That was Dr. Patrick Plunkett on Morning Ireland earlier.  Drive Time’s Health Policy Analyst, Sara Burke, is here in studio.  Sara, you might just fill us all in on what it’s all about.

 

 

Yes, well before we get to the trust issue because certainly that was named loud and clear this morning, Ingrid’s story was based on a discussion document that was tabled, I think about ten days ago, at a meeting between HSE, senior management and the consultants unions, which is the Irish Medical Organisation and the Irish Hospital Consultants Organisation, and it was in relation to progress around different bits within the Croke Park deal.  So there was a discussion paper and obviously not much progress was made and this document was put out into the public domain and when I saw it on the news last night I thought this was PR, dark arts, but it’s pretty clumsy PR, dark arts, and I would gamble it’s HSE clumsy PR, dark arts, although the HSE absolutely refuted that when I put it to them earlier.  But the particular discussion Patrick Plunkett was referring to was about increased rostered hours and under the last consultant’s contract higher pay was given to consultants as long as they met a whole range of conditions.

Mary Wilson:

 

It was the eight to eight day and there was so many elements and you had a number of different contracts as well...

 

 

There’s loads of different contracts.

 

 

So we’re not going to get bogged down.

 

 

Exactly.  In general terms the consultant’s contract increased the consultant’s hours from thirty-three to thirty-seven hours and then under Croke Park was the agreement that these thirty-seven hours would be spread from five days over seven and there’d be a flexibility between 8am and 8pm.  Now I think it is important to say that actually most consultants work way more than their thirty-seven hours.

 

 

Now will you remind us how long it took to get to that contract?

 

 

It took about three years to get it signed, sealed and delivered in autumn 2008.

 

 

Alright.  The rationale around all these contracts, it’s about giving better care to the patients, the patient can be seen by a consultant on the ward or in an emergency department, there will be more consultants on duty twenty-four-seven.

 

 

Totally and this is a long promised and much needed Government commitment, since 2001, since the health strategy they’ve been promising what they call “consultant provided care”, so if you or I end up in an emergency department tonight we’re not seen by the new rookie junior doctor who’s been trained or not been trained, we’re seen by a consultant, and that’s what you want, for anyone, ourselves or anyone close to us, and they have increased the number of consultants but we still have significantly fewer in place, but there was new information, or there was new conditions in this discussion document and again that’s what Patrick Plunkett was referring to because it talked about increasing the working hour from thirty-seven to forty-plus, it had a sort of ‘x’, so forty-something hours, so that is very different.  Now they do already work that but it would be about putting this place and also this potential for some consultants to work 24/7.  Now many  babies are born after, before 8am or after 8pm, many people end up in emergency departments after those hours and are seen by consultants, so it’s not that this practise isn’t already in place but what this HSE document was doing was putting it out there that this might be part of new working arrangements and in a way Dr. Plunkett is right, this is a very new contract negotiations that they were doing and I think if they were doing it on the airwaves or through the media, it’s not a very...

 

 

It was also clear listening to Dr. Plunkett this morning that if there had been any trust there well it’s completely gone now, there is no trust between consultants and the HSE.  What was he referring to when he said, he kept talking about the HSE apparatus?

 

 

Yes, and I asked a spokesperson for the IMO, the Irish Medical Organisation, who Patrick Plunkett was speaking on behalf of today, and I said was this Sean McGrath, who’s the National Director for Human Resources within the HSE and they were keen to say no, no, this is an agency wide issue and this is about senior management within the HSE.  Again he was explaining to me that, and this was the point being earlier that, for example, the higher pay was to come to them in three stages and the first two stages sort of got under the radar before the entire global, economic meltdown, and specifically before the Irish meltdown, but if we can bring ourselves back?  Brian Lenihan commissioned this higher review, this review of higher pay within the public sector and one of the recommendations was that group, so in fact it was a Government decision rather than a HSE decision, was not to pay this third pay increase to the HSE, so he is right in saying that.

 

 

So there are many elements to this discussion document but the reality is that the element that grabs the headlines and the element that leaves people with their mouths open is this whole idea of this historic payment.  Talk to us about it again, historic rest hours.  Now Dr. Plunkett talked about this as well and he used his own personal story to describe how he would benefit from that agreement.

 

 

Well my take on this is this is a complete red herring in a separate issue which is about longer working week and 24/7 rosters but historic rest hours are what was agreed in 1997 when Minister Brian Cowen, when he was Minister for Health, and again it seemed to be, I think the 2008 was a very bad deal in the public interest, but the 1997 deal was a particularly bad deal in the public interest and they agreed that consultants, like Dr. Plunkett, who’d been working weekends, because at the time there was a real underprovision of consultants so they...

 

 

So they couldn’t take the time off.

 

 

So they couldn’t take the time off and they weren’t entitled to overtime so this was the deal done and then the HSE have done the sums on the basis of four hundred and fifty of these, which is about a fifth of all the consultants in place and if they work up to twenty-seven, and again a brief communicae I had from the Hospital Consultants Association said they didn’t believe the figures and queried the salaries and all of that but basically it was meant to be payback for overtime done between 1991 and 1997 and sure those people are entitled to some form of payback but the fact that that wasn’t dealt with in 2008.

 

 

And what added to it was that a locum would have to be employed to cover the year they were off but they could be their own locum so in addition to getting the year’s salary they could get the year on top of that, another €230,000, for acting as locum in their own interest.

 

 

Yes, it does seem extraordinary when you hear it like that, yes.

 

 

But they have a contractual arrangement.

 

 

They do and it wasn’t, it was Government that agreed to this, Government led these negotiations in 1997 and led them in 2008 so in a way the current regime, be it the Government or the HSE, has inherited this historical deal and they’re trying to get it out the window.

 

 

Let’s talk about the numbers that may be leaving the HSE because we keep hearing about public servants, you know, eight and a half thousand is the latest figure we hear, wanting to leave the system before the end of February, what sort of benefits to those who leave and what impact will it have on the health services?

 

 

Well the benefit is that you get your lump sum and lump sums generally are a salary and a half and you get them tax free and also, really importantly I think, you get your pension at the pre-pay cut rates, so 2008/2009 rate, and of course that benefits the higher earning public servants much more than it would benefit a low earning porter or healthcare assistant and again I put a question to the HSE do they know how many will go?  My gut is there’ll be quite a lot of them getting out of the system before February, a lot of consultants of a certain age because it’s financially beneficial to them and the conditions they’re working in at the moment are hardcore.

 

 

So people, if they can afford to go, they will be anxious to get out?

 

 

I think, now they’re meant to give three months notice so we’ll have better information on this come November I  think, but they will be gone by February and given that there is still this HSE freeze and in fact they’re meant to be providing us with more consultants under the Clinical Care Programmes, it really provides big problems for the HSE

 

 

Alright Sara, thank  you very much.  That’s Sara Burke, our Health Policy Analyst.