Austin Currie
Ceist:10 Mr. Currie asked the Minister for Health the current position of his discussions on the implementation of a new contract for consultants to which the Gleeson report refers.
Ceisteanna — Questions. Oral Answers. - Consultants' Contract.
Joe Sherlock
Ceist:63 Mr. Sherlock asked the Minister for Health the latest position regarding his proposals to introduce a new contract for consultants, as recommended by the Gleeson Committee; and if he will make a statement on the matter.
I propose to take Questions Nos. 10 and 63 together.
Formal negotiations on the implementation of the recommendations of the Review Body (Gleeson) Report on Higher Remuneration in the Public Sector on Hospital Consultants were completed on 20 May 1991. At a meeting held on that day a final set of proposals was presented to the Irish Medical Organisation and the Irish Hospital Consultants Association. I understand that the two bodies concerned intend to ballot their members on the proposed revised contract. I expect to receive the formal response of the two organisations at the end of this month.
Does the agreement talked about by the Minister propose a greater role for consultants in many hospitals, as has been referred to previously, and would the Minister elaborate on the way he expects that to be implemented? Would there also be an agreement whereby chief executive officers could previously direct a consultant in regard to a medical problem or medical issue in a hospital? What increases are granted to consultants under the agreement?
As the consultants are balloting on the results of the negotiations at the moment, it would not be appropriate, as with any industrial negotiations, to go into any great depth. The memorandum that consultants are voting on ranges over a wide number of issues, including the nature of the consultant appointments, the structuring of consultant appointments, their remuneration and expenses, conditions of employment, superannuation, the nature and conduct of employment relationships, consultants in management, grievance and dispute procedures and provision for review of contract. When negotiations are finalised I shall be glad to deal with that matter in the House.
What effect does the Minister predict this will have on public patients given that it will cost £35 million? Will the Minister comment on the dropping of the deduction that was included in the Gleeson recommendation for private practice, where consultants would be paid less if they had a large private practice? Will the Minister comment on whether or not that will represent damage to availability to public patients? Would the Minister comment also on the dropping of the common waiting list that was envisaged by Gleeson and what impact that will have on the result of this contract for public patients?
I dealt with the question of the common waiting list at length during the debate on eligibility. The common waiting list would be to the disadvantage of public patients. What we have achieved in eligibility is in the best interest of public patients. In future public beds will be available for public patients only. Where formerly private patients used public beds as public patients and paid their consultant as a private patient, that will no longer be allowed in the new arrangements so that those public beds will be free for public patients. If we had a common waiting list we could not have that system because by definition the next patient on the list would go directly into whatever bed was available and it would be the decision of the consultant as to who was next on the list.
In relation to the deduction as outlined in the Gleeson report, the Deputies will appreciate that the Gleeson report was published before the decision on eligibility was taken and that during the negotiations the question of eligibility, which was a change for the consultants, was taken into account and therefore what is in the Gleeson report in relation to the deduction for the use of private facilities does not apply as a result of that change in eligibility.
Can I take it that there will definitely be fewer private patients in public beds in our hospitals?
Yes.
Will a patient entering the hospital who wishes to go private be private to the hospital or private to the consultant? Will the consultant still have private beds in our hospitals?
Yes. At the moment there are three categories. There are public patients in public beds, private patients in semi-private and private beds and up to 1 June there were private patients who availed of public beds who paid their consultant as private patients. That third category will no longer exist. There are only two categories, public patients in public beds and private patients in private or semi-private accommodation. Everyone can opt for one or other. A private patient of the consultant is automatically a private patient of the hospital. One cannot be a private patient of the consultant and a public patient of the hospital. That is no longer possible. In an emergency, patients will be dealt with and they will use whatever bed is available. An emergency will never be refused treatment or a bed.
The £35 million is a big charge on the taxpayer. The Minister has not eliminated the back door way to care in public hospitals. How does the Minister propose to deal with the situation whereby a patient can go to a consultant's private consulting room and if it is deemed necessary to go into hospital, he can go immediately on to a public list, as against a patient who will possibly have to wait 18 months from an appointment in the hospital in the consultant's private room? How does the Minister reconcile the two cases? There is an 18 month head start for the patient who goes to the private room as against the patient who goes to the public hospital. The Minister has not yet given an answer to that despite the many questions that have been asked by us. The health boards do not know the answer. I would like to hear the Minister's explanation.
I challenge Deputy Allen to produce the evidence that back door methods are being used now.
Answer the question.
If the Deputy has any evidence I will pursue it. I assured the House during the debate on eligibility that there will not be any advantage to private patients, that there will be equity in admission to hospital, to an out-patient waiting list or to an in-patient waiting list. If a patient decides to go publicly to a hospital he will go on a public waiting list and he will be admitted in turn.
They will wait 18 months for an examination.
That does not reflect the position.
ENT, orthopaedic——
The waiting time for general medicine and general surgery——
(Interruptions.)
Deputy Allen, you asked pertinent questions. Please be good enough to listen to the replies.
We are getting waffle in return.
It is not waffle. The Deputy does not like the facts. The Deputy comes in here and makes wild statements and expects us to accept them.
I asked the Minister a question.
The general waiting time for medicine and surgery is three weeks. There will not be a back-door entry to hospital and there will not be a question of a patient going to a private consultant——
That is not true.
——and then going on to a public waiting list at a point that will give them an advantage over the public patients.
There is an 18 month head start for the private patient.
The waiting time for medicine and surgery is about three weeks.
Is the Minister aware that in Dublin if one wants to see a surgeon, out-patient, for orthopaedic reasons, the earliest one will get an appointment is February 1992? Would the Minister not agree that if that person went privately he would get an appointment next week and can thereby get on to the public waiting list for hospital care and admission within three weeks as a result of that private consultation?
Answer that, Minister.
I do not accept the waiting times as detailed by the Deputies.
It is two years in Cork. Are you in touch with reality at all?
My understanding is that the waiting time, the maximum waiting time for an appointment——
They are not giving appointments in Cork at the moment. That is the reality.
Order. Deputy Ferris.
——for orthopaedic surgery in Dublin is 16 weeks.
I was put out of this House some weeks ago over the Minister making misleading statements. The Minister is repeating that. Today the Minister is not answering the question. It is a grave injustice to the people of this country.
Deputy Allen, you are being highly provocative now.
The Minister is still giving us waffle, the same as you. I apologise.
If you persist in interrupting the Chair I will insist on you leaving this House.
Sorry.
Do it once more, Deputy, and you will leave. If the Deputy is dissatisfied with the Minister's replies, he has a remedy. If the Deputy finds it difficult to listen to what the Minister has to say, there are many avenues out of this House, and he can take one, before he is compelled to take one.
He took one last week.
Would the Minister not agree that if a person is seen by a consultant, either privately or publicly, that person has a much better chance of being admitted to a hospital if he needs to be? If a person cannot see a consultant, what chance has he of being admitted to a hospital? Does the Minister not agree that there is an anomaly in this? Two weeks ago I spelt out specific cases as to how this happened. A backdoor method was not used, it was was just frustration with the waiting list in the public area. The people had to go private and then it was realised that the person in question was going blind——
Let us have finality on this question. I want to get on to other questions.
I do not accept that the system is anything like what the Deputies are describing.
That is true.
I have already referred to the fact that almost 500,000 people were seen at out-patient departments in Dublin in one year and that that was a massive increase on the previous year, an increase of 30,000. That is 500,000 such cases in a city of 375,000 people. The Kennedy Group found that the waiting time for orthopaedics for a new appointment varied from one to 16 weeks on average.
It is 18 months.
The position has deteriorated rapidly and it will be February 1992 before people can get appointments.
What about Tullamore?
We must move on to Question No. 11.