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Dáil Éireann díospóireacht -
Tuesday, 1 Dec 1987

Vol. 376 No. 1

Ceisteanna — Questions. Oral Answers. - Consultants' Common Contract.

2.

asked the Minister for Health if he will indicate the extent of progress to date in negotiations with the medical profession on the common contract; and if he will make a statement on the matter.

13.

asked the Minister for Health the present position regarding the review of the consultants' common contract.

I propose to take Questions Nos. 2 and 13 together.

It has been agreed by the management side and the Irish Medical Organisation that, having regard to the delicacy of the negotiations and the importance being attached to the talks, details of the proceedings would remain confidential. I can say, however, that the preliminary stage of the negotiations, whereby both sides are considering the key issues, is proceeding constructively.

Would the Minister inform the House how much consultants contributed in the last year, or in the preceding period, to the administrative, secretarial and nursing and pathology services they use for their private patients in public hospitals and what was the total cost of providing these services? What is the Minister's own position in the negotiations on a fee per patient system of payment as opposed to a fee per visit, or the provision of a salary whereby consultants would simply be paid a flat salary without any fee per patient or per visit?

The Deputy is clearly widening the scope of the question.

I do not have the information requested in the first part of the Deputy's supplementary question which, in fact, is a separate question altogether. With regard to his second question — the common contract — I should say that consultants are paid a fee for a limited number of hours of work. Negotiations are proceeding and it would not be in the interests of their successful outcome for us to debate their details in the House.

Would the Minister indicate to the House when the first of these meetings took place, how many meetings have taken place to date and when it is proposed to hold the next one? Furthermore, would he outline to the House the matters under discussion, in other words, what is the broad range of subjects to be discussed and agreed between the parties to these negotiations?

I initiated discussion on the review of the common contract. I attended the first meeting held between the management side and the Irish Medical Organisation on 8 September last. At that meeting I stressed the need for both sides to work together with a sense of urgency to examine the existing arrangement for consultants. I should say that consultants, through their pivotal role, control the resources deployed in our hospitals system. It is essential that hospital consultants work in a setting which ensures that resources are used effectively and with regard to the need for accountability. There have been three meetings to discuss the review of the common contract to date, one on 8 September last, another on 6 October last, another on 17 November and the next has been set for Thursday, 10 December 1987.

It would appear from the Minister's reply that the pattern appears to be one meeting a month. In view of the complicated matters to be resolved, would he agree that it could be years before any decisions are taken, or a year anyway? In view of the widening gap, which is proceeding at an accelerated pace, between private and public medicine in this country and the general concern felt by the community generally about this development, would the Minister not agree that there is a great degree of urgency in ensuring that these talks are brought to a satisfactory conclusion as speedily as possible so that we will know in what direction Government health policy intends to move in the years ahead?

As I said earlier, at the first meeting which I attended myself I stressed the need for urgency. I am satisfied that there will be one meeting a month——

One meeting a month does not appear to be very urgent.

Please, Deputy.

This is a very important matter. One thing about which I am particularly pleased is that this review — which was due in 1986 and did not take place then — is now taking place; I am particularly pleased at that.

Because of pressure brought by this side of the House.

That side of the House were in Government and the review did not take place in 1986. I have stressed the need for urgency in arriving at a conclusion to these negotiations.

Would the Minister agree that the key element in the whole contract is the level of private practice, the need to monitor and control private practice which is now up for discussion between the Department and consultants?In my opinion that constitutes the essential element of the contract. Does the Minister now concede that that issue should be under review?

Each side in the negotiations will be preparing their agenda as to what they wish to have discussed. Certainly all aspects of the services provided by consultants will be discussed and, where necessary, negotiations to improve the service to patients.

A Cheann Comhairle, I accept your ruling on my earlier supplementary.Could the Minister make the figures I sought available separately? Would the Minister agree that the erosion of the existing contract concerning the percentage of beds in public hospitals available to consultants for their private patients now far exceeds the actual terms of the contract, is touching 40 per cent of all public beds in public hospitals rather than the 15 per cent maximum originally intended?

With regard to the first part of the Deputy's supplementary, I will ascertain whether it is possible to provide the relevant information, although I doubt it because I doubt that individual hospitals would have that information available to them. As regards the consultants and the number of beds, perhaps we have laid too much emphasis on the number of beds. It is the number of patients and the procedures carried out for them in those beds that I would consider to be important.

The effect of the Minister's reply——

I want to deal with other questions which are equally important.

Is not the effect of the Minister's reply that he takes no account of the number of beds being used in public hospitals for private patients? Does he agree that the effect of this is that public patients are now in queues of two years duration, while private patients can get into the publicly-funded hospitals as private patients right in front of the people for whom these hospitals were intended? Furthermore, would he agree that the use of beds in public hospitals is of prime importance?

I agree that it is the use of the beds that is important, not the number of beds. There has been a wide variation in what has been happening in hospitals throughout the country over the current year——

Forty per cent being allocated to private patients.

In one particular hospital in Croom a larger number of public patients have been seen this year to date in the orthopaedic hospital there. That is the case in many other hospitals in this city. As I have said, what is important is the service provided and not the number of beds.

And the numbers on the waiting lists, which have doubled.

The waiting lists have not doubled. I might add that in other countries where they have tried to abolish waiting lists — for example in a recent survey carried out in the United Kingdom where they have tried to abolish such waiting lists, indeed where there were 500,000 people on the waiting lists in 1946——

That is where they tried to abolish public medicine.

——when they quadrupled the number of consultants, they found there were still 500,000 people on the waiting lists.

That does not justify what is happening, which is that if one has not got the money one can wait.

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