Thursday, 8 November 2012

Ceisteanna (5)

Caoimhghín Ó Caoláin


5. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the position regarding the Health Service Executive negotiations with representatives of hospital consultants and on the proposed new working arrangements; and if he will make a statement on the matter. [49095/12]

Amharc ar fhreagra

Freagraí ó Béal (6 píosaí cainte) (Ceist ar Health)

The measures agreed between health service management and the consultant representative bodies at the Labour Relations Commission, LRC, in September will allow for very significant reforms in how services are delivered and ultimately will lead to improved outcomes for users of the services. The agreement encompasses a range of flexibilities centred on enhancing productivity and efficiency on an ongoing basis and on maximising the availability of consultants, as key clinical decision-makers. Health service managers are proceeding with implementation of these measures as appropriate to each site and service, with effect from 5 November, that is, last Monday, in line with the procedures provided for in the public service agreement.

On 6 November, the Labour Court issued its recommendations regarding three matters which had been referred to it. These concern consultants' current “rest day” arrangements, the fee to consultant psychiatrists for giving a second opinion under the Mental Health Act 2001 and the issue of “historic rest days”. Health service management will take the necessary steps over the coming weeks to give effect to the court's recommendations.

I look forward to all consultants embracing the changes agreed at the LRC and complying with the terms of the Labour Court recommendations in the interests of providing the most appropriate and cost-effective services to patients.

Will the Minister outline the improved work practices that have been achieved thus far arising from the engagement between the Department of Health, the HSE and the consultants? What improved work practices can the Minister outline for Members this afternoon that actually are being delivered on the ground in hospitals? Are there any? In respect of the Irish Hospital Consultants Association, IHCA, will the Minister clarify whether it has been or is now engaging fully, given the association's earlier position of refusing to participate in the industrial relations mechanism of the State? The Minister made reference to the Labour Court. Does the Minister echo the call of the Labour Court, as do I, for consultants to forego so-called historic entitlements, which allows many of them to receive double pay when they choose to work the final year before retirement? Does the Minister agree it is perverse that psychiatrists, who already are in receipt of very high salaries from the HSE, are being paid €500 a time for second opinions? There are so many examples of inappropriate payments and unacceptable practices associated with the consultants down through the years but most certainly, in these times when savage cuts are being imposed on older people, it is absolutely unacceptable and must be addressed properly.

I first will outline what were the measures agreed at the Labour Relations Commission, LRC, after which I wish to make a few other comments, if possible. Consultants will be available for rostering for any five days out of seven, as opposed to weekdays only at present There can be rostering of consultants, where required, on a 16-hour, seven-day basis from 8 a.m. to midnight, or on a 24-hour, seven-day basis where this is required. Consequently, clinical directors will have a much strengthened management role in respect of consultants. Heretofore, consultants have co-operated, in the main, around their holidays, when they would take their leave and so on but from henceforth, the new clinical director will have the authority to actually dictate when people go on holidays and it can be done only in consultation with him or her. Consultants will co-operate with a range of measures to support community and mental health services Consultants will comply with contractual requirements regarding private practice. Consultants have committed to expeditious processing and signing of claims for submission to private health insurers and there will be more cost-effective arrangements for funding of continuing medical education. I should point out to the Deputy that the IHCA did engage with the Labour Relations Commission but failed to engage with the Labour Court.

I wish to point out something which it is important to state and I will be as brief as I can. Many of these practices to which I have alluded here as being now agreed at the LRC already have been taking place on the ground. I have commended consultants on this and their change in work practices with regard to the new clinical programmes and teams led last year to €63 million in savings through the saving of 70,000 bed days. As I often have stated, it is not so much the money saved as the fact that more patients can be treated more quickly that really is the point in this regard. Through the LRC, I sought to push this pro bono arrangement, with which consultants have co-operated, into a formalised contractual arrangement because one cannot run the health service on a pro bono basis and that is what this is about. I am sure the Deputy will have a further supplementary question.

Hopefully, if we have time.

The Minister has read out a list of specifics that were addressed in the LRC. However, as my question first posed sought, can the Minister tell Members what improved work practices are currently in place now thus far from among those measures? This is what I am particularly interested to hear, rather than what actually is intended or what will happen. On a related matter, what action is the Government taking to ensure there are sufficient hospital doctors, either consultants as we know them or the new category of hospital doctor that has been talked about in the past, to provide the necessary care for patients?

Does the Minister agree that it is not only an issue regarding pay but, rather critically, it is about staffing and such needs for the varying services that we all depend upon at some time?

I will have great pleasure in answering those specific questions. Many consultants are doing excellent work, although many of them feel there has been much "consultant bashing". As with all groups in Irish society there are always some who deserve a good bashing but the vast bulk of people working as consultants in this country do an extraordinary job, going way beyond the hours they are contracted to provide.

To answer the direct question of what is being done now that was not done before, in the past year or 18 months consultants have been coming in on Saturdays and Sundays, although they are not contracted to do so. They are doing ward rounds and discharging patients, as well as examining X-rays and other diagnostics in order to allow diagnoses to be made and patients to be discharged. Those initiatives alone have brought about improvements and saved 70,000 bed days, allowing many more patients to be treated much more quickly.

The Deputy knows about the new stroke care programme that is saving one life per week and preventing three other Irish citizens per week from going into long-term care. He asked about ensuring there are sufficient hospital doctors and I again allude to a previous comment made in the debate on the national paediatric hospital: this is not so much about input but rather outcomes for patients. We can improve outcomes for patients by ensuring consultant specialists are doing the sort of work only they can, with work that can be done by other doctors and nurses done by those doctors and nurses. If health care assistants can do some of the work of nurses, they will do so. With regard to physiotherapy and speech and language therapy, the addition of allied health professionals to the stroke units have made a significant difference.

It is about the right person treating the patient at the right time and with the right cost, and the new arrangements for consultants are a key part of that. They will open the way for many other groups within the health service changing work practices, as they can no longer point to consultants as leaders who do not lead the way. We can significantly improve the care we give in the health service in a far more cost-effective fashion.