Hospital consultants working in the public sector need to be properly rewarded with better pay and bonuses so they are no longer drawn towards also having a private practice, the chief executive of the HSE, Prof Brendan Drumm, has said.
In comments aimed at encouraging consultants back to talks on a new contract which the HSE believes should be a public hospital one only, Prof Drumm made it clear that "incentives" would be provided for consultants to work in the public sector only.
"I think we need incentives to make sure that consultants are actually focused on the public hospital system," he said, adding that with incentives consultants would find "their public work sufficiently rewarding and enriching that the draw of private practice" would become "increasingly less attractive".
Asked what type of incentives he had in mind, he said: "We certainly have to look at bonuses and pay."
He added that these also had to be looked at for clinicians getting involved in management.
Prof Drumm said incentives were a reward but also a recognition of work done. "It's a major change from the present system."
The personal commitment to patient care of many consultants in the public sector "sometimes does not attract the appropriate reward".
He said there were many different ways in which consultants could work within the health service.
"There are some consultants who may well decide to work mainly in the private sector. We should welcome their involvement on a contractual basis to come and provide services in the public sector so it's not an all or none situation.
"We seem to be wedded to a very rigid model which is category one and category two consultant contracts. Most consultants, I believe, are interested in looking at alternative models."
Talks between the HSE and the consultant representative bodies, the Irish Hospital Consultants' Association (IHCA) and the Irish Medical Organisation (IMO), have been stalled for months. The unions are refusing to go back into talks since the HSE decided no category two consultants would be appointed in future.
These consultants get paid around €160,000 a year to work a minimum of 33 hours a week in the public sector but their contract also allows them to undertake private practice, for which they are paid separately.
Prof Drumm, who was speaking to The Irish Times after addressing a congress of the European Association of Hospital Managers at Trinity College Dublin, said most consultants wanted a better health service and he could not believe "we cannot even get into talks" to achieve that.
Finbarr Fitzpatrick, secretary general of the IHCA, said Prof Drumm was free to put "anything and everything" on the table for negotiation, but he had to remove the obstacle to consultants returning to negotiations first. He could do so by reinstating category two consultant contracts.
He added that he still hoped he would be able to report to the IHCA's annual general meeting in October that the organisation was in a position to re-enter contract negotiations.
The IMO's director of industrial relations, Fintan Hourihan, said Prof Drumm's ideas were ones his members would wish to engage with him on but this could not happen until the HSE rowed back on its decision to abolish category two appointments.