The IMO wants to re-enter talks about new contracts for consultants, writes George McNeice
While there have been many innovations led by consultants within the existing common contract, the Irish Medical Organisation believes that greater innovation and change would be enabled by a revision of the existing contract. Of course, many other reforms are also needed as changes in consultants' work practices alone will not answer the many problems faced by our health service. However, the first task for all parties to the discussions is the removal of the roadblock to the resumption of the consultant contract talks.
Clearly, the reason for the collapse of the talks seven months ago needs to be addressed. The decision by the Health Service Executive unilaterally to refuse to approve category-two consultant positions - which permits a consultant to maintain a private practice in addition to his or her public duties - was not only wrong as a policy option, but also the cause of a more serious breach of trust, especially when trust has been so lacking and so badly needed in the relationship between the HSE and consultants.
This decision has profound implications for both the current contract talks but also for the ongoing relationship between consultants and policymakers in the HSE.
There is a variety of options and processes available to resolve these types of disputes; the IMO has participated actively and successfully in such initiatives previously and can do so again.
Any such initiative must also ensure that existing agreements are honoured and that a climate for professional, even robust, negotiations can reign.
Clear confidence-building measures are required to enable a more appropriate relationship between consultants and health service managers.
The abolition of the health boards removed the last semblance of a formalised system of engagement between the profession and policymakers. The abolition of Comhairle na nOspidéal, a statutory advisory body which was expressly designed to allow consultants access to policy formation and decision-making based on their own professional expertise, only served to exacerbate the damage done when proper systems of engagement are absent.
Proper consultative forums must be established on a permanent footing to take advantage of the strategic skills and professional expertise of consultants who have to be actively involved to make this work.
The IMO and its consultant members are ready for contract talks. More importantly, we are prepared to attend such talks, so long as the status quo is restored, without preconditions on either side. We have our own detailed agenda for the talks but, for now, we feel it appropriate to comment on the agenda for change as sketched out in headline form to us by the HSE.
Firstly, the notion of a "public-only" contract (treating patients within public hospitals only) is an idea the IMO has championed previously, and fought to retain in previous contract talks, but we feel that insisting on this as the only option for new and existing consultants who may wish to sign up to any revised contract will fail to provide the choices being demanded by patients and doctors.
From the patient perspective, we must remember that over 50 per cent of the population has private health insurance and expect the highest level of medical expertise to be available. Private hospitals are also being developed with Government support and in response to demands which may alleviate, even though in a limited fashion, pressures on our public hospitals.
However, precisely because the IMO wants to see public hospitals flourish, we want to see consultants able to have a menu of options available to avoid mass migration of world-renowned consultants from our public hospitals.
Further, the training of our future generation of doctors depends on recruiting and retaining the best consultants in our public hospitals.
We are unambiguous in calling for priority to be afforded to public hospitals and promoting greater access for all patients to those same hospitals.
To avoid unintended consequences for hospitals, patients and doctors, we must ensure that, within a nationally agreed template, flexible options - including "public-only" contracts, public/private mix contracts and part-time contracts - for consultants are available.
That possibility of unintended consequences being visited upon us, should official policy persist with insisting on "public-only" contracts exclusively, also needs to be understood.
Patients must be treated by clinical need rather than the availability of consultants on an appropriate contract; greater team-working would be impossible if the 2,000 existing consultants were practising on an entirely separate contract to new recruits.
Health insurers and subscribers are not happy at the implications of insurers gradually being unable to offer members guaranteed consultant service of the highest standards, a scenario which could cause public hospitals to be overwhelmed and insurance costs to skyrocket.
Pushing "public-only" contracts also runs the risk of curbing enterprise and innovation. Consultants, in our experience, are the pioneers of change in so many areas. They regularly work up to 70 hours per week, so they have everything to gain from performance-related incentives.
We feel that individual practice plans, which the IMO has supported previously, should not only detail what is expected of a consultant but also what is expected of the employer in terms of support and resources.
Doctors want to be involved in the management rather than the administration of services and, more importantly, they must have a role in the strategic planning of services. The teaching requirements of doctors also need to be addressed, while the need to provide appropriate resources to enable greater quality assurance of doctors by continuous medical education is a key imperative.
The IMO Consultant Committee supports the recommendations of Justice Harding Clark in her recent report and will continue to highlight the need for significant extra resources to enable those changes be realised.
The IMO has a positive agenda for change and will advocate that fresh thinking is required in terms of the policy and direction apparent in the proposals so far tabled in outline form by the HSE.
However, what will doubtless be tough negotiations can only resume when the roadblock preventing such talks is removed and measures are agreed which can allow such talks take place in an appropriate climate for reform. The IMO will not shirk its responsibilities and can engage with the HSE as soon as the circumstances are right for dialogue to resume.
- George McNeice is chief executive of the Irish Medical Organisation