The IHCA is concerned that some of the documentation it has seen in relation to the clinical director appointments process and their job specification 'do not tally with what is in the consultant contract'
Gary Culliton reports from the IHCA Annual Conference in Waterford on the ongoing uncertainly over the role of the clinical director.
There have been battles over the appointment of a Clinical Director at the Mid-Western Regional Hospital in Limerick for the past five months, the IHCA Annual Conference heard.
A Clinical Directorship model for the Mid-West hospitals was being “imposed from above”, which sets the clinical input at a very low level — a level that “would render our input ineffectual”, Dr Bryan Kenny, a consultant radiologist from Limerick, told the conference in Waterford.
“The HSE is usurping the role of clinical directors,” Dr Kenny informed the conference, which approved a motion supporting a clinical directorship model proposed by the Mid-Western Hospital Group “to progress development of systems of government based on clinical directors”. The aspiration is to create an executive board similar to those which exist in certain voluntary hospitals, explained Dr Kenny, IHCA Treasurer. “We have proposed a ‘four directorate’ model to the management. We are keen to progress with that.”
Concern was expressed from the floor that when the consultant contract was negotiated in 2008, clinical directors were supposed to take the place of senior management in much of the hospitals’ governance structure, but that this has not happened.
Mr Cliff Beirne from Dublin said it was difficult to support the motion “given the paucity of information”. He suggested asking the Minister for Health to analyse and scrutinise the model being proposed. “The proposal from Limerick is for an interim structure over the next three months,” said Dr Kenny. “A forum is needed to establish precisely how governance would function beyond that. This needs to be sorted out. To date, we have not achieved that.
“There have been various attempts to impose a single-person clinical director,” said Dr Kenny. “That person would report at a very low level; just to the general manager at the main hospital in Dooradoyle only. This person would not have any executive role.”
Dr Kenny added that clinical directors were now “not functioning at any level” in the MWRH, Limerick. “The person who took up the post in 2008 retired in July,” Dr Kenny said. “At the request of hospital management, the Medical Board formed a sub-committee to address the issue of a replacement. The sub-committee proposed a four-person Directorate earlier this year.”
The proposal was for a new forum as an interim structure “with a stronger clinical group on that body”. This was to be a new entity within the Limerick HSE hospital system. Similar structures do exist on other sites and particularly in voluntary hospitals. The proposed interim structure would include the Chairman of the Medical Board, the Director of Finance, the Director of Nursing and the Integrated Service Area Manager. The proposed structure would constitute the hospital executive for the region — not just for one hospital site. A first meeting with management regarding the proposal took place on October 6.
Beaumont histopathologist Prof Mary Leader asked whether it was being claimed that the role of clinical director within the hospital was being usurped by the HSE. Dr Kenny responded: “People who work in voluntary hospitals live in a different universe to those of us who work in the HSE hospitals.
Until 2008, consultants in HSE hospitals did not have any executive input whatsoever. It isn’t a question of roles being usurped as in the past; there was no executive role at all.”
Dr Peter Kelly, Consultant Histopathologist at the Mater, said the role of the clinical director was grounded in the current contract and he suggested that the authorities in Limerick were “obliged to observe that role”.
The IHCA is concerned that some of the documentation it has seen in relation to the clinical director appointments process and their job specification “do not tally with what is in the consultant contract”, said IHCA Secretary General Martin Varley, who has been engaged in talks with the HSE on this matter.
“The clinical director job is quite an onerous and important position,” said Varley. “There is an increased emphasis on clinical leadership. The provision of resources to clinical directors is hugely important.” The consultant contract provides for locum cover where a consultant is carrying out a dual clinical and clinical director role, Varley said. Comprehensive secretarial assistance and management support structures were also supposed to be provided but this was not heppening, he added.