Gagging clause difficulties for consultant talks

Talks on a revised contract for hospital consultants are to face new difficulties when they resume today with a row over the right of doctors to speak out publicly on behalf of patients.

Under the terms of a draft contract circulated by health service management yesterday consultants would in future have to seek permission from new clinical directors before commenting in public on hospital services.

Doctors are also unhappy that the definition of a consultant in the draft contract is different from that in the existing agreement. The document does not define a consultant as being able to treat patients unsupervised.

Consultants are also to express strong concerns at reports that the Government has drawn up contingency plans to advertise 300 senior medical posts, with revised terms and conditions, in mid-April.

Secretary general of the Irish Hospital Consultants Association (IHCA) Finbarr Fitzpatrick said clauses in the draft contract relating to advocacy and the right of doctors to independent clinical judgment were unacceptable. He said that while the talks would not collapse today consultants would not be able to agree a final contract without these issues being reviewed.

Minister for Health Mary Harney has set a deadline of March 27th for agreement on a new contract with consultants.

Ms Harney has indicated that in the absence of such a deal the Government would press ahead with the appointment of the first of about 1,500 new consultants on revised terms.

The IHCA said that it had learned that the Government had in recent weeks drawn up contingency plans to advertise these new consultant posts while the current talks process was underway.

Mr Fitzpatrick said the plan to advertise the new posts indicated there was a pre-planned strategy on the part of health service management to bring down the negotiations. The draft contract circulated yesterday states that "in the the course of their employment consultants may choose to advocate on behalf of patients or persons waiting for consultation or treatment. In the first instance such advocacy should take place within the employment through the relevant clinical director or other line manager and the consultant should seek the approval of the clinical director before engaging personally in any further advocacy", it states.

The document also re-states a controversial confidentiality clause which would prevent consultants from divulging or discussing "hospital business" and information on staff or patients without authority except in the performance of their duty.

Management is expected to argue that in future consultants will operate as part of hierarchical teams and that no-one else in the health service has the right to speak out publicly without official approval.

Management is also expected to argue that in the new structures consultants' traditional clinical autonomy will have to be circumscribed to a degree.

Management is expected to claim that the absence of supervision and the ability of consultants to operate alone could lead to bad outcomes for patients such as in the case of the patients of Dr Michael Neary.