Sir, – Paul Cullen describes the “chutzpah” of hospital consultants who appear reluctant to accept a new HSE contract (“New hospital consultant contracts risk replacing one two-tier anomaly with another”, Analysis, Health, March 8th). This contract greatly increases consultants’ working week and contains clauses that can see them moved anywhere around the country, all the while blocking access to private practice.
Paul Cullen fails to see why concerns exist, despite immediately going on to reference a 2018 High Court case required by consultants due to HSE contract breaches and failure to pay doctors. Next comes mention of the 30 per cent pay cut applied in 2012. Followed by a description of how existing contracts are applied differently in each hospital.
This is rounded off with a quote from an unnamed Department of Health official who suggests contract issues are solely about private pay, despite doctors voicing multiple other concerns.
There should be no mystery why doctors are reluctant to accept this contract. Doctors have little trust that the HSE will honour this contract or apply it fairly, based on existing evidence. Others see that major changes could be applied at any moment, for example, with a change of government.
Ann Ingle: Deliberately going out of my way to move for no particular reason has never appealed to me
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Assurances that external private work will be possible are not believed on the ground.
Paul Cullen describes how the HSE initially planned to introduce this contract without any consultation at all and will now do so despite ongoing concerns from doctors and their unions. It is very clear that this is not the path to filling our 900 vacant consultant posts or improving the health service for patients. – Yours, etc,
STEVEN MALONEY,
Dublin 6.
Sir, – I started as a consultant in emergency medicine in August 1988. For 10 years, I was single-handed, despite making a business case for a second consultant within 12 months of commencing my post, as the work pattern had changed markedly. I was running an observation ward where I did ward rounds seven days a week and was on call 24/7 throughout the year. I was able to get locum cover on three occasions over the 10 years, and took three periods of three months of leave at about three yearly intervals. In 1997, I signed a new contract, with better pay but without the previous generous leave entitlement. My cumulated leave was curtailed to one year, to be taken immediately prior to retirement.
My salary had always been reduced by 10 per cent from the agreed rate on the basis of entitlement to private practice within the public hospital, whether I had private clinical practice or not. Only psychiatrists and geriatricians got the full salary in the eastern region. Private practice was unilaterally blocked for my specialty by the Department of Health in the early 2000s. In 2008, as a result of a binding arbitration, I was finally awarded my salary deduction, but it took almost a year for it to be paid. The HSE then unilaterally reduced my cumulated pre-retirement leave from one year to nine months. I had signed the new 2008 contract, with a staggered series of pay uplifts, only to have the final tranche stopped by the then-minister for health without negotiation. This was before the Financial Emergency Measures in the Public Interest (Fempi) legislation of 2009, which affected all public servants.
In 2012, the then minister for health unilaterally reduced salaries for new entrant consultants to by approximately 30 per cent, with a major adverse effect on recruitment.
I have now been retired for six years and have only this month received the final restoration of pay from the Fempi 2009 reduction, despite a prior agreement that this would be paid from July 2022. I understand why the current cohort of consultants have declined the new consultant contract 2023, despite what seems to be a large salary.
It is primarily because they do not trust the HSE, or the Departments of Health, Public Expenditure and Reform, or Finance. I cannot imagine how matters can be improved, as so many of our trainees are simply fleeing the country permanently.
The suggestion that we increase numbers of medical students does not take into account the lead time for them to become trained specialists, especially as those who will be required to train them are steadily reducing in number. – Yours, etc,
PATRICK K PLUNKETT,
Adjunct Professor
of Surgery,
Trinity College Dublin,
Dublin 2.
