The Tánaiste and new Minister for Health, Ms Harney, seemed on a collision course with hospital consultants last night, after her appeal to the consultants to enter talks on a new contract, before a row over their insurance cover is solved, was rejected by the Irish Hospital Consultants Association (IHCA).
Ms Harney said the IHCA could not adopt an "à la carte" approach to negotiations, and she stressed that all issues, including consultants' concerns about who would cover claims for negligence arising out of incidents in the past, must be dealt with at the same time.
She also said she wanted talks on a new contract, which have yet to begin, to conclude as "quickly as possible".
The IHCA wants consultants' concerns about medical indemnity to be sorted out first. It is especially anxious that the State agrees quickly to insure a number of obstetricians and surgeons who have been refused cover by the British-based Medical Defence Union, even though they had paid it insurance premiums over the years.
Ms Harney's tough approach differs from that of her predecessor, Mr Martin, who had regular meetings with the IHCA on the indemnity issue alone.
A new contract must be negotiated with consultants to enable the Government to implement its health service reform programme, which will involve consultants being rostered to work around the clock to ensure a consultant-based service is available to patients at all times. At present, it is mainly junior doctors who provide night-time cover in hospitals.
Ms Harney, who was speaking in Tullamore, said consultants were central to finding a solution to the difficulties in our health services. "There are many issues of concern to the consultants. There are equally issues of concern to the Government. We want to discuss all of those issues together. I think that's fair and reasonable," she said.
"Clearly you can't deal with these matters in a piecemeal way, and I would like to see all of the issues discussed together in the context of the renegotiation of the contract. We need more consultants. We need consultant-led, 24-hour-a-day services, seven days a week, and clearly we need more consultants," she added.
"The public want to see the reform of the health service put in place as quickly as possible, and I'm very anxious to make sure that I deliver on the commitment I made in the Dáil last week to apply all my energy as quickly as possible to delivering that reform.
"Everything has to be dealt with together. We can't have an à la carte approach to these issues. I read in the paper today references to guns to head. Neither side can put guns to heads. We have to have an open mind in relation to this. I think the consultants will find in me somebody that's determined to resolve the issues quickly. I won't be indecisive. I won't be found wanting in terms of making decisions quickly, and the sooner that we can get down to negotiations the better, and I would ask everybody to approach these negotiations with a very open mind"
Her remark about guns to heads referred to an article in yesterday's Irish Times, which quoted Mr Finbarr Fitzpatrick, secretary general of the ICHA, as saying it was unacceptable for the Tánaiste to want a date for the conclusion of contract talks before the insurance issue had been settled. "We are not going to accept a gun to the head," he said.
Last night Mr Fitzpatrick reiterated that consultants would not enter talks on a new contract until the insurance issue was resolved. He said a resolution was in sight when Mr Martin left office. "The fact now that there is a change of policy is disappointing," he added.