HSE set to propose private patient increase

Consultants may be allowed to see more than 20% private patients in public hospitals as part of negotiation

The Government and the Health Service Executive (HSE) is to offer medical consultants the right to carry out a greater level of private practice in public hospitals as part of an overall agreement on a new contract with the State.

At present, the level of private practice in public hospitals is capped at 20 per cent. HSE sources said last night the new level of private practice permitted in public hospitals would be a matter for negotiations. However, sources said it was unlikely to be as high as the 40 per cent private practice rate disclosed for some hospitals last year.

HSE chief Prof Brendan Drumm signalled yesterday that health service management would be flexible on the public-private ratio in hospitals as long as there were specific protections for public patients.

The new HSE offer is aimed at breaking the deadlock in negotiations on a new contract. In addition to increased private practice rights, hospital consultants would almost certainly receive a significant pay increase in return for changes in work practices.

However, it is understood the HSE would insist there would be no new consultant posts approved with rights to see fee-paying patients in private hospitals.

The abolition of these so- called "category II" contracts, which allowed for private practice in private hospitals, has been one of the main issues that prevented progress in talks on a new contract for almost a year.

The new HSE offer has the potential to divide doctors in the organisations representing hospital consultants. About two-thirds of consultants have contracts which allow them only to see private patients in public hospitals.

They are largely unaffected by the HSE decision to abolish the category II posts but would be able to treat more private patients and receive higher public salaries and pensions under the new HSE proposals.

The Irish Hospital Consultants Association (IHCA) and the Irish Medical Organisation (IMO) said yesterday that while they were committed to a speedy negotiations process, it was difficult to see significant progress in the absence of a removal of the ban on the category II posts.

The IHCA is to hold an extraordinary general meeting next weekend to discuss the impasse. It is also to propose a motion of no confidence in the HSE over how services are being run.

The IMO's consultant committee is to meet on Thursday to discuss the contract issue.

Prof Drumm said yesterday that throughout the talks process, the HSE had indicated it would be be flexible provided a situation could be reached that allowed for equity for public patients in terms of access.

He said that there would always be private patients in the public system as State-funded hospitals were the only ones providing some critical services.

"What we need is to show is we have an agreed mechanism whereby a significant majority of patients that are seen by consultants are public," he said.