Waiting room: Consultants expecting €700m pay day

Don’t expect others in the public service to rally behind the hospital consultants, writes Health Correspondent Catherine Shanahan

THERE’S no denying that many hospital consultants are worth their weight in gold. These are the men and women who, by and large, are buried in books for the best part of 10 years.

And even when trainee doctors finally reach the hallowed heights of hospital consultant, the learning is not done. In fact it’s never done — they are on a continual learning curve, presented with new patient challenges every day, new medical breakthroughs, new research. They are all the time honing and deepening their expertise. This is good news for the patient. None of us wants a novice in the resus room.

Private practice aside and the astronomical amounts some consultants seem to earn from this, few would argue that hospital consultants who work exclusively in the public system are undeserving of their earnings of c.€240,000 a year. But there may be less public understanding for an emerging claim of €700m owed to consultants under salary increases due in 2009 as part of the 2008 consultants’ contract. This promised a number of increments in exchange for changes in work practices, including longer hours, greater on-call commitments, and more weekend work as well as restricted private practice.

Even though consultants signed up for the changes, Mary Harney, then health minister, refused to sanction full implementation of the payments because of the financial crisis. Her action was estimated to have saved €50m a year since 2008, but given the €700m now being bandied about, it appears that estimate was significantly wide of the mark.

This pay bill has not come out of the blue for the HSE. Early threats to sue for payments withheld on foot of a unilateral decision by Harney go back to 2009, although the figure reported as owed to the consultants back then was one tenth of what it is now.

The consultants’ case was strengthened in January when two of their members who took a case to the Employment Appeals Tribunal won. The tribunal ruled that payments to the two had essentially been withheld illegally and between them they received payments totalling €114,000.

On the back of this, the IMO announced in April that it had commenced legal proceedings in the High Court to secure the monies due. With the first High Court case due to be heard either later this year or early next year, the HSE appears to have worked out the actual pay bill, arriving at the staggering figure of €700m — more than any bailout the HSE has ever received to drag itself out of the inevitable annual financial doldrums. How the HSE arrived at this figure — double what was first mooted — is a mystery. It was refusing to comment yesterday, as was the Department of Health.

Consultants can expect flack for the attempted clawback. Compared to other public servants, they are handsomely remunerated. Anticipating this, they were out of the traps yesterday warning that failure to honour a contract had dire implications for the rest of the public sector.

“It’s a fundamental question around contract,” said IMO consultant committee chair Dr Peadar Gilligan. In reality, it is a contract issue for all public-sector employees, he said.

Except that the consultants are the only ones affected and it seems unlikely many other public workers will come out in sympathy. He is of course correct to point out that it does nothing to help recruit and retain consultants to the public service — there are currently 250 vacancies — because concerns that an employer cannot be trusted to honour contract terms is not conducive to attracting new staff.

But then neither is a health service where 93% of consultants claim to feel stressed and undervalued, as per a study published in the British Medical Journal earlier this year where the main cause of stress is lack of long-term planning and working in an “always reactive” environment.

What cannot be lost on anyone is the timing of this information, that the State has an outstanding €700m pay bill, given that the budget is announced next week. One could argue it’s a strategic move to ensure the Government sets the money aside. In addition, there have been ongoing soundings about a new consultants’ contract, so one could also argue it’s a strategic move by their representative bodies to ensure the issue is addressed within the framework of any fresh consultant contract talks.

In the meantime, doctors are pressing ahead with their claims. Dr Gilligan told the Irish Examiner yesterday that an estimated 500 consultants are taking cases in the High Court. While the tribunal found that the unilateral decision to withhold payment was illegal, Dr Gilligan said there is no guarantee the High Court would decide likewise. “If they do decide otherwise, what is there to stop other ministers making similar unilateral decisions?” he said.