After four years of negotiations it appears that one way or the other the current process is coming to a close. Martin Wall, Industry Correspondent, reports
The new proposals on pay and conditions for hospital consultants put forward yesterday will add greater impetus to intensive contacts scheduled over the coming days between health service management and medical organisations in a bid to finally agree a deal on new contracts.
There appears to be a general acceptance on all sides that a full new contract is unlikely to be agreed prior to a deadline of Christmas set in recent weeks by the Minister for Health, Mary Harney.
However, it seems that at the very least management will be seeking confirmation from the Irish Hospital Consultants Association (IHCA) and the Irish Medical Organisation (IMO) this week that the new proposals will break the back of the contentious issues of pay and private practice rights which have beset the process for some time now.
This would allow the final touches to a new deal to be put in place in January.
Management has now said that it will pay up to €230,000 per year to consultants who take the new contract which will involve working as part of teams over an extended working day. Consultants will also be rostered to work in hospitals at weekends in the future.
Management has also signalled that it is prepared to move further on the thorny issue of private practice rights.
It has signalled its agreement to some increase in the number of new doctors appointed who will be permitted to treat fee-paying patients in off-site hospitals and clinics.
However, as ever it is likely that the devil will be in the detail.
It is understood that there is currently no new management document per se. Rather it has signalled to the medical organisations what it is prepared to offer to finalise a deal through the chairman of the talks process, senior counsel Mark Connaughton.
The €230,000 offer is for consultants opting to work exclusively in public hospitals under a new type A contract with no private practice.
It is understood that there is no salary scale as of yet in relation to the other categories of contract and this is something that the medical organisations will be anxious to explore.
In addition, while management has signalled that a more expansive number of new type C posts with rights to treat fee-paying patients in off-site private hospitals will be created than was envisaged heretofore, there is no definitive figure for the number of these positions.
It is understood that health management has insisted that there will be not be a quota for these type C posts but that a new group with strong public interest representation should be established to set out criteria for these positions.
However, it is also thought likely that management will argue that there has to be demonstrable benefit to the public system and not to the consultant for the establishment of such a post.
It is likely that the consultant organisations will seek greater clarity on who would be appointed to such a group and whether the HSE would be obliged to take on board any recommendations it may make.
The new private practice proposals, if implemented, would represent a considerable move from the Government's original stated intention of putting in place a public hospital-only contract.
However, in reality such a development was not likely to have been feasible without a damaging and potentially protracted industrial dispute with the medical organisations.
Under the proposals as they now stand, private practice would remain a feature of the healthcare system, both in public and in off-site private hospitals for the foreseeable future.
On the other hand there would be greater regulation of private practice in the future. Four public patients would have to be seen for every one fee-paying patient treated. And it is also envisaged that there would have to be some new mechanism for ensuring compliance with this cap, although this has not yet been agreed.
Perhaps most importantly there would also be a new common waiting list for patients requiring outpatient diagnostic procedures such as X-rays or MRIs so that fee-paying patients would not have an advantage.
After four years of negotiations it appears that one way or the other the current process is reaching the end of the road.
The IMO, the IHCA and health service management are likely to consider the outstanding issues in intensive bilateral meetings with Mr Connaughton in the days ahead.
If the main problems of pay, private practice and hours or work can be cracked, a full new contract which is one of the main elements of the Government's overall healthcare reforms could be finalised within weeks.
However, if there is no agreement, it now seems likely that the Government will press ahead, unilaterally, with its plans to recruit new consultants on revised conditions. This would inevitably lead to a showdown with the medical organisations.