Brennan report author criticises consultants' contracts

Medical consultants' contracts contains "shocking" weaknesses that allow them to pocket €152,000 a year for work on public patients while delegating the work to a junior, it was claimed today.

Prof Niamh Brennan, chairperson of the 13-member group who produced the Brennan Report into Financial Management and Controls in the Health System, this morning said the existing contracts create a conflict of interest.

The group estimated consultants earn on average €127,000 per annum for treating private patients in addition to their average €152,000 public contract for 33 hours work per week in public hospitals.

"The reason there is a conflict of interest is that if you pay somebody extra they will be motivated to work for that extra money . . . the contract is so loosely drawn that that they can delegate their public duties to someone else".

She said it was "shocking" a consultant in a contract to the State could delegate their contractual duties to someone else. "A more junior doctor usually does the work but the consultant pockets the money," Prof Brennan told RTÉ Radio 1 today.

"The arrangements of consultants, I think, by any standards don't stand up to scrutiny", she said.

She described this system as unfair to public patients who, as taxpayers, pay for care from consultants, not from junior doctors. It is also uneconomic for the taxpayer because, on average, junior hospital doctors earn their salary again in overtime, she said.

Non-existent control mechanisms prevent taxpayers from ensuring they are getting value for money for the €152,000 they pay consultants per annum, Prof Brennan said.

In her report, Prof Brennan recommends all new consultants sign a mandatory contract to only carry out public sector work. She said contractual commitments for existing consultants must be delivered.

The Minister for Health, Mr Martin, has said the consultants' contract will be reviewed in the context of the Hanly medical manpower report, which is expected to recommend the appointment of 1,000 extra consultants.

She denied this would lead to a "brain drain" of consultants from the health service. Describing the hospital consultants' sector as a "closed shop", she said there were many Irish medics working overseas who would like to come back to Ireland.

However, she warned that "you will never get away from resources being a limiting factor", adding the key was to deal with limited resources as efficiently as possible.