Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the delegates and thank them for the presentations. Representatives of the HSE and the Department attended a previous session this morning. This emanated from an RTÉ programme. I assume the witnesses have seen it and are aware of its contents. It is not just about that as the matter has been discussed at this committee for some time. It concerns stretched budgets and the perverse incentivisation at the heart of the public hospital system, which has been referenced by Dr. Ryan. More than €600 million every year comes from treating private patients through the public hospital system. It has been correctly pointed out that if that was not there, the public hospital system would collapse.

However, the "RTÉ Investigates" programme focused on several issues that are of critical importance. Both contributions referred to the 80:20 split provided for in consultant contracts, but what we are talking about goes beyond that. The issue concerns the commitment of a small number of consultants who do not seem to be performing their full contractual duties. We are not just addressing the 80:20 split across the system, but also individuals within that who are not performing their contractual obligations. As referred to by Dr. Gilligan, there is also the bigger picture in terms of court cases on the broader issues. However, we are just talking about the issues highlighted by "RTÉ Investigates".

With that in mind, what is the process for bringing a case where a consultant is not performing their contractual obligations to the attention of the clinical director, the hospital manager or the HSE? Is there a process? Does someone pick up a phone and say that a certain consultant is not performing, since he or she is only doing 13 or 14 hours a week instead of 33 hours? Is there a process in place? Has there ever been a consultant who was disciplined because he or she did not perform his or her contractual obligations?

The reason I ask is that there are 685,000 people on waiting lists. I can assure the delegates that I am not blaming any consultant, or the consultant bodies represented here. Primarily a lack of capacity across the public health system, both in physical infrastructure and personnel, is the reason for the 685,000 people on waiting lists. However, the delegates can understand that if one was among the 685,00 people on a waiting list, one would be extremely angry to think that a consultant was not carrying out his or her full public duties under his or her contractual obligations. One would be extremely angry if one was waiting for a long period of time while at the same time we are sending people to Belfast for cataract operations and people are applying for treatment abroad schemes under the cross-border directive. There is an obligation on everybody to ensure that there is as much fairness in the system as possible, accepting the limited capacity, and that all consultants fulfil their contractual obligations.

Both submissions referred to the issue of recruitment. In all the manpower planning assessments over the years it is accepted that we are short of at least 2,000 consultants. There are changing demographics and an increasing population to consider. The situation is not going to improve in the short to medium term. There will be high demand. Reference was made to the fact that we cannot get suitable candidates for vacant posts. In 2013, the Irish Hospital Consultants Association said that the type C contract would be able to attract consultants to posts if it was available more frequently. It would improve the ability of the country to recruit. Is that a factual situation, or is it an aspirational view on the part of the Irish Hospital Consultants Association or the Irish Medical Organisation?

That brings me on to the next question. If we cannot recruit, we face huge difficulty in addressing the problems that are out there, including the 685,000 people we can identify who are on some form of waiting list, although there are probably more we cannot identify. What do we need to do to attract consultants? I assume that turning a blind eye to contractual obligations is not one of the solutions to the problem of retaining and attracting consultants. In the witnesses' view, what would be required to attract consultants? There is a remunerative element. Let us be under no illusions. I said this when the cuts were originally brought in. We compete in an international environment. We do not necessarily compete against Germany, France and the Nordic countries. We compete primarily with English-speaking nations to retain our consultants. That is the market that we are in. I would like to get some views on what we need to do.

The role of clinical directors was also raised this morning. They are paid an extra €46,000. Let us be honest, given the responsibility involved in being a clinical director, one can certainly argue that these remunerative arrangements are required. However, the directors are meant to be at the heart of the delivery of health care, managing the organisation of consultants and the seamless flow through public hospital systems. Is this role working in the way that was envisaged, that is, primarily to ensure consultants were involved in the management process and had a say in how hospitals worked? Equally, it was intended that they would uphold their contractual obligations, and that through the clinical director there would be seamless interaction between the management and the clinicians. They are actually overseeing the enforcement of the public-private partnership.

Reference was made to co-location. Of course, that was a change of policy. There was a policy until the election of 2011, and with many other proposals, it was changed fundamentally. Some of those proposals have not happened, and will not happen because there have further changes. However, the Sláintecare report is the template that has now been accepted by the vast majority of people, although admittedly there are some deficiencies in it. If we do not fund its proposals, it will be just like any other report that has been drafted. It will remain on a shelf and will have no impact on patients and the health system in general. Do the delegates accept that the Sláintecare report's recommendations are the right way to go about addressing the challenges facing the public health system? At the heart of the Sláintecare report is a recommendation that we would disentangle the private from the public system. There was also an impact assessment study into the effects of this disentanglement at the heart of that report. That study is now being carried out by Dr. de Buitléir. Do the delegates accept that public hospitals should be for public patients, assuming that we can address the other issues of recruiting and retaining consultants and attracting them to primarily work in the public hospital system, without having to dangle C contracts in front of them for the years ahead?