SOME TERMS IN a draft Sláintecare consultant contract have caused outrage among doctors, with unions set to engage with the HSE and Department of Health on the details of the deal. 

The public hospital contract firmed up on 31 May will not allow doctors to conduct any private hospital work and will have a starting salary of almost €189,000, the Department of Health said.  

This will increase to a range of around €220,000 to €252,000 by July 2022 under public service pay restoration agreements.

The contract forms part of the government’s Sláintecare cross-party plan aimed at transforming Ireland’s health and social care services over the course of a decade. 

There have been ongoing disputes between the Irish Medical Organisation (IMO) and the Department of Health for years in relation to issues such as consultant pay disparity and treatment of junior doctors.

Ahead of engagement with unions, the public-only consultant contract contains some terms that doctors say they are not satisfied with. These include clauses around patient advocacy, work location and intellectual property rights.

One doctor said the contract is arriving into an “already demoralised health system”.

The Department of Health and HSE said they are “open to engaging on the draft” deal with the Irish Medical Organisation and the Irish Hospital Consultants’ Association (IHCA). 

The department said the contract will be introduced following this engagement. 

Much of the contract is similar to other consultant contracts, with some differences doctors have taken issue with. 

The contracts will apply to junior doctors going for consultant roles, but existing consultants who want to change over will also be able to make the switch. 

Many hospital consultants at the moment have contracts allowing them to treat both public and private patients. 

In December 2019 when this contract was announced, the then-Health Minister Simon Harris said: “Moving towards single-tier public hospital care will mean a fairer health service, a more sustainable and efficient hospital service, and shorter waiting times.”

Doctors who spoke to The Journal don’t believe this aim will be achieved with the draft consultant contract, and believe consultants already on contracts are unlikely to change over under the current conditions. 

‘Lack of respect’

One doctor said they believe the contract shows a “lack of ambition” around Sláintecare.

A significant issue concerning doctors is the “gagging clauses and the lack of respect towards doctors and consultants”, one doctor said. 

Consultants can advocate for patients and speak out against wrongdoings they see, and this draft contract says consultants may advocate on behalf of patients/service users or people awaiting service.

The contract adds that this advocacy “should take place within the employment context through the relevant Clinical Director or other line manager”. 

A similar line was included in previous contracts, but with the prelude to contact a clinical director or other line manager “in the first instance”. This is not included in the Sláintecare contract.

One doctor said they believe this change will not be “in the best interest of patients” as it may lead to issues falling below the surface.

They also criticised the “very surprising clause” around intellectual property rights, saying it was “baffling”. 

These rights could be applied for the creation of innovations.

Doctors are concerned that the wide-ranging terms set out in the contract will mean the rights for anything they create, whether inside or outside work, could be stripped from them. 

Previous contracts said intellectual property generated by the consultant in the course of their employment “shall be in the ownership of the relevant health sector/academic employer(s)”.

This contract expands on this, saying that “all Intellectual Property Rights and Inventions created wholly or party” by the consultant during the course of their employment “whether or not during working hours or using the Employer’s premises or resources” belong to the employer “to the fullest extent permitted by law”. 

Consultants also can’t attempt to register intellectual property rights or seek to patent any invention unless instructed to do so in writing by the employer. 

Another doctor described this condition as “draconian”. “This is a level of control that we haven’t seen before,” the doctor said.

A statement from the Department of Health said: “The implementation of the new Consultant Contract will be the first step along the road to public-only care in public healthcare facilities. 

“The draft Consultant Contract was forwarded to the representative bodies for hospital consultants on the 31^st May for consideration.

The Department of Health and the Health Service Executive are open to engaging on the draft Contract, subject to the policy positions adopted by Government, with the representative bodies for hospital consultants in the public health service, the Irish Medical Organisation and the Irish Hospital Consultants’ Association.

“While the Contract is a new Contract it does contain significant elements from the previously agreed Type A Contract, amended to provide for public-only practice in accordance with Government decisions and to provide for a number of other changes to reflect updated HR policies and public service agreements.”

In a recent circular sent to members of the IHCA, it’s understood the association said it set out a “determination that the negotiations must be meaningful and constructive” in a meeting with Department of Health officials on 1 June.

It said “growing pressures” on a daily basis are “pushing consultants and public hospitals to breaking point”. 

One in five permanent consultant posts are unfilled, the circular said.

In a statement on Friday, IHCA president Professor Alan Irvine said that Ireland has a “chronic recruitment and retention crisis” and the association is seeking “urgent” contract negotiations. 

“This recruitment and retention crisis is being exacerbated further by the health services’ current proposals for a new consultant contract.

The draft terms are driving the highly trained specialists we desperately need to live and work abroad. To meaningfully tackle this problem and halt the growth of record lists, a new approach is needed.

“The IHCA is seeking urgent negotiations on the contract proposals to ensure that the contract is modified so that our public hospitals can recruit and retain the number of consultants they need for the patients who depend on them.”

‘Firing up the wrong group of people’

Another doctor told The Journal: “There’s a perception that doctors are so desperate, they’ll take the jobs – it’s been proven since 2013 that’s not the case.

“You’re firing up the wrong group of people. The new group are junior doctors who went on strike in 2013. These are people now at consultant level with very little trust in the HSE and the Department of Health.” 

They added that it’s “an unlikely scenario” for current consultants to switch over contracts under the current terms. 

They said it “doesn’t take many [consultants] to leave, retire or die for the system to really ground to a halt”. 

The IHCA said in April this year that 728 consultant posts remain vacant in Ireland. 

More than three-quarters of hospital consultants in Ireland showed signs of burnout, according to medical research results from March this year. 

The doctor added that they would “no way” accept this contract, saying contracts should benefit “employers and employees” and they don’t believe this contract fulfils that purpose.

‘Fig leaf’ solution

Another doctor told The Journal a number of “alarming things” stood out upon reading the contract. 

“Sláintecare is supposed to be a means of getting private practice out of hospitals”, they said, claiming this contract won’t have that effect as current consultants are unlikely to sign up due to the current terms. 

They described this contract as a “fig leaf” solution, adding that it “doesn’t do anything to solve the problem it aims to solve”.

They also expressed concern about the location clause and the prospect they “could be sent anywhere” to work.

The contract says the consultant will “work in the most appropriate setting as directed by the employer, having regard to clinical programmes and models of care”.

It adds that an employment location “may be subject to change” depending on the needs of the service, reconfiguration or the shift in care to the community.

However, it said the employment location may be changed “within the functional area and service range” applicable to their employer.

In the first instance, it says, this will be within the hospital group/regional health area. 

It adds that the employee “shall be consulted” if it’s required for them to change employment location outside these kinds of areas. 

It also says the consultant “may be required to work across multiple sites” for procedural and surgical work.

Doctors are concerned this may result in them being dispatched to work in other parts of the country, which is not a requirement under many contracts at the moment. 

Money

The expected salary would be a “significant” increase for many, doctors said, particularly consultants who signed contracts after 2012 when the starting salary for consultants was cut by around 30%.

The department said the rate of pay attached to the contract is the pre-2012 contract pay. The rates will range between €188,902 to €226,909 at first and increase to between around €220,000 and €252,000 by July next year. 

There are no explicit figures mentioned in the salary. It reads: “The Consultant’s annual salary shall be as set out in Department of Health salary scales.”

(The doctors who spoke to The Journal did not want to be named in this piece.)