As talks between the HSE and hospital consultants resume today, Martin Walllooks at what progress has been made so far and what issues remain outstanding
Q. How long have the sides been talking now?
A. Talks on new contracts for hospital consultants have been taking place, on and off, for several years. The negotiations on the revised contract, which is seen as one of the key elements of the Government's overall healthcare reforms, have been interrupted by various different rows over that period.
The current talks started in November 2005 but quickly became bogged down in a dispute over the unilateral abolition by the HSE of a type of contract which allowed doctors to treat fee-paying patients in off-site private hospitals. Progress has been made on some issues but others have still not been resolved.
Q.Why was the time for negotiations extended?
A. The Government had initially set a deadline of March 27th to conclude the talks. However last Monday week, the independent chairman of the negotiations wrote to the Minister for Health Mary Harney to indicate he was cautiously optimistic on reaching a settlement.
However, he said, more time was needed to deal with several outstanding issues.
Q. Is it feasible a deal will be agreed within this three-week deadline?
A. The official view of all the parties is that a deal can be reached if there is goodwill on all sides. However, a number of very tricky issues remain unresolved. Some of these issues are the same ones that have divided the parties for the last year - such as private practice rights for new consultants and whether doctors should be allowed to advocate publicly on behalf of their patients.
Q.What happens if the next deadline is missed?
A. The Government has said that it will advertise around 350 new consultant posts on revised terms from the middle of April. If it seeks to do so without the agreement of the medical bodies we are likely to see a major confrontation between the parties.
The consultant organisations will seek to arrange a boycott of the positions and will attempt to block the establishment of interview panels to select candidates. The Government will try to get around any boycott by advertising the posts internationally and arranging for people from outside the system to assess candidates.
Q.What has been agreed so far?
A. The talks have operated on the basis that nothing is agreed until everything is agreed. However, it is understood that there has been progress on the appointment of new clinical directors in hospitals who would head teams of consultants in particular areas.
There has also been progress regarding the introduction of greater flexibility and the operation of services over an extended day. However there are difficulties over how this would come about. Consultants are objecting to proposals that they would be rostered to work on Saturdays and Sundays as part of their normal week.
Q. What are the main issues dividing the parties?
A. The issue of private practice rights has never gone away. Management has insisted that no new consultants can be appointed with rights to treat patients in off-site private hospitals. The medical bodies believe that there has to be some concession in this area and have proposed that new consultants with such private practice rights could be appointed on a part-time basis. This has been rejected by management.
There is also disagreement over private practice rights within public and co-located hospitals for consultants who take the new contract. Management has proposed that no more than 20 per cent of a consultant's total output could be devoted to private patients. It has suggested that doctors' private fee income be paid into a common pool to be distributed by the HSE to ensure compliance with these rules.
Consultants are also insisting that they should be allowed to retain the right to advocate publicly on behalf of patients. Management has maintained that doctors should have official approval prior to speaking out publicly.
It has also contended that doctors should be bound by a confidentiality clause regarding patient information or "hospital business". Consultants have said that this issue could be a deal breaker.
There is also disagreement on a clause in the draft management proposals, which sets out that consultants should work in accordance with professional and corporate standards. The medical bodies have major problems with the issue of "corporate standards" which they believe could undermine traditional medical ethics.
Q. What about pay?
A. Management has yet to show its hand on the issue of remuneration for a new contract, although figures of around €240,000 per annum were mentioned in political circles some weeks ago. Ms Harney said last week that an "interim" pay scale would be offered in the current talks and that this figure would be examined later in the year by the review body currently looking at top level pay in the public sector.
Either way, management will come under strong pressure in talks this week to give some indication on pay scales.
Q. If there is an agreement what will it mean for the health services?
A. Management believes that a new contract could transform key parts of the hospital service.
Essentially, it believes that it could lead to the introduction of a consultant-provided service whereby patients would have a far greater chance of being diagnosed and treated by a consultant, rather than by a non-consultant doctor in training in a specialty.
Q. How quickly could new consultants be recruited?
A. Ms Harney has said that if the new contracts are advertised later this month, the first consultants could be appointed in the autumn.
However this timescale could change in the event of a major dispute.