Eithne Donnellan, Health Correspondent, examines the issues facing IMO members
With the threat of having imminent pay rises withheld, doctors gathering in Killarney for the annual conference of the Irish Medical Organisation later this week will be in militant mood.
Even before it emerged last Friday that health service employers were citing GPs, junior doctors and public health doctors for breaches of Sustaining Progress and recommending they not be paid a 2.5 per cent pay increase on June 1st, medics were angry at being, as they saw it, constantly blamed for a host of ills that beset the health service, not least the crisis in A&E units.
Blame was levelled at the doctors by the Taoiseach Bertie Ahern who suggested if consultants and GPs worked longer hours or provided a proper out-of-hours service, the A&E crisis would ease.
But the IMO, which represents around 6,000 doctors including consultants, junior doctors, GPs and public health doctors, insists he is misinformed. The union's outgoing president Asam Ishtiaq says Ahern is "trying to shift the blame".
Never before has he seen morale among doctors so low. And now a threat to their pay rises is bound to heighten tensions.
Martin Daly, the IMO's GP leader, says the Taoiseach's comments in relation to doctors working longer hours reflect "more on his own desperation of being unable to grapple with the problem".
"A casual observer might observe that the Taoiseach only spends a small amount of time in the Dáil. We know he works very hard and long hours trying to get re-elected. Doctors by the same token can be observed maybe at certain times in certain venues but their commitment is a 24-hour commitment. The general practitioner contract is a 24-hour obligation," he said.
The problem of A&E overcrowding - recently declared a national emergency by the Tánaiste and Minister for Health Mary Harney - should result in some lively discussion at the conference, which begins on Thursday and continues until Saturday. Several of the 120 or so motions down for debate touch on this issue. One of them is an IMO demand that the HSE no longer permit the back of ambulances to be treated "as equivalent to an A&E department, an intensive care unit or a hospital". Another calls on the Department of Health and the HSE "to cease arguing about the precise number of patients on trolleys and instead ensure that no patient should remain on a trolley following the clinical decision to admit".
There are also motions condemning the Government for failing to reduce the number of deaths on our roads, calling for increases in the price of alcohol and tobacco products, deploring proposals to have a majority lay membership on the medical council, and opposing plans by Harney to use public hospital sites for the development of private hospitals.
But most attention is bound to focus on industrial relations issues and the fact that negotiations which were under way to broker new contracts for hospital consultants, GPs, and junior doctors have stalled.
In addition, negotiations with public health doctors on the provision of an out-of-hours service to deal with disease outbreaks such as TB or even avian flu outside normal office hours have got bogged down in a row over how the doctors will be remunerated for doing this work. There are also too few public health doctors in posts, in the IMO's opinion, to provide a decent out-of-hours service.
The consultants' contract talks meanwhile became derailed after the HSE board decided to bring an end to category II consultant posts (which allow consultants treat fee-paying patients in private hospitals) in the health service even before the negotiations had begun to make progress. The consultants' unions, including the IMO and Irish Hospital Consultants Association, say this is in breach of Sustaining Progress and they are refusing to return to the talks table until the decision is rescinded.
There are no plans to row back on the decision however, according to the chief executive of the Health Service Executive Employers Agency (HSEEA) Gerard Barry. He said the decision by the HSE board was totally consistent with the proposal tabled at the talks by the employers' side for a public-only consultants' contract. He insists the talks are stalled over other issues also, including a lack of agreement on how any new consultants' contract would be priced and disciplinary procedures.
Then there are the GP contract talks. The IMO said it expected a new draft contract for GPs before its conference this week but it never materialised. It said the negotiations on the contract were to have concluded by the end of March. Barry disputes this. He says the HSEEA had agreed to produce a draft contract by mid-May and is working to that deadline.
"We are aiming at this stage to have a contract negotiated with GPs by the autumn," he said.
"Essentially we are saying we need a whole new deal with GPs to have greater accessibility of GP services and that includes out-of-hours services and a much more comprehensive range of services from GPs," he added.
One of the additional services being sought from GPs by Harney is provision of cervical screening as part of a national screening programme, for which planning has started. The GPs agree with the proposal but want to be adequately resourced and remunerated for providing the service.
The talks with junior doctors on new contracts are aimed at reducing their working hours to comply with the European Working Time Directive, which aims to cut their hours to a maximum of 48 hours a week by 2009. Local implementation groups were asked to draw up new rosters for junior doctors to comply with the directive. The plan was that these would then be approved by a national implementation group, chaired by Cillian Twomey, and piloted across the State. However, the HSEEA says junior doctors are not co-operating with the implementation groups and this is why it wants to withhold their pay increase on June 1st. The IMO says the rosters mean junior doctors would spend part of their core hours working at weekends when they would miss out on structured training opportunities and this was unacceptable. The HSEEA claims the main reason they are objecting to working core hours at weekends is they want to be paid overtime for working outside normal office hours. It points out that the annual overtime bill for junior doctors is more than €200 million a year.
Public health doctors are incensed at being offered what they say is €3 an hour to provide an out-of-hours service. Barry claims they were offered €500 a week to be on call. He says this is "a generous offer" given that he claims most of the time on call will just involve being at the end of a telephone. The IMO rejected the offer and, according to Barry, refused to go to the Labour Court for mediation and he is recommending they not get a pay rise on June 1st either.
IMO chief executive George McNeice insists the IMO is willing to discuss any proposals. Fintan Hourihan, director of industrial relations with the IMO, says all these threats to withhold pay increases are an attempt to scapegoat the medical profession across the board for the failure to deal with problems in the health service.
McNeice says that in the health section of Sustaining Progress "the basic premise by which you got paid your normal national wage rounds was to negotiate an extended day for every grade of staff in the health services. Now that hasn't happened. The management people are responsible for not negotiating that but they have received every pay round anyway".
Adopting a more conciliatory tone he adds: "I think what's really required is a constructive engagement by the senior people in the HSE and the politicians with the senior people representing the health services staff and that includes the IMO, the nurses, the paramedics and everybody else . . . and that is not taking place."