Well-paid consultants to get even more

It not possible to see yesterday’s announcement that hospital consultants will get pay rises of up to €72,000 in any context other than this week’s announcement of record numbers of public patients on waiting lists.

As an agreement was reached yesterday to resolve a pay dispute 511,904 people — one-in-ten of the population — are in a queue to see a specialist. Some 44,029 of these are children, 10,000 of whom have waited longer than a year and a half.

Consultants will argue that the queues are long because there are not enough consultants — or beds — in the system. They argue this is the case because pay rates and working conditions are easily improved abroad. An Oecd report from 2015 contradicts this and shows Irish hospital consultants are among the best paid in the world despite cuts. Irish consultants earned more than their peers anywhere except Australia or Luxembourg.

A web search yesterday showed a principal consultant in a German hospital earns €85,765 and confirms our consultants enjoy pay levels their international peers must envy. Despite this, hospital queues offer powerful, almost irresistible leverage. Politicians will embrace short-term solutions and make whatever concessions needed to get queues moving before an election comes along. That is how our for-profit health system works.

The Government decision to use private investigators to spy on 10 consultants suggests public unease with consultants’ expectations has had an impact. Three departments initiated surveillance to establish if doctors treated more private patients than allowed — as an RTÉ investigation had shown. That, as The Sunday Business Post reported, the Department of Health had to over-rule the HSE insist the surveillance go ahead shows how fraught the issue has become and how questionable the HSE’s behaviour really is.

Some further context is appropriate. A consultant who works full-time in public hospitals, with no fee-paying patients will now get around €252,000. Consultants who treat private patients in a public hospital will get approximately €225,000. It is believed that those who work in both areas at least double their €225,000 public income. Even if it is comparing apples with oranges it is no harm to point out that the CSO records the average wage of full-time workers is €45,611. It may be comparing apples and oranges too to point out that Taoiseach Leo Varadkar earns a modest €185,350 for running the country, suggesting he would have been better off had he advanced his medical career. It must mean something very significant too that no government minister earns more than a junior consultant confined to public work.

Consultants’ pay is not the only issue bedevilling our health service — insurance costs is another — but it is as symbolic as it is significant. They are an essential cog but also seem a cabal with a heightened sense of entitlement and the capacity to get their way. It is uncertain how this might be resolved but it is certain that the €200m in back pay and the annual increase of €60m agreed yesterday could be far better spent in our health service rather than giving it a group who are already very well paid by any standard anywhere.