Consultant dispute unlikely to immediately lead to full-scale strike in hospitals

The dispute between doctors and the Government over pay for specialists appointed over recent years is unlikely, initially at least, to lead to a full-scale strike in hospitals.

Rather, if approved in a ballot of members, the Irish Medical Organisation is likely to opt for an escalating campaign of industrial action.

This could commence with hospital doctors working only to their strict contractual terms or refusing to provide out-patient clinics.

A further escalation of the action could involve a ban on carrying out elective or non-urgent procedures.

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A full strike would more than likely be a last resort in any campaign.

However, even initial action involving out-patient clinics would cause serious problems in an already-stretched health service, particularly as it approaches the key winter period.

The logistics of balloting members and giving official notice to health service management would mean that any industrial action would not commence until early in the New Year — precisely the time when traditionally the hospital system is most under pressure.

Earlier this year the cancellation of out-patient clinics during the nurses’ strike affected about 15,000 people each day.

Such postponements do not only disrupt the plans of patients but also add to waiting lists at a time when there are already more than 568,000 people on the queue to see a medical consultant in an out-patient clinic.

A key question will be how widespread any industrial action by the IMO would be.

The Irish Hospital Consultants Associations (IHCA) , like the IMO, also represents medical specialists. The IHCA traditionally has had an effective no-strike policy.

However, IMO plans for industrial action would not only involve consultants but also non-consultant hospital doctors who are effectively the medical specialists of tomorrow and who would, as things stand at present, be affected directly by the two-tier pay system in years to come.

The Irish health system operates largely on the basis of a consultant-led service which sees medical specialists lead teams of doctors in training in their particular areas.

An IMO dispute involving non-consultant doctors would have a significant impact on out-patient clinics, for example, even if consultants represented by the IHCA were not involved.

However industrial action is not a certainty. There are likely to be further talks with the Government in the weeks ahead.

Talks between the IHCA and the Government on Wednesday appear to have gone better than management had anticipated with the consultants’ organisation setting out its own reform proposals to be negotiated once the pay issue is addressed.

Ending the two-tier pay system could cost about €40 million and this would have to be achieved in a way that did not upset other delicate pay arrangements across the public service.

The Government also has to set out in the weeks ahead what it wants on the key Slaintecare proposal to end private practice in public hospitals.This arrangement is very lucrative for some doctors and the Government’s proposals in this area could pose another flashpoint.