After nine-month deadlock, HSE and consultants' unions are urged to re-enter talks Talks on the consultant contract could be back on track shortly, writes Eithne Donnellan, Health Correspondent
Last January Minister for Health Mary Harney was playing hard ball with hospital consultants.
Her message was clear and simple. Irish consultants were the best paid in the world and she was not prepared to wait indefinitely for them to agree to a new contract.
She indicated that if the unions representing hospital consultants - the Irish Hospital Consultants Association (IHCA) and the Irish Medical Organisation (IMO) - hadn't agreed to a new contract within two months, she would impose one on them and it would be a public-hospital only contract, denying them the right to lucrative private practice.
While her intention was to make fast work of getting the most senior hospital doctors to agree to new work practices, it didn't work. It's nearly nine months on and the parties haven't even gotten around the table yet to begin the negotiations proper.
However, in recent days and weeks, the head of the Health Service Executive (HSE), Prof Brendan Drumm, and Harney have begun adopting a more conciliatory tone and were intimating that a breakthrough was on the horizon.
They know that a new contract, which was promised in the national health strategy in 2001 and which would see consultants working in teams around the clock, thus reducing dependence on junior doctors, is an essential building block of the health service reform programme. And this is something which they must be seen to be implementing.
Harney, who set down the agreement of a new contract with consultants as one of her priorities when she became Minister for Health in late 2004, won't want the failure to agree a contract thrown at her in the run-up to the general election.
At a meeting of the Dáil Health Committee last Thursday, she said it was disappointing that talks with consultants on a new contract had broken down, but she hoped a formula would be found to allow them to resume soon. She added that, despite earlier suggestions the HSE would only be issuing public-hospital only contracts in future, it was now accepted that one size did not fit all. "We will probably need a variety of options," she conceded.
Drumm told the same meeting that the HSE "remains totally committed to developing a new working relationship with consultants that will benefit patients and consultants", and he was hopeful negotiations could recommence soon.
He added: "Achieving this may involve exploring a variety of arrangements. For example, arrangements that would address the needs of the public health system, foster productive and equitable relationships between public and private providers and facilitate consultants who wish to contract with the public health system for less than a full-time commitment."
He continued: "We need to accept that the workload carried by consultants at this point will not be acceptable to young doctors going forward. We therefore need to develop structures with more flexibility to allow consultants in the future experience a more even work-life balance . . . The challenge for the HSE and consultants is to be more open and flexible so that we can quickly move to a new era in healthcare provision."
The independent chairman of the talks, Mark Connaughton SC, has contacted all sides over the past week to see where they stand and yesterday issued proposals for a resumption of the talks in two weeks.
The talks stalled last February because the HSE board decided not to issue in future a type of contract currently held by 30 per cent of consultants. These so-called category II contracts allow doctors, on average State salaries of €160,000 a year, to work 33 hours a week attending to public patients in public hospitals, and also to work off-site in private hospitals, once their commitment to public patients has been fulfilled.
Both the IHCA, which represents about 1,800 consultants, and the IMO, which represents about 800 consultants, said this could not be decided before the talks had even begun and pulled out of the negotiations.
The HSE later offered to lift the ban on the appointment of category II consultants for the duration of any talks which might take place. But this was not acceptable to the unions because it did not lift the restriction on the filling of 24 category II posts which were sanctioned when the HSE made its decision.
With no movement on either side for a number of months, the sides were deadlocked.
However, the chairman's intervention yesterday may be the breakthrough that was needed. It is understood that he has suggested the issue of these 24 category II posts and what should become of them should be discussed at the talks table.
He has also asked the HSE to lift the ban on the appointment of category II consultants for the duration of the resumed talks, which he believes should take place for an intensive two-month period.
Furthermore, the other contentious issue of the pricing of any agreement - in other words what consultants would be paid for agreeing to the changes - should, he suggests, be discussed at the negotiation table.
All sides have been asked to indicate to Connaughton if the proposals are acceptable to them within the next week.
While the unions were reserving their position on the new proposals last night, it seems there is a degree of optimism now that the talks will resume shortly.
It would seem unlikely that any of the sides would have anything to gain from turning down an invitation to return to negotiations at this stage.
Finbarr Fitzpatrick, secretary general of the IHCA, would not discuss the proposals last night. He would only say the IHCA national council would meet to discuss the proposals at a meeting next Friday night and it would then make a recommendation to the union's annual conference on Saturday as to whether they should be accepted or rejected.
Fintan Hourihan, director of industrial relations with the IMO, said he could not comment on the proposals until the IMO had had time to consider them fully.
The HSE board is expected to consider the proposals at its board meeting on Thursday.