IMO Article Archive Pre 2014
Haddington Road Proposals and FEMPI legislation June 2013
The Haddington Road proposals will be subject to a ballot of IMO members commencing Monday 10 June and closing on Wednesday 26 June. The proposals, along with the relevant legislation, are available here. A summary will be circulated with ballot papers
ICTU unanimously endorses IMO position on health funding
The Biannual Delegate Conference of the Irish Congress of Trade Unions (ICTU), which met in Belfast from 2nd to 4th July, unanimously endorsed the motion proposed by the Irish Medical Organisation (IMO) which called for both the maintenance of health service funding and the better targeting of that funding.
Given the challenging economic times, the IMO motion called on the Government to put the emphasis in health service funding on those preventative programmes and services that would ensure that individuals could avail of treatment, prior to falling into chronic illness.
The text of the motion and supporting remarks by Mr Anthony Owens are set out below.
Motion 39 – ICTU Biennial Delegate Conference – Belfast, 2nd – 4th July, 2013
In launching the ‘Healthy Ireland’ policy document on 28th March last, the Minister for Health, Dr James Reilly TD, observed that the current generation of Irish parents are in danger of becoming the first generation to bury their children. Given the increase in childhood obesity and other factors, the Minister may be correct. However, the deliberate decision of the Fine Gael / Labour Government to drastically reduce the funding available to hospitals and primary care, cannot but adversely affect the health of the Irish population, both adults and children. It is imperative that the Irish Government reverse course and invest in our health service and in the future health of the Irish people, instead of slavishly adhering to the targets of the Troika.
In launching the ‘Healthy Ireland’ policy document in Dublin on 28th March last, the Minister for Health, Dr James Reilly TD, observed that the current generation of Irish parents are in danger of becoming the first generation of Irish parents to bury their children. This fear is borne out by research conducted by Temple Street Children’s Hospital in Dublin which indicates that there are almost half a million overweight or obese children in Ireland, that is 32% of the total child population and places Ireland in fifth place out of the EU 27, in terms of childhood obesity.
The scale of the problem, therefore, is evident but Dr Sinead Murphy of Temple Street Hospital advised the Joint Oireachtas Committee that state expenditure on treating this obesity pandemic is “close to zero.” The cost of treating the chronic diseases and co-morbidities arising out of childhood obesity runs to almost €5,000 per annum per child; however, the cost of effective weight reduction programmes in this area are approximately €600 per annum per child. Not alone is treatment better than cure, it is more cost effective in the short, medium and especially long term.
With this in mind, ‘Healthy Ireland’s’ emphasis on launching a whole of Government approach to tackling the various population level health issues affecting the Irish population is to be commended. The Government should also be commended for thinking a little creatively and linking the built environment to leisure activities and on to health. However, the construction of cycle paths, while welcome, is not substitute for a properly resourced and integrated public health strategy. In fact, I would contend that the hope that lifestyle factors alone will improve the health of the nation is akin to performing surgery armed only with a scissors, some plasters and a lot of good intentions.
It is in this context and forewarned as to the potential costs – both human and financial, that the overall health budget including capital spending has fallen by over 12 percent since 2009. Over the course of a twenty year period starting in 2001, it is likely that health spending in Ireland will come to resemble the classic bell curve. This is evidenced by the Department of Health’s contribution to the 2011 Comprehensive Review of Expenditure which spoke of reducing the health budget to approximately €12.3bn by 2014, at which point the total number of staff in the health service will have been reduced to 98,600, or about three thousand less than the figure at the end of 2012.
Indeed, the enormous miscalculations in the health budget for 2012 resulted first in the emergency transfusion of a supplementary €360m in December 2012 and a promise from the Department of Health to repay that €360m with a further €360m in additional revenue reductions in 2013.
Yet, this is all in the name of false economy. This has been implicitly recognised by the Department of Health itself. For those obese children, we are in a position where we must spend €5000 per annum, rather than sensibly investing €600 per annum. We know that some procedures, minor ophthalmic surgeries for instance, cost twice as much in the already overcrowded and stretched hospital setting as they do in the community setting. Yet, there is little investment in transferring these procedures to community based specialist physicians. We know that vaccination programmes save money in the long run, yet we reduce community medicine budgets. We know, because surveys have told us, that General Practice is likely the most efficient and effective part of the Health service, yet it’s resource supports are cut – most recently this week, while additional hospital workload is transferred to GPs without any thought for the patient or the Doctor whose workload overtakes their ability to deliver best care for patients. Let me say in passing, and in light of this morning’s debate, that this had been the fourth FEMPI process involving General Practice. All the while, patients continue to sit on trolleys and Doctors continue to look abroad to continue their careers in health systems that aren’t governed by the economics of the instant, where 60 hour weeks are not the norm, and where contracts are more than mere words on a page.
All of this is being done in the name of dragging the deficit to 3pc of GDP by 2015, it’s presently around 8.5pc – economic growth might take care of some of that reduction but further cutbacks are inevitable on this path, and so what if half of Irish adults are obese and in need of chronic care in 2030?
The Irish Government needs to stop thinking five minutes down the road in terms of health policy. Yes, the economy might get fixed – might – but at what cost? It would be a scandal for the ages, if the economy was fixed at the cost of the health of the Irish people.
It is imperative that the Irish Government reverse course and invest in our health service and in the future health of the Irish people.
It is imperative that the Irish Government devise health policy, not position papers and slogans that are as empty as some shuttered wards. It is absolutely vital that the Irish Government design and resource a health policy that is not so overtly and unambiguously hostile to the medical profession; so hostile in fact that some hospitals are so understaffed with these vital professionals as to be barely safe places for patients, as will become very evident next week after the next Non Consultant Hospital Doctor changeover.
Finally, it is imperative that the Irish Government follow their own logic, and place the goal of a ‘Healthy Ireland’ at the centre of policy making, and not allow the coming generation to be held a captive of the need to slavishly adhere to the targets of the Troika.
I commend the motion.
Motion Passed.
Pensions
Superannuation provisions for doctors employed in the public health system are predominantly provided under the Local Government Superannuation Code.
The pensions legislation covering the vast majority of people pensionable under this scheme of the Local Government (Superannuation Revision) (Consolidation) Scheme, 1986 (sometimes called the 1986 Revision Scheme). The Scheme applies to pensionable staff in Local Authorities, Health Boards, Health Bodies, VEC's and Institutes of Technology. Most pensionable staff will also be covered for benefits for a surviving spouse and qualifying children under either the Widows' and Orphans' Pension Scheme or the Spouses' and Children's Pension Scheme.
The 1986 Revision Scheme is dealt with under various headings. Likewise, as both the Widows' and Orphans' and Spouses' and Children's Schemes are similar, these Schemes will be dealt with jointly under several headings, concluding with a brief note on the main differences between those Schemes.
Purpose of the Pension Scheme
The purpose of the Scheme is to provide superannuation benefits for retiring pensionable staff, or for pensionable staff who die in service. All permanent, temporary wholetime, and certain categories of part-time staff are pensionable under the Scheme from the date of becoming so employed.
The determination of pension benefit depends on whether benefits are co-ordinated with Social Welfare entitlements. If pension benefit is co-ordinated it means that the Scheme member is fully insured and is entitled to a Contributory Old Age Pension together with pension benefit under the superannuation scheme. If pension benefit is unco-ordinated there is no entitlement to a Contributory Old Age Pension. Accordingly, co-ordinated staff pay a lower contribution to the occupational pension scheme and receive a lower level of occupational benefit also. The table below summarises the position in relation to the categories of staff who are co-ordinated and uncoordinated.
Co-ordinated Uncoordinated
Officers All pensionable staff appointed All pensionable staff
on or after 6 April, 1995 subject appointed before to certain conditions. 6 April, 1995.
Normal Retirement benefits take the form of a tax free lump sum and an annual pension, which is taxable, based on the person's pensionable salary and pensionable service.
The Lump Sum is calculated, using the same formula for co-ordinated and uncoordinated staff as follows:
3/80 X Pensionable Pay X Pensionable Service
Unco-ordinated staff: 1/80 X Pensionable pay X Pensionable Service
Co-ordinated staff:- 1/80 X (Pensionable pay - (2 x annual rate of maximum old age contributory pension) x Pensionable Service
To qualify for pension and lump sum benefits you must have a minimum of 5 years pensionable service. Maximum benefits are attained by staff after 40 years pensionable service, this amounts to a pension (inclusive of the Contributory Old Age Pension in the case of co-ordinated staff) of one-half of retiring pensionable pay and a lump sum of one and a half times retiring pensionable pay. Pension benefit payable is increased usually in line with increases in pay in the pensioners former grade.
If a pensionable officer dies in service a death gratuity is payable. The death gratuity is calculated as the greater of the deceased's annual pensionable pay or the lump sum the person would have received had s/he retired on grounds of permanent infirmity. The method of calculating a death gratuity is the same for co-ordinated and unco-ordinated staff.
EXAMPLE
Salary €30,000; service 20 years, age 55
greater of (a) €30,000
or
(b) €30,000 x 25 x 3/80 = €28,125
NOTE: that 25 years service is used in the calculation since the person concerned in this example would be entitled to an addition of five extra years, assuming a minimum retiring age of 60, if s/he retired on ill health grounds on the date of death.
Purpose of the Widows’ and Orphan’/Spouses and Childrens Pensions Scheme
The Scheme applies automatically to permanent male officers of local authorities, appointed to pensionable posts on or after 1 January, 1970, and to female officers appointed on or after 1 October, 1984. Staff pensionable prior to those dates were given an option to join the Widows and Orphans Scheme. Similarly when the Local Government (Spouses' and Children's Contributory Pension) Scheme, 1986 was introduced, it was automatically applied to all full-time staff appointed on or after 1 January, 1986 and existing staff were given an option to join.
The purpose of both Schemes is to provide a survivors benefit for spouses and/or dependant children of a member who, dies in service, dies while in receipt of a pension or dies while having an entitlement to preserved benefits.
A pension is payable under this Scheme to a surviving spouse and eligible children.
A children's pension, regarded as the child's own income for tax purposes is payable in respect of children under the age of 16, or under the age of 22 in full-time education, apprenticeship or training. A pension is also payable for life in the case of a permanently incapacitated child.
Survivors benefit payable is calculated by reference to the members or former members actual pension entitlement.
If a Scheme member dies in service or dies having retired on ill-health grounds, the survivors pension payable is calculated by reference to the pension the member/former member would have received had he s/he remained in employment up to age 65.
The following is a breakdown of the pension entitlements of a spouse and/or children of a member, or former member who dies:
Dependants Fraction of deceased’s member's pension payable*
Spouse One-half
Spouse & one child Two-thirds
Spouse & two children Five-sixths
Medical Council & Bankrupty
Following concerns raised by members that a declaration of bankruptcy would result in a doctor being unable to practice the IMO contacted the Medical Council for clarification.
While the Medical Council will make searches to ascertain if a doctor has been declared bankrupt, this is to protect against any potential conflict of interests. The IMO has been assured that – in normal circumstances - being declared bankrupt does not render a doctor unable to practice, i.e. their registration with the Medical Council should not be affected.
IMO message on Government proposal for under 6's
Dear Doctor
As you will be aware the IMO today met with Minister Alex White to be briefed on Government policy concerning the introduction of a universal GP service without fees at the point of access with particular emphasis on the implementation of the first phase concerning children aged 5 and under.
The IMO outlined its position as follows:
•The IMO is the sole Trade Union holding a negotiating licence to act on behalf of GPs and is a named party to the GMS and all publicly funded contracts
•What is being proposed here is, in substance, a significant variation of the contract and has been devised without negotiations or agreement with IMO
•It is an express term of the current contracts that negotiations take place with the IMO and those contracts remain in place
•The consultation process as outlined is, in our view, flawed as it is clear that decisions have already been made and announced – Budget allocated, patient cohort and workload identified, with an indication that fees are to be in line with current GMS capitation rates
•Currently there is a dispute concerning the GMS and publicly funded contracts that is impacted by these issues which has yet to be determined by the Courts
THE IMO HAS CALLED FOR THE COMMENCEMENT OF FULL AND MEANINGFUL NEGOTIATIONS
Notwithstanding the fact that the “consultation process” being employed by the Government is flawed the IMO intend to make full and detailed submissions on this significant development, while maintaining our right to fully represent and negotiate on behalf of GPs.
It is important that GPs express their views through the IMO as the only trade union and negotation licence holder for GPs in Ireland.
We will be in contact with you in the coming days on this process
It is universally accepted that General Practice is key to the development of our health services however the absence of negotiation, due to interpretation of Competition Law, has led to a stagnation of development in general practice and the absence of meaningful engagement has frustrated any development of new services to patients. General Practice has huge potential but can only deliver upon that potential with proper resources and funding and with negotiation with GPs, through their trade union the IMO.
Additional cost savings 4/09/12
As you will be aware, the HSE announced on 29th August that €130m in funding was to be cut from the health budget for the remaining months of 2012. These cuts were given effect by a memo issued by Ms Laverne McGuinness, National Director for Integrated Services. Quite a few of our Members contacted the IMO to express specific concerns about Section 2.3 of the memo which calls for an immediate cessation of funding for education and training, particularly medical education and training. In response to our Members concerns, the IMO wrote to Ms McGuinness outlining the statutory obligations on Doctors to participate in continuing medical education and training and the responsibility of the HSE to facilitate this.
Please see a copy of our letter below.
Vat on medical services 26/01/2012
Changes to be introduced following a European Court of Justice (ECJ) examination of the nature and scope of medical exemptions in a number of cases are referred to in paragraph 4 (Decisions of the ECJ) of the following Revenue leaflet: Medical Services.
Medical practitioners should seek professional advice from their accountant or tax advisor. Advice is also available on registering for VAT at www.revenue.ie which is reproduced below for convenience.
How do I register for VAT?
To register for VAT, you need to complete the below Form TR1 (PDF, 240KB) (if you are an individual, partnership or unincorporated body) or a Form TR2 (PDF, 410KB) if you are a company. The form, when completed, should be forwarded to yourlocal Revenue District.
Special care should be taken, when completing the form, to include your name, address, PPSN, business type and the relevant tax types. The form must also be signed and dated. Make sure to include a contact phone number with the form when sending it in. This will enable the office to contact you with any queries regarding the information on the form.
Public Service Agreement
Public Service Agreement
• No further pay cuts until at least 2014
• Efficiencies and productivity to be maximised by appropriate use of resources
• Significant cost-saving reform measures across all parts of the public service including by extensive reforms in work practices and conditions of employment
• Review of extent of savings generated to be held in early 2011 to determine if scope for any reimbursement of pay cuts (priority given to reimbursing workers with pay rates of €35,000 or less)
• Similar reviews to be carried out in following years
• Reduction in staff numbers across the public service by end-2012 to be implemented by employment control frameworks
• Current Government moratorium on recruitment and promotion to continue to apply until numbers employed in each sector have fallen to the levels set out in the employment control frameworks
• No compulsory redundancies but flexible re-deployment arrangements necessary
• Unified public service labour market to be created
• Promotion and incremental progression based on performance
• Industrial peace clause to be put in place- no cost-increasing claims can be made for improvements in pay or conditions for the duration of the agreement .Strikes or other forms of industrial action in respect of matters covered by the pay agreement will be banned
• Discussions to take place with the IMO in relation to the Government commitment to make appropriate changes to the Competition Act and the Transformation Agenda for GPs to be completed within 2 weeks
Download the Public Service Agreement 2010 - 2014 here.
Update
The Health Sector implementation group is chaired by Mr Pat Harvey, a former health board CEO and includes an equal representation of both union and management representatives. The unions represented on this group are the IMO, INMO, SIPTU and IMPACT The first meeting of this group took place on 6 October and it has responsibility to implement savings under the agreement and to implement the Health Sector Plan. In summary the plan provides changes for employees in the health service by
1. redeployment of staff with particular focus on ensuring the retention of services which would otherwise be discontinued due to budgetary shortfall;
2. acute hospitals - move from seven days to five / day case work;
1. review of rostering;
2. escalation policies in the emergency department; and
3. review of operating theatre rosters.
3. the introduction of staff to population ratios with regard to all health professionals e.g. nurse/midwives/physios etc with a view to standardising the staffing structure across the country;
4. radiology - extending the working day;
5. primary care;
6. Reassignment of staff.
A template has been agreed that will be used to record any savings made.
The working group is now working on the arrangements that will apply in cases where adjudication is required under the agreement.
Further to a meeting of the Health Implementation Body on 12th January 2010 revisions were made to the Health Sector Action Plan to reflect the discussions held and in light of the decisions taken by the Government in the context of the Estimates and Budget 2011 in order to ensure that the Plan supports the changes to follow from those decisions. The budgetary measures decided by Government to implement the National Recovery Plan, require underlying savings of €960m in the HSE budget for 2011 (which includes the cut in cash terms and the cost of unavoidable cost increases) allied with reductions in numbers required under the employment control framework. Notwithstanding these reductions the HSE has committed, in National Service Plan, approved by the Minister on 21 December 2011, to maintaining services at last year's level. In order to achieve this, the HSE needs to make significant savings in non-pay costs and in non core pay expenditure and crucially has to deliver the same quantum of services with less staff. The revised action plan has been prepared with this imperative in mind. Progress has been made in a number of areas of the Action Plan including the transfer of the Community Welfare Staff to the Department of Social Protection from 1 January 2011, changes in laboratory work practices, the completion of the Voluntary Early Retirement (VER) and Voluntary Redundancy Scheme (VRS) for management administration and support grades. It is proposed that there will be a number of new clinical programmes in 2011 on which the IMO will be working to ensure doctors interests are protected at all times.
Medical Practitioners Act (November 2010)
Background
The Minister for Health & Children gave effect to the establishment of a new register under the Medical Practitioners Act 2007. With effect from 16th March 2009 the General Register of Medical Practitioners and the Register of Medical Specialists was replaced by the Register of Medical Practitioners compromising of four divisions. There have been a number of practical difficulties with these new registration arrangements.
There were a number of motions on this issues debated and passed at the IMO AGM which will now be progressed by the IMO including regarding the issue of registration difficulties.
Download the Medical Practitioners Act here.
Update
A meeting was held with the Medical Council on the issue of professional competence.
The meeting was attended by Prof Sean Tierney President IMO, Dr Bridin Cannon, Dr Patrick O Sullivan, Dr Henry Finnegan, Dr Matt Sadlier and Mr Eric Young.
The meeting dealt with the issues arising out of professional competence, registration issues, Registration of practitioners providing medical services from outside the state, NCHD Registration issues, and language competence for those providing treatment. There was a good exchange of views and the IMO confirmed there would be a formal submission made to the Medical Council about the issue of professional competence. The IMO made this submission in November 2010.
Moratorium on Recruitment
The Government has taken a decision in relation to the Implementation of Savings Measures on Pubic Service Numbers and Employment Control Framework 2009 that with effect from 27th March 2009 to end 2010 no post in the public sector, however arising, may be filled by recruitment, promotion, nor payment of an acting up allowance for the performance of duties at a higher grade. Therefore when vacancies arise the HSE must relocate or reorganise work or staff accordingly.
This moratorium also applies to temporary appointments on a fixed-term basis and to the renewal of such contracts. As a result of this decision Mr Sean McGrath, National Director of Human Resources, HSE issued HSE HR Circular 10/2009 detailing its application within the HSE. A notable exception to the moratorium is the Hospital Consultant grade; however any new post of hospital consultant will be created by the suppression of 2 NCHD posts.
The IMO along with the other Staff Panel Unions met with representatives of the HSE including Mr Seán McGrath to discuss the moratorium and to request further details on its application in the health service. Discussions are ongoing between the Staff Panel and the HSE on the issuing of a revised Circular by the HSE which would allow some flexibility to deal with arising issues.
Reduction of surgical services in Navan hospital 2010
In August 2010 Navan hospital announced in the media that it was to cease acute surgical services in the hospital with immediate effect. This was done with no consultation with IMO members and publically announced without any prior information, consultation or discussion with members.
All unions represented at the hospital, including the IMO, raised objections to the nature of the changes and the serious lack of consultation before these changes were announced. The approach outside the provisions of the information and consultation act and is poor management practice. At a subsequent meeting the management explained that the decision was made by the Director of Quality and Clinical Care, Dr. Barry White and the Acting Chief Executive Officer Mr. Brian Gilroy
The issue was referred to the Labour Relations Commission under the Information and Consultation Act 2006 and the hearing was held on 17 September 2010.
Medical Council
The IMO & The Medical Council
The IMO met with representatives of the Medical Council to discuss the introduction of Professional Competence. Under Part 11 of the Medical Practitioners Act 2007 doctors registered with the Medical Council are required to participate in a Professional Competence Schemes. Doctors must enrol in a scheme by 1 May 2011. These are the formal structures provided to ensure that all doctors registered and working in Ireland maintain their education, knowledge and skills (competence) at an acceptable level.
Practitioners will be enrolled in CPD activities as defined by the Training Body for their specialty and will be required to submit evidence of their participation in educational activities. It is envisaged that doctors will be expected to participate in 50 CPD hours per annum (250 hours over a five year period). In addition the IMO made a submission to the Medical Coucil on the operation of these schemes.
The IMO discussed registration issues with the Medical Council and provided feedback on issues of concern to members.
Contact the Medical Council
Medical Council
Kingram House
Kingram Place
Dublin 2
Telephone +353 1 4983100
Fax +353 14983102
Email: info@mcirl.ie
HIQA
The Health Information and Quality Authority (HIQA)
The Health Information and Quality Authority (HIQA) was established in May 2007 as part of the government's health reform programme. They cover the entire health and social services system, with the exception of Mental Health Services. It is an independent Authority, with broad ranging functions and powers reporting to the Minister for Health with responsibility for driving quality and safety in Ireland's health and social care services. This is done through
• Setting Standards in Health and Social Services
• Monitoring Healthcare Quality
• Social Services Inspectorate
• Health Technology Assessment
• Health Information
We have been set up to drive quality, safety, accountability and the best use of resources in our health and social care services, whether delivered by public, voluntary or private bodies.
They set the standards for delivering health and social care services and continuously inspect to ensure that these standards are being met. They have stated they will take action if there's a risk to the safety of any person using our health services.
HIQA publishes the findings of their inspections so that the public can make informed choices when seeking care.