Relations steadily worsen following report

RELATIONS between the Department of Health and the country’s consultants have grown steadily worse since a Government-commissioned report on health reform last year recommended the renegotiation of the consultants’ contract.

Under the deal with the State they are committed to providing 33 hours a week to public patients. In return, they are paid an average of €152,000, and the contract does not preclude them from carrying out private work.

There are approximately 1,500 consultants in a health service comprising almost 100,000 people. Theirs is a relatively small number but belies the influence that they have: consultants form a hugely powerful medical and political lobby.

So when Professor Niamh Brennan published her report on the reform of the health services last June and sharply criticised consultants in the process, they hit back hard. Mr Brennan, while stressing many consultants worked more than 33 hours on their public patient work and delivered "outstanding value for money", identified several major concerns with their contract.

One was that he individual consultant was not actually required to treat the public patient, and could delegate the duty to junior doctors. This meant the taxpayer paid twice for the same service once to the consultant and a second time to the junior doctor.

A second concern was consultants were allowed to treat private patients during the 33-hour scheduled commitment to public patients. Mr Brennan argued it was not in the taxpayers' interest to see consultants earning extra monies from treating private patients in the time they were being paid to take care of public patients.

The Brennan Report recommended the common contract be renegotiated so that, in existing contracts, there would be an agreement of core hours in which the consultants would be in attendance at public hospitals.

It was also recommended that, where there were competing public and private demands on a consultant's time and resources, the public patients would have priority.

All new consultants, the report recommended, would be contracted to work exclusively in the public sector.

The Irish Hospital Consultants' Association immediately announced it would fight any bid to force its members to work exclusively for public patients.

However, in October, following the publication of the Hanly Report, Health Minister Micheál Martin said he would seek the immediate re-negotiation of the common contract.

Meanwhile, the consultants and the department were already on a collision course over the Clinical Indemnity Scheme proposals.

While both sides will insist their professionalism will prevent the current dispute affecting the common contract negotiations, there seems little doubt the divide between the consultants and the department continues to widen.