'Dealing with a month's workload in a  day': Lack of respect from government for public health, says expert

'Dealing with a month's workload in a  day': Lack of respect from government for public health, says expert

Every coronavirus case in a school leads to several hours’ work and specialists could face cases in multiple schools on any given day.

THE recent overwhelming of contact tracing, which resulted in 2,000 people being asked to conduct their own tracing, is a result of the “disrespect” shown by the Government towards public health, says an expert.

Dr Ina Kelly said the Government’s failure to resource public health and provide the sector’s specialists with a consultant-level contract has left Ireland’s first line of defence against Covid-19 weakened.

Dr Kelly, a former lecturer in public health at University College Cork and current chair of the Irish Medical Organisation’s (IMO) Public Health and Community Health, spoke after it was revealed that the contact-tracing system was so overwhelmed recently that 2,000 people who tested positive were asked to do their own contact tracing.

Dr Kelly explained that, while public-health specialists in other countries, such as Scotland and New Zealand, are on consultant-level contracts and have large teams at their disposal, specialists in Ireland are not treated in the same way.

“In Ireland, we’re on non-medical contracts, where, if we actually worked to them, I’d be an assistant or out making tea,” Dr Kelly said. “However, as things stand, we have the responsibility for the investigation and control of Covid-19, all while on this contract.

“We’ve been papering over the cracks for a very, very long time and people are getting tired of doing it.

“We won’t be able to recruit and retain staff, because people in training and people working in public health are becoming increasingly disillusioned with the system here in Ireland. People are being recruited to other countries.

“Colleagues of mine have been headhunted for positions in the UK, where they will be recognised as consultants, and are being offered the opportunity to work from home in Ireland.

“How are we going to hold onto people? People are burnt-out, overworked, exhausted, and they feel disrespected; it’s not a good set-up for staff retention in a critical service that is required to protect the rest of the health service.”

A failure to recruit and retain professionals in public health is not just a problem for public health, but for the whole country, Dr Kelly said.

“The silence is deafening from the Department of Health. We were supposed to have this contract by July, but we got nothing.

“We fear that if we don’t get a consultant contract for public health, we’ll never get one and that there’s no future for public health medicine in this country.”

Dr Kelly said that, as things stand, public-health specialists are overworked and underappreciated.

She said the Covid-19 pandemic has highlighted the fact that they are on the frontline without the resources or time to fight the virus.

“It’s an 11- or 12-hour day and it’s not like it was in March: We’re all burnt out now,” she said. “If we are notified of a case in a school, for example, it takes maybe two or three hours to do all the work needed there.

“That includes a risk assessment, contact tracing, letters of information for the school and parents, and liaising with the school on what exactly is going to happen. If you have four schools a day, that’s the whole day gone,” Dr Kelly said.

“If you have nursing-home outbreaks, that’s a huge workload on top of that, because you may have to meet with them several times a week to work to minimise cases and control the outbreak.

“I could be working on a GAA team outbreak, a disability unit outbreak, a workplace outbreak on any one day,” Dr Kelly said.

“It’s not just about containing these outbreaks: It’s about figuring out where the virus came from to cause these outbreaks, and to stop its spread.

“In doing that, we could find any one outbreak is linked to multiple other outbreaks and the process starts again.”

Dr Kelly said that public-health specialists are tasked with analysing and controlling complex outbreaks of a new virus, and yet they have little time and resources to do it.

“We’re doing it on the hop,” she said. “We’re jumping from outbreak to outbreak, case management to case management, and risk assessment to risk assessment.

“That’s what we do, day in, day out. We could have 50 to 100 open cases in our department at any one time and new cases are coming in all the time.

“It’s time-consuming work and you can’t be too tired doing it.

“The workload that we have in infectious diseases has gotten to the stage where we’re dealing with a month’s worth of work in just one day,” Dr Kelly said.

“The number of cases is so great and our resources are so sparse. There are probably preventable infectious diseases happening in the country, but we don’t have the resources to prevent them.

“People only notice public health when we fail and that failure is inevitable, unless we’re resourced enough.”

A spokesperson for the Department of Health said it was committed to the establishment of a consultant-led public-health model, as recommended in the Crowe Horwath report on the specialty.

“The minister and the department recognise that the specialists are leading the State’s response to the pandemic,” they said. 

“The Department and the HSE are currently working intensively to finalise the body of work necessary in order to engage with DPER on the matter of approval for a public-health model that would include consultant posts.”

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