At last we are able to glimpse what lies at the core of negotiations on the new contract for hospital consultants. As the talks waxed and waned with excruciating slowness over the past four years, the ground continually shifted. Every conceivable obstacle has been grasped by consultants to hinder the introduction of a vital reform within the system, writes Mary Raftery
One minute it is the issue of clinical indemnity that holds everything up. The next, the problem is supposed interference in the doctor/patient relationship. For the past few months the consultants have been telling us that their main objection to the proposed new contract is that it contains what has been dubbed a gagging clause, curbing their right to advocate on behalf of patients.
This week, however, the smokescreens lifted. The Irish Hospital Consultants' Association deserves credit for the shattering clarity with which it explained its problems.
"Mickey Mouse" was the term they used on Tuesday to describe the offer made to them of a new annual salary of €205,000 plus bonuses of €40,000. Faced with such a derisory offer, the IHCA has abandoned negotiations and intends taking industrial action.
This salary is designed for public-only consultants. Those wishing to continue supplementing their income with private work will continue to be allowed to do so. The offer to them is a salary of €185,000. This is for a 39-hour week, but 20 per cent of those hours are allowed to be used for private, fee-earning work. The remainder is to be taken up with the treatment of public patients only.
In other words, consultants are being offered what by any standards is an enormous salary for a mere 31 hours a week of public hospital work.
"Mickey Mouse" is not how any other consultant in the world working in the public system would describe such an offer. International comparisons (OECD health statistics, 2006) show that Irish consultants earn among the highest salaries anywhere in the developed world. Include their private fees, and Irish earnings become stratospheric.
With all the verbiage about advocacy and clinical independence pushed to one side, what we are left with is the obscene spectacle of a group of individuals motivated by naked greed.
It is difficult to believe that this motivation applies equally to all consultants. Many share a very real dedication to patients, whether public or private, and a burning desire to see people treated fairly and properly. A number have courageously spoken out, highlighting gross inadequacies within the system.
For this group, the so-called gagging clause is a serious problem. However, it does not appear that the HSE actually has any intention of silencing consultants. The relevant clauses in the new contract to be offered to anyone who applies on foot of the advertisements published today for the new consultant posts contain nothing which could remotely be described as a gagging clause.
Directly the opposite, in fact. The new contract clearly states that consultants "may advocate on behalf of patients". The only limitations are that they must first raise matters with their line management, and that they should make clear that their public comments are made in a private capacity - hardly unreasonable or draconian conditions, and in fact far more generous than those applying in almost any other kind of employment.
Under the heading of "confidentiality" they are required not to divulge any confidential patient or staff information. Again, no evidence here of a conspiracy to silence doctors campaigning for better healthcare.
In the light of this, it seems clear that there is a group of consultants, centred mainly in the IHCA, who are attempting to present themselves as patient champions, facing gagging orders from hospitals and heroically determined not to back down in the face of such bullying tactics.
The reality, however, is that they have shamelessly fabricated an issue which does not exist in order to hide the true basis of their opposition to the new contracts - namely the shocking view that a salary of almost a quarter of a million euro is "Mickey Mouse".
The IHCA has already been seriously discredited by its role in the Michael Neary scandal, during which it actively sought to facilitate his remaining in practice after the midwife whistle-blowers had reported his grotesque malpractice to the health board.
Its placement of self-interest at the heart of its activities is most certainly not in the interests of patients. Nor indeed is it ultimately in the interests of doctors or even consultants.
As a counter to the IHCA, it is interesting that the Irish Medical Organisation has not walked away from the negotiations on the new consultant contract, nor has it threatened industrial action. The IMO represents a minority of consultants, but the majority of junior hospital doctors. In this context, it has the potential to remain a voice of sanity, allowing us to cling to the notion that there are doctors within the system who are motivated by concerns other than pure greed.