Martin Wall examines the opposing positions as the tortured talks on filling posts are set to resume
Next Saturday, the national council of the Irish Hospital Consultants Association (IHCA) will meet to consider plans for a boycott of new senior medical posts in hospitals which the Government wants to have in place by later this year.
The boycott would come into effect in the event of the Tánaiste and Minister for Health Mary Harney going ahead with controversial proposals to recruit hundreds of new medical consultants under revised terms and conditions in the months ahead without agreement with the main medical bodies.
Consultant organisations are furious with comments made by Harney in an interview with The Irish Times over Christmas in which she said that the Government would not sit around forever waiting for an agreement on a new contract with senior hospital doctors.
Harney set a deadline of "spring" for agreement on a new contract. She said that if a deal was not reached, the Government would go ahead unilaterally and advertise for hundreds of new consultants on revised terms and conditions.
The new contract governing these posts would include restrictions on the right to private practice.
And, in fact, in an interview in yesterday's Irish Times, Fine Gael's health spokesman, Dr Liam Twomey, said Harney should carry out her threat, adding that the status quo could not continue.
Under the Tánaiste's proposals, the Republic's existing 2,000 hospital consultants would retain their current contractual arrangements.
However, Harney pointed out that with nearly 1,000 senior consultants over 55, within 10 years the revised terms and conditions would become the norm.
In addition to these replacement posts, the Government also wants to establish a further 1,600 consultant posts under revised terms and conditions.
The medical organisations believe that the proposals put forward by the Tánaiste to recruit unilaterally hundreds of additional consultants on "public-only" terms would be unworkable and could undermine existing services in hospitals.
The IHCA said Harney's comment as well as separate remarks by Finance Minister Brian Cowen had "soured the atmosphere" for negotiations on a new contract which are expected to begin in earnest in late January.
Cowen said that the consultants currently had a "gilt-edged" contract and that doctors needed to "get real" and accelerate discussions with the Government on a new agreement.
The IHCA has pointedly countered that despite two rounds of talks on a new contract in recent weeks, the Health Service Executive (HSE) and the Department of Health had been unable to table an opening management position paper. The IHCA said that it was told that the management side was awaiting political agreement for its opening proposals.
The IHCA has said it will not accept a Government "guillotine" on talks on a new contract.
The association said if given a "take-it-or-leave-it" offer by the Government when talks recommence at the end of the month, it will leave it and walk away.
It seems clear that any move by Harney to introduce a new consultant contract without agreement will lead to the biggest test of strength between doctors and the Government in recent years. Up to 50,000 patients per week could be affected if widespread industrial action breaks out in the State's hospitals.
However, it is likely that, initially at least, protest would centre on moves by hospital consultants to stymie Government plans to recruit new specialist doctors.
Under its contingency proposals, the IHCA would instruct its members not to facilitate in any way the proposed new recruitment process either by serving on interview panels or by involvement in the selection or shortlisting of candidates.
The organisation would also advise potential candidates for such posts abroad about the industrial relations difficulties and advise them not to apply.
The IHCA said it would also urge senior consultants in Britain or elsewhere not to participate in the process by serving as external examiners on interview panels.
The organisation is confident that if consultants stood together it could block the implementation of any such recruitment programme.
In a circular sent to members before Christmas, the organisation reminded consultants that the Government's plans to establish mental health tribunals - which would review the cases of persons detained involuntarily in psychiatric hospitals - have been delayed for nearly two years due to opposition from doctors.
However, the medical organisations believe that even if the new consultants were appointed, it would be unworkable to have two distinct cohorts of medical consultants working side by side but on significantly different terms and conditions in public hospitals.
The secretary general of the IHCA, Finbarr Fitzpatrick, questioned what would happen under the Government's proposed reforms in units where, for example, there were three consultants operating under the existing contract and three others working under the revised terms.
"Would it be expected that the consultants on the revised terms would work from 5pm to 9am all the time while their colleagues on the existing arrangement work from 9am to 5 pm," he said.
The IHCA also argued that the planned reforms to private practice rights could cause chaos.
Fitzpatrick asked what would happen in the event of a private patient being taken in to a public hospital at night where there was only a consultant with a "public-only" contract on duty.
"Would there have to be two sets of doctors on duty, one to treat public patients and one to treat those with private cover. Or would the patient be expected to waive his or her right to eligibility to determine whether to be treated as a public or private patient, as is set out in the 1991 regulations," he asked.
Fitzpatrick maintained that some of the posts which the Government would seek to have restructured as "public-only" under the proposed reforms were replacement positions for consultants who have retired in recent months or who were about to retire.
He said that a boycott of such replacement posts could affect existing level of services provided in hospitals. He said that it was possible that some consultants on retirement may opt to carry on as their own locum until the row was sorted out.
However, in other cases the doctors involved may decide to leave the service altogether at their scheduled retirement date. Posts where consultants had died in service could also be similarly affected by any boycott.
A spokesman for the Tánaiste said health service management would have draft proposals on the table for a new contract for the next round of talks with the consultant organisations on January 26th.