THE TENTATIVE deal reached between health service management and hospital consultants over new work practices is most welcome. At a time of intense pressure on health budgets the agreement to work more flexible rosters could, the Government argues, save up to €200 million in a full year. However, these savings are unlikely to materialise in 2012 and so will not help alleviate the expected €500 million deficit facing the Health Service Executive this year.
It is not unreasonable to ask why it has taken four years for the rosters to be agreed. A consultant contract negotiated in 2008 included significant salary increases for hospital consultants in return for a range of changes in the way they would work. At that time issues such as seven-day rostering and the introduction of clinical directorships to oversee individual consultant practices were supposed to have been settled.
Minister for Health James Reilly’s tactic in holding the medical representative organisations to a weekend deadline appears to have worked. Those issues not agreed, such as rest-day entitlements and “historical leave”, have been referred to the Labour Court. And he has stated that, despite no agreement from the Irish Medical Organisation and the Irish Hospital Consultants’ Association on the issue, new consultant appointees will henceforth be on salaries of approximately 30 per cent less than current postholders.
On a salary scale of €116,000 to €121,000, future hospital consultant renumeration will compare favourably with that paid across Europe. While the reduction may disappoint those on the cusp of being appointed, it is unlikely to lead to a reduction in the quality of candidates in the long term. Indeed, if the overall deal leads to a consultant-provided service by a greater number of consultants, rather than the current consultant-led one, the working environment for all future hospital doctors will be improved.
The impact of having consultants rostered on a 24-hour a day, seven-day a week basis cannot be overstated. For patients it means the standard of care at night and at weekends will improve, with consequent benefits for patient safety. It also removes a significant barrier to the full utilisation of hospital resources, facilitating evening use of operating theatres and weekend use of expensive radiotherapy suites.
In this respect the deal will be key to achieving progress on the entire Government health strategy. Yet it is not a done deal. The medical organisations have yet to put the detail to members. But there is one major incentive to agree to it. Unlike other health professionals such as dentists, pharmacists and GPs, the income of hospital consultants has not been reduced other than by levies affecting all public servants. Indeed their 2008 pay increase was implemented just as recession hit. Not agreeing to the proposals would only shine an even brighter spotlight on this anomaly and would certainly lead to increased pressure on Government to achieve further health service savings directly from the current hospital consultant pay bill.