Seanad Report: Consultants appear to be uncontrollable at present, Mr Brendan Kenneally (FF) said in a debate on the proposed health reforms.
It had puzzled him how dentists and orthodontists could be employed totally within the public service, while other consultants could have both a public health role and a private practice as well.
"I have come across cases where consultants are manipulating the hours and services of registrars and house officers. This is totally unacceptable, but consultants appear to be uncontrollable at the moment.
"A new agreement requiring consultants to give a certain number of years exclusively in the treatment of patients in the public health service is long overdue."
It was clear that there were practices in our health service which were neither user friendly nor administratively acceptable, Mr Kenneally said. "We must eliminate bad practice and vested interests, maximise the resources available and examine every euro of our money which is being spent, to extract full value from it."
Tough decisions must be made, he added.
Dr Maurice Hayes (Ind), who in the recent past made a study of the hospital service in Northern Ireland, said one of the reports prepared for the Department of Health here suggested that consultants be made accountable.
"Of course, they must be accountable, but it's the way you express it. What you have got to remember is that these are very scarce commodities, these are very special people and if they don't get jobs in this country, the world is their oyster. If you talk about accountability are you going to sack them; are you going to discipline them?"
This whole area would have to be handled very sensitively.
Dr Hayes said he commended the Minister for Health for the approach to reform that he proposed to take. "I urge him to put his hand to the plough and stick to it." It was a great tragedy that the Fitzgerald report of 40 years ago had not been implemented.
There was a danger that people would think that managerial and administrative changes were sufficient. "At the end of the day you might only be rearranging the deck chairs on the Titanic," he said.
The outcome must be one that enabled gifted, dedicated and able people in the medical, nursing and allied professions to treat patients. The important thing was to change attitudes, not the titles over people's chairs.
The Minister of State for Health, Mr Ivor Callely, said members of the Dáil had accused Minister Martin of deliberately withholding the Hanly Report. That was nonsense. The report was not yet available because a lot of the partners in the process had not yet signed off on it.