New contracts for hospital consultants could end up costing the State more without increasing the amount or quality of the work received from the consultants, the State's financial watchdog warned yesterday.
A report by Comptroller and Auditor General John Purcell on the contract which currently governs the work of consultants found that there was insufficient evidence to assess to what extent it was being implemented.
The report also found that more private patients were being put through public hospitals than was intended and that this was happening at the expense of public patient care.
The confusion over the current contract, which was negotiated in 1997, extends to a "fundamental difference of interpretation" between the consultants and their employer, the HSE, over how many hours a week the consultants are supposed to work.
The HSE claims that the contract provides for 39 hours a week, including six hours of unscheduled activities, while the consultants claim that the contract is for a 33-hour week.
Mr Purcell's report says there are more than 2,000 medical consultants working in public and voluntary hospitals, and they received a total of €350 million in pay from the State in 2006, the equivalent of €175,000 each.
Under the current contract, the consultants are also allowed to treat private patients while working in the public hospitals.
The theory is that the proportion of a consultant's work on private patients should reflect the ratio of private to public beds in public hospitals, which is 20 per cent.
"In practice, private patient treatment in public hospitals exceeds 20 per cent in all three categories - elective, emergency in-patient and day case. To the extent that the private patients are accommodated and treated in excess of the designated level, there are implications for equity of access."
The report also says 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".
The report is the result of a one-year inquiry by Mr Purcell's office as part of its financial audit of the Department of Health. It was given to the Minister, Mary Harney, last week, and she decided to publish it yesterday.
The report said that 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".
Ms Harney welcomed the report and said that it provided supporting evidence for a new consultant contract which would ensure a proper scheduled and validated commitment by consultants to public hospitals. "In particular, there is a need to ensure that consultants' private practice does not prevent or hinder access by public patients to public hospital services," she said.
Talks aimed at negotiating a new contract for hospital consultants broke down last Monday. The Irish Hospital Consultants' Association (IHCA) is to hold an extraordinary general meeting tomorrow. It has already warned hospitals that consultants may withdraw their co-operation on a whole range of administrative and managerial duties.
The Irish Medical Organisation, which represents 800 consultants, said that it welcomed the report, which "confirmed that serious difficulties are apparent in the management systems within our hospitals".
It also said that the report "highlights the need for verification systems, which the IMO supports".