Public patients in Irish hospitals have less resources spent on their care than is intended because of how the current hospital consultants' contract operates, the State's financial watchdog has reported.
The report by the Comptroller & Auditor General (C&AG), laid before the Houses of the Oireachtas today, is certain to fuel the row between the Government and consultants over proposed new working arrangements.
John Purcell, Comptroller & Auditor General
The common contract is the subject of negotiations between the Department of Health and Children, the Health Service Executive (HSE) and the medical consultants' representative organisations.
C&AG John Purcell set out to examine the extent to which the terms of medical consultants' existing contract, signed in 1997, are implemented in State hospitals. The Government paid consultants some €350 million in salaries last year.
In a summary of his findings, Mr Purcell says the way the current system operates has "implications for equity of access" to healthcare.
He says key elements of the current consultants' contract are "undefined or lacked sufficient clarity to allow for smooth implementation".
"There is a fundamental difference of interpretation between the HSE and the consultants about the number of hours to be worked under the contract. The HSE claims that 39 hours per week, inclusive of six hours of unschedulable activities, is provided for, while the consultants contend that a 33 hour week is what was contracted for.
"It is disappointing that this matter has not been resolved in the ten years since the contract was signed in 1997," the report says.
It also notes "a general lack of information" available in hospitals to enable managers to satisfy themselves that consultants' contractual commitments are being discharged.
"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."
Currently, consultants are allowed to treat private patients in public hospitals while also discharging their contractual obligation to treat public patients. But there is a policy to limit private treatment to a designated level based on bed numbers.
Overall, 20 per cent of all beds in public hospitals are designated as private beds, the C&AG report states. "In practice, private patient treatment in public hospitals exceeds 20 per cent in all three categories of clinical activity - elective, emergency inpatient and day case".
"To the extent that private patients are accommodated and treated in excess of the designated level, there are implications for equity of access. It also means that less resources than intended are being applied for the treatment of public patients."
Mr Purcell says t here is "considerable tension between the sessional nature of consultants' work and the freedom to engage in private practice which could give rise to conflicting professional responsibilities".
"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. Firm information on consultants' existing work patterns is essential to cost effective delivery of consultant services," Mr Purcell says.
"Ultimately, the attainment of value for money from any new contract will largely depend on how well organisational and system change complements and supports the revised arrangements. Otherwise, there is a risk that the State will end up paying more for, what might turn out to be, the same quantum and quality of service."
Minister for Health Mary Harney
The Minister is in dispute with consultants over new contracts. Around 68 jobs were advertised this week without the agreement of the doctors' unions.
Ms Harney welcomed the report and said it "confirms deficiencies in the current contract which have already been identified in the Hanly and Brennan reports".
In a statement, Ms Harney said: "The report provides supporting evidence for a new consultant contract which will 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.
"The need for change in consultants' contractual arrangements has been evident for a number of years and this is supported by the C&AG's report," she said.
"The need for the appointment of a significant number of additional consultants in order to produce a consultant-delivered service has also been acknowledged by the Government. Patient care and the health service working environment can only benefit as a result."
Some 60 per cent of consultants have "category I" contracts that oblige them to spend substantial amounts of their time, including time spent on private practice, working at designated hospitals.
A total of 32 per cent have "category II" contracts that allow them to engage in both on-site and off-site private practice.
The remainder are mainly engaged in academic work.