Mary Harney (Dublin Mid West, Progressive Democrats)

The HSE is responsible for hiring consultants and Comhairle na nOspidéal has been subsumed into the HSE since the end of December last, which makes sense.

Consultants are currently contractors in the health care system and are not employees of the hospitals. We wish to move to them being employees. A public-only contract commits the individual to work on all patients that come into a specific hospital for a particular salary. There would be no incentive with regard to remuneration received for a doctor to take one patient over another, and this would be a desirable scenario.

There are roughly 2,000 consultants at the moment. There are approximately 500 consultants in what is termed as category 2, which means they work on-site in public hospitals and off-site in other places. There are approximately 1,500 consultants in what is termed as category 1. These can carry out public and private work on one site. Very few do not have a private practice. It has been decided that no more category 2 consultants will be employed. Private hospitals must move to employing their own staff.

There are 2,500 private beds in public hospitals, for which the hospitals get paid by insurers in any one year. One Dublin hospital only gets paid for approximately 20% of the beds, although 46% of the beds are used for private work. This is an incredible statistic at one level. The idea behind the hospital initiative is to remove private beds from the public hospital system and convert these to public beds for use by public patients. This is the reverse of how it is being presented in some quarters. The role of the HSE is to assess applications, and there have been six different expressions of interest. The HSE will shortly formally go to tender to receive expressions of interest.

The HSE will have to consider whether needs are being served in a particular area. It may be the case that there is adequate private provision in a specific area and it may not make sense to create another private facility. It may also be that capacity is such in a public hospital that it would not make sense to have another facility co-located. In the context of a new contract, these hospitals may well supply services and occasionally supply staff to the public system, rather than the other way around, or the public system supplying private facilities with staff.

We will be in transition for some time as the existing consultants' contract has no review clause and is therefore a legally binding document for all consultants who have it until they retire. The timeframe is at least another 20 years or more depending on whether one takes the view of these consultants retiring at age 60 or 65. Our current cohort of consultants have a legally binding contract that entitles them to public and private practice, either on-site or off-site. This is the transitional arrangement we will have for the next 20 or 25 years, unless everybody opts for a new contract, which is unlikely despite being desirable. It would not be attractive enough for those who have a big private practice.

We wish to see a new contract focused on patients not on whether patients will pay in public hospitals. We wish to see a review clause in the contract as it is not desirable to have a contract which is not subject to review at least every five years to ensure it is meeting the needs of the health care system. There is no difficulty in what is being put on the table for discussion. We need to employ, as I acknowledged earlier, more than 2,000 more consultants in the health care system over the coming years. We should employ them on the basis of a contract that serves the needs of the public health care system in a better fashion than the current contract arrangements.

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