The Hanley Report
© Marie O’Connor

The new Medical Manpower Report, now confusingly referred to as the Hanley Report, is imminent, and with it, the death-knell of small hospitals.

The Hanly Report has had a long gestation, as long as an elephant’s. The first Forum on Medical Manpower was set up on 7 May 1998, by Brian Cowen, then Minister for Health.

Its brief was ambitious: ”to facilitate the development and implementation of a comprehensive manpower policy relating to training, career structure, and service delivery”.

The Minister spoke about why we had to create better careers for young doctors, reduce the need for so many to emigrate after qualifying, improve postgraduate medical training and deliver better medical care to patients. Clearly, improving things for doctors, not patients, was the main priority. The Hanly Report appears likely to continue, and intensify, this tradition. We are now being asked to accept as a blueprint for hospital care in this country a scheme that grew out of a career plan for doctors. And, from leaks, this is the unspoken yet all-encompassing bias that pervades the Hanley Report.

For two decades now consultants have been complaining about too many trainee doctors and too few qualified clinicians, omitting to mention that they themselves controlled entry to the various hospital training schemes and to the hospital posts that accompanied them.

Medical consultants have traditionally controlled entry to their various specialities, jealously guarding the huge financial benefits of private practice that accrue to some doctors, particularly in Dublin, in some areas of medicine, such as obstetrics and gynaecology, by limiting suppliers in an expanding market for private health.

Over the years, a dearth of senior doctors led to an over-reliance on junior hospital doctors, or doctors in training, with decisions on patient care being taken at times by staff who were unqualified to take them. Shortages developed in particular specialties, hospital staff were unevenly distributed, and bottlenecks developed in the career structure available to hospital doctors.

Failing to get one of the much-coveted consultant posts, as so many did on qualifying, they emigrated. Over time, this brain drain reached massive proportions. There were problems with out of hours medical cover, and difficulties with medical cover impacted on the delivery of accident and emergency services.

Consultants were rarely rostered to work first on call; first on call, with its guarantee of anti-social hours, was traditionally left to trainee doctors. Although many consultants could expect to be called in at weekends, they did not routinely work, as a general rule, outside the hours of 9 to 5, Monday to Friday.

All other doctors were expected to work around the clock. They worked on average 75 hours per week. Many worked longer hours. Now, all of this is about to become illegal. The European Working Time Directive, adopted in 1993, limits the working hours of workers in the European Union, providing minimum work breaks, protecting night workers, and providing minimum holidays.

The extension of this Directive to doctors in training is now only a year away. By 1 August 2004, the 56-hour working week will have arrived in Irish hospitals, while 2009 will see the advent of the 48-hour week. Doctors will then be required to work not more than 48 hours on average in any given 17-week period; their night work will not exceed 8 hours in 24; and they will be entitled to 11 consecutive hours of rest between each working day.

These requirements pose major challenges, and opportunities, for hospital health care. It now appears that the challenge will be to local communities to put up and shut up when local hospitals are downgraded, while the opportunities will accrue to medical consultants in the form of better and bigger empires.

There is a danger that legislation changing the face of Irish health care will be railroaded through the Dail; Member States are required to bring in laws, regulations and administrative provisions necessary to implement the new Directive by 1 August 2004.

So who has been taking the hard decisions? Some will remember the composition of the last Medical Manpower Forum, a small, unrepresentative, consultant-studded group of 14. The quango included the heads of medical professional bodies such as Barry O’Donnell, President of the Royal College of Surgeons, Brendan Drumm, President of Comhairle na-Ospideal, and Medical Council President Gerard Bury, who was also a member of the Hanly think-tank.

Most were presidents or chairs of their respective medical associations, and this probably explains why the Forum failed to give even the appearance of meeting government rules on gender mainstreaming. According to this, 40 per cent of seats on government bodies are supposed to be allocated to the other half of mankind.

The Task Force contains some surprises. Readers of this newspaper will be interested to learn that Mr Pawan Rajpal, one of the surgeons at the centre of the consultant row in Cavan Hospital, currently suspended by the North-Eastern Health Board, was nominated by the Irish Hospital Consultants’ Association to the Hanly Steering Group. What is now being referred to as “Cavan/Monaghan General Hospital” had a second representative on the Group, Dr Deborah Condell, a consultant histopathologist. The Group included no other members from the North East.

It was chaired by David Hanly, who is referred to as “Independent Chairperson”, without any identifying details. Although much will undoubtedly be made of Mr Hanly’s “independence”, his independence must, to some degree, be open to question. As an “inducted” member of the Royal College of Surgeons “Court of Patrons” since 1997, Hanly belongs to a select group of individuals that includes Bernard McNamara of Michael McNamara (Builders), auctioneer John Finnegan and Michael Smurfit. Having served on the College’s Development Committee for a number of years, it seems reasonable to assume that Mr Hanly is both familar with, and supportive of, the College’s agenda.

Did his appointment as Chair signal a further drift towards the American idea of health as business? His company, Parc Developments, was nominated as one of the Irish Times’s top 1000 Irish companies. In 2002, it had a turnover of 111m, employing 135 staff. The Santry-based company recruits for a wide range of industries from defence in Britain to telecommunications in Ireland; construction, engineering, pharmaceuticals and electronics are some of the sectors it serves.

How does the new quango compare with the old? Was the Task Force more or less representative than the old Medical Manpower Forum?

Sitting beside David Hanly on the Task Force was Professor Arthur Tanner, Dean of Post-graduate Studies at the Royal College of Surgeons of Ireland. Comments attributed to him in national newspapers suggest a preoccupation with local accident and emergency departments as training sites for his students.

A bigger body than the old Forum, the Task Force consisted of 52 individuals, the majority of whom, were doctors. The remainder were mostly public or civil servants. Consultants, as usual, got the lion’s share, with 19 out of the 52 seats, giving them around 40 per cent of the vote. Health service users, citizens and patients, as always, were excluded.

The Task Force contained just one “representative of the public interest”, Senator Geraldine Feeney, a member of Fianna Fail’s Committee of 15. Some things just don’t change.

©Marie O’Connor
27 August 2003

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