Saturday, 26 December 2009

Irish healthcare workers feeling the recession blues.

There's a recession in Ireland.

A really BAD recession.

We've had to stop buying new BMWs and 500,000 euro houses while earning 30k per year. That's no bad thing, it has to be said. But it's meant a pretty lean Christmas for a lot of Irish folk.

So, a budget was called recently, to sort out this mess. This PR (and I mean that in the non medical way) exercise had, and will continue to have, signifcant repercussions for healthcare staff working in our beleagured public service. It was aimed at punishing those with a weak voice (with social welfare cuts) and placating those who tend to vote in greatest numbers (The private sector workers and pensioners).

The public wanted public sector heads to roll, because they were angry at giving up their BMWs and 500,000 euro houses that they bought on credit. There was a bizarre thought process that permeated the private sector regarding the payment of all public sector workers. The logic was that "we've all taken pay cuts, so now it's your turn".

The public sector is too expensive, went the argument, so the public sector workers have to pay to keep it running.

We have hospitals that cost millions to run every month. We can't afford it, so we need money. Fair enough. The whole country uses these hospitals. So, how do we get the money? We take it from those people WORKING in the hospitals. A friend argued that he had already taken a 6% paycut while working for a large accounting firm, so he shouldn't have to pay for the hospitals and the police service and the fire service to keep operating. Only in Ireland.

I'm just back from Australia for a holiday, so I thought I'd missed something. "But you've taken a pay cut so your boss's company can survive. That's exclusively for your company's benefit. But the public sector is used by everyone, so why do only the 1/6th of the workforce who work in it have to pay to save it?"

I've asked this question several times, and have been told the following:

A) The public sector are useless and "bloated". As this is a medical blog, I guess we should be focussing on whether that's true in healthcare. And healthcare workers took the same large cuts that everyone else did. In my experience in Ireland, EVERY SINGLE hospital department I've ever been in has been grossly understaffed. Pregnant doctors have been working 48 hour shifts. It's common to work 24 hours every 4th day. Now THAT is value for money!
My sister used to work in medical records, and came home a shell of herself each evening. Another sister worked at a reception desk in a large hospital, until she got a much more sedate, and much better paid job in the private sector.

B) The public sector are overpaid: This is more difficult to fathom. There are various reports that support this claim. But they compare averages. In the private sector, some people are on pheomenal money, but some people get left to the dogs with appalingly low wages. Averages work best when there's a normal distribution. The private sector has been quick to throw the crumbs to it's lower skilled workers for donkey's years. I don't think that should be applauded. My private sector friends have been almost boasting about how there are people in their offices doing long hours for a pittance while angrily frothing at the mouth thinking about public sector workers earning a fair wage.
Then the comparisons with the UK start getting made (particularly in relation to doctors and nurses) and my eyes start to roll.
People in Ireland look at the NHS as a utopia where fatcat doctors and nurses get paid a smaller wage than they do in ireland. It's probably true. But the morale of the doctors in Britain is unbelievably low (and not just because of their pay). It's probably true that junior docs in the UK DO get less money than their Irish counterparts. But the UK docs don't have to cope with 24-72 hour straight shifts on a very regular basis. Plus the cost of living is much higher in ireland. I get paid less in oz than in Ireland, but I get a MUCh better stanbdard of living for my money (and I live in a big city). Same when I worked in the UK. I used to own a lovely apartment in the posh part of town, but wouldn't have been able to afford a cardboard box on that wage in Ireland. So, there's a context to wages.
I'm just not sure why Irish docs have to be benchmarked against British doctors, when both are treated like dirt by their employers. The only difference is that the Irish docs have been a bit more successful at getting remunerated for it.

Also,and I realise I'm being controversial, getting a place in nursing school in the UK is a LOT easier than getting a place in ireland. Irish nurses TEND to be better qualified in my experience, and to adopt the private sector mantra, we should reward excellence. I have a good friend in the UK who is a qualified nurse who tells me he never learned ANY pharmacology at nursing school!!

But I guess the real purpose of this post is to ask whether anyone can explain to me why public sector workers in Ireland have to pay more for the upkeep of these PUBLIC sectors than anyone else? Are, Irish healthcare workers now more entitled to a hospital bed? or a quicker police response?

Please enelighten me.

Dr. Thunder.


  1. They (eventually, we; I’m a medical student in .ie) have stable jobs they won't be fired from, no matter how long the waiting lists for surgery get or how long the turnaround for a grant application is, with good pensions.

    Where I grew up, an awful lot of people moved to construction and property-related jobs at the start of the decade, as the profit from small farming evaporated and the 1990s-Celtic-Tiger jobs in pharmaceuticals and IT and multilingual call centres remained as out of reach as they always had been. Those construction and property-related jobs are gone, and if you are young enough and you didn't get on as well in school as you or I did, things are pretty bleak in comparison to the public sector. Even with all the public sector cuts.

    Which is not to say at all that it's a nice thing to have to deal with, or that having to deal with the same long-term workload without temporary staff when people are on maternity leave or long-term sick-leave is anything but very very wearing.

  2. when you leave med school you'll most likely be on a series of 6 month contracts, which can place you anywhere in the country, until you're a consultant. You are certainly not permanent. If you're a nurse, you may be on rolling 30 day contracts.

    I don't know if that is job security!

    But this post is not about who has the worst job conditions. It's about why the public sector are the people who have to pay the extra so that the public sector can function, when the service is there for everyone.

    Dr. Thunder

  3. It's not a popular comment for an NCHD to make but I think we're overpaid. The main reason we're overpaid is because there aren't enough NCHDs to man our hospitals. We're working incredibly long hours, often in appalling conditions with dismal training and education but I think the renumeration is more than generous.

    When I was a lad and contemplating a career in medicine I never thought a junior doctor earned a fortune. You knew they worked incredibly long hours, put up with poor conditions, invariably left the country if committed to a hospital specialty. You assumed the financial reward came at the end of the process when you were a consultant.

    I would have no problem earning less money as an NCHD. I'd much prefer to work less than 80 hours a week. I'd trade in the lucrative "on-calls" for more sleep and more personal time. As yet, we do not have the numbers to staff such a utopian ideal. And the other issue I have is that even if I don't expect to earn megabucks as a junior doc I do think I'm entitled to better working conditions and much better training than I get at the moment.

  4. I think most NCHDs would agree that they'd like to work less hours for less money, but you won't find many agreeing that the hourly rate is overpaid. Well, that would be my opinion anyway.

    Dr. Thunder

  5. I'm currently working as part of a nursing bank (basically an internal nursing agency within one of the main Dublin hospitals, implemented to save money). I get paid crap and I'm only on "hours as required", so my contract can be terminated on a whim.

    My private sector friends love to tell me how I'm spoiled because I can "pick" my own hours, (not true, work is few and far between, so whatever I'm offered I generally take). In the last 6 weeks I have worked 4 weeks of nights, which last time I checked isn't legal. I also find it difficult as I am being constantly rotated to different wards to fill vacancies, so consistancy of care for my patients rarely occurs, which saddens me greatly.

    Personally I feel that healthcare workers in this country are treated like dirt. I'm newly qualified and I feel like for the blood, sweat and tears I put into my degree and professional development, I get treated with no respect or appreciation and am rewarded with a pittance. How is it that a private sector worker who doesn't have a degree and works less hours gets paid more than me?

    ...and then the media bitch about the "selfish" Irish healthcare professionals who are emigrating in their droves. We are not martyrs, we are human beings.

  6. In another twist to the public/private sector debate....I was talking to a friend today. He has been almost obsessive in spouting anti public sector rhetoric over the last few months.

    Today, he was whingeing that the roads weren't gritted (crazy weather in Ireland right now). Our local council is telling us that gritting has been cut back because the public demanded a reduction in public sector overtime. And that's what they got.

    Dr. Thunder

  7. I think you're right that cutting public sector pay is advantageous politically, as opposed to raising taxes (because private sector/unemployed voters outnumber public sector voters).

    What about the following argument against raising taxes to fund the public sector? Higher taxes will limit the potential for economic growth that will take people off the dole and put them back in work. It will leave people who are hanging on to their jobs in an even more unstable position. Although it's not fair to only make public sector workers pay for shortfalls in the budget for running the country as everyone, public/private/unemployed uses the services provided by the public sector, raising taxes is unfair to people who are hoping for an upturn in the economy to alleviate their plight.

    I'm playing devil's advocate here, and I admit my argument is simplistic and uninformed, and not a well developed idea!