THE HEALTH Service Executive wants medical consultants to work additional hours in hospitals for existing levels of pay as part of reforms. It is understood that HSE management also wants to scrap an arrangement that allows consultants who had not been able to avail of their full entitlement of contractual rest days in the 1990s to retire a year early on full pay.
In some instances, consultants have been able to continue in work after this earlier retirement date as their own locum, effectively receiving double pay. In a document given to medical organisations, the HSE said that assuming an average consultant employment cost of approximately €230,000, this represented “a cost to the health service of €103 million in the period up to 2027 when the last of the cohort of eligible consultants is set to retire”. The HSE said the rest day arrangement was an anachronistic and costly means of compensating consultants who did not receive their full complement of rest days – eight days off per month in addition to weekends over 1991-1997.
Management said this practice should be terminated and alternatives should be agreed with the Irish Medical Organisation and the Irish Hospital Consultants Association.
The HSE also signalled it wanted to increase the weekly working hours of hospitals consultants from the present 37 or 33 hours – depending on the contract – to more than 40 hours per week. The HSE has not specified the working week it envisaged.
Under the proposed reforms, the HSE would be allowed to roster consultants on five out of any seven days, covering a span from 8am until 8pm. Consultants would also be rostered to work at weekends – for which an additional allowance is currently paid.
In areas like anaesthesia, obstetrics and paediatrics/neonatology in a limited number of hospitals, consultants could be rostered to cover a full 24/7 period. The HSE told medical organisations it was seeking to implement these reforms under the provisions of the Croke Park agreement to which they have signed up.
However, it is understood the Irish Hospital Consultants Association has contended that the HSE proposals do not come within the scope of the agreement. The HSE document stated the proposed increase in weekly working hours “will be underpinned by an audit/review of all existing clinical rosters/work schedules which will focus on the extent to which contracted weekly hours are aligned to service priorities.
It is anticipated that the 8am-8pm working day and 5/7 working days already agreed as part of the public service (Croke Park) agreement means that, where necessary, consultant rosters can be realigned to ensure a rostered consultant presence onsite on Saturdays and Sundays in line with the volume or acuity of workload in acute services.
“This will improve the quality and safety of clinical care and service to patients/clients, timeliness of senior decision-making, efficiency and effectiveness in the functioning of the hospital/facility and ensure appropriate levels of supervision for NCHDs.”
The Irish Hospital Consultants Association said the rest day arrangement had prevailed since 1998 to recognise weekend work.
“In the vast majority of cases, the compensation accepted did not match the amount of weekends actually worked.”