Hospital consultants have successfully obstructed necessary reforms for six years in an effort to protect lucrative private practices and their near-autonomy within the health system. In the latest episode of resistance, the Irish Hospital Consultants' Association (IHCA) has embarked on industrial action in order to prevent the recruitment of 68 desperately needed medical consultants. Such behaviour is damaging to the public interest.
The issue here is one of control. No vested interest should be allowed to dictate the terms of its contract with the State. Unfortunately, that was permitted to happen in the past. And consultants are, understandably, reluctant to modify their extraordinarily generous terms of employment. Nowhere else in the world are public service doctors allowed to earn twice or three times their official salary through additional private practice.
A National Health Strategy, published in 2001, identified a renegotiation of such contracts and the introduction of flexible work practices as the bedrock of reform. It envisaged a "public only" contract, at least in the initial stages, for new consultants and a "cap" of 20 per cent on the treatment of private patients in public hospitals. Consultants would operate as a team, rather than as sole traders, during the course of an extended working day.
Efforts by former minister for health Micheál Martin to secure a new contract were stymied as consultants extracted concessions concerning their medical insurance. Following further delays, the appointment of a special talks chairman by Mary Harney failed to resolve differences over private medical work. The IHCA withdrew from negotiations when new posts were advertised this month. It is now attempting to prevent such appointments being made.
A two-tier health system is a recipe for waiting lists. And when there is a shortage of both hospital beds and hospital consultants, you get the trauma our health system is experiencing. Retiring chief executive of the Health Research Board Ruth Barrington has called for the establishment of a common waiting list for both public and private patients in order to provide quick access, on an equal basis, for urgent medical cases. That will not happen as things stand because the sole reason many people take out medical insurance is to ensure they can jump the public queue.
Ireland has the lowest number of medical consultants per head of population in the developed world. Many young doctors would be happy to accept the pay terms on offer but older members with dual contracts are resisting change. It is time the interests of patients came first.