Martin Wall reports on the behind-the- scenes thinking and manoeuvres in the talks between the HSE and the Irish Hospital Consultants Association on new consultant contracts
A move by health service management to temporarily suspend the introduction of a controversial ban on the appointment of consultants with rights to treat fee-paying patients in private hospitals could pave the way for the re-commencement of talks between the Government and medical organisations on a new contract for senior doctors.
The latest talks were adjourned amid much acrimony and recriminations last Thursday with very little progress made.
At the close of the talks, the medical organisations, the Irish Medical Organisation (IMO) and the Irish Hospital Consultants Association (IHCA) effectively laid down a number of pre-conditions to be met by management before full-scale negotiations could start.
Chief among these was a requirement that health service management drop the abolition of the so-called category II contract - which allowed consultants to work in private hospitals - pending the conclusion of the current negotiations.
Both medical organisations were furious at the announcement by Tánaiste Mary Harney in the Dáil earlier this month that no new consultants would be appointed on a category II contract.
The decision to abolish this type of contract had been made by the Board of the Health Service Executive (HSE) in early January. However, health service management never informed the medical organisations of this development at contract talks held several weeks later.
The HSE has said it never got the opportunity to make this known to the parties as they had refused to discuss management proposals for a new contract at the meeting in late January. This explanation has been rejected by consultants who claim that health service managers deliberately withheld the information in a bid to provoke them.
However, there were indications in recent days that there could be some scope for movement by management on the timing of the abolition of the category II contract. Such a development could allow the talks to resume.
Sources told The Irish Times that while the Government agreed that there should be no consultants appointed under a category II contract in the future, that the issue of when exactly the shutters came down could be open for discussion.
Harney stated last Friday that she was concerned at the failure of the consultant talks to make progress.
However, informed sources said it was unlikely that she would tie the hands of her negotiating team on an issue such as the timing of the abolition of the category II contract if it would allow an overall deal to be reached.
Any such compromise is likely to involve HSE management suspending the implementation of circulars issued to hospital chiefs in recent days about future consultant appointments.
Last Wednesday, for example, the National Director of the Office of the HSE chief executive wrote to hospital managers telling them that all approved vacant category II posts which had not been advertised to date had to be re-classified as a form of contract that would not allow outside private practice.
However, even if a compromise proposal was reached and talks re-commenced, there is no guarantee that a deal could be agreed between the parties. There is, at present, very little trust between the medical organisations and the Government and this is before any substantive negotiations even start.
The medical bodies believe that health service management have adopted a deliberate strategy of trying to provoke them into pulling out of the negotiations - a move they believe would clear the way for the Tánaiste to introduce unilaterally a new contract for future doctors appointed.
The medical bodies point to the failure of the Department of Health and the HSE to table proposals for a revised contract until the end of January despite having talked about the need for a new deal for months.
They also highlight the announcement by the Tánaiste at Christmas of plans to impose a guillotine on negotiations if no agreement was reached within a couple of months.
However, health service management believes the row over notification of the abolition of the category II contract is "a distraction".
Management argues that this is aimed at taking attention away from the need for consultants to provide a greater commitment to public hospitals in the future.
Senior health service figures also maintain that consultants have delayed the proceedings in a bid to show they had the strength to push the talks beyond the two or three month deadline set out by the Tánaiste.
If the row over the category II contracts can be overcome, the next major sticking point will be how and by whom the issue of payment for the revised contract will be determined.
Management is prepared to discuss a possible financial package in the course of negotiations and use the chairman as a mediator if necessary.
However, it wants the right to refer the matter to the Review Body which determines pay at the top level of the public sector in the event of a stalemate.
The medical bodies are adamant that pay must be determined within the talks process. They believe that if there is an escape clause for management to go to the Review Body then it will engineer a breakdown between the parties which would allow this to happen.
It is the trust issue again.