The introduction of new arrangements which would see hospital consultants treat only public patients in public hospitals is one of the key pillars of the Sláintecare health reforms.
After a long delay caused in part by the Covid-19 pandemic, talks will get under way on Thursday between the Department of Health and medical representative bodies on the proposed new Sláintecare contract for senior doctors.
In late 2019, the then government announced that all future consultant appointments to public hospitals would be on the basis of the doctors concerned treating only public patients .
Minister for Health Stephen Donnelly wants to introduce the new contract by the end of June. However the talks process may not prove to be straightforward or as speedy as just setting out a new contract with higher pay for those who agree to forego private practice in public hospitals.
Department of Health officials warned Donnelly in briefing material provided on his appointment last summer that “implementation of the new Sláintecare contract and move to public- only contract with the support of the representative bodies will be a significant challenge”.
At the start of Thursday’s talks, the Department of Health will offer salaries for the new contract of between €189,000 and €227,000 across a six-point scale. This will increase to between about €210,000 and €252,000 when financial emergency measures introduced after the last economic crash are fully unwound next year.
The medical representative organisations were never wildly enthusiastic about Sláintecare in the first place. The Irish Hospital Consultants Association (IHCA) has regularly raised question marks over how the €600 million generated for public hospitals from the treatment of private patients in their facilities would be replaced.
The IHCA in recent days commenced a confidential survey of members asking, in part, their view on the effect of Sláintecare contract proposals on staffing levels, recruitment and retention.
The pace of the new talks process is likely to be determined on how quickly preliminary arrangements can be progressed.
Priority
If the talks become embroiled over, for example, the appointment of an independent chair, it could signal they may continue for some time. The talks that birthed the last consultant contract in 2008 famously went on for several years.
The IHCA and the Irish Medical Organisation (IMO) will have a priority in the in the new negotiations of pressing the Government to address the lower pay rates in place for those consultants appointed after autumn 2012. They maintain that these doctors can earn up to €50,000 less than their longer-serving colleagues.
The medical organisations argue that the two-tier pay system is directly responsible for the inability of hospitals to fill up to 700 consultant positions on a permanent basis.
The Government believes the higher pay on offer under the Sláintecare contract proposals would deal with the pay disparity issue for consultants currently on contracts known as type “A”, who currently work exclusively in the public system.
It is unclear as of yet what will happen in relation to the hundreds of doctors with other types of contracts who currently have rights to treat fee-paying patients either in public hospitals or in off-site private facilities.
Donnelly told the annual conference of the IHCA last October that he supported pay equality for consultants on type “B” and “C” contracts - which have private practice rights.
“ This is something I committed to in Opposition. It is something I strongly advocated for at your conference last year. It is something I am still strongly committed to as Minister. I believe it to be one of the changes necessary to unlocking reform and addressing retention in our public system. It is a policy I am pursuing.”
However it is understood there have been concerns among some other Ministers that pay restoration for all could have implications for the plan to encourage the move to the Sláintecare contract.
The Department of Health is expected to propose that existing consultants with private practice rights will be offered the opportunity to switch to the new public-only Sláintecare contract. However doctors who wish to remain on their existing arrangements can do so.
At this stage, there is no indication that the Government will offer to buy out existing private practice rights. In essence this would mean that private practice could remain a feature, in diminishing levels, for years to come.