Professor Alan Irvine:

I will be very brief because Ms Clyne has not had a chance to speak and she has two questions to answer while I have just one. On the question of the public-only contract, one of the reasons we are in this position is that we have a vision that is created centrally by employers that will "solve the problem". It does not take cognisance of what the people who actually know what will solve the problem will say. If this is another unilateral offer, it will not work. Unilateral offers rarely do. The public-only contracts will work for some disciplines and some people, depending on the conditions. We have not seen those. We are not in a negotiating space yet, nor is the IMO. We are not involved in that yet. We will negotiate things as we are allowed, but if there is a prefixed ideal from one side of where that should end, it probably will not solve the problems.

There are reasons that people want to retain freedom to work outside the public system, and they are not all financial. Many of them are due to work satisfaction, having access to a list and perhaps being able to do a procedure one cannot do. We are going to see procedures squeezed out of the public hospitals because of capacity issues. We are already seeing the cancellation of routine work. If one is a physician or a surgeon who does procedures, one wants to be able to keep the skills set in which one has invested heavily over the years in training, and perhaps one cannot express that in the public system. Controlling every aspect of these senior professionals' lives, over and beyond what they discharge wholly in their public contracts, does not necessarily make good sense. It will not fill all the gaps in the system. We need a flexible approach, but we mainly need people to listen genuinely and not come with a prefixed idea.