Mr. Liam Woods:

I thank the joint committee for the invitation to discuss the consultant contract. I am joined by my colleagues Ms Colette Cowan, chief executive officer of the University of Limerick hospital group and Ms Angela Fitzgerald, deputy director of the acute division.

The recent "Prime Time" programme examined the issue of private practice in the public hospital system and identified a number of unnamed individuals who allegedly were not meeting their contractual obligations. The issues raised are concerning for patients, their relatives and the wider public. Our hospital level data show that with a small number of exceptions, individual hospitals are compliant with public-private mix requirements. In fact, the proportion of public patients treated is higher than the required level. This suggests that the issues raised in the programme are about individual practice rather than whole system non-compliance issues.

I propose to move on to the next section on fulfilling commitments. Consultant duties in a hospital encompass three distinct elements, namely, health care provision, education and research. I will move on to discuss the types of contract under heading two of my statement. Type A contracts are for consultants treating public patients only while type B contract doctors can treat private patients within public hospitals. Type B* doctors were employed pre-2008, which is the latest contract date, and transferred to the new contract and they are allowed to have off–site practice. Type C doctors are allowed to have off-site practice and their private practice limits within a public hospital are also prescribed.

Nationally within the acute system, there are 6%, or 169 consultants holding type A contracts, while two thirds or 1,789, contract holders are on type B contracts while 28% hold types B*, C, or pre-2008 contracts.

For the committee's information, there are 364 consultants who are holders of pre-2008 contracts. That contract is colloquially known as the Buckley contract.

The oversight arrangements have been outlined. They are designed as points of reference with a view to ensuring accountability, recognition of joint appointments and cross-hospital work arrangements, and guidance regarding detailed calculation of compliance. There is a detailed guidance note, which can be made available to the committee, for hospital groups and hospitals to implement the contract. We can return to this issue later if the committee so requires.

Current compliance was referenced in the Department of Health's opening statement. Some 82% of inpatient work and 85.8% of day-case work is public. Thus, at a national level the overall hospital system in is compliance. Clearly there is a challenge around individual compliance within that, which we will come to discuss. For those sites where more than 30% of work consists of private practice, there are relevant factors to be considered, including the impact of paediatric and maternity, historical bed designation and the absence of private services in locations.

I refer to interventions in cases of non-compliance. The HSE's performance management process has highlighted issues or areas of potential non-compliance, and has, where it has been deemed appropriate, intervened to examine and address such non-compliance through independent review or internal audit. Two examples of such reviews took place in the University of Limerick Hospitals Group and St. Vincent's University Hospital Group. The findings from such review processes serve to inform improvements in internal controls.

I refer to structural challenges in overseeing the contract. I mention the decision by way of legislation to de-designate private beds. The 364 holders of Buckley contracts are entitled to practice in beds that were designated private. That designation situation changed in 2013. That does not mean that those contracts become unmanageable. However, the expression "designated bed" has been removed from the legal framework but still resides within the contract. There is no mechanism to allow the HSE to determine if consultants have billed and been paid for all patients recorded as private on hospital systems. None of the consultant contracts makes provision for the monitoring of off-site practice and private patient income accounts for 12% of total acute hospital funding.

I will take the issue of the potential displacement of public work as read. There is a lot of content on this topic. In our submission we have flagged some of the factors that are more generally pushing the hospital system. These include the growth in emergency attendances; an increase in attendances by the over-75 age cohort; bed-days lost to delayed discharges, typically accounting for around 550 beds; beds closed due to staff shortages; and consultant manpower shortages. By comparison with OECD, Health at a Glance comparators, and other analysis, we would need at least another 2,000 consultants to reach a middle level across OECD comparators. One of the core issues facing our system is that we do not have enough consultants in certain key specialties.