respiratory Physician Bon Secours, Cork • Dr Barry O’Connor Consultant Gastroenterologist Mater Private Hospital, Cork • Ms Margaret O’Donnell Consultant Plastic Surgeon Blackrock Clinic • Dr Conor O’Riordan Consultant Radiologist St Luke’s Kilkenny • Mr Ashley Poynton Consultant Orthopaedic Surgeon Mater Private Hospital • Mr Peter Ryan Consultant Urologist Bon Secours, Cork

9 Full Time Private Practice Committee The Full Time Private Practice Committee consists of the following members. It is chaired by Mr Peter Ryan, Consultant Urologist, Bon Secours, Cork.

• Mr David Borton Consultant Orthopaedic Surgeon Hermitage Medical Clinic • Dr Eilis Cryan Consultant Gastroenterologist Bon Secours, Galway • Mr Colm Fahy Consultant ENT Surgeon Galway Clinic • Prof John McElwain Consultant Orthopaedic Surgeon Blackrock Clinic • Mr John Nee Consultant Surgeon Bon Secours, Galway • Mr Maurice Neligan Consultant Orthopaedic Surgeon Beacon Hospital • Dr Oisin O’Connell Consultant Respiratory Physician Bon Secours, Cork • Dr Barry O’Connor Consultant Gastroenterologist Mater Private, Cork • Ms Margaret O’Donnell Consultant Plastic Surgeon Blackrock Clinic • Mr Ashley Poynton Consultant Orthopaedic Surgeon Mater Private Dublin • Mr Peter Ryan Consultant Urologist Bon Secours,Cork

10 Psychiatry Committee

The Committee is chaired by Dr Kieran Moore, Consultant Child & Adolescent Psychiatrist, Our Lady’s Children’s Hospital, Crumlin. The Committee membership includes:

Dr Richard Blennerhassett Consultant Psychiatrist St John of God Hospital, Stillorgan Dr Roy Browne Consultant Psychiatrist Phoenix Care Centre

Dr Kieran Moore Consultant Psychiatrist Our Lady’s Children’s Hospital, Crumlin Dr Donal O’Hanlon Consultant Psychiatrist Naas General Hospital

Dr Annemarie Waldron Consultant Psychiatrist St Mary’s Drogheda

11 #CareCantWait

• Launched in June • Highlights lack of access and consultant recruitment crisis

• Twitter followers ↑ threefold

12 Outpatient Waiting List (Dec 2013-Aug 2019)

600,000 569,498 (Aug-19)

500,000

400,000 375,440 384,632

300,000 300,752 177,748 200,000 (Aug-19)

137,721 103,420 100,000 (Aug-19 80,332 37,197 9,887

0 3,618

Jul-13 Jul-14 Jul-15 Jul-16 Jul-17 Jul-18 Jul-19

Jan-14 Jan-15 Jan-16 Jan-17 Jan-18 Jan-19

Sep-13 Sep-14 Sep-15 Sep-16 Sep-17 Sep-18

Nov-13 Nov-14 Nov-15 Nov-16 Nov-17 Nov-18

Mar-13 Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19

May-13 May-14 May-15 May-16 May-17 May-18 May-19 Total Outpatients Over 12 months Over 15 months Linear (Total Outpatients) Linear (Over 12 months) Linear (Over 15 months) Source: NTPF (2013 - 2019)

• 569,500 in August • ↑ 53,336 (10.3%) in 2019 • ↑ 205,000 (56%) in 5 years 13 Total Inpatient and Day Case Waiting List (Dec 2013-Aug 2019)

100,000

90,000 86,111

80,000 68,086 70,000 68,390 (Aug-19 60,000 47,413 50,000

40,000 44,870

30,000 17,977 20,000 10,369 (Aug-19) 10,000 5,665 11,041 503 217 7,195 (Aug- 19)

0 0 746

Jul-13 Jul-14 Jul-15 Jul-16 Jul-17 Jul-18 Jul-19

Jan-14 Jan-15 Jan-16 Jan-17 Jan-18 Jan-19

Sep-13 Sep-14 Sep-15 Sep-16 Sep-17 Sep-18

Nov-13 Nov-14 Nov-15 Nov-16 Nov-17 Nov-18

Mar-13 Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19

May-13 May-14 May-15 May-16 May-17 May-18 May-19 Total Inpatients/day cases Over 12 months Over 15 months Linear (Total Inpatients/day cases) Linear (Over 12 months) Linear (Over 15 months) Source: NTPF (2013 - 2019)

• ↑ 25,339 (59%) in 7 years

14 #CareCantWait

15 #CareCantWait – Media Coverage

16 Consultant Vacancies and the Recruitment and Retention Crisis Specialist medical practitioners per 1,000 population in EU in 2018 (or nearest year) • 42% 1.44 France fewer Denmark 1.76 Belgium medical Finland Poland specialists Netherlands 1.97 Norway than EU Luxembourg UK 2.09 average Sweden Slovenia EU Average 2.47 Latvia Portugal 2.49 • Over 500 Spain Switzerland posts Hungary 2.62 Estonia vacant or Austria 2.75 Czechia filled on a Italy 3.1 temporary Germany 3.25 Lithhuania 3.51 basis Greece 4.95 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Source: Eurostat 17 Specialist medical practitioners in Ireland per 100,000 population as a percentage of the EU average (2016 or nearest year)

% of EU Average 100 1 1 • /4 to /2 in 90 82 82 many 80 70 66 specialties 61 58 60 55 53 52 51 48 50 46 40 37 32 32 30 • UCC at 30 25 23 Connolly 20 10 Hospital only 1 0 open for /3 of planned hours

Source: Eurostat

18 Consultant Vacancies and the Recruitment and Retention Crisis

• Vacancies + 108 non-specialists in Consultant posts since 2008 • “Jeopardising patient safety” – Justice Peter Kelly • Medical agency spend 2012-2018 ↑€57m p.a. • Agency Consultant costs up to three times New Entrant salary • New Entrant salary is up to 51% below colleagues • Failed to fill 38% of posts advertised 2015-2017 • Not competitive – salaries in Australia, Canada and US up to 48% above non-new entrant salary

19 Consultant Vacancies and the Recruitment and Retention Crisis

• 73% of trainee specialists who are considering working aboard say it is because of discriminatory New Entrant salary (‘Your Training Counts’, IMC)

2 • /3 of those considering working abroad say it is because of long working hours (‘Your Training Counts’, IMC)

20 Political Support for Consultant Pay Parity

Mr Micheál Martin, TD, Fianna Fáil

Mr Barry Cowen, TD, Mr Michael McGrath, Public Fianna Fáil Expenditure Spokesperson, Fianna Fáil

Ms Louise O’Reilly, TD, Health Spokesperson, Sinn Féin

Mr Stephen Donnelly, TD, Health Spokesperson, Fianna Fáil

Dr Michael Harty, TD, Ms Róisín Shortall, Chair, Oireachtas Health TD, Social Committee Democrats Campaign to Restore Pay Parity for New Consultants

Simon Harris, Minister for Health

Paschal Donohoe, Minister for Finance and Public Taoiseach Expenditure and Leo Challenging Reform Varadkar complacency at Government and DPER levels

Robert Watt, Secretary General, Department of Public Expenditure and Reform Media Coverage Increased Acute Hospital Capacity Requirements Public Hospital Inpatient and Day Case Beds, 2008 to 2019 • Population Total Inpatient and Day Case beds 2008-2019 YTD ↑ 9.7% • Bed capacity 13,584 ↓ 2.9%

13,191 13,141 13,096 • 12.6%

12,847 12,835 increased 12,732 12,630 deficit 12,486 12,499 12,386 12,432 • Still 22% ↑ (273,433) in inpatient and day 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 YTD cases

Source: Department of Health Open Beds Report May 2019; Health in Ireland: Key Trends 2017, DOH 24 Hospital beds per 1,000 of population in EU, 2018 (or nearest year)

Sweden 2.04 UK 2.11 Denmark 2.44 Spain 2.43 Italy 2.62 Ireland 2.77 Our hospital Finland 2.8 Netherlands 2.92 bed capacity: France 3.09 Portugal 3.25 • 31% below Latvia 3.3 Cyprus 3.43 EU average Estonia 3.45 Greece 3.6 Luxembourg 3.7 • Regular bed EU28 4.02 Czech Republic 4.11 shortages Slovenia 4.2 Hungary 4.27 Malta 4.69 • Rationing Poland 4.85 Slovak Republic 4.91 care Belgium 4.98 Austria 5.45 Lithuania 5.47 • Delays Croatia 5.49 Germany 6.02 Romania 6.84 Bulgaria 7.27 0 1 2 3 4 5 6 7 8

Source: OECD.Stat; Eurostat 25 Number of patients treated on trolleys annually (2008 – 2018)

108,227 98,981 100,000 92,998 93,621 86,481

80,000 75,859 77,091 66,308 67,863 63,713 59,435 60,000

40,000 NumberPatients of

20,000

0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Source: INMO Trolley Ward/Watch

• 108,000 admitted patients treated on trolleys in 2018 • Nearly double ‘national emergency’ level of a decade earlier

26 Trolley Analysis January/July 2008-January/July 2019

Source: INMO Trolley Ward/Watch • Year round problem • July 2019 (9,439) a record for the month – ↑ 33% on July ’18 • August 2019 (9,562) highest ever for the month – ↑ 10% Aug ’18 27 Delays in Accessing Treatment resulting in missed Cancer KPI targets

• Symptomatic Breast Disease Clinics 44% < target

• Rapid Access Clinics for Prostate Cancer patients 21% < target

Source Health Service Performance Profile January to March 2019 28 Investment Needs and Plans

• Front-load delivery of 2,600 acute beds, 4,500 community beds • 4,000 beds needed for internationally acceptable service • 40 fewer ICU beds (249) than a decade ago. Need double • Inadequate and obsolete equipment 29 Sláintecare and the de Buitléir Report

• €20bn to implement Sláintecare in first decade (€28bn thereafter) • Confirms need for more Consultants and beds • Removing private care from public hospitals to cost €6.5bn over 10 years (€8bn thereafter) • Loss in private health insurance income will not be replaced • Exacerbate Consultant recruitment and retention crisis & hospital capacity deficits • Ideology v Pragmatism

30 Pre-Budget Submission 2020

• 2020 Health Budget must provide true cost of maintaining existing levels of service, unmet demand and increasing demand • Resources needed to eliminate rationing of care, growing waiting lists, and trolley crisis • Need to fill all approved Consultant posts on permanent basis to address waiting lists • Increase bed capacity

31 Pre-Budget Submission 2020

• Increase staffing for Mental Health Services (24% below AVFC) • Restore pay parity for Consultants appointed on 2008 CC since October 2012 in order to fill posts • ↑Capital investment after decade of cuts (€1.88bn health capita cuts 2009-2019) • Need separate funding for NCH’s overspend • Frontload NDP investment

32 Contract Matters • Advancing 300 New Entrant legal cases • High Court Settlement Agreement being implemented – 2,411 (95% of number deemed eligible) sent offer letters – 137 awaiting offers – 2,171 (90% of offers) have returned consent & release – 2,111 ‘instructions to pay’ to Hospital Groups/CHOs – 10 with eligibility undetermined – 160 awaiting salary validation – 67 awaiting pension calculations/documents • Reversal of FEMPI salary cuts continuing

33 Clinical Indemnification

• Clinical Indemnity Scheme (CIS) cost quadrupled in 5 years to €247m, up €184m p.a. • Liability of €2.33bn, more than double 2013 figure • Contributory factors: - Capacity constraints - Consultant vacancies - Waiting lists and delays • Fill approved Consultant posts on a permanent basis • Reform Tort Law, pre-action protocol, incentivise mediation

34 Regional Health Areas

• Governance improvements needed • Reduced corporate management and administrative staffing • Increase front-line resourcing and staffing • Opening 2,600 additional public hospital beds and 4,500 community beds in NDP • Reduce delayed discharges

35 Health Insurance

• Extensive discussions with insurers

• Revised Annual Schedules

36 Consultant Posts

Consultant Applications Advisory Committee: • 233 approved Consultant posts in past year (87 replacement, 146 new) • 25 contract changes (16 Buckley to 2008, 9 between Type A, B and B*)

Type C Committee: • 29 approved changes in past year

37 Conclusions

• Fill over 500 vacant posts by restoring pay parity for Consultants appointed on 2008 CC since October 2012 • Front-load delivery of 2,600 additional public hospital beds, 4,500 community beds, and equipment & facilities • Urgently Address: • Rationing Care • Record waiting lists • Unacceptable numbers on trolleys 38 Thank You

Support the IHCA campaign at:

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