Martin to take on consultants in health service shake-up

THE Government will attempt to completely change the work practices of hospital consultants in the next stage of their radical reform of the health service.

The Hanly report, due to be published in the next two weeks, will lay the groundwork for a major overhaul of the way consultants operate in the Irish health service.

The Government intends to:

reduce or completely halt the treatment of private patients by public consultants;

make consultants accountable for their budgets at present a consultant can instruct that a procedure be carried out without reference to the cost to the hospital;

change consultant working hours to force them to provide 24-hour cover seven days a week, thus reducing the number of hours worked by junior doctors.

Health Minister Mícheál Martin confirmed yesterday that the Cabinet had decided to renegotiate consultants' contracts.

"My view is we need to change the consultant's contract. Hanly will give the agenda for the negotiations," Mr Martin said yesterday.

The author of the damning Brennan report on financial mismanagement in the health service, published yesterday, described the current work practices of consultants as "shocking".

The fact they can see private patients while being essentially subsidised by the taxpayer was unacceptable, Professor Niamh Brennan said.

Negotiations with the consultants on the Government's proposed changes are expected to be fraught.

Irish Hospital Consultants Association general secretary, Finbarr Fitzpatrick, said consultants have strong reservations about the Government's proposals and they will not be made scapegoats for budget shortfalls.

"Consultants won't do the Department of Health's dirty work. If administrators want to close down a dialysis machine in a hospital they will not get out of it by blaming the consultant in charge," he said.

The reform of consultants' work practices is part of the Government's overhaul of the health services, described as the most significant reform in 30 years. Other proposals include:

A major rationalisation of existing health service agencies - 32 agencies will be amalgamated or abolished. This includes the abolition of the existing health board structure.

The reorganisation of the Department of Health making it responsible primarily for policy.

The establishment of a Health Services Executive, to manage the health service as a single entity, and a National Hospitals Office.

The establishment of four Regional Health Offices within the executive, to deliver regional and local non-hospital services.

The devolution of budget responsibility to those in charge of delivering services.

Although the Taoiseach Bertie Ahern said the Government was committed to delivering on the reforms, there were no budgetary commitments in the plan, or set timescales for delivering improved services.

Tánaiste Mary Harney has ruled out tax increases to fund the reforms, despite the Department of Health saying it needed an extra 900m next year to continue its current level of services.