The Minister for Health, Mary Harney, has threatened to bring a new hospital consultants contract to Cabinet for formal ratification next week with a general election in the offing. Like all of her predecessors for the past 15 or 20 years, she knows that changing the consultants' contract is the biggest structural reform needed in the health service since the Mother-and-Child Scheme.
Is the Government going to take on the biggest vested interest on the eve of an election? The Opposition parties are giving them the support to do so.
The Government is certainly annoyed with the Irish Hospital Consultants' Association. The political risks arising from a disruption of the health services are great. But with the Taoiseach, Bertie Ahern, signalling his desire for a resumption of negotiations, the Health Service Executive is likely to embark on that process within the next few days.
At stake will be effective control of the public hospital system, the authority of the HSE and the reputation of the Government in the health area. On the basis of the progress made so far, the Government's will to prevail against entrenched medical interests must be questioned. Ms Harney undertook to have new contracts in place by last Easter. The State agreed to underwrite insurance claims against vulnerable consultants. When that issue was resolved, talks broke down over the freedom of consultants to engage in private practice.
The head of the HSE, Brendan Drumm, has argued there is no system in the world where public service doctors are paid full-time and still allowed to earn twice or three times as much in private practice. But an initial proposal for public-only contracts was changed under pressure to allow for the treatment of private patients, provided it was delivered "on campus". At the moment, some 30 per cent of consultants work "off campus". Most are concerned about possible changes to their traditional status and work practices within hospitals.
The separation of public and private medicine has been identified as a necessary step in the elimination of hospital waiting lists. But that is not proposed here. As things stand, there is an official cap of 20 per cent on the percentage of private patients that can be treated in public hospitals. But it is widely ignored by consultants. Double that percentage may be treated.
By focusing attention on hospital consultants, the Progressive Democrats have chosen a big target. There is a public desire for tough administrative decisions after years of prevarication and poor-quality services. The initiative could overshadow failed promises from the last election to end hospital waiting lists, provide an additional 2,000 beds and issue 200,000 full medical cards. On the down side, however, the public mood may change if hospital services are disrupted. If a new contract cannot be agreed in a matter of weeks, the public's confidence in the health system will be utterly undermined.