There will be further pressure on hospital consultants to change their work practices when the third in a series of reports on the restructuring of the health service is published next month.
The Hanly report on medical staffing has followed the lead of the Prospectus and Brennan reports, published earlier this week, in calling for immediate negotiations to amend the exclusive contracts which underpin consultants' working conditions and which have become the subject of much controversy.
The latest draft of the report - expected to be the final one and which has been seen by The Irish Times - has stated that consultants should be available, on a rostered basis, to work 24 hours a day.
The findings of the report, which has yet to be considered by Cabinet, will form an integral part of the Government's health service reform programme, the Minister for Health, Mr Martin, has indicated.
The report has recommended that consultants work in teams around the clock and said this was "the only way to ensure high-quality, safe patient care".
This may lead to a reduction in the amount of time they can spend on their lucrative private practices.
The Government has not "had a good deal" from the common contract enjoyed by medical consultants, who are employed by the State for 33 hours a week for €150,000 a year, the Taoiseach, Mr Ahern, said on RTÉ's Prime Time last night.
Apart from meeting with opposition from consultants, the Hanly report will anger communities and local politicians throughout the State over its plans to withdraw services from a number of smaller hospitals.
It has proposed, as a starting point, a radical reorganisation of hospital services in two health board areas, but if this is used as a blueprint for other areas, maternity units and emergency services at several smaller hospitals will be axed.
The report has recommended that hospital services be organised in regional networks in the Mid Western and East Coast Area Health Boards. These regions, it says, should have just one major acute hospital with a full range of regional services, including A&E. The smaller hospitals in these regions, such as Nenagh General Hospital, would then provide routine services such as ante-natal classes, elective day surgery, services for older people and minor injury units. While the Hanly task force has yet to devise a plan for other regions, it says its proposals at this stage "should be used to help inform the development of proposals nationally".
Furthermore, it clearly states it wants a reduction in the number of hospitals providing services 24 hours, seven days a week, and it wants decisions on health services to be made objectively on the basis of best practice rather than on the basis of "narrow sectional interests", political or otherwise.
Mr Martin indicated his support for the Hanly proposals on Wednesday, when he said it was neither practicable nor realistic to suggest that specialist treatment facilities could be provided within immediate reach of everyone's home. "It's time we faced up to these issues," he said. He said he had yet to receive the final draft of the report but he expected to be able to publish it next month.
Meanwhile, the report says that more than 1,000 additional consultants will have to be appointed to cover around-the-clock rosters and also to take the place of non-consultant hospital doctors (NCHDs) whose working hours will have to be drastically reduced to comply with a new European work directive. This requires NCHDs to work no more than 58 hours a week by August 2005.