Ciarán Cuffe (Dún Laoghaire, Green Party)
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Question 112: To ask the Minister for Health and Children if her attention has been drawn to the pay demands of consultants and junior doctors; her views on whether such demands should be linked to negotiations on their respective contracts; and if she will make a statement on the matter. [29561/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am aware the Irish Medical Organisation has, on behalf of junior hospital doctors, submitted a claim to the Public Service Benchmarking Body for a 20% pay increase. The benchmarking body, which is independent, examines and reports on the pay of public service grades with reference to pay rates for similar types of employment in the private sector. A media report has suggested that a similar claim may be submitted to the Review Body on Higher Remuneration in the Public Sector on behalf of consultants. The review body, which is independent, examines and reports upon the remuneration of consultants and other senior public service grades. In making its report, the review body is expected to have regard to the desirability of encouraging a high level of efficiency and effectiveness in the relevant areas. The Health Service Executive and I are keen to ensure that any pay increases awarded by either body will reflect the level of co-operation by medical grades with the health reform programme. A new contract for consultants and junior hospital doctors is a central element of that programme.

John Gormley (Dublin South East, Green Party)
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When I attended the recent People of the Year awards, at which the Minister, Deputy Harney, spoke eloquently, I spoke to a consultant who expressed his view that the Minister's long-term aim is to introduce what he called "yellow pack" consultants, who would not be as well qualified as Irish consultants. I ask the Minister to comment on that. The consultant made the point that some young consultants who have returned from the United States are having difficulties in finding houses in Dublin and living in Dublin. I ask the Minister to comment on his suggestion that media reports of consultants' huge salaries are often exaggerated. Is the Minister aware of the interesting RTE documentary series, "Junior Doctors", which highlights the excessive hours worked by such doctors? They work even harder than we do, which is saying a lot. When we have been working for many hours we can go on auto pilot, but junior doctors have to make decisions of life and death in such circumstances. Does the Minister agree they should be remunerated properly for all their work and responsibility? Does she believe their hours should be cut, for the sake of patients?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I want to refute the term "yellow pack" consultants. I do not know what that is supposed to mean. I will not be appointing consultants; they will be appointed on the basis of their expertise. In many countries, after a doctor is trained as a consultant, he or she then takes up a consulting position. In Ireland one could be training for 20 years and never, unfortunately, be given a consulting position. I am not suggesting that every junior hospital doctor or non-consulting doctor should become a consultant. That is a decision I am not qualified to make nor should I make.

A consultant's basic pay begins at €139,000, rising to €181,000. On top of that, he or she will have allowances of about €22,000. That is not an inconsiderable salary. An academic consultant will be paid €222,000. There is not much private practice for many consultants in specialties such as geriatrics and paediatrics. In other areas, the opportunity for private practice, on top of the existing salary, exists. The intention with the working time directive is to reduce working time for a junior doctor from 77 hours to 55 hours per week. A junior hospital doctor receives almost the same pay as a consultant, particularly when one factors in overtime. On a 55 hour week, the earnings of a senior house officer stand at €104,000 while those on the special register stand at €152,000. We want fewer junior doctors in the health service. We have 2,000 consultants but 4,000 is the figure we need to achieve in the next few years. I hope we can have a new contract of employment that delivers flexibility and teamwork.

I referred earlier to the clinical directorate. Doctors are among the brightest and best educated of our graduates. Their remuneration must reflect that, as it does in other countries. This is not a question of saving money but of having flexibility and a contract of employment that suits our health care needs. It cannot be a one-size-fits-all solution. I want a range of different contracts that suit different circumstances.

In many countries, a doctor working in a peripheral location will be offered a more lucrative salary than if working in a large centre of population. I acknowledge the Deputy's comments on house prices. There is no doubt, particularly in Dublin, Cork and some of the larger cities, it is a factor in attracting people home.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Is it acceptable that five years after the Government's health strategy which promised a new consultants' contract talks leading to it have not even begun? What is the Tánaiste's view on this? Gabh mo leithscéal, I meant former Tánaiste. Will she acknowledge that this Government, of which she is an integral part, and a succession of other Governments, have allowed an elite in the medical profession to enjoy a position of privilege unrivalled by any other sector in society? Will she accept that her initiative of private hospitals being developed in public lands adjacent to existing public hospital sites is undermining the Government's negotiating position with the consultants' representatives? Only yesterday, this was demonstrated by a spokesperson from the Irish Medical Organisation, Mr. George McNeice. He asked why the Government will proceed to deal with category 2 contracts while allowing for the development of new private facilities adjacent to public hospital sites.

What are the Minister's plans to stand up to these vested interests which perpetuate a piggybacking off our public health care system for their personal greed? The people want to know what she intends to do about it.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy need not apologise for calling me Tánaiste. For the first two months when I had the job, I always thought it was Dick Spring was being referred to when the title was used. It does get confusing. I also remember the Taoiseach, on this side of the House, referring to John Bruton as Taoiseach.

I do not share the Deputy's perspective on consultants. What is needed with the consultant contract is flexibility and teamwork. It may sound clichéd but we want consultants to deliver the services because they are the most experienced and competent in the business. The category 1 contract allows doctors to engage in public and private practice in a public hospital. Category 2 allows a doctor to have a private practice off-site in several hospitals. I want doctors to be kept on hospital sites. If a co-location facility exists on a hospital site and it fits in with a current category 1 contract, a doctor will be on-site and working in the facility.

I am concerned that particular arrangements are in place for a public practice in a public hospital and to which a consultant will be committed. It must also be measured and monitored so we get what we are paying for. We get an excess of what we pay for from many doctors who work beyond the 11 sessions or 33 hours a week. There are many difficulties with the current contracts and we could never negotiate such contracts again.

I agree with the Deputy that it is disappointing new contracts have not been agreed. The talks began and collapsed on two occasions. I understand Mr. Connaughton, SC, the chairperson of these talks, is talking with both sides. I hope this will have a successful outcome. I saw many positives in Mr. McNeice's article yesterday. I got the impression the IMO wants to return to the negotiating table. I would welcome that and like to see it happen as soon as possible.

John Gormley (Dublin South East, Green Party)
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The Minister said that with overtime, a junior doctor could earn considerable amounts. How much of the 77 hours a week is overtime or is it on top of that figure? How confident is the Minister that the working time directive will be introduced? When will junior doctors be working a 55 hour week?

Mary Harney (Dublin Mid West, Progressive Democrats)
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It should be 58 hours. I was wrong when I said 55 hours. Agreement has been reached on nine pilot sites where this working time structure will be implemented. It is, however, on hold pending the talks at the LRC and I cannot say when these will be completed. The sooner, the better because no one wants junior hospital doctors working the hours they have to now. It is neither good for them nor their patients. The only way this can be reorganised is through agreement. We cannot, however, be expected to pay 20% more for a substantially reduced working week.

John Gormley (Dublin South East, Green Party)
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How much of the 77 hours is overtime?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not know the breakdown.