Seán Fleming (Laois-Offaly, Fianna Fail)
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To ask the Minister for Health the latest situation with regard to consultants' pay; and if he will make a statement on the matter. [7505/13]

James Reilly (Dublin North, Fine Gael)
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Consultants play a central role in the delivery of our health services. They are committed to the provision of the best quality care to those who use these services. I welcome the leadership and co-operation shown by consultants in the development and implementation of new models of care through the HSE’s national clinical programmes. Two of these programmes were mentioned by Mr. Dan Barrick, who is one of President Obama's health advisers, in a keynote speech given in Oregon several months ago. Our stroke care programme saves one life per week and pre-empts the necessity for three people to go into long-term care.

My priority has been to achieve effective implementation of the existing consultant contracts so that patients get faster access to services and that better patient outcomes are achieved. In September 2012, following intensive engagement between health service management and the consultant representative bodies at the Labour Relations Commission, a comprehensive set of measures was agreed. The agreement encompasses a range of flexibilities to enhance productivity and efficiency and to maximise the availability of consultants, as key clinical decision-makers. The Labour Court issued its recommendations regarding a number of further issues on 6 November 2012. Two of these relate directly to consultants pay, historic rest day arrangements and the fee for the provision of a second opinion as required under the Mental Health Act 2001. Health service management is now engaged in implementation of the measures covered by the LRC and Labour Court processes. I look forward to all consultants embracing the changes agreed at the LRC and accepting the terms of the Labour Court recommendations in the interest of providing the most appropriate and cost-effective services to patients.

In September 2012 I announced that in future consultants would be appointed at a significantly reduced rate, involving a 30% reduction in the salary previously set for new entrants. The first point of the revised pay scale for type A consultants is now €116,207 compared with €166,010 previously, and for type B consultants is €109,381 compared with €156, 258. I appreciate this is a substantial reduction in the rate payable. However, it is a necessary measure if we are to continue to renew and develop the workforce and to provide consultant level career opportunities for doctors.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am sure the Minister has read the programme for Government even if he has not acted to implement it. The programme clearly and unequivocally states that the pay of hospital consultants will be reduced. There were negotiations and flexing of muscles but, in the meantime the Labour Relations Commission and the Labour Court dealt with two issues. What is the position on the agreement that the Minister indicated would be implemented by early October? Are all the consultants abiding by the agreement? Have they embraced the new practices as outlined by the LRC and the Labour Court or are the negotiations ongoing? Are all consultants buying into this and what will be done to those who do not abide by the LRC and Labour Court decisions that the Minister welcomed with open arms? They have not exactly embraced the agreement. It is not news to us that consultants are a critical component of the health service but some sort of sanction is required if they do not embrace the new work practices.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Is the €500 payment for second opinions to consultant psychiatrists still in place? It is scandalous if it is still payable to consultants who are already generously paid. What is the position on the payment, what was the Labour Court's recommendation and what has happened since then?

James Reilly (Dublin North, Fine Gael)
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I will first deal with Deputy Ó Caoláin's question. I have already pointed out that it was a matter to be ruled on by the Labour Court and that we do not believe the practice to be sustainable or justifiable.

The majority of consultants are compliant to the best of my knowledge. I am not aware of instances where they are not compliant. I am reluctant to use the word "always" nor am I confident to use the word "never". I would like to be made aware of any instances of non-compliance and I will ask the HSE to take action to ensure the agreement is enforced. The negotiations are over on this matter.

One of the areas I have not mentioned is the power of the new clinical director, which is particularly important. In the past the clinical director did not have powers to enforce or dictate policy.

Now they are appointed and have the power to direct their colleagues as to when they must be available, when they can take their holidays and when they should be on duty. This is a very important part of reorganising the service to ensure it is done on the basis of what suits patients best, rather than what might suit individual providers of care within the system.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister said he would start off by answering the previous Deputy's question, but he did not. He just alluded to it. My question is straightforward. Is the second opinion payment still in place? What was the Labour Court recommendation? Has it been implemented and if not, when will it be implemented? If the Minister does not know the answer, that is okay. I will not scold him over that. He can send me the information when he has had the chance to check it.

Billy Kelleher (Cork North Central, Fianna Fail)
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In the context of the national clinical care programmes, we all agree consultants are an integral part of the delivery of health care. I do not know of a specific case, but the Minister said there were continuing negotiations regarding the implementation of the Labour Court and LRC recommendations. Generally, is the Minister confident there has been a positive buy-in by consultants with regard to the changes for the clinical care programmes and other work practices?

James Reilly (Dublin North, Fine Gael)
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I will provide Deputy Ó Caoláin with a more complete response when I have had a chance to check the exact status of things. With regard to Deputy Kelleher's point, there are no ongoing negotiations. The negotiations are over. The LRC negotiations have finished.

Billy Kelleher (Cork North Central, Fianna Fail)
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Are there not negotiations with the HSE on the implementation of the recommendations?

James Reilly (Dublin North, Fine Gael)
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No, there is no negotiation. The implementation of the arrangements will be done through the clinical directors. It is important to point out that the bulk of consultants had been doing this sort of work pro bono, and I thank them for that. They have done an extraordinary job in terms of embracing the new changes. In 2011, they have, through the clinical programmes and coming in at weekends to discharge patients and read diagnostic reports, such as MRIs, X-rays etc., saved €63 million and 70,000 bed days. Last year, they saved €90 million and 100,000 bed days. Therefore, the savings are being made in a real way. I cannot run a service on a pro bono basis and that is the reason the LRC talks were so important so that this issue could be nailed down as a contractual obligation, which it now is. We are getting co-operation on it and I have not heard of any areas where we are having difficulty. If I do hear of such areas, I will, through the good offices of my Department, encourage the HSE to ensure the arrangements are enforced. It is important to remember that this should be about patients and patient outcomes and we are all focused on that now.

Again, I reiterate my thanks to the new leadership emerging through the clinical programmes, the nursing profession, the medical profession and allied care professionals in regard to working in a different way. I would not dream of insulting people in the health service by saying they must work harder or smarter. They already work very hard and that has never been the issue. The issue has been a system which was allowed to evolve in a chaotic fashion that frustrated and prevented them from delivering the care they wished to provide.