Irish Medical Organisation

Address by Dr Paul McKeown - IMO President

Please see below for transcript

As President of the Irish Medical Organisation, it’s my great pleasure to welcome you all here this afternoon to the Hotel Europe and to our Annual General Meeting.

The AGM is a critical event in our annual calendar. It’s an opportunity for members to gather together and discuss the issues of the day, reflect on and debate policies and renew acquaintances and friendships with fellow professionals.

But for this organisation - at this time - I think it’s fair to say that we have never had a more important Annual General Meeting than the one that begins this afternoon.

This has been a very, very difficult few months for everyone in the IMO. I’ve spoken to members up and down the country over recent weeks and I know that everyone who is involved with the organisation is angry, frustrated and annoyed at what emerged about the contract held by the former CEO and the settlement negotiated on his departure before Christmas.

That anger and frustration is shared by my colleagues on the various IMO Committees and on the Council of the organisation.

It’s shared by our dedicated staff in IMO House who work hard for our members on modest salaries and who are shocked at his contract, angered that his demands could threaten their futures and embarrassed at the attention he has brought to the organisation.

And it’s shared by me.

I felt those emotions again this morning when I read the papers and saw the attempt to justify a salary of almost €500,000 a year on the basis that it was widely known about throughout the organisation.

Well let me be very clear – I utterly reject that claim.

I am President of this organisation and I can say without fear of contradiction that I didn’t know that our CEO was earning half a million euro a year and I was shocked when I found out.

I didn’t know that he had a contract which would give him a €1.5 million lump-sum on his retirement in his mid-fifties and I was staggered that he had.

And I didn’t know that he was building up a liability for the organisation that would threaten its very future and I don’t believe for a second that my colleagues did either.

I’ve no difficulty in putting up my hands and acknowledging that in hindsight I should have done more to find out just what contract terms he was working under.
But I won’t allow a rewriting of history and suggest that the relevant information was widely known. Moreover I think the huge surprise that surrounded the matter both within and without the IMO when it emerged testifies to the degree to which it had been kept secret.

The timing of this intervention is interesting.

It happened on the day that we publicly advertised a tender for an independent retrospective review to examine all matters connected with the contract, the payment and the pension arrangements of the former CEO within the IMO and with any companies associated with the IMO including the governance systems for negotiating such contracts and appointments.

I firmly believe that the only way we will truly understand how this situation arose is through the independent retrospective review that we have now commenced and I hope the former CEO makes himself available to co-operate with the review.


We have a very full agenda over the coming days.... lots of organisational work to be completed…. and important issues and motions to discuss and debate.

Once again of course this AGM takes place in the context of continuing economic hardship and fewer and fewer resources in the health sector and across the broader economy.

Yesterday the papers carried stories that the Troika was setting down new requirements on the Government to control spending in the health sector.

And the IMF warned about continued risks for the economy and the danger that it might commence on what they referred to as – and I quote - “an unsustainable path”.

But the real question now is just what is so sustainable about the path we’re on now? What makes the Government – not to mind the international organisations that dictate to this Government – so certain that the path on to which they’ve driven us is sustainable now?

I don’t think it is. I don’t believe that the majority of men and women in this country believe it is and I think it’s time that we stopped waiting for reports from the IMF and the Troika to warn us about the risks we are facing if we veer from their prescription ………… and started writing reports to them to warn them about the risks we face if we continue with their prescription.

Every day health professionals see at first hand the damage being caused to the fabric of our health services by enforced austerity.

We see the damage patients are enduring by the withdrawal of services; the indignities being inflicted on vulnerable and disadvantaged people by the penny pinching that is now demanded in the health and social welfare budgets.

And we see the corrosive effect of these cuts on our patients and on our members.

In this context it’s inevitable that much of our attention as an organisation over the past twelve months has been on fighting for our members – individually and collectively – and for their rights. The IR agenda has never been so busy or so important for this organisation as it is now.

It’s busy across the specialities. Some of the issues are unique to different craft groups. Some are common to all such as the almost wilful disinterest in contract agreements which they no longer suit the agenda of the HSE.

Lets look at some of the key issues in the different specialities – starting with General Practice.

Everybody here knows that General Practice is critically important to the Irish health system and it offers enormous potential both in terms of the services currently provided and in offering new whole population chronic disease care on a cost effective basis.

But despite offering so much, general practice is under enormous threat. The existing contract is being undermined and abused and severe cuts are being pushed through in shocking ignorance of the inflexibility of the GP cost base.

What does that mean for patients? Well where fixed costs account for a dominant proportion of the costs of a typical GP Surgery – as they do in Ireland – cutbacks lead inevitably to a reduction in patient services and that’s already beginning to happen. GPs are being forced to ration care because they simply can’t afford to continue to provide all the services which their patients need.

So we are fighting to try to resist the imposition of any further cuts which will have a disproportionate impact on the old, the vulnerable, and those in nursing homes, particularly people living in disadvantaged urban and rural areas.

The attack by the HSE on the existing contract on a national and local level is a threat which requires vigilance from the IMO and all our members. Increasingly we’re seeing efforts by some local HSE offices to coerce GPs to provide services not covered in the existing contract but the IMO will continue to protect the contract and the patients served by it and fight for the resources to deliver what is a first class service.

In respect of consultants, the HSE is fighting them on two fronts; trying to force through massive reductions in pay for new appointments – including in some cases new appointments of existing consultants - while also trying to push through unfair changes to work practices under the original Croke Park deal.

On this issue, we’ve resisted efforts, for example, to remove historic rest days, to reduce the number of rest days in the future, to withdraw second opinion payments and to impose unfair roster arrangements and preventing the removal of outstanding entitlements from the 2008 contract.

The pay issue affects both consultants and NCHDs and both Committees have jointly affirmed their opposition to the policy. The policy is outrageous on many fronts and it holds a real threat to the country’s ability to retain doctors and even attract new doctors to this country. We’ve sought various meetings with the relevant authorities including the Minister for Health and the Department of Health and the Department of Public Expenditure and Reform. None have been taken up.

Through the past 12 months we’ve worked closely with NCHDs to roll out a very dynamic and high profile campaign against the dangerous working hours that these members are forced to work

NCHDs play a key role in the delivery of the country’s health services but it is a role which is unappreciated and undervalued by the policymakers and HSE managers who control the service.

Fundamentally there is a disconnect between the attitude of the HSE which sees NCHDs as cost-effective highly skilled labour to staff hospitals without due regard to career planning and the aspirations of NCHDs themselves for whom their time as NCHDs is a critical step on their career path during which they expect to receive training and critical hands-on experience leading to a specialist post.

Add in an absolute disregard by hospital management for the NCHD contract of employment and appropriate working conditions and the consequences are as inevitable as they are damaging; a crisis in morale amongst NCHDs best exemplified by the IMO Boarding Pass campaign of November 2012 which saw over 800 NCHDs indicate their intention to leave the Irish Health Service to make the point clearly that unless things change there will be more NCHDs in our airports than in our hospitals.

Without doubt patient care is being jeopardised in a system which routinely expects doctors to work excessive hours without adequate breaks or rest. Despite the best efforts of NCHDs, who take their responsibilities extremely seriously, it is clear that an accident will happen as a result of this working regime and it will have serious, perhaps even fatal consequences.

Of course the health of our members is also jeopardised and there are many incidences of mental and physical health issues arising for NCHDs purely as a result of the excessive working time arrangements they are subject to.

In my own specialty of Public Health Medicine, we need no lectures about the shortage of resources that is affecting the health service. We are a small group, where – to use a phrase much beloved by health service management - putting your shoulder to the wheel is obligatory. We are a group where the non replacement of every colleague who leaves is keenly felt.

In 2009, to ensure that the State met its international obligations, we entered into an interim Emergency Medical Out of Hours Service. We did this with understandings from management with regard to staffing levels, rosters and supports. Some of us hoped that establishing this Service would herald the grand bargain that would finally allow us to resolve many of the issues that have bedevilled our specialty over the years. It was this hope that persuaded us to stay in the Service when an independent report clearly highlighted safety concerns, and when the promised supports failed to materialise within the interim period.

Despite our misgivings we have stayed in this Service, and we have lobbied, pushed and cajoled the management side to put in place the supports that will to allow the Service to stand on an enduring and sustainable footing. We will increase those efforts this coming year and let me clearly state to the management side that irrespective of resource constraints, we cannot and we will not practice makeshift medicine.

And what do I mean by supports? I mean the systems that ensure that when the Specialist on call notifies a hospital of the possibility of an infectious disease outbreak, there is an identifiable person in the hospital who can act on that advice. I mean ensuring that never again will the Specialist on call be required to drive around on a weekend night looking for a pharmacy in which to buy medicine to treat a patient.

It is simply not good enough that there is no intermediate step between a Service provided by a lone Specialist with a mobile phone and an address book, and calling out Crisis Management Teams. It speaks volumes of the intellectual and moral bankruptcy of health service management, when they are at ease with crisis as the new norm.

My colleagues in Community Medicine provide the same cost effective but dedicated service to their patients, and their patients are many of our most vulnerable fellow citizens, ranging from newborn infants to our most senior citizens. Yet this group of Doctors, perhaps more so than any other, have suffered from the casual indifference of the management of the health service.

From the perennial problem of the remaining Area Medical Officers to the Community Medicine Review, this group of Doctors, despite their expertise and importance in promoting and maintaining public health, have been sidelined by management. It seems that they are never on managements radar, only ever in its sights when savings are sought.

As we move towards making our case at the Equality Tribunal, I urge you to afford whatever assistance you can to Dr Kathleen O’Sullivan and her brave stand against the HSE’s refusal to recognise her experience and her specialism. That our Area Medical Officer colleagues are confined beneath the entry grade to their specialty is an ongoing disgrace.

I also call on the HSE to take the Review of the Community Medical Service off the shelf, and to engage with the IMO on its recommendations, some of which are long overdue. If management do this, they will find us to ready, willing and eager to respond.

Finally I want to say a few words about Croke Park II.

As you are aware, the IMO, along with the INMO, CPSU and UNITE left the Croke Park 2 talks on Sunday 24 February last as we all agreed that there was nothing being proposed that addressed the savings being sought other than to increase the working of hours of doctor and take more money out of the pockets of public sector workers.

Since leaving the talks the IMO Council unanimously agreed to recommend rejection of the proposals - the proposals are bad for public sector workers, bad for private sector workers and will do nothing to start to build growth in the economy.

We have also seen unprecedented interference by government ministers in the democratic processes of trade unions. Threats and bullying tactics in an attempt to coerce union members into accepting the unacceptable.

Along with the other unions who left the talks the IMO has spoken at 11 meetings across the country to explain what the proposals mean in reality. Details can be found on the IMO website and through the numerous e-communications sent to members impacted by the proposals.

The Public Service Committee of the ICTU meets on 17 April when the results of union ballots will be announced.

If the proposals are accepted the IMO, and the other unions standing alongside us, will have to decide on the next course of action.

So I think you will agree that on the IR front its been a very busy 12 months and it will continue to be so through the year ahead and beyond.

I am realistic enough to understand that we won’t be successful in all of the campaigns we undertake or the causes we support. But having served as President for the past year, I now believe more firmly than ever that there is a really great NEED for the Irish Medical Organisation.

To put it simply, if we don’t advocate for the rights of our members and our patients, nobody else will.

The IMO is in a privileged position. It is the only Trade Union for doctors in Ireland and it is licensed to negotiate on behalf of its members.

We represent over 5,000 doctors in different specialities and in all parts of the country and that great diversity and breadth gives us our strength.

I know the events of recent months have tested the loyalty and the patience of members but I also know that there have been many moments in the past year when I’ve seen up close, the valuable contribution which we’ve made to the lives of our members and the value of the contribution we’ve made to the public debate.

I think the IMO is more necessary than ever. I am optimistic that we can emerge renewed and stronger from this current crisis and I know that we have a crucial role to play.

So lets get down to the business of this AGM and lets start the next chapter in our organisations history today.

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