Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Ceann Comhairle for giving me the opportunity to raise this issue in order to clarify exactly what was agreed at the Labour Relations Commission recently. Obviously, we have all been for some time awaiting a conclusion to the discussions that were going on in the background. In recent weeks, the Minister said that, after losing patience with the progress that was being made in terms of the implementation of the 2008 agreement and the discussions under the Croke Park agreement, he referred the matter to the Labour Relations Commission. We then had an announcement that the Minister was pleased with the outcome of the Labour Relations Commission discussions and that agreement had been reached.

Although I am not definite on this, it seems the Irish Hospital Consultants Association and the Irish Medical Organisation have stated they did not actually agree anything and that it would be a matter for consultation and discussion. I am trying to get clarity as to whether an actual agreement has been reached and the IHCA agrees with that agreement or whether the Minister announced something in haste and in advance of the actual agreement being signed off by its members. I say this because an internal document circulated to IHCA members stated there was no agreement yet on proposals for work practice reforms, which is a fundamental issue that was being discussed in terms of the Labour Relations Commission dialogue with regard to rostering, 7-7 discharge and so on.

In addition, the Minister said these work practice changes, the 7-7 discharge and the reduced consultant pay for new entrants would generate savings of about €200 million and that it would be implemented on 1 October. That date is coming quickly upon us and, as I said, it seems to be the case that the IHCA and IMO are first going to circulate this for discussion with their members and they would then consider the Labour Relations Commission recommendations after hearing from their members. There is some confusion as to what exactly is agreed, as opposed to what we might like to think is agreed, in terms of rostering, changes to work practices and so on.

The other issue concerns the level 1 consultant with no private practice, which is a post the Minister talked about establishing, although it seems to have fallen completely off the agenda. This is another key area where we need clarity.

In conclusion, the two issues are, first, what exactly has been agreed and, second, how the Minister has analysed that this will save €200 million in view of the fact we are not quite sure the representative bodies have agreed to the full package of measures the Minister announced and welcomed with a certain amount of fanfare a number of weeks ago after the dialogue with the Labour Relations Commission.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy for raising this important issue. The Government has confirmed on a number of occasions the unprecedented nature and scale of the financial pressures facing the State. Ongoing reform and increased efficiency in service delivery is essential. It is imperative that consultants, given their role within the health system, lead this process.

The recent discussions with the consultants' representative bodies took place in the context of the public service agreement, better known as the Croke Park agreement. The health sectoral agreement constitutes a key element of that agreement. It emphasises that the required reorganisation of health services and the health service workforce will focus on providing, across all settings, planned services over an extended day, from 8 a.m. to 8 p.m., on a Monday to Friday basis and/or a five over seven day basis, while also providing emergency services on a 24-hour, seven day basis. This requires achieving a more productive match between staffing and service activity levels while safeguarding quality and clinical performance.

These requirements provided the background to the recent engagement with the consultant representative bodies. Following direct negotiations on proposals put forward by the management side, management referred the proposals to the Labour Relations Commission, LRC, in accordance with the public service agreement. Intensive discussions between health service employers and the two consultant representative bodies commenced on 13 September 2012 at the LRC and concluded on 17 September 2012. These dealt with a range of matters, including measures to ensure that the relevant parts of the health sectoral agreement within the public service agreement 2010-2014 can be given effect. The management team comprised officials from the HSE, my Department and the Department of Public Expenditure and Reform.

The outcome of this engagement is that detailed proposals have been agreed between the parties. The key provisions include an agreement that consultants will be available for rostering for any five days out of seven as opposed to weekdays, as at present. Consultants can be rostered, where required, on a 16 hour day basis, that is from 8 a.m to midnight, or on a 24 hour day basis, where this is required. Clinical directors will have a much strengthened management role in respect of consultants. Consultants will co-operate with a range of measures to support improved community and mental health services. Consultants committed to measures that ensure that public patients waiting for elective care of any type are seen within clinically appropriate timeframes. It was agreed that consultants will comply with the contractual requirements regarding private practice. Consultants commit to expeditious processing and signing of claims for submission to private health insurers. There will also be more cost-effective arrangements for funding of continuing medical education.

The agreement also puts on a formal basis consultants' co-operation with a range of productivity flexibilities, which will allow for considerable efficiencies in the use of hospital beds, with the potential to deliver a saving of 220,000 bed days annually. Implementation of the agreement will result in more patients being treated more quickly, more efficiently and with greater consultant input.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister for his reply. Is he confident that the full range of measures he says have been agreed with the IHCA and the IMO within the terms of the LRC's recommendations will begin to be implemented from 1 October onwards and that savings will start accruing immediately? Another issue of concern, about which I asked some parliamentary questions some time ago, is that of consultants complying with the contractual requirements regarding private practice. The replies I received outlined the fact that there were breaches of such contractual requirements and that the Department would have to move to disciplinary action if the issue was not addressed. Is the Minister satisfied that this agreement, as outlined, will commence on 1 October, as stated, and that action will be taken to ensure that those who are currently in breach of their contractual obligations will comply?

James Reilly (Dublin North, Fine Gael)
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The proposals agreed with the representative organisations put a range of productivity flexibilities on a formal basis. The organisations have agreed to present the agreed proposals on reforms to their members for consideration. I expect this to be done in a timely manner, having regard to the relevant provisions in the public service agreement.

Separately, new consultants will be appointed at a significantly reduced rate, involving a 30% reduction in salary for future consultant appointees. The relevant pay scales have now issued from my Department for implementation. Management proposals to reduce the rest day arrangements that currently apply and to eliminate the fee to consultant psychiatrists for giving a second opinion under the Mental Health Act 2001, will be referred to the Labour Court, in line with the procedures provided for in the public service agreement. The issue of historic rest days will be referred to the Labour Court, in line with normal procedures.

The proposals which have been agreed between the parties, when implemented, will allow for very significant reforms in how health services are delivered and ultimately will lead to more efficient service delivery and improved outcomes for all users of the services.