Liam Twomey (Wexford, Fine Gael)
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Question 1: To ask the Tánaiste and Minister for Health and Children her views on extending the working date for hospital consultants; if it is part of the present contract negotiations; the negotiations which have taken place to date; and if she will make a statement on the matter. [8735/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Under the terms of the 1997 consultant contract, each consultant is contracted to work within the normal working week from Monday to Friday. Most consultants are also available on an on-call basis outside these hours. In 2003, the national task force on medical staffing recommended that health professionals should work as part of a multidisciplinary team centred on delivering quality patient care over the full 24-hour period. Since 2003, management has sought to begin substantive negotiations on a new contract with the medical organisations. For a number of reasons, including the organisations' opposition to the extension of the clinical indemnity scheme to consultants, both the IMO and the IHCA did not begin talks until November 2005.

Talks on a new contract began on 24 November 2005 under the independent chairmanship of Mr. Mark Connaughton SC. At that meeting and at a further plenary meeting in December, both the IHCA and the IMO indicated that they required a number of issues to be addressed before they could engage in substantive negotiations on a new contract. A position paper outlining proposals on a new employment contract for consultants working in the public health system was tabled by management at a plenary meeting on 26 January 2006. The medical organisations have refused to engage in substantive discussions on these proposals. The talks were adjourned at a further meeting on 9 February. While a further meeting between management and the consultant representative bodies has not yet been arranged, the independent chairman is maintaining contact with both sides with a view to arranging a formula to effect the resumption of substantive and intensive negotiations at an early date.

In its proposals to the medical organisations, the management team has outlined the need for consultants to work a 39-hour commitment over the 24-hour, seven-day period agreed and detailed in an annual work plan for each consultant. Work plans will follow a framework developed at national level and will be reviewed and agreed annually by consultants, clinical managers and management.

Additional information not given on the floor of the House.

The key objective of the new contract is to address the needs of all patients by achieving greater equity and increasing productivity in a consultant-provided 24-hour, seven-day hospital service. This will ensure that patients have access to senior clinical decision makers, that is, the consultants, when they need them. Rapid access to consultants will speed up diagnosis and treatment and reduce the need for repeated reviews by junior medical or other staff. It will also mean that patient or clinical need determines the nature of rostering arrangements for consultants and that patient access to care and the speed with which care is delivered is determined only by clinical need.

Liam Twomey (Wexford, Fine Gael)
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Has the Department ever seriously considered extending the consultants' working day from its current format of 8 a.m. to whenever? If work was done on the issue in the Department, what were the difficulties encountered in extending the consultants' work time? The four-page document given to the consultants by the Health Service Executive on behalf of the Minister did not mention extending the consultants' working day. I thought such an extension would have been an integral part of both the European working time directive and the Minister's plan, namely, the Hanly report. Why does this aspect not feature in the renegotiation of the consultants' contract? Has the Department more or less rejected the idea of extending the working day?

I understand what the Minister says about the negotiations with consultants not happening, but there is nothing coming from the Department indicating that she has any great interest in it either. What background documents does she have? What difficulties does she think she will encounter, apart from those with the consultants? The extension of the consultants' working day would make outpatients clinics more available, but that idea seems to have fallen off the radar.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is correct. The idea is to provide a 24-hour, seven-day service delivered, rather than led, by the consultants. There are 4,000 non-consultant hospital doctors and 2,000 consultants working in this country and we need to change that ratio around if we are to have consultant delivered services. The commitment in the current contract is for 39 hours to public service work and we want to change that. We want to introduce a new contract for full-time public consultants so that consultants are not incentivised to see one patient over another and that all patients who enter a public hospital will be seen by a consultant who is salaried to see them. As part of any new contract of employment, we want to have consultants employed on a 24-hour, seven-day basis. These issues must be agreed in the negotiations. It is not correct to say that we are trying to have an 8 a.m to 5 p.m. day for consultants. Consultants will be expected to work evenings, nights and weekends. Perhaps that could be excluded for older consultants, but it would be the norm for younger consultants and part of their contract of employment.

Liam Twomey (Wexford, Fine Gael)
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My question has not been answered. The idea was to extend the core working day. Discussions on this issue went back to 1999 when we first raised the idea of extending the consultants' core working day. That seems to have fallen off the radar completely. Why is that the case?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Unless we can change the current consultant contract, it is not feasible to negotiate the extension of the working day either from a personnel perspective or a financial perspective. To address one issue in isolation is not satisfactory. Consultants have a contract of employment that lasts their working career. Either side can break or alter the contract, but there are serious financial implications if that is done.

We want a new contract for new consultants which is more modern and which involves consultants working in teams with clinical directors and so on. The clinical director would be responsible for ensuring that consultant cover is provided on an ongoing basis. However, it would not be satisfactory to negotiate it in isolation from the other issues.