It remains to be seen if agreement can be reached with the IMO, writes Martin Wall
The new contract for hospital consultants will represent a fundamental change for public health services in the State.
However, the new deal has only been concluded with one of the bodies representing consultants and it remains to be seen how members of the Irish Medical Organisation, which was not present for the crucial final talks over the last day or so, will react to the agreement.
The IMO walked out of the negotiations in the early hours of Wednesday morning as it was dissatisfied with the proposals on the table at the time.
Yesterday morning it decided to re-engage in the process and argued that its decision to withdraw had resulted in the management adopting a more reasonable approach.
However, in the interim period the vast bulk of the current agreement, including the critical basic pay scales, had been effectively concluded in talks between management and the Irish Hospital Consultants Association (IHCA).
At the end of the marthon 20-hour session on Thursday morning the only issues outstanding between the IHCA and management was a disagreement over an allowance paid to consultants and the phasing in of the new salary scales.
In reality these were never going to be deal breakers.
The IMO understood that further contact would take place yesterday with the chairman of the talks process, senior counsel Mark Connaughton, and that face-to-face talks involving all parties could take place today.
However, in the background the IHCA and health service management agreed a compromise on their outstanding issues at about teatime yesterday and signed a deal.
The IHCA is now likely to recommend the new contract in a ballot of its members. However, the response of the IMO remains to be seen. The IMO last night said it was still in discussions with Mr Connaughton.
In a brief statement it said it remained "confident that, if the talks can proceed with realistic expectations on all sides, an early resolution can be reached".
However, it appears highly unlikely that health service management, having secured a deal with the IHCA which represents some 1,700 consultants, will now wish to engage in further negotiations with the IMO which could cause problems for its existing agreement.
One informed source said last night that management would now have to defend the deal it had concluded.
Minister for Health Mary Harney last night said she hoped that when IMO consultants saw the terms of this agreement that they will be in a position to accept it.
The new deal for hospital consultants is not like a normal industrial relations dispute where a final decision is based upon a majority vote of union members.
While the IMO and the IHCA are expected to conduct a ballot of members, in reality each of the 2,100 public hospital consultants has an individual contract and will now have to decide for themselves whether to effectively trade this in for the new document.
However, if a large number opt to remain with their existing arrangements, which set out a 33-hour week which is largely confined to the regular working week, it could cause problems for management's plans for an expanded service.
The main aim of management over recent years has been to see a greater consultant presence on the public hospital campus.
Arguably the most important feature of the new deal - and one which was promoted by the medical organisations - is that in future outpatient and diagnostic services will be provided on the basis of medical need and that fee-paying patients do not enjoy any priority.
It should also trigger the appointment of hundreds of additional consultants and pave the way for the long-awaited personnel reforms which would see the introduction of a service where public patients are seen by a consultant rather than a non-consultant doctor.
Consultant contracts: the new deal
TYPE A:Salary range up to €240,000. Public-only practice.
TYPE B:Salary range up to €220,000. A minimum of 80% of the consultant's work load will be devoted to assessing and treating public patients in public facilities and a maximum of 20% can be devoted to private patients.
TYPE C:Salary: €175,000. These Consultants will be appointed in exceptional situations and will be entitled to treat private patient outside the public hospital campus.
• The length of the working week is to be extended from 33 to 37 hours.
• An extended 8am to 8pm working day will be introduced where required, increasing the number of hours a scheduled on-site consultant service available on-site by four hours per day
• Consultants may under certain circumstances be required to work five hours on Saturdays and Sundays to expand access for patients/clients to consultant provided services.