“Unacceptable reality of a service where resources are stretched too far” - says Consultant body

Statement by the Irish Hospital Consultants Association on recent findings in relation to Child and Adolescent Mental Health Services and Consultant shortages

Commenting on reports this week, the Irish Hospital Consultants Association (IHCA) said: 
“The reports emerging this week around Child & Adolescent Mental Health Services (CAMHS) are sobering. 

“After almost two years of Covid-19 challenging our hospitals and healthcare services, the findings of the review in South Kerry come as a blow to those who have worked tirelessly to provide care during these unprecedented conditions – and to the parents and young people who have dealt with the emotional and physical stress throughout. 

“But to hear An Taoiseach this week describe the situation as ‘shocking’ is very upsetting for patients and their families, and frustrating and demoralising to healthcare staff.

“The persistent Consultant recruitment and retention crisis has reverberated across the nation’s public hospital and mental health services for over a decade, with over 700 vacant permanent posts and ever-growing waiting lists – an issue which is raised daily by Consultants, patients, politicians and others.

“A significant brunt of the impact of these staffing shortages is felt in our mental health services, where the combination of gaping capacity deficits with significantly increased demand for treatment of mental illnesses is stretching our acute services to breaking point. 

“As at last February, we know that of the 485 approved permanent Consultant Psychiatry posts, some 136 were not filled as needed (either being left vacant or filled on a temporary basis or by agency Consultants). 

“This recruitment crisis has manifested itself in the appointment of over 100 Consultants employed by the HSE who are not on the specialist register, which poses a potential risk to patient safety and quality of care. This is a particular challenge in mental health where 23 non-specialists have been appointed to Consultant Psychiatry posts across all psychiatry specialist areas and Community Healthcare Organisations*. 

“The South Kerry CAMHS team has been without its only permanent Child and Adolescent Consultant Psychiatrist since August 2016, except for limited temporary locum cover for short periods. This is despite a regular and far-reaching recruitment campaign rolled out in Ireland, Europe, Australia, New Zealand, South Africa and North America. The deadline to apply for the sole Child and Adolescent Consultant Psychiatrist post in the region was in fact extended six times last year due to a lack of suitable candidates, and it remains unfilled. We know that in part this is due to the discriminatory contract terms introduced by the Government in 2012 which remain unresolved. 

Dr Kieran Moore, Child and Adolescent Consultant Psychiatrist said: “Operating services without the required Consultant leadership can have a direct impact on the continuity and quality of patient care. Yet this is the unacceptable reality of a service where resources are stretched too far. There is little clarity on where this situation occurs across the different mental health services, but with nearly 1 in 3 permanent Consultant Psychiatrist posts either vacant or filled on a temporary or agency basis, with some of the consultants employed not being on the specialist register, some of our most vulnerable patients will continue to wait too long for proper assessment, treatment and follow-up care. 

“The HSE’s own analysis and recommendations have identified that our health service will need a further 245 Consultant Psychiatrists (an increase of 42% on current staffing levels) by 2028 – this would mean appointing 35 Consultants a year over the next 7 years**, in addition to replacing the significant number that will retire or resign to practise elsewhere. 

“The Taoiseach is ordering yet another review of health services before taking any action – but we know what and where the issues are. There is an urgent need to dedicate specific funding and resources to mental health, as well as to address the significant recruitment challenges faced at Consultant level. 

“All the while, the critical talks around Consultant contracts, aimed at helping to alleviate a number of these recruitment challenges, have stalled in the absence of the Minister for Health engaging with the IHCA to appoint an agreed Independent Chair. 
“None of this is news to our Taoiseach, Government or health service management - these deficits have been building for years and they have failed to focus their attention on these issues as a priority.”

ENDS

Notes: 
* https://www.medicalindependent.ie/number-of-non-specialist-consultants-remains-static/ 
** https://www.hse.ie/eng/staff/leadership-education-development/met/plan/demand-for-medical-consultants-and-specialists-to-2028-november-updates-v2.pdf

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