Teachers’ and Doctors’ grievances – public service or self-service
The ghost of Easters past. Politicians vamoosed for a fortnight or more. If they left the phones on, more likely than not you would hear the long continuous beep telling you they had accumulated a couple of air miles during their break.
As a political hack, slim pickings awaited you.
You foraged and rummaged along the long acre in the vain hope that you might chance upon a grassy knoll (yep, it’s a corny metaphor but it works on so many levels!)
News wise, the only thing that gave real fillage during long gap were the conferences from teachers and medics, of interest (to be brutally honest about it) predominantly to teachers and medics.
And here we come to the point. What’s going on at both sets of conferences is no longer of interest only to sectional groups. We all have ownership now. There are two issues being discussed at both conferences – one broad; the other narrow. The broad issue is about the impact of cutbacks on the health and education sectors. The narrow issue has to do with pay. And I’m going to concentrate on that for the remainder of this post.
I have the impression (and it might be wholly wrong in this) that the broader issue is being used as a fig leaf for the real issue… the hit cutbacks in pay, pensions, fees and conditions.
Of course, the unions are charged with representing the interests of their members. But when you look at the figures, do either (especially the medics) have any real basis for complaint… especially when so many others are making pain.
John Carr, the secretary general of the INTO, said that teachers were being asked to carry the can for criminal capitalist bankers.
It sounded great. But the truth, of course, is far more complex than that. It’s far to easy to blame the bankers as being the authors of all our woes. And it’s also easy to blame politicians in a blanket kind of fashion. For everything. But if truth be told most of us were partly complicit in it. Sure, those who lead and who directed must carry their share of responsibility. But we were not all lemmings or village idiots, programmed to obey orders and do what we were told. Most people bought into this collective or communal sense that there was no downside, now or ever ever. We were all duped. But we must recognise that we were dupers as well as the dupees. The teacher who berated Brian Lenihan so emotionally on the Pat Kenny show owns an apartment in Croatia. Nobody vice-gripped her into buying it. Our human frailties – a pinch of illogical hope, a dollop of greed, a tablespoon of mé-féinirism – were all there to be seen.
No such fantasies any more. Times are tough. There have been a couple of reports in recent days that TDs and Senators might be able to backtrack and recoup some of the expenses, ministerial pensions and seniority increments that they lost in the Budget. The Independent carries the latest this morning. That better not be true. Because no other cutbacks in Irish society will have any credibility if this cohort reneges on that undertaking.
To the teachers: RTE ran a story this morning the basis of which is that male teachers earn €8,000 more than their female counterparts. Of course, that inequality should be addressed.
But I had to take a double-take when I heard what the average salaries were. €64,000 for males and €56,000 for females. I can remember Joe O’Toole as secretary general of the INTO urging teachers to accept benchmarking which he characterised as as ATM. How right he was. By any standard, teachers are well-paid, especially when you take holidays, pensions and permanency into account.
How can they argue against the pension levy when so many others in Irish society are being given ‘an bata agus an bóthar’ (the stick and the road… or the P45) or being told to take huge reductions in salaries or go on a three-day week. Private sector pensions have also taken a wallop from which they will never recover.
And to consultants. Is it just me or does the offer of €280,000 per annum for the new contract sound obscene? Sure, medics have to go through more years and training to get to the top. But is the huge premium they get justified or warranted? The contract agreed in 1997 was a joke. Immediately, there was a dispute between the Department of Health and consultants as to whether the public patient requirement was 39 hours or 33 hours per week. Of course, the dispute was never settled and the 33 hours per week prevailed for many, if not most, consultants.
Mary Harney was on Questions and Answers some time back saying that the HSE would get more bang for their buck from consultants. According to Harney, they would work longer hours, they would form part of a multi-disciplinary team, they would be available for weekend rota work.
But where is the detail? Where is the stipulation that will make it apparent to the public that these schedules will be adhered to.
In March 2007, the then Comptroller and Auditor General John Purcell investigated the consultants’ contract for a Value for Money Report.
Its findings were very disquieting. I was shocked when I read it then. And I was still shocked when I read it this morning. This was at a time when consultants were earnign €200,000 for their public work (how much more did they earn from their private practices?). The lack of monitoring and the clear bias towards private work among some consultants is apparent from the report.
A couple of phrases came to mind. The most printable of them was: “Having your cake and eating it too”. On the new contract, for €280,000 a year, you would have to make sure (and show in the most transparent way) that the agreed schedules were being worked to the full.
The situation outlined by the C&AG was simply outrageous.
Here is the relevant extract from his summary:
Monitoring Consultants’ Commitments
“The examination found that key elements of the contract were undefined or lacked sufficient clarity to allow for smooth implementation.
There is a fundamental difference of interpretation between the HSE and the consultants about the number of hours to be worked under the contract. The HSE claims that 39 hours per week, inclusive of six hours of unschedulable activities, is provided for, while the consultants contend that a 33 hour week is what was contracted for. It is disappointing that this matter has not been resolved in the ten years since the contract was signed in 1997.
The 33 scheduled weekly hours are divided into 11 three hour sessions, comprising 7-8 clinical sessions and 3-4 flexible sessions covering training, research and management activities. There are also provisions for on-call availability. The contract envisaged the production of schedules which would be agreed with hospital managements in order to show how the service commitment would be delivered by each consultant.
The examination found that, while most hospitals had received work schedules from consultants after their initial appointment to the post, these were not generally subject to systematic review, and in many cases, remained unaltered for many years even where consultants’ delivery of sessions had changed. Most hospitals did not request updated schedules from consultants.
There was a general lack of information available in hospitals to enable managers to satisfy themselves that consultants’ contractual commitments were being discharged. There was a particular difficulty in establishing exactly how flexible sessions are delivered and what gets done during those sessions.
Although there was a belief among hospital managers that many consultants exceed their contractual commitment, this cannot be substantiated in the absence of reliable records.
The contract allows consultants to treat private patients while discharging their obligation to the public hospital. Accordingly, in addition to their salary, consultants receive fees for the treatment of private patients. While there is universal entitlement to treatment in the public hospital system, there is also a policy to limit private treatment in these hospitals to a designated level set by the Minister by reference to bed numbers.
The contract provides that a consultant’s overall proportion of private to public patients should reflect the ratio of public to private beds as designated by the Minister at individual hospital level. Overall, 20% of all beds in public hospitals are designated as private beds. In practice, private patient treatment in publichospitals exceeds 20% in all three categories of clinical activity – elective, emergency inpatient and day case. To the extent that private patients are accommodated and treated in excess of the designated level, there are implications for equity of access. It also means that less resources than intended are being applied for the treatment of public patients.
There is considerable tension between the sessional nature of consultants’ work and the freedom to engage in private practice which could give rise to conflicting professional responsibilities. There has been no meaningful attempt to monitor the level of consultants’ private practice for its impact on the fulfilment of the contractual commitment within public hospitals. Firm information on consultants’ existing work patterns is essential to cost effective delivery of consultant services. Ultimately, the attainment of value for money from any new contract will largely depend on how well organisational and system change complements and supports the revised arrangements. Otherwise, there is a risk that the State will end up paying more for, what might turn out to be, the same quantum and quality of service.”
Purcell’s succint summary is so telling. The IMO will have to make out a very powerful case that its campaign against cuts or reductions in professional fees is motivated by the public interest and not be self interest. And in a similar vein – though their salaries are far more modest – the same onus must fall on teachers to show they are not just carping about pay cuts.