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Major changes for consultants with new contract
[ by Niall Hunter, Editor www.irishhealth.com]
Consultants who have moved over to the new contract have taken reductions in private practice, and some have given up their private practice entirely, according to Paul Oslizlok, President of the Irish Hospital Consultants Association.
In an interview with irishhealth.com, he said while consultants were agreeing to work longer and more flexible hours under the new deal, there were problems in funding ancillary staff to work with consultants later into the evening.
Dr Oslizlok said its members might consider a deferral of the pay increases due to them, but stressed the Government must first stop claiming that consultants are not changing their work practices and using this as an excuse for not paying the increases.
Mary Harney and the HSE are currently withholding €68 million due to consultants in 2008 as part of the new contract deal, as they say the has been no real evidence of consultants changing how they work in return for the increases. This sum includes back pay, a special 5% pay rise and funding for new higher pay rates for doctors who sign up to the new deal.
Dr Oslizlok told irishhealth.com the Government's approach was dishonest. He said consultants had changed their work practices and were working to the new contract, which includes longer hours, some reductions in private practice and weekend work in return for higher pay for treating public patients.
"If the money is not there somebody needs to tell us that. As regards whether consultants might be willing to agree to a deferral of the pay increase I cannot promise that but we would certainly be willing to discuss it and be willing to work with the Department of Health and the HSE. However, we need a measure of honesty from them on this."
Dr Oslizlok said logistical problems could arise in hospitals in view of the fact that 25% of consultants are remaining on the old contractual arrangements.
He said while the new contract will help tackle the issue of access to the public hospital system, new working arrangements for consultants need to be supported by other changes in hospitals, and new consultant posts were badly needed.
Around 75% of the consultant cohort have now switched to the new contract. The €68 million is due to consultants who signed up to the deal before last September. Additional consultants signed up before the final deadline of December 31. The new deal will cost the Government an estimated €140 million in 2009.
Consultants recently threatened to take legal aciton to have the increases implemented.
On the new consultant contract
Around 75% to 80% of existing consultants have switched over to the new contract. I think there was a clear understanding on both sides that change was needed and that there had to be a different way for consultants to work within hospitals. As regards the dispute over the payment of the €68 million owed to us in pay increases and back-pay under the new agreement, we are acutely aware that the country is suffering financially, and that the Government and the HSE have a very difficult balancing act to perform. We are also acutely aware that there is to be a reduction in the health budget of nearly €1 billion, with probably more to come.
On the other hand we have signed a new contract and it is the only contract we have. The Minister and the HSE before Christmas accused consultants of not delivering on changed work practices under the agreement and consultants are annoyed that this untrue allegation has been made. Consultants have changed their work practices; they are working the contract and expect to be paid for it. Around 75% have now accepted the new deal and have started to change their work practices.
Having said that, if Mary Harney or Brendan Drumm simply do not have their money to pay the increases they need to come to us and tell us that. We are all grown-ups, we are all responsible citizens . If the money is not there somebody needs to tell us that. As regards whether consultants might be willing to agree to a deferral of the pay increase, I cannot promise that but we would certainly be willing to discuss it and be willing to work with the Department of health and the HSE, but we need a measure of honesty from them on this.
Our feeling on this is that the Government realised they were now in a very different economic situation and they would find it hard to pay doctors any more money; so they needed somehow to put a hold on this and the best method of defence was attack, so they claimed doctors were not complying with the contract and they were not paying the money to us on that basis. That is simply dishonest.
It would be far more honest to come to us and say we don't have the money. In that context people would be far more agreeable to consider some way of making some economic concession. There would be a lot of sympathy among consultants for the dilemma the Department and the HSE is in with their finances, but there is very little sympathy for them stating that consultants are not working the new contract when they clearly are.
I am not aware of any hospital manager that has any problem with consultants not working to the letter and spirit of the new contract. Many consultants have stopped their private practice and have become wholly public practitioners under the new agreement.
On taking legal action
Yes, the IHCA has offered to assist any of its members wishing to take legal action to secure the money owed. Our fear here was that having spent four years negotiating the contract there would be short-term economic measures that might lead the HSE to dismantling the contract. We believe in the new contract, we want to protect the work that has gone into it. While we can work around the pay issue, one thing we cannot do is to allow the contract to be dismantled. So the threat of legal action is a very real one and it is there primarily to protect the notion that an agreed contract is an agreed contract. It is about the principle of adhering to a contract.
On reductions in private practice
Consultants who have changed to 'category A' under the new contract obviously have sacrificed all their private practice as there is no provision for it under this category. People have done that for a variety of reasons; for example philosophically they thought it was good to change to public practice only; or because they did not have much private practice anyway or perhaps because they were nearing retirement and wanted to make their lives simpler. Others may have moved to other categories which would have reduced their private practice. I am 'category B' under the new contract so I would have reduced my public/private ratio from 65/35 to 70/30. I have put on extra outpatients clinics to adhere to the 70/30 ratio.
On consultants working longer hours
There is provision for consultants to work longer hours in the public sector under the new agreement; contracted hours have been extended from 33 to 37 per week. The problem we have, however, is that in many hospitals consultants would have already been working between 40 and 50 hours a week in the public hospital anyway, and most of that would be treating public patients.
The irony of the longer hours provision in the new contract is that most consultants were already working over 37 hours anyway. When we go to hospital managers now they realise we are working in excess of our contracted hours and they cannot afford that we do extra work other than what we are already doing because they could not afford the ancillary staff. What we have done is made our hours more flexible; agreeing to come in earlier or to work at weekends. So the change with the new contract has been a more efficient use of people's time. There was a large measure of agreement between ourselves and the HSE that we had to make our hours more patient-friendly and flexible; for example, allowing clinics to take place later in the evening so that people can attend after work. A problem, however, is that in order to make the consultants' time more efficient you need to have ancillary staff in place. There's no point in me holding a clinic at seven in the evening if nobody else is around. Managers are saying "tell us what extra hours your are going to do but do not tell us to provide extra ancillary staff because we cannot afford that."
On clinical directorates
Clinical directorates are important components of the changes planned in hospitals under the new contract. A clinical director would be a senior consultant in charge of, perhaps, three or four hospital departments and they would be fundholders and fund managers. They would also be responsible for,if you like, the 'hiring and firing' of staff; not just medical staff. However, there has been a difference of opinion between ourselves and the HSE over how these directorates should be rolled out. Our concern is that the model being proposed by them is too ambitious, and the planned directorates are too unwieldy. What the HSE is proposing is there would be directors responsible for around 100 to 150 consultants and their teams, and the entire panoply of services related to those consultants.
The HSE's model is that the directors would be given some time off their clinical duties to carry out the directorate work and to do that they would be paid an additional €50,000. That was the carrot, which particularly in these days of recession is not a small amount. Our concern is that running a unit that big is at least a full-time job and it would mean that a consultant would need to give up all their practice for the three to five years they might be in the job. At the end of this period, the worry would be that these consultants would become deskilled clinically. We are also concerned that the structure of the directorates would give them a lot of responsibility but no authority and that another layer of bureaucracy will be created.
On consultants who have not signed up to the new contract
I think that is a concern. We have really worked hard to try and convince as many of our colleagues as possible to take up the new contract. We felt that, particularly with the planned clinical directorates, it would be very difficult if some of the clinicians in a hospital department were within that directorate and some were not. Inevitably, this would cause problems but we are all individuals and people have made their choices. I think, in terms of those (around 20% to 25% of consultants) who did not accept the new contract, For a certain number of people there was a large measure of distrust with the HSE and Department which they felt would be difficult to overcome and they did not want to be under more control than they are currently under. While there may have been an element of concern about reduced private practice income, I think that many of the people who make a lot of income from private practice would in any case have probably opted for the category in the new contract that allows them to retain private practice so i don't think money was necessarily the issue with consultants who did not sign up to the contract. I think it was more an issue of control that was the major deal-breaker for them.
On equal access for public patients
Under the new contract there is to be equity of access to outpatient diagnostic testing services. However, I don't think it is has been the case that public patients in public hospitals are told they can have the same test done quicker in the same hospital if they go private, and if it has been happening it is clearly wrong. Clearly, some consultants within a public hospital have an entitlement to a certain amount of private practice but to have lists much longer for public than for private patients within the same hospital has never been acceptable to us within the IHCA. It's quite different if people choose to go to a separate private hospital to access care. Within my own specialty of paediatrics there has never been a tension between private and public care. If somebody rings up with a sick baby the last thing anyone is going to ask is if they are public or private.
On co-located hospitals
The IHCA has supported whatever allows better access to care. The difficulty has been that there have been mixed messages on co-location. Mary Harney has been strongly in favour but I am not sure that Brendan Drumm has been such a strong advocate. If consultants on the new contract are to work within a 70/30 or 80/20 public/private ratio then I think there is concern about how these hospitals are going to be staffed. However, I think generally we have no strong views either way on co-location.
On whether our hospital system is safe enough
I think systems to minimise adverse incidents are evolving and are much better than they used to be. I think the whistle-blower concept within hospitals is much more accepted now. We have to accept that if someone is operating below standard there should be mechanisms to deal with that and it should not just involve a casual chat in a back room. There are quality control measures as part of the new contract. Also, quality assurance measures are being brought in by the Medical Council. I think these are all healthy initiatives.
On criticism of consultants
Consultants, I believe are very good public servants. We work long hours. The pay has certainly been good, we cannot deny that the pay is certainly an attraction within the profession but it is not out of keeping with what people are asked to do. With a very few exceptions consultants are honourable and work their contracts and hours. They make personal and family sacrifices. I rarely get home before eight or nine at night because that is what it entails and that is what other consultants do.
I can understand why people will criticise; when there are the Michael Nearys, when things go wrong. When people are negligent then it lets us all down badly and we all suffer as a result. But that is still very much an exception in what is still a very fine body of public servants. It is gratifying to see the number of positive comments about consultants and hospital staff on the Rate My Hospital website.
On reform of the health service
I think that management of change and effecting change is an area the Department of Health and HSE need help with. They need to perhaps use a business model of how large organisations effect real change. It doesn't just come from having grandiose ideas; it comes from supporting people from the ground up and involving them in the change process.
Once you get into the hospital system it is fine, but getting in sometimes can be very difficult. We are aware that if access to the private sector is significantly shorter than to the public we need to build up the public sector and the new contract will be part of that process of change. But the new consultant working arrangements will have to be supported by other changes in hospitals, and we certainly need more consultant posts put in place.
|benjy Posted: 22/01/2009 19:07|
more window dressing by people where most of them in my opinion are driven totally by greed for money
|brandy Posted: 22/01/2009 20:35|
I'm really scared and worried:
"clearly, some consultants within a public hospital have an entitlement to a certain amount of private practice but to have lists much longer for public than for private patients within the same hospital has never been acceptable to us within the IHCA. It's quite different if people choose to go to a separate private hospital to access care....."
1. 'an ENTITLEMENT to a certain amount of private practice' ???
What the hell should we think about that?....perhaps only the logical thought.....that private practice is the 'gravy' that consultants will not do without.....despite the 'advice' they give to their own patients about unnecessary, unhealthy, fatty additions to their diet.....they persist in fattening their very own 'coffers' !!
2. ' It's quite different if people choose to go to a separate private hospital....' ??? Please, please...tell me that these words were not written by a doctor who is supposed to be pro-bono-publico!!
I hope the 'doctor' replies and clarifies the two points above.....because I'm sure the public want to be assured that all doctors/consultants are not 'in it for the money' like the politicians !
|Quack Posted: 23/01/2009 10:34|
We are as we Eat, Drink, Sleep and Exercise. If the medical profession prescribed and acted on these nine words our hospitals would be less than quarter full. A change of lifestyle is all many of their clients need. Just imagine the saving to the finances of the state as the sickness industry went into free-fall.
|Anonymous Posted: 23/01/2009 14:54|
Consultants agreeing to work longer and more flexible hours under the new deal and members might consider a deferral of the pay increases due to them. Well isn't that mighty big of them? Are they coming into the real world with the rest of us afterall? Well the recession might do some good, if so.
|backtothedarkages Posted: 30/01/2009 11:00|
On foot of this article and other positive media reports, and as a mental health clinician working in the public sector, I have many concerns regarding the proposed implementation of clinical directorates in mental health settings- ie the assertion that at a local level we have either been informed or consulted.
I am aware that significant changes are occurring at a corporate level under the ‘Change Programme’; again we have not been consulted in this regards although the information has suggested that we have. Current line management is proposed to change with Clinical Directorates being “responsible for how patient and client services are developed and delivered to defined populations across care groups, service settings and professional disciplines….This programme will over time provide expansion of Clinical Directorates to effectively encompass service delivery across social care and personal social service programmes”. This suggests that line management for other disciplines apart from medicine will be changed in breach of current contracts.
It has also been reported that “the HSE is committed to having Consultants function as senior clinical leaders and decision-makers….central to this new way forward are Clinical Directors” and “A key objective…of establishing Clinical Directorates is to attract high calibre Consultants…”. This suggests that medicine is the only discipline proposed for these positions, which has both a cost implication to service delivery and a service provision implication.
Vision for Change, a programme based on international best practice guidelines for health, proposed a multi-disciplinary approach as agreed best practice for service delivery as opposed to a uni-dimensional and medical approach and these proposed Clinical Directorates contradict this document certainly for the future of mental health in this country.
what is going on? doesnt everybody want best service provision for their own and their families' psychological health in the years to come? we are taking a huge step backwards and nobody is talking about it!!
|backtothedarkages Posted: 02/02/2009 12:47|
i can so see that now that i re read that posting! the quotes are from HSE 'Vision for Change' documents and articles and to be clearer, my main concerns are that mental health practice in this country is being utterly hijacked by one discipline ie psychiatry. Speech and language therapists, nurses, child care leaders, social workers and psychologists are not part of the design or implementation of this line management. To my knowledge noone is being asked!
Multidisciplinary working is becoming a total sham - all the work done to provide services for children ie full assessments for autism, talking therapy services for teenagers who deliberately self harm or attempt suicide, play therapy for features of attachment disorder, family therapy when crisis hits are obviously not valued by the HSE, as the people who provide these services are not part of the proposed changes, and will have their contracts breached (ie by having to be clinically told how to work by these psychiatrists/ directors).
hope this is clearer!
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