Wednesday, 13 March 2019

Questions (3)

Stephen Donnelly


3. Deputy Stephen Donnelly asked the Minister for Health his plans to address the new entrant pay disparity for consultant doctors; the status of new contracts for hospital consultants; the number of meetings he has had on these topics with consultant representative groups (details supplied) in the past 12 months; and if he will make a statement on the matter. [12662/19]

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Oral answers (6 contributions) (Question to Health)

We have a chronic and urgent issue with the low levels of doctor and consultant numbers. It is leading to the longest waiting lists in the history of the State. More than 500,000 people are waiting to see a consultant and 1 million people are waiting for diagnostic tests, consultant appointments, special needs services and so on. One of the biggest drivers of this is the massive pay disparity between existing consultants and new entrants. Will the Minister of State outline the status for new contracts for hospital consultants? How many meetings has the Minister for Health, Deputy Harris, had on this issue with representatives of doctors and hospital consultants?

The difference in pay between established consultants and new entrants - those who joined the public health service from 1 October 2012 - has been highlighted extensively by the consultants’ representative bodies. My colleague, the Minister for Health, Deputy Harris, met the Irish Medical Organisation, IMO, at its annual general meeting last year when he addressed the issue of new entrant pay. He also met the Irish Hospital Consultant Association, IHCA, last week when the issue was discussed. The Minister has also met members of the representative bodies at various engagements at which the issue was raised. The matter has also been highlighted in meetings involving Department officials, including in the past year.

An increase in the gap between the pay of existing consultants and new entrants was a product of the settlement of the legal dispute surrounding the consultant contract under which it was argued that existing contract holders were due certain pay increases. The Public Service Pay Commission, in its report published on 4 September 2018, identified difficulties in attracting consultant applications for advertised posts and acknowledged that the pay rates for new entrants had been highlighted as a factor in this. Given its analysis, the commission proposed that the parties to the public service stability agreement jointly consider what further measures could be taken, over time, to address the pay differential between pre-existing consultants and new entrant consultants. The Departments of Public Expenditure and Reform and Health have noted the commission's views and consideration will need to be given to potential solutions which are in line with public sector pay policy and available budgets. This will be a significant challenge given the amounts involved.

With regard to the new contracts for hospital consultants, no engagement has taken place with the representative bodies to date. The contract currently available to new entrants is the common 2008 consultant contract.

That is an appalling situation, for which I blame not the Minister of State, Deputy Daly, but the absentee Minister for Health. Less than one week from St. Patrick's Day, the Minister is active on Twitter but he is not in the Dáil to answer questions. He was not in the Chamber last night for a Private Members' motion on the national children's hospital, nor was he before the Select Committee on Health to take Committee Stage of legislation on the HSE board. The Minister seems to be missing in action, except when it comes to Twitter.

Essentially, the Minister of State has just said there has been no engagement. Ireland is running out of doctors. We have the lowest level of hospital consultants in the OECD. At the same time, we have the highest waiting lists for patients - men, women and children - to see these doctors. These issues are linked. Any doctor thinking of returning from Australia, America or elsewhere will end up earning between €60,000 and €90,000 less than colleagues who have the same experience and may have graduated from the same medical schools. As a result, doctors are not coming back and the Government does not seem to be doing anything about it.

Does the Minister of State accept that we now face an urgent crisis in respect of the low number of doctors and consultants in the country? Does he accept that one of the key drivers of that is the massive discrepancy in new-entrant pay? If he accepts those things, why has there been no engagement whatsoever with representative groups to do something about it?

I confirmed in my reply that the Minister, Deputy Harris, met the representatives of the Irish Hospital Consultants Association last week. It has been accepted that there is a disparity in new-entrant pay for consultants and the Government would like to see it addressed. It has been acknowledged by the Public Service Pay Commission that the disparity is contributing to recruitment issues in the sector. As the Deputy is well aware, however, there is no pot of endless money there. There is also a public sector pay agreement within which we have to keep. We have already addressed the significant issues affecting the pay of consultants, notwithstanding the issue of new entrant consultants. That was an issue the Deputy was rightly making a great deal of noise about in the past. It has been addressed. Nursing pay is a very significant pay bill also. There is no endless pot of money and there is a sectoral agreement that has to be respected and worked within as we advance the issue. We have addressed issues for consultants and nurses and, over time, we will also address this issue. However, it cannot be done as one would flick a light switch. We must continue to work within the parameters of available budgets and the public sector pay agreement. In fact, we are continuing to do so and engaging to achieve it.

The Minister of State says there is no endless pot of money and I agree. Is it not then extraordinary that €1 billion can be found to build the same hospital? When it comes to certain things, there is an endless pot of money. My calculation is that the switch can be flipped. When our healthcare system is about to explode and half a million people are waiting to see a consultant, it can be done. Flipping that switch would cost approximately €25 million a year by comparison to an additional €1 billion for the children's hospital. The Minister has met the Irish Hospital Consultants Association once. That was last week and after the association had waited a year for the meeting. I am sure the Minister of State saw The Irish Times today which featured new research that half of hospital doctors in Ireland are emotionally exhausted and overwhelmed by work. One third are experiencing burnout. We are mistreating, disrespecting, overworking and ignoring our hospital consultants, doctors and nurses. Today is about hospital consultants, of whom we need more. We need them to be able to do the best job they can do. We do not have enough of them and they are becoming burned out, are leaving the country and are not coming back. If the Minister of State does not believe a switch can be flipped, albeit I do, when does the Government expect to see actual movement to close the gap for new-entrant consultants?

I am not going to argue with the Deputy but we cannot flip a switch. The Deputy is comparing apples and oranges when he refers to capital and revenue budgets. He says it is €25 million, although I am not certain his figure is correct, to bridge the gap but that is each and every year. The other budget to which he referred is a capital budget for a build which is a one-off cost. They are very different. Further, we have not spent an additional €1 billion on any children's hospital. The Deputy makes the point that we found €1 billion but we have not spent that yet. Be that as it may, while it may not be politically opportune to bring the children's hospital into this, it is also the case that it is not relevant factually. I have explained already to the Deputy that we have made very significant progress on the issues of pay in very challenging times. We have come out of the deepest, most difficult and darkest recession the country has endured in the history of the State and we are only starting to get back on our feet economically. We do not have a magic wand to fix everything. The Deputy can take a sectoral approach and progress and campaign for matters piece by piece. We have to take a helicopter view. That comes with the responsibility of Government. We have to do it within the confines of the public sector pay agreement which we cannot jeopardise. There is only so much capacity within the agreement to deal with these issues. We also have only a finite budget. We are engaging with the relevant people and intend to address the matter when we can.