With talks on new consultant contracts due to start again today, Martin Wallgets to the heart of the matter
Q What does Minister for Health Mary Harney want?
The Minister wants to introduce a new agreement between health service management and hospital consultants which would see more specialist doctors working exclusively in public hospitals.
She envisages major restrictions on private practice. However, under the new contract, consultants would be allowed to see patients in the proposed new private facilities to be developed on the sites of public institutions. She also wants consultants to work in hospitals over an extended day - some starting earlier in the morning and others working until later in the evening. In some specialities she believes there will have to be a consultant presence on a 24-hour basis.
The introduction of a new contract for hospital consultants is considered to be one of the key elements of the Government's overall reform plans for the health service.
Currently, consultants are committed to working 33 hours per week in public hospitals, although many work much longer hours. Around 600 of the 2,100 consultants in public hospitals have contractual rights to see fee-paying patients in off-site private hospitals.
Q What difference will it make?
The primary change is that under the Government's proposals, public patients would have a much greater chance of being seen, diagnosed and treated directly by a consultant. At present, medical services in public hospitals are generally consultant led, not consultant provided. This means public patients are often seen by non-consultant doctors who serve on a team led by the consultant. The Government plans to appoint up to 1,500 additional hospital consultants under revised contractual arrangements.
Q When did the talks start and why have they taken so long?
For more than a decade the Department of Health has been talking about introducing a consultant-provided service in public hospitals.
The introduction of the European Working Time Directive which set limits on the hours that could be worked by non-consultant doctors concentrated minds, and talks between the Department of Health, the HSE and consultant representative bodies got under way on a new contract about 2½ years ago. However, the negotiations became bogged down because of a dispute over insurance cover for consultants.
When this was resolved negotiations resumed but stalled quickly following a unilateral decision by the HSE board, outside of the talks process, to abolish a form of contract which allowed some consultants to see fee-paying patients in off-site private hospitals. New talks with a seven-week deadline are due to start again today. Harney has signalled that the Government will move to impose a new contract if agreement is not reached with the consultant bodies.
Q What contracts are consultants currently on?
A variety of contracts are currently in place. Around 1,300 doctors are on category I contracts which allow them to see private patients in the public hospitals in which they work. A further 600 have category II contracts which permit them to see fee-paying patients in off-site private hospitals. Around 200 have academic or other forms of contract.
Q How will the proposed new contracts differ?
The Government wants to introduce a new public hospital only contract. There will be two "manifestations" of this contract. One type would see consultants appointed on a salaried basis but with no rights to private practice. The other form of contract would allow consultants to see fee-paying patients either in the public hospital or in the new private co-located facilities to be developed on public hospital land. It is envisaged the consultants with no private practice rights would receive a higher salary, possibly up to €240,000. There will also be a bonus scheme of up to 20 per cent on offer. Neither form of proposed contract would permit private practice in off-site private hospitals.
Q How many new posts are involved?
The Government plans to appoint 1,500 additional consultants over a three- or four-year period. This would bring the number of consultants in public hospitals up to around 3,600.
Q How will the new consultants be sourced?
The Government envisages advertising the new contracts internationally. It is expected that many consultants will be appointed from within the Irish system or by Irish graduates who are working abroad.
Q Can existing consultants opt for these new contracts?
All existing consultants will be offered the new deal. The revised contract is expected to have a higher salary and the Government hopes the terms will be attractive to doctors who have limited private practice rights. A higher salary would also translate into a higher pension in some cases and the Government hopes many doctors close to retirement age will seek to switch over.
The new contract may prove unattractive to consultants who have recently invested hundreds of thousands of euro in suites in new private hospitals which have been developed around the State.
Once the new contract is agreed no consultant will be appointed on any other terms and over time the new arrangements will be the only ones in place in the hospital system. However, this could take up to 30 years to achieve.
Q How quickly could we see the new consultants coming into the system?
If a deal is reached on a new contract by Easter, health service management believe the first of the new consultants could be appointed by the autumn.
Q How important is a deal to the Government?
A revised contract for consultants is a key element of the Government's overall healthcare reforms programme. However it, in itself, will not solve all the existing problems. For the public hospital to work over an extended day, there will have to be agreements with nurses, radiographers, porters, etc.
Q What options are open to the consultants if the talks fail and the Government presses ahead?
Consultant representative bodies would probably seek to organise an international boycott of the posts and seek support from medical organisations overseas. They would more than likely seek to block appointments by refusing to serve on interview panels.