Pádraic McCormack (Galway West, Fine Gael)
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Question 85: To ask the Minister for Health and Children her views on the recent comments by the Irish Hospital Consultants Association that the new consultants contract is deficient in many areas and does not reflect the agreement announced in January 2008; the aspects of the agreement reached in January 2008 that were omitted from the proposed contract; if a revised contract will be presented to the consultants; when she expects the Health Service Executive to begin recruiting consultants; and if she will make a statement on the matter. [9398/08]

Eamon Gilmore (Dún Laoghaire, Labour)
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Question 148: To ask the Minister for Health and Children the position with regard to agreement on the consultants' contract; and if she will make a statement on the matter. [9325/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 85 and 148 together.

Negotiations between health service employers and the Irish Hospital Consultants Association, IHCA, on new contractual arrangements for medical consultants came to a successful conclusion on 24 January 2008. While the Irish Medical Organisation, IMO, withdrew from the talks on 22 January 2008, it engaged in subsequent dialogue with Mr. Connaughton, who had facilitated the agreement. Mr. Connaughton issued a final document on 1 February 2008 setting out the agreed position and his recommendations on a number of issues.

All parties agreed that Mr. Connaughton be invited to draft the formal employment contract and that a composite document summarising the key elements of the agreement be prepared and forwarded to him at the earliest opportunity. It was clearly understood — and agreed — by the employers, the IMO and the IHCA that this document would be a summary of the agreement rather than a formal contract.

On 22 February, a revised composite document, based on the various documents and recommendations issued by Mr. Connaughton during the course of the negotiations, was circulated to the IHCA and IMO. The national council of the IHCA considered this document on 23 February but deferred a decision on it until the end of March. We are satisfied that the document reflected the main areas of agreement under various headings. However, there is ongoing contact between the parties to clarify certain aspects.

As far as health service employers are concerned, the only substantive issue outstanding is the rate of salary applicable to academic consultants who sign up to the new contractual arrangements. This is the subject of ongoing contact between the sides. In the meantime, we need to proceed with the process of recruiting new consultants. I have already engaged in discussions with the HSE in this regard. The delay in filling posts in critical areas such as cancer care, neurology, rheumatology, respiratory care and mental health is having a detrimental effect on the development of much-needed services.

James Reilly (Dublin North, Fine Gael)
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The Minister announced the agreement on the contract, to great fanfare, a couple of months ago. What has happened in the interim? Why is the IHCA of the view that nothing meaningful has occurred? Is it possible that a new contract will not come into being in 2008 and that the HSE will not, therefore, employ any new consultants, thus avoiding the €300 million shortfall it faces in the context of funding? Many people are coming to the view that this is the strategy.

How many new consultant posts will be filled this year? I would like the Minister to provide a definite number in that regard. She may, if she so wishes, provide written information at a later date in respect of the nature of the specialties to which these new posts will apply.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not accept that there are many issues outstanding. The agreement was reached and announced in good faith and was signed off on by Mr. Connaughton. As the Deputy is aware, we do not have agreement with the IMO. There were a number of issues in respect of which tidying up exercises were required. One of these related to academic consultants and another to emergency consultants and the current group thereof. We are satisfied that the composite document circulated recently to both organisations reflects the agreement that was reached. There has to be a contract, which is different from, although it encompasses, the agreement. Close to 100 consultants will probably be recruited but I do not know when they will all be in place. We have advertised for 68 and Professor Drumm announced 100 plus as a result of performance in accident and emergency departments.

James Reilly (Dublin North, Fine Gael)
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There is funding for only 20.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy misunderstands. These posts are not being funded by additional revenue. The idea is that we suppress junior posts to create senior ones. All bodies acknowledge that we need 6,000 hospital doctors, 4,000 consultants and 2,000 juniors. We have 4,000 juniors and 2,000 consultants. The Deputy knows from his own experience that suppressing the cost of many of the non-consultant doctors will more than meet the cost of appointing consultants. The intention is that the additional resources, such as they are, will mainly come from the suppression of junior posts rather than additionality.

Jan O'Sullivan (Limerick East, Labour)
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Some medical newspapers report that there is a problem with the detail of the 80-20 mix for consultants. Will the Minister clarify whether that is a problem? Is the Minister saying that there will be money to appoint extra consultants this year?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The move from 4,000 non-consultant hospital doctors to 4,000 consultants should be cost-neutral. This has been the subject of discussion for many years. It is not a question of keeping the 4,000 non-consultants and having 4,000 consultants as well. The Health Service Executive will receive an additional €1.1 billion during 2008.

There are transitional arrangements for the incumbents agreed over a three year period. The 80-20 mix will no longer be designated by beds but rather by volume so a consultant will be entitled to see one fee-paying patient in a public hospital for every four public patients he or she sees. That is very different from the situation in many hospitals today.

Pádraic McCormack (Galway West, Fine Gael)
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The Minister said agreement was reached in January. Why is the matter now being revised again and why is the Minister saying it may be the end of March before we reach an agreement? The Minister does not sound as confident as usual that this matter is settled. The negotiations started almost five years ago and the Minister announced a deal. Is the HSE stalling agreements and why would it do this and not appoint consultants? When will the consultants be appointed and by what process? Will there be a public advertisement and will they have to give notice where they are now? Will it be another year before they are appointed? What is the time scale for the appointment of the necessary consultants if this agreement is reached at the end of March?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We would have reached agreement with the consultants a long time ago if we had simply agreed with everything that everybody sought but there is give and take in negotiation. It was no different here and access to public hospitals for public patients was crucial to negotiating a new contract so that there would be one for equality of access to diagnostics, outpatients and so on. That is extremely important in facilities funded by the taxpayer in a society where we are all entitled to coverage.

It takes time to recruit consultants. It is a global search although many of the senior registrars will qualify for many of the appointments. We are seeking to bring the best doctors to Ireland, many will be our own people who work in Canada, the United States, the United Kingdom and elsewhere. For them to disengage from their existing employment and come here can take upwards of a year.

The HSE is not trying to revise anything. Mr. Connaughton, the chairman of the talks, announced the agreement. He was an independent chairman whom both sides respected highly. As in all agreements, when it comes to dotting the i's and crossing the t's problems arise. These mainly concern the academic consultants. We have offered a salary of €265,000 but consultants want €310,000. We have suggested referring the matter to the review group on higher pay because of that difference.

Pádraic McCormack (Galway West, Fine Gael)
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So there is no agreement.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister has indicated that she regards the scandalous delays of up to 18 months in diagnostic procedures for cancer, including colonoscopy, as unacceptable. She has also cited the new consultants' contract as a means to address the situation. Will the Minister advise the House on how exactly that will be done, where the new consultants will be deployed and how that will impact on the scandalous waiting time?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I dealt with this earlier today. It is a matter of great concern, especially for cancer care, and Professor Keane is in discussions with the professional organisations, particularly the Irish College of General Practitioners, about the form of referral so that we can separate what would be broadly called urgent from routine cases. There are protocols and best practice models in place in many jurisdictions, including Canada, that we will put in place here. The intention is that people will be diagnosed within a two-week timeframe. They can get early diagnosis and treatment. That will be done for the main cancers at the eight centres.

We have all acknowledged that the best health care system is one in which consultants deliver the service, not just lead the team. That requires doubling the number of consultants. This year we will begin to recruit those additional consultants, including in cancer care.

James Reilly (Dublin North, Fine Gael)
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If there are 6,000 hospital doctors comprising 2,000 consultants and 4,000 non-consultant hospital doctors, which will change to 4,000 consultants, the pay equivalents do not stack up. Junior hospital doctors cost so much only because of the inordinate overtime they do, up to 100 hours per week. I doubt that is envisaged in the new consultant contract, so it will never be a 1:1 or even 1:2 ratio. Will the Minister explain what ratio she is working off because, as I pointed out, there is funding for only 20 consultants although she talks about appointing 100?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Part of the new contract includes longer working days and cover for 24 hours a day, seven days a week, where required. We will not be funding the substantial overtime bills that we fund at the moment. These have arisen because of the manner in which we have employed consultants in the past. It is often the case that because consultants work across several different sites ward rounds are done in the evening and the team has to stay back on overtime to accompany the consultant so there are many such issues to be resolved.

I am not saying that the additional money will be a zero sum game for the Health Service Executive but the bulk of the additional resources will come from reducing the number of non-consultant hospital doctors, many of whom are qualified to be consultants, and enhancing the number of consultants.