Last week, I wrote an opinion entitled The Public Purse. My opinion considered some of my concerns with our healthcare system. Of recent, our healthcare system has been one of my main focuses and this is partly because at some point, we have all been dependent on this system which is in need of revamping.
A reader reached out to me and expressed his thoughts on consultants working for both the public and private sector and its connection with recent articles in our daily newspaper. I thank him for his email, as it really made me consider an important aspect of our healthcare system which has failed us for many years.
The Welch committee was appointed in November 2015 and was mandated to review our healthcare system. In particular, the committee was instructed to consider our current system whereby doctors contracted to the regional health authorities also worked in their private practices.
The question of whether doctors should be allowed to work simultaneously in both the public and private sectors has been a cause for debate for many years. The committee, in their report, concluded that doctors being employed in both sectors were having disastrous effects on the delivery of services.
As a layperson, I could have concluded the same by simple means of observation. Nonetheless, the committee was divided in their view. Some members felt that this practice should be abolished and public sector doctors should not be allowed to work in the private sector, while the other members believed that stronger management practices could resolve the issues and rectify the delivery of care. But, as with most committee reports, even this one became a report generated with no follow-up and little consideration for its recommendations.
Through the medical negligence matters I have filed and my own experience with the healthcare system, I know some of the shortcomings of consultants. I have sat in the hospital on many occasions waiting for the consultants who were due to take up duty at a certain time but walked in several hours later. I have had legal matters grounded in the consultant’s failure to perform their duties as they were otherwise disposed.
Doctors attached to the regional health authorities are public servants. Yes, many would refuse to accept this, but they are public servants, with a higher pay package and different responsibilities, but still public servants. Section 137 of the Civil Service Regulations stipulates: “An officer shall not, directly or indirectly, be involved in any financial or other interest or undertaking which could compromise, or reasonably be said to compromise that officer’s job performance or office.”
I have to pause to consider this for a moment, a public servant ideally should not have a second job if it compromises their job performance, yet, a consultant can work at two different places at the same time. While a consultant does not fall under the ambit of the civil service, it makes me wonder whether the thinking is that a consultant is much better able to manage two positions when compared to other public servants.
As far as I am aware (I am subject to correction on this), most consultants attached to regional health authorities have the benefit of annual contracts. In theory, it would not be difficult for the Minister of Health or the boards of the regional health authorities to instruct that the contracts be reviewed upon expiration and the terms of contracts be reconsidered.
In this way, a new term can well be that consultants attached to the regional health authority cannot have the benefit of a second job, much like other public servants.
It may well be argued that some much-needed consultants may elect to work only in the private sector and refuse to work in the public sector if such terms are now considered. In this eventuality, the regional health authority should not be held at ransom, but still consider terms which benefit the parties and ensure that consultants are dedicated to their public sector employments. As per the terms of the current contracts, the regional health authority indemnifies consultants from acts of negligence in carrying out their duties. For consultants who are otherwise employed, the regional authority can consider only a 50% indemnification, this would pressure consultants in being more dedicated to their service, as any negligence on their part will come with a price attached and not a free pass.
It would also be incumbent on management to properly enforce contractual terms. In this regard, consultants should be treated as public servants, with a roster being maintained on attendance, signed times for assuming duties and signed times for completion of duties. Instances of unaccounted hours should be subject to a deduction in salary and affect any performance appraisals to be conducted. By reviewing terms of employment and ensuring that such terms are met, the regional authority may be better able to ensure that consultants’ private practices do not compete or overshadow their public practice.
While this does not fully resolve the issue of consultants’ divided loyalties, this allows for some measure of accountability without having to engage our politicians. It is evident that politicians are unwilling to make the difficult decision of having consultants choose between the public and private sectors. In their refusal to make this decision, the public sector continues to suffer. Reconsidering the terms of employment is not a process which would involve the approval of the parliament. Instead, the boards of the regional health authorities can elect to review their terms of employment as a short-term measure to determine whether it will assist in the better delivery of care.