It takes a certain type of chutzpah to reject a contract offering up to €257,000 a year but hospital consultants have never lacked confidence in their ability to fight a tight corner.
It is only a few years since they took on a previous government in the courts over back-money and won hands-down.
Now they have given the cold shoulder to the Government’s plan to introduce a public-only consultant contract intended to end the two-tier system that currently allows doctors treat their private patients in public hospitals.
The idea of disentangling public and private care came from the Sláintecare plan for reforming the health service back in 2017, which was endorsed by all the main parties.
Six years on, after long delays and largely fruitless negotiations, the resulting contract has been rejected by the Irish Medical Organisation and the Irish Hospital Consultants Association (IHCA). Th rejection comes in spite of major Government concessions during the talks – more money, for example and a decision to allow consultants accepting the new contract to continue doing private work in private facilities, once they had put in their hours in the public sector.
The contract is seen as key to tackling the core problems of the health service. Long waiting lists and hospital overcrowding are rooted in staff shortages and a health service that is not busy enough for long enough during the week.
It does not require any doctor to work beyond the existing 37 hours, but those who sign up to it will be liable to be rostered over a much longer period.
Currently, there are huge variations in the rostering arrangements in different hospitals, and there is little formal monitoring of productivity. Consultants in Crumlin children’s hospital are rostered from 8am to 6pm for example, while those in Temple Street children’s hospital a few miles away are rostered 8am to 11pm.
At University Hospital Waterford, which has not had a patient on a trolley in more than 1,000 days, doctors are rostered from 8am to 11pm, according to figures obtained under the Freedom of Information Act. At University Hospital Limerick, consistently the worst performer in the country, the roster runs from 8am to 5pm.
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The rejection of the contract by the IHCA in particular has left Department of Health officials seething. “Their so-called concerns were misleading. You have to think they don’t want to give up their private practice rights,” one source fulminated.
Despite the rejection, the department had already decided to press ahead with the new contract.
There will not be any “big bang”. The only new contracts offered from Wednesday will be the new Sláintecare documents. The rest of the medical workforce can continue on their old contracts.
It is impossible to predict what will happen. Younger consultants who started after pay was lowered in 2012 are expected to sign up, because it will boost their pay. Many others are likely to wait and see. Will the loss of private practice rights in public hospitals be worth the extra money?
There is the risk of replacing one two-tier anomaly with another. Nothing chafed with doctors more than the lower salary paid to post-2012 recruits for doing exactly the same work as colleagues who were recruited under an earlier contract. Now, the division will be between those older staff allowed to practise privately in a public hospital and new arrivals for whom this will be prohibited, working longer rosters.
Over time, this fissure will disappear, but this will take decades.