Over the last decade or so, going back to Mary Harney’s time as Minster for Health, the State has sought to exert greater control over the working arrangements of hospital consultants on its payroll, particularly in relation to their private practice.
However on Saturday the current Minster for Health Leo Varadkar effectively indicated that this policy was not working and instead suggested moving to a new system which would give greater freedom for senior doctors to see fee-paying patients, provided their public work had been carried out.
In what appeared very much like the beginnings of a multi-pronged strategy of various financial incentives to tackle the current consultant recruitment crisis, Varadkar spoke of the possibility of new pay rates, bonuses and reforms to existing private practice restrictions.
Since the Government unilaterally cut the pay for new entrant consultants by 30 per cent in the autumn of 2012, the State has faced increasing difficulties in securing hospital consultants. Varadkar acknowledged on Saturday that about 170 posts are vacant. In some cases no applications have been received at all for positions that were once highly coveted by young doctors.
In 2008 the then Government introduced a new arrangement which governed the extent of private practice permitted by consultants paid by the State.
Doctors with one type of contract would work exclusively in the public service, albeit on a higher salary, another cohort could see fee-paying patients in public hospitals while a third group could have private practice in off-site private hospitals.
It is precisely disputes over this arrangement – who can work where and in what circumstances - that is at the heart of the ugly row between the HSE and the St Vincent’s Healthcare Group which operates the publicly-funded St Vincent’s University Hospital in south Dublin and the adjacent St Vincent’s Private Hospitals.
At the same time in 2008 caps were put in place on the amount of private practice work that could be carried out by doctors in public hospitals.
On Saturday as part of a wide-ranging speech at the annual conference of the Irish Hospital Consultants Association, Varadkar appeared to back major changes to these arrangements. Although he pointed out that his proposals should form the basis of negotiations.
“It is my own view that the system of Type A, B and C contracts isn’t working any more. It creates an inequality among consultants in what’s a very unequal health service.”
The Minister said he would prefer to have a single contract for hospital consultants, perhaps similar to one in place in the NHS in the UK where senior doctors receive a basic salary and a system of bonuses and excellence awards.
Elsewhere at the conference the Minister spoke of how paying more money to health service managers was “politically toxic”, largely to public envy in the wake of the recession.
However given the experience with Irish Water, there is no guarantee that bonus payments for doctors would not also attract controversy.
From an industrial relations perspective, the introduction of bonus payments for employees in the mainstream public service – not in commercial State companies such as Irish Water – could also lead to knock-on claims from other groups for similar arrangements.
Bonus payments in the public service were abolished in 2009.
However it was the Minister’s comments on private practice rights that, if implemented, would mark a significant shift in public policy.
He said that being a hospital consultant in a public hospital was a really busy, full time job. He said that consultants shouldn’t really have time for private practice outside of the hospital during normal working hours.
However he proposed that doctors who wanted to do private practice, should perhaps have part time or session contracts instead.
“And those who wish to do private practice in their own time should be allowed to do so, provided they honour the terms of their public contract, and provided we have a means of verifying that they have. But these should all be matters for future negotiation.”
