IHCA and IMO meet HSE management ahead of crucial annual conferences
AFTER FOUR years of negotiations and two months after a deal was announced by the Minister for Health Mary Harney, health service management and medical organisations will this week make a final bid to agree on a new contract for hospital consultants.
The Irish Hospital Consultants Association (IHCA) and the Irish Medical Organisation (IMO) will meet management today and tomorrow to try to agree a comprehensive document setting out all the areas of agreement which could subsequently be put to members in a ballot.
The parties will also seek to reach a deal on a number of outstanding issues, such as payments for academic consultants and new disciplinary procedures, as well as the contentious issue of private practice.
The timing for the new talks is crucial. The IMO, which has never formally accepted the deal announced in January, is to consider the contract issue at its annual conference at the weekend, while the IHCA will do likewise when its national council convenes on Saturday.
If there is no agreement this week, health service management could be facing the possibility of the January dealunravelling or else having to handle a situation where one organisation accepts the new arrangements and the other rejects them.
At the end of January, the Minister and IHCA negotiators announced that they had reached a landmark agreement on a new contract which would see doctors paid up to €240,000 per year for operating a revised contract with very different working practices. Under this deal, doctors would work as part of teams over a longer working week and be rostered to be available later into the evening and at weekends.
There would also be restrictions on private practice and new measures to provide greater equity of access to services for public patients.
However, a number of problems remain unresolved. This has prompted claims that the momentum had gone out of the process and accusations that management was stalling, as it did not have sufficient money to appoint the hundreds of new consultant posts which were promised once the new arrangements were in place.
The first problem was that the deal was only concluded with the IHCA negotiators; the IMO had walked out of the talks for a period during crucial negotiations last January. In its absence, agreement was reached on crucial issues such as pay.
The IMO was never happy with the pay proposals which it has argued are not sufficiently attractive to encourage doctors to opt for arrangements to work exclusively in the public sector. The IMO, which had sought pay scales of up to €260,000 per year, also has concerns about how the new arrangements would affect retired consultants and regarding the level of training required for the new doctors to be recruited. However, management has insisted that no more money is on the table.
The second difficulty was that no comprehensive contract document has been produced to the satisfaction of all the parties. This meant that the IHCA's governing national council has never formally ratified the deal.
Two drafts drawn up by management have been rejected as deficient, with the IMO claiming that they included elements which had previously been strongly opposed in the talks process.
Some sources said that in a significant number of outstanding areas to be included in an overall document, such as holiday entitlements and sick leave, there is no real disagreement between the parties.
However, there are substantial problems in a number of other areas which will have to be addressed over the coming days if a final deal is to be secured.
Private practice rights remains a major issue, with the parties at odds, for example, over how restrictions in this area should apply to consultants working in job-sharing or part-time arrangements.
One of the major elements of the new contract is that consultants in public hospitals with private practice rights would have to treat four public patients for every fee-paying patient seen.
However, it is understood that the IHCA is seeking to have this 80/20 arrangement revised downwards to 70/30 for existing consultants.
The issue of revised disciplinary procedures to apply under the new deal, particularly the question of by whom and in what circumstances consultants could effectively be suspended, has also taken on a new importance in the wake of the row over cancer services in the Midlands.
Some medical sources maintained that there was strong concern that in Portlaoise a consultant was the only person to have been placed on administrative leave in the course of the recent controversy. The doctor concerned was recently invited by management to return to work.
The January agreement also did not cover a new contract for the 130 or so doctors who hold various forms of academic contracts - which require them to participate in teaching and research activities as well as their clinical practice.
The IHCA and the IMO have rejected salary scales of up to €265,000 proposed by management for medical professors and heads of academic departments. Under the management offer, these rates would have be discounted by 20-30 per cent for associate professors and senior lecturers in academic medical departments.
The medical bodies have sought salaries of up to €310,000 for academic consultants.
This issue will also have to be addressed if an overall deal is to be concluded, as the IMO and IHCA's position is that nothing will be agreed until every aspect of the agreement is agreed.
Some senior management sources accept that the next few days are very important for the process and that movement will have to be made soon if the credibility of the January deal is to be maintained.
One question to which management has never given a satisfactory answer is why no effort has been made to even start on the process of recruiting new consultants. In January, management's position was that, such was the need for additional consultants, it would move immediately to appoint doctors unilaterally on revised terms if no agreement was reached with the medical bodies.
However, when a deal was signed with the IHCA, the whole process went cold.
This has led some in the medical bodies to ponder whether the real reason for the two- month delay was not drafting problems but rather the HSE's €300 million financial difficulties. This suggestion has been denied by the HSE. However, it has yet to say how many new consultants will be appointed this year.