A locum consultant in Enniskillen’s South West Acute Hospital (SWAH) has called for “more leadership in Government” in a bid to tackle increasing waiting lists and rising budget deficits.

Alison McCoubrey is on a one year contract as a locum Consultant Surgeon in SWAH (dealing with colorectal surgery, repairing damage caused by diseases such as cancer and bowel disease).

This week she speaks to The Impartial Reporter about the Trust’s desire to remove expensive agency locum staff from the hospital and suggests that a text message reminder to patients might lower the number of patients not turning up for appointments.

A lack of political movement on expert advice such as The Donaldson Report and Transforming Your Care frustrates Ms. McCoubrey, who has been employed by the Western Health and Social Care Trust for two years.

“Our politicians are afraid to take the hard decisions because they are not something that politically would attract many votes, but for us they are the right thing to do for the health service,” she states.

“For example, the Donaldson report published last year, I agree with what he says about having only six major acute hospitals and reconfiguring services to the other areas based on need. That report has been out for a year now but nothing has happened.” Western Trust Directors, battling to reduce their deficit (which is almost £3 million in the first four months of the 2015-16 financial year), have repeatedly pointed to the use of locum and agency staff to fill workforce gaps as being a large contributing factor to its overspend. Trust officials have also highlighted issues in attracting health professionals to work in the West, thus leaving them with no option but to fill posts with more costly locum or agency staff.

Asked for her view on the use of agency locums, Ms. McCoubrey responds: “Yes I’m a locum but that just means I’m on a temporary appointment. I get paid the same pay as every other consultant in that hospital. I get paid a normal consultant salary. I’m not through an agency so I don’t get that extra pay. It’s the agency staff that cost extra but that’s because we’ve had a recruitment crisis.

“We’ve had trouble recruiting people to posts and the only way to fill rotas to run the hospitals safely is to hire agency locums unfortunately. But yes, that is a huge trend, no-one is denying that.” She reveals: “[The Western Trust] recently held a recruitment drive and all of the five surgery posts will be filled by Trust staff within the next few months. There will be no agency staff which will be a big help in terms of savings.

“I can’t speak for the other specialities because I don’t really know.” Living in Lisburn, Ms. McCoubrey travels to and from Enniskillen for work. She acknowledges that the Western Trust has experienced difficulty in recruiting staff to Enniskillen.

“Partly the location of SWAH has something to do with it,” she acknowledges. “A lot of people are based in and around Belfast who don’t want to relocate.

“I like working in the South West. It’s a great hospital and they’re lovely people to work with. I don’t know how to attract more people down here.” Waiting lists in Northern Ireland hospitals are now among the worst in Europe. The Health and Social Care Board has said that, financially, the situation is so dire that they cannot afford to pay either the independent sector or local health service consultants over-time to clear the backlog.

“We are often asked why can’t we clear the waiting time backlog,” Ms. McCoubrey says. “The honest truth is the Trust don’t have the money for that because that would be extra work over-and-above your contract. There’s only a certain amount of patients you can see in a clinic. I do two clinics a week and I see 16 patients. I can’t physically see any more than that. If the Trust were to run extra clinics, then that’s over and above what your contracted to work, which you’re supposed to get paid in accordance to. It would be what we call ‘additional core work’. And that doesn’t just mean getting the doctors to run the clinic; we need nursing, administrative staff etc.” She continues: “The Trust are trying to make savings; that’s not a new thing. They had been spending some money on sending jobs out to the private sector but that’s stopped as well because they can’t afford it.” Asked what measures can be taken to clear the backlog, Ms. McCoubrey replies: “It’s multi-factorial as to why the waiting lists are as long as they are. The demand currently exceeds the capacity we have to get them in in an efficient time.

“If we get a lot of urgent ‘red flag’ referrals such as cancer, they need to be seen within two weeks so they take priority, meaning the routines get pushed further back.

“How you deal with it is difficult.

“Across the province there are quite a few people who don’t turn up for their appointments; they cancel on the day or they just don’t come and don’t tell anybody. We have a partial booking system whereby a patient can choose a time that suits them but yet they still don’t show up.

“Perhaps text message reminders to patients in the lead up to and on the morning of their appointment could help; I get a text reminder for a hair appointment.” Sending work to the private sector in a bid to cut down waiting lists “is only a stop gap measure,” she believes. “That’s not a total solution; whether we need more doctors, more clinics, I’m not sure what the solution is.” Waiting lists for surgery “are constrained by beds,” she points out, adding: “If our beds are full, you can’t get your routine patients in for surgery. There’s lots of reasons that people are still in beds e.g. delayed discharges, people waiting for care packages to be put in place or waiting for a nursing home.” Staff morale in SWAH within the surgery department is “pretty good at the moment”, says Ms. McCoubrey, who worries that the Conservative Government is “trying to topple the NHS.” She concludes: “The NHS is something I am very passionate about and to loose it would be a tragedy.”