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Harney and consultants- the mother of all battles?
By Niall Hunter-Editor
The Independent Chairman of the much beleaguered hospital consultant talks, barrister Mark Connaughton, said last week that in order for the talks to resume, trust between the HSE/Department of Health and the consultant organisations would have to be restored.
He was being a little optimistic. The seemingly pointless talks process now appears close to final collapse, although there is a chance they could resume,with Mary Harney's plan to force through new contracts for new consultants looming in the background. Events, however, are moving towards the type of showdown between Government and consultants that has been fantasised about, not just by PD 'neo-cons', pub bores and Fianna Fail populists, but also by many hapless users of the public health service, for many years.
Mary Harney knows instinctively she could be on to a winner with her 'take on the consultants'’ policy, whatever the cynics may say about it perhaps being a smokescreen to cover up other health service deficits and the fact that other vested interest groups still have to be taken on.
While consultants may argue to the contrary, the Government, and much of the public feel, that consultants, by virtue of their infuential position within hospitals, their high earnings, perceived lack of accountability and private practice rights, and in view of the inequities in hospital access which lead to treatment delays, were always going to be the first target on a reform agenda.
Consultants,who number around 2,000, argue that they are being demonised and cannot be solely held to blame for all the ills of a health service that employs 100,000 people and is top-heavy with administrators. However, to date they have failed to shake off the accusation that they are a major part of the problem with the hospital system and have so far declined to be part of the solution.
In the coming months, as the battle for the public's heart and mind accelerates, consultants will need to be at their most eloquent in convincing the public that their cause is just. Mary Harney appears to have already achieved this.
A formidable obstacle for consultants is that the Minister's policy is largely supported by the public, by patient groups, and importantly, by Fine Gael, in olden days regarded as the political wing of the consultant collective. So are the 'vested interests' going to lose their shirts in this mother of all battles?
That remains to be seen–as it is not as simple as a battle between 'good and evil'; 'brave Mary vs greedy consultants'’as it is often portrayed in the media, unpopular although consultants on an collective basis usually are with the general public.
Like all staff groups working in the health service, consultants are skilled political practitioners, with many 'human interest' and patient advocacy cards to play, so Mary Harney's glorious battle could turn out to be a messy one.
Already the IHCA is threatening to boycott the interview process for the new consultants, and may even try to dissuade specialists from the UK to come over and sit on interview boards for the new posts.
While it has often been said that any reforms can only apply to newly-appointed consultants and existing consultants cannot have their contracts changed, there have been dark mutterings from the Tanaiste that this may not in fact be the case.
Michael Mc Dowell's facing down of the Gardai on the Garda reserve issue is given as an example of PD steel in the area of seeing off vested interests (Fianna Fail politicians and their occasionally loose interpretations of financial propriety do not always count as a vested interest in this context, of course). However, the health service is a complex area with many potential pitfalls for the moral crusader.
Consultants as a group are often media
and political 'whipping boys' on a regular basis, often justifiably so.
But on an individual basis they are popular, as can be seen by the many
positive comments about individual doctors on irishhealth.com's Rate
my Hospital site.
The consultant bodies will try to utilise this potential well of goodwill
if the going gets tough with Mary Harney, while the Minister will, of course,
claim, in as subtle, or perhaps not so subtle a way as possible that consultants
are against health reform and are, for want of a better word, greedy.
The events of the weekend were dramatic, but for all that, probably fairly well-rehearsed. With a report from Mr Connaughton indicating that the contract talks were going nowhere, Mary Harney said she would act on her threat to produce new consultants with new contracts in the absence of the two sides agreeing to get back around the table.
The IHCA then agrees to go back to talks, with the sting in the tail that it has also voted 'no confidence' in HSE senior management. Many of the public who have had dealings with it would agree with the IHCA's contention that the HSE, in spite of trying to be a shiny new streamlined body, is still a bureaucratic monolith. Mary Harney pounced on this however, querying how the IHCA could agree to talk again to people it apparently had no confidence in. She was going ahead with her new consultant plan regardless of what she had said previously, believing talks to be a waste of time.
The consultants now claim that the Government never really wanted to negotiate with them on new flexible contracts, but always intended to impose a solution. The unilateral decision last year by the HSE to stop filling posts with 'off-site' private practice is seen by consultants as a deliberate provocation to ensure that consultants would be up in arms and no agreement could be reached in the talks.
The Government for its part, probably reckons that the consultants never really wanted to take part in meaningful negotiations on more flexible working, however much they paid lip service to it, and that they would certainly resist restrictions on private practice and plans for more accountability.
So the conspiracy theorist may feel that both sides deliberately painted themselves into corners, preferring in the end all-out war to media skirmishes.
At the heart of these recent events is the need for reform of the hospital service, and whether this is going to be brought about with or without the cooperation of consultants.
Reforming the way consultants work is not the only aspect of the reform agenda which needs to be tackled. The Hanly hot potato of hospital reconfiguration for example, now five years old, has barely been touched. Work is either incomplete, or has yet to get underway on reforming how other hospital staff work. At present for example, nurses are the only hospital staff group who work on a shift system over 24 hours.
Consultants claim, probably correctly, that they in fact work more flexibly than many other grades of other hospital staff, with whom flexibility also needs to be discussed. However, they have been identified as the custodians of much of the activity that takes place in the hospital service and are therefore left carrying the can for the time being.
The creation of hundreds of new consultant posts under more restrictive contractual conditions with our without the say-so of the consultant organisations has been a not-so-secret PD weapon, since even before Mary Harney assumed office in September 2004, and changing how consultants work was always going to be a key component of her reforming agenda.
In the end, health consumers will not be too concerned with whether the niceties of the often strange world of industrial relations have been adhered to, or whether or not health reform is merely a political football, if they get the right result.
They want a more efficient and equitable hospital service for all. Certainly, consumers also want more resources put into health, but the Government message that with resources must come reform seems to have been accepted by the public, and probably will continue to be until real efforts are made to 'reconfigure' local hospital services.
Mary Harney’s 'back-burner' policy has always been, with apologies to the Six Million Dollar Man, that if consultants are not willing to build themselves into a new, more flexible model, then 'we’ll build our own'. This is what she is now doing. But have they the technology, or the capability? We’ll have to wait and see.
Toni Posted:
02/02/2007 12:30 |
| I have paid for a private consultation and got it - after months of waiting. I have attended the public A&E recently and waited 4 hours. If I waited for the private consultation on this occasion I could be blind by the time the appointment came up. I will be sticking to the public A&E and am very grateful to them right now. |
|
Tara Posted:
02/02/2007 14:52 |
| On the flexibilty issue, I think it depends on the consultant. I have been in a situation in A&E where the junior Dr. didn't seem able to diagnose and the staff seemed to be afraid to call the on-call consultant on a Friday at 5.30 and suggested we go home and come back on Monday!!! I put the foot down and we were transferred to another hospital where the consultant called in and available within 45 minutes, diagnosed and organised a bed within another hour. However, think Harney is right to take on the majority of them, who do come accross as greedy, manipulative, uncarig and even rude to patients. |
|
vulnerably ill Posted:
02/02/2007 18:57 |
| I am glad that the Minister has the interests of the sick at heart. At present, we have consultants who are paid by taxpayers and yet are not accountable to anyone for the salary they receive. They can see private patients during their publicly paid for sessions. If they are to be paid a basic salary, paid for by the tax payer, then they should be accountable to an elected representative of the public, i.e. the Minister, or her nominees, ie. the HSE. |
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John(johnwilliams) Posted:
02/02/2007 20:25 |
| This is just what Harney wants - to be seen as 'tough' a Margaret Thatcher wielding her sword to defeat 'vested interests'. Coming close to an election Mary Harney needs to demonise someone to shift the focus of blame from her. How does she answer the charge that consultants in St James' Hospital could not carry out their operations because of no itensive care beds? It is very simplistic to say that the appointment of consultants alone will solve the problem of the health service. Every consultant has to have back-up staff, beds, theatres etc. and Mary Harney knows that but her department spent €13 million last year on PR and spin to fool some of the people. The showing of only 1% support for the PDs in today's Irish Times poll proves you can't fool all the people all the time. |
|
rusty Posted:
06/02/2007 17:18 |
| The consultants may not be the cause of all the problems in the health service . However , it is they and they only who 'operate' our two tier health system . They give preferential treatment on their waiting lists to those who have private insurance to put extra money in consultants pockets . |
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Frqnk Posted:
06/02/2007 19:37 |
| Mary Harney has my full support in taking on the greedy, arrogant and grasping consultants. The public would not tolerate the behaviour of any other group that behaved like these consultants. Let us not be coy on this matter, they are salaried employees like the rest of us, there are only 3000 of them. So Mary go for it. I just might vote PD in May if you succeed. |
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Marti Posted:
22/03/2007 19:55 |
| She can get 2 for the price of 1 in Finland which has the same standard of living as Ireland so that would be a good place to start recruiting. |
|
Anonymous
Posted:
23/03/2007 08:51 |
| Finland does not have the same standard of living as Ireland, it is in fact a lot lower. You can buy a 3 bed city apartment for 80K. Here the same would cost over 200k. Also, salaries are a lot lower. |
|
Toni Posted:
23/03/2007 10:50 |
| Ah, Marti, that would really Finn-ish the argument...... |
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Norm Posted:
26/03/2007 12:17 |
| Consultants and other doctors or any other persons accepting salaries from the public purse should work their full hours honestly before going off to do extra hours of private practice. I know some of them personally and am ashamed of the duplicity they employ. Mary is right to try to sort them out along with other daft selfish practices which prevent good value for money being achieved. |
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