After years of stop-start negotiations, Ireland’s hospital consultants have finally concluded a new contract with health employers as of May 2008. The new contract gives medical consultants a significant pay increase in return for agreeing to both reduce their private practice (while increasing their input into the public hospital system), and increase working time flexibility. Moreover, the government aims to step up the number of consultants working in Irish hospitals.
Health employers in Ireland, represented by the Health Service Executive-Employers Agency (HSE-EA), have concluded an agreement, as of May 2008, with trade union representatives on a new contract for hospital consultants. This latest agreement was reached after over four years of stop-start negotiations between both sides. Health employers, and the Irish government, want to reduce the amount of private practice conducted by consultants, in order to increase the amount of time they are contracted to work in the public hospital system. Furthermore, health employers want to increase the working time flexibility of consultants.
The Irish Hospital Consultants Association (IHCA) represents the majority of consultants, with about 1,650 members, while the Irish Medical Organisation (IMO) represents about 700 consultants. IMO also represents nearly 5,000 non-consultant hospital doctors (NCHDs), as well as general practitioners (GPs) and public health doctors, and therefore has a broader membership.
New contractual terms
The main features of the new consultants’ contract deal agreed by IHCA members are as follows:
- a new type A contract is offered, with salaries of up to €240,000 for public-only practice;
- a new type B contract is offered, with salaries of up to €220,000. A minimum of 80% of a consultant’s workload will be devoted to treating public patients in public facilities and a maximum of 20% can be devoted to private patients in co-located private hospitals;
- a new type C contract is offered, with salaries of up to €175,000. These consultants will only be appointed in exceptional situations and will be entitled to treat private patients off-site, away from the main public hospital campus;
- private practice will be monitored;
- the working week is extended from 33 to 37 hours;
- the working day is extended from 08.00 to 20.00, thus increasing the number of on-site hours by four hours a day;
- consultants may be required to work five hours on Saturdays and Sundays, in order to expand access for patients to consultant-provided services;
- consultants will be led and managed by fellow clinicians. Clinical directors will be appointed to manage clinical services, budgets and lead the development of services for patients;
- consultants will be requested to work in teams, thus supporting consultant-provided rather than consultant-led services;
- in addition to the basic salaries above, consultants will be eligible for various extra payments for on-call commitments, amounting to as much as €36,000 a year;
- pay rises will attract increased pension entitlements;
- consultants who choose to continue working under current contracts will receive a 7.2% pay increase.
Extra consultants, fewer NCHDs
The government intends to increase the number of consultants working in Irish hospitals. At present, it is perceived that there is too much reliance on non-consultant hospital doctors. Therefore, with the latest contract agreement, the intention is that a number of current NCHDs will become consultants. In view of this, the recruitment of the first batch of 124 new hospital consultants is ongoing. Some 80 new posts will be created for new type B contracts – allowing a maximum of 20% private practice – and 44 new type A public-only contracts. The new contracts will apply automatically to new recruits, whereas existing consultants can either continue with their present contractual arrangements or volunteer to work under the new contractual arrangements.
Reaction to agreement
Some commentators view the common contract for hospital consultants as pivotal in forging a new approach to industrial relations across the health service, based on productivity bargaining; however, it could take many years for wider reform to take shape. Notwithstanding the increased negative press and disputes enveloping the health service in recent times, practitioners at the ‘coalface’ – namely, those who are actively doing the job – are trying to progress with highly complex issues. A perception has long existed that if a new consultant’s contract can be put in place at the top of the health service pyramid, it would become easier to slot in the other blocks lower down the pyramid.
However, other critics are more circumspect. Professor Michael O’Keefe, a senior consultant ophthalmologist at the Mater Hospital in Dublin, has argued that the new consultants’ contract will have little impact without ‘root and branch reform’ of the entire health service.
Tony Dobbins, IRN Publishing