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Consultant deal a big boost for Reilly
[ by Niall Hunter, Editor www.irishhealth.com]
The new hospital consultant agreement, hammered out following marathon four-day talks, will be seen as a coup for beleaguered Health Minister James Reilly.
Not all of the potentially contentious proposals from health management were included in the agreement and some have been kicked to touch.
But any deal that promises to get consultants to work more flexibly and which cuts basic pay, albeit only for newly-appointed consultants in future, was a badly-needed good news story for a Minister in a week when he faced increased pressure despite winning a Dail confidence vote
Dr Reilly's star has been at an all-time low following his hamfisted handling of the HSE cuts, concern about outpatient waiting lists, his ongoing tension with his junior Minister Roisin Shortall, and his well-publicised personal financial woes.
While it remains to be seen how the agreement will be implemented, Dr Reilly can now justifiably proclaim that he has achieved, on paper anyway, what his predecessor failed to deliver in the 2008 consultant contract - better availability and flexibility of consultants leading, hopefully, to a more efficient and effective hospital service.
The practice of leaving patients in hospital beds for a weekend with no treatments or tests being carried out, and of patients staying too long in hospitals whole awaiting the opinion of a senior clinical decision-maker on whether they can be discharged may become a thing of the past. We will have to wait and see.
Dr Reilly was a hiding to nothing in betting all his chips on a new consultant deal.
On coming to office, he had pledged to cut consultant pay. He quickly found he couldn't do this under the Croke Park deal, so he concentrated on the flexibility issue.
It was a high stakes game but Dr Reilly appears to have won handsomely. Not only do we apparently get guaranteed weekend availability of consultants but we also have significant pay cuts for new consultants, cuts in overtime and on-call pay, and more rigorous reporting relationships for specialists with their clinical directors.
For the consultant organisations, the IHCA and the IMO, it was always a bit of a 'lose-lose' game for them.
There is certainly no largesse on the table to 'quid pro quo' with in this austere industrial relations era. They can, however, point to the fact that they managed to sideline for another day some of the more contentious proposals from management, such as the historic leave and rest day entitlement issues.
They may too have a point about saying it may be difficult to attract new consultants to jobs at the 30% lower pay rate.
The salaries of existing consultants, earning between €160,000 to €200,000 or more for their public work, cannot be touched under Croke Park.
However, salaries for the new entrants, which are €109,000- €116,000 at the bottom of the scale, may have been pitched a little low. Many senior doctors trainee doctors would already be earning that type of salary with overtime.
Also, it could be invidious to have new consultants with the same responsibilities and duties as their older colleagues making 30% less.
However, these pay issues may appear frivolous in an economy where many less fortunate people now have to decide between buying enough food or paying the mortgage - a dilemma few consultants are likely to be facing.
Many would feel a better solution would be to have all consultant salaries, new and existing, fixed at around €150,000, but that is probably impossible at present without renegotiating the Croke Park deal.
A €150,000 cap on the earnings of all consultants in post at present would save the Exchequer around €100 million a year. However, the Minister says the new flexibilities should eventually save €200 million annually.
Before Dr Reilly gets too carried away with his apparent victory, there is, as ever, an elephant in the room.
The Minister, in the wake of the consultant deal, said it "paved the way for the more effective treatment of patients as we continue to reform our health services for the better in the interests of patients"
While considerable efficiencies may be gained and considerable sums may be saved for the Exchequer with this new consultant agreement, the fact remains that the health service is still broke and the HSE still has a massive deficit. We are still unclear on how exactly that deficit is going to be reduced.
Ultimately, can make consultants as flexible as the day is long and reduce their pay and overtime as much as you like.
But if you don't have the hospital beds to admit patients into from emergency departments, if cutbacks in nursing home beds and home care are leading to some patients spending too long in hospitals, if you don't have enough nurses or other staff on the floor in hospitals, it's going to be very difficult for the new deal to deliver a better service.
We also need far more consultants appointed on the ground to provide this new more efficient care model.
So until the circle is squared on healthcare resourcing, James Reilly's euphoria on the new consultant deal could be short-lived.
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