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'Year-off' row masks real healthcare issues
[ by Niall Hunter, Editor www.irishhealth.com]
Hundreds of hospital consultants are entitled to a fully-paid year off before they retire. Some of them have been doing their own locum work (effectively replacing themselves) after this early retirement.
This cosy arrangement will cost the taxpayer €103 million over the next decade and-a-half, according to a top secret HSE document which has been miraculously leaked all over the place. The HSE wants to end this practice and also wants consultants to work longer hours.
Hold on a minute, didn't we already get more flexible consultant availability and more equitable access for public patients to hospital care in a new consultant contract introduced in 2008 at great expense to the taxpayer?
Also, weren't we supposed to get a 'consultant provided' and not a 'some guy just out of medical school' provided' service.
Not really, it seems, as 'the last time we looked' the hospital system was still in chaos and public waiting lists were growing. We don't have enough consultants and we have proportionately too many inexperienced juniors at the coalface. Yes, this issue is about far more than what consultants are paid, or not paid.
Ok, back to the 'year off on full pay'. Cue outrage, much of it, admittedly, justified. However, in this case, it is not simply a case of consultants helping themselves. Blame should also be squarely aimed at previous governments and healthcare managers over the years for presiding over a dysfunctional, unreformed, and in many ways morally dubious hospital system.
This system in the past often provided, and still often provides, the wrong care at the wrong time, delivered and organised in and inefficient manner, which disproportionately rewards some of those working in it (not all of them consultants) and perpetuates an iniquitous public/private divide.
The 'paid year off' issue is the type of thing that crystallises how badly our health service is planned and run.
The issue is admittedly a bit complex, but it's not just a case of 'those greedy consultants getting away with murder again.' The consultants concerned are being compensated for a vast amount of accumulated weekend work for which they were not paid prior to a revised contract being introduced back in 1997.
They were entitled to take 'rest days' in lieu of the extra work but due to the shortage of consultant manpower, which still exists and for which those running the health service are to blame, they could not take off of the time off in lieu due to them.
In fact, many of the consultants are being under-compensated, as the year off does not fully reimburse them in time-off terms for the amount of weekend work they actually did prior to the 'year-off deal being done in 1997.
If any other group of public sector workers was undercompensated for work done in this way they would perhaps get a more sympathetic hearing than consultants.
However, that is not the reality. The 'optics' on this issue favour the HSE. We live in straitened times, to put it mildly, whereby thousands of people every month now face a mortgage/food dilemma.
The issue of already highly-paid and well-public pensioned professionals getting proper compensation for overtime they did in the past, while important in terms of industrial relations, doesn't, to quote Humphrey Bogart, amount to a hill of beans' compared to the nightmare that many ordinary people are wading through through nowadays.
Not a very subtle argument, admittedly, but it does have a certain ring of moral truth.
It is in this context that the HSE saw fit to broadcast its intent to claw back the year off and to extend consultants working hours. There will be negotiations on this, but despite the HSE's cack-handed way of announcing its plans, it would have much public support in trying to 'rein in' consultants in this way.
Cue obligatory caveat. Consultants are a hard-working and highly-skilled group of professionals, but that's probably axiomatic, given what they earn, even after recent public service pay cuts.
And then there are the bow-tied behemoths; the financially bionic 'half-million euro' or even 'million euro' men scooping in big private practice bucks of top of their public salaries. These are highly-skilled people, but is any healthcare worker really worth a million a year, especially in these (sorry to bore you) straitened times?
The current health minister, himself a doctor, has highlighted the inequity of this. A little bit of socialised medicine and income equality really wouldn't go amiss in the emerald isle right now.
The public individually holds consultants in high esteem for their skills but collectively they are seen, rightly or wrongly, as financially grasping. The HSE is playing on this perception.
Cue an even bigger caveat. This particular industrial relations shenanigans is essentially meaningless. The bottom line is the health service is a mess and this particular example of HSE 'kite-flying' is not going to change things one whit.
The depressing history is - the HSE, its predecessors, and successive governments, presided over, when it suited them, a crazy hospital staffing system, over-reliant on too many inexperienced junior doctors , not employing enough consultants and employing some consultants on far too generous terms, even in more financially opulent times.
Out of this came the 'year off' fiasco.
Cue soap box - governments and employers gave very generous pay deals and private practice rights to consultants in contract negotiations without demanding overly rigrorous quid pro quos. However, many consultants will point out too that in this system they worked and still do work, much overtime for no money in public hospitals.
But the work some consultants do in public hospitals is spent treating private patients, as per their current entitlements. A small minority still performs private work above the allowed levels. There was little in the way of significant private practice restrictions agreed in the 2008 contract deal.
The HSE and the government encourages private medicine in public hospitals as it makes financial, if not moral, sense, but it is up to the them to regulate this.
And then there's a wider moral issue. We constantly hear about the benefits of our public/private mix in healthcare. The real benefits here are sometimes difficult to fathom. Does it benefit all the people who need public hospital treatment as quickly as possible? Ask someone in constant pain on a three-year outpatient waiting list.
Let's go to another example of craziness. The previous Health Minister Mary Harney said the 2008 consultant contract, under which most consultants now work, would make them labour more flexibly and for longer hours. It would, we were told, also provide for equal access to public and private patients for outpatient appointments and tests in hospitals.
The latter promise was essentially hollow. It doesn't matter if there is an 'equal' public-private waiting list in a public institution. If there is a long list, many patients with health insurance usually have the option of going elsewhere to get seen quickly.
Also, Mary Harney said consultants would work longer hours under this new contract. Many consultants said they already did these longer hours anyway. But did these longer hours, whether already in existence or newborn, actually lead to a better hospital service?
The public would give a swift and rude answer to that one. In fact, you have to query what was the point of negotiating that much-hyped 2008 contract at all. Especially as the HSE now seems to want to renegotiate it only three years later.
Is there any point to all this industrial relations tit-fot-tat? No, it's all your usual Irish healthcare mess.
But on this occasion, it would be wrong-headed simply to say it's another example of greedy consultants. In fact, the savings to be made by cancelling the 'year off', which technically consultants are entitled to, might not be worth all the troubled negotiations it would entail. Such pointless and never-ending rows simply serve to mask the severe faultlines in our health system.
Politicians, health planners and managers and healthcare professionals need to stop scoring points off each other and partake in a root and branch reform of how healthcare is provided in this country, with every group in the health service working as flexibly as possible to benefit the service user.
We need a better and fairer health system, with a better return for our considerable investment - a system that pays people a fair rate but not an excessive rate.
For too long it's been a cash cow for some people working in it and profiting from it and a cash dilemma for others who are trying to access it.
The protagonists need to stop indulging in essentially pointless rows about historical agreements, the renegotiation of which would only generate relatively minor savings in any case. They need to deal with real issues.
James Reilly's universal healthcare plans may be the solution, but it too could encourage profiteering at the expense of patient care unless it is organised properly. Whether these plans ever come to fruition is anybody's guess, as the current Minister is having difficulties plugging gaps in the current dysfunctional system as it is.
However, it is unfair to expect the beleaguered Irish health consumer and taxpayer to put up for very much longer with with our 'rich man-poor man' for-profit healthcare fiasco.
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