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A false dawn?

A joint HSE/public appointments service project team has been established to advertise consultant positions under the new pay and career structures, this newspaper has been informed. The new team is part of the push to realise the Minister for Health’s stated hope that the new deal would encourage Irish doctors to stay at home and “consultants who are working overseas to return to Ireland,” a Department spokesperson tells the Medical Independent (MI).

According to the spokesperson, the first “approximately 60 posts” under the new structure will be advertised this week.

A HSE spokesperson tells MI that a specifically-targeted advertising campaign for consultants abroad “will take place end of Quarter 1 2015.”

All this follows the recent acceptance of the new consultant pay structure by a majority in an IMO ballot. But rarely has a successful vote been greeted with such differing responses. While IMO consultant and NCHD members voted by 60 to 40 per cent to accept the Labour Relations Commission (LRC) proposals on a revised consultant pay scale and career structures, it has not happened to much fanfare. That is, with the exception of what was heard from the Minister’s own office.

There had been some difficulty in getting to this point in the first place and the background is well known to most NCHDs and consultants.

In October 2012, the Government unilaterally introduced a 30 per cent pay cut for all consultants appointed after that date. This move has caused frustration and anger among doctors, while experts generally agree it has helped fuel a growing recruitment and retention crisis in the health sector.

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Minister Leo Varadkar

In October last year, IMO members overwhelmingly rejected initial proposals from the LRC for a new pay scale.

Following this rejection, the union helped negotiate a revision (with the Department of Health, the Department of Public Expenditure and Reform, the HSE and facilitated by the LRC) that among other changes, means that it will reduce to nine years the incremental period within which consultants could reach the top of the pay scale. Also, consultants with experience will be able to begin at Point 6 (see table on p5), earning up to €155,000. With these alterations, the organisation’s NCHD and Consultant Committees recommended an acceptance of the most recent ballot.

While this may be what the IMO leadership recommended, there was no dancing in the aisles of the Organisation’s headquarters.

Indeed, the reaction of the IHCA, IMO and Minister Leo Varadkar to the ballot result was somewhat reminiscent of the three bears towards Goldilocks’s porridge.

For each, the new pay scales and conditions was greeted with either a cold, tepid or warm welcome.

From the IHCA, the response to the new terms and conditions has been decidedly chilly.

When asked whether the new pay framework would see more young doctors staying in Ireland, the IHCA President is clear.

“No,” Dr Gerard Crotty told MI recently. “It is discriminatory and does not represent a return to the agreed contract.”

In a more detailed statement, released following the ballot, the Association’s President outlined his organisation’s chief concerns.

“These revised proposals will drive potential new consultants abroad who expect parity with their colleagues because they have the same demanding responsibilities for the delivery of high-quality patient care,” warned Dr Crotty.

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Dr Gerard Crotty, IHCA

Because it is not a part of the Haddington Road Agreement (HRA), the Association was left outside the negotiations that led to the new terms. This exclusion was one of the reasons why Dr Crotty regards the proposals as flawed. He claimed the lack of meaningful discussions with the IHCA — which says it represents over 85 per cent of all hospital consultants — mean the proposals “lack credibility”.

The IHCA has consistently stated that nothing short of a full reversal of the 30 per cent cut should occur.

“This is a major concern for acute services, which have in excess of 250 consultant vacancies that cannot be filled,” added Dr Crotty in the statement.

“Hospitals throughout the country have consultant posts vacant in specialties which already had low numbers of consultants on a per capita basis to start with, making it impossible to continue to provide safe, high-quality care to patients. This has already impacted adversely on patient care and safety.”

The Association claimed there is “no credible support” for the proposals, which it said represent a significant salary cut for new-entrant consultants, on a like-for-like basis after four years in a post, and which fail to deliver parity even after nine years.

The relative merit of the new pay scale has been much debated, as can be seen by the fact that 40 per cent of those voted cast a ballot against the deal. On forums such as the popular NCHD ‘Enough is Enough’ Facebook page, voices both for and against the proposal have been aired. While some online participants seemed to agree with the IHCA’s general stance, they queried what the Association can do to negotiate a better deal. Part of the Association’s traditional core principle is its reluctance to launch industrial action.

Despite sitting at the negotiating table, the IMO was quick to emphasise that it regarded the proposals as far from perfect.

“The vote in favour of these revised proposals is a heavily-qualified endorsement of proposals which mark the beginning, not the end, of our campaign for improved terms and conditions for consultants in Irish hospitals,” said the Director of Industrial Relations at the IMO Mr Steve Tweed in an IMO statement.

Evidently, nobody in IMO headquarters is jumping for joy with the new situation, but rather are seeing it as another step in a longer journey.

“We are warning the HSE and the Department not to overestimate the support they have received for these proposals,” Mr Tweed added.

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‘Catastrophic impact’

“The unilateral cut of 30 per cent in pay for new consultants has had catastrophic impacts on our health services and forced 300 consultants to leave the country.

“The ballot will only mean anything if it is seen by the Government as the beginning of a concerted effort to return to equal pay for equal work.”

In terms of the details of the new pay structure (see table on p5) the pay rates remain the same as those rejected last October, however doctors will now make the top of the scale in three less years. The new proposals also have details regarding performance management arrangements and their linkage with pay.

Doctors working on category A contracts will enter the scale at €127,000. After nine incremental points (most likely linked to years) — which are performance related — this will rise to €175,000. For those on type B, the entry level is €120,000, with potential to reach €157,000 and type C consultants will see their entry at €105,000, with the potential to rise to €134,000.

Doctors who already have some years of experience and who enter the scale may do so at a higher point (up to point 6). The proposals also include set pay levels for heads of departments and for clinical directors of €190,000. For consultants currently working, the new pay rates will be backdated to last September.

If there was one person who felt the IMO ballot was a moment for celebration, it was Minister Varadkar, who welcomed the result with warm words and high hopes of a new dawn in the recruitment and retention of Irish consultants.

“I am delighted that IMO members have accepted the new salary scales for new consultants,” the Minister said on news of the ballot result.

“The HSE will now advertise posts where there are vacancies as a priority, which I hope will be a significant step in attracting more consultants to work within the public health service.”

Big claims

Unlike the IMO, Minister Varadkar did not mention any more steps ahead — instead he makes big claims for the new consultant contract. It would encourage younger doctors to stay and it could well mean we will witness the returning home of many consultants who have left in recent years.

“I expect the new pay scales and the improved salaries will help us to keep more of our graduates at home and persuade consultants who are working overseas to return to Ireland,” Minister Varadkar added. “I want this new package to send a strong message to Irish medical graduates that pay, terms and conditions are improving again and that they can be part of the health recovery in Ireland.”

But will the Government do anything proactive to encourage this group of Irish consultants back to Ireland, as the Minister hopes?

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Mr Steve Tweed, IMO IR

“A joint HSE/Public Appointments Service project team has been appointed to progress, inter alia, the advertisement process,” the Department spokesperson tells MI.

And the HSE tells MI that an advertising campaign targeting potential candidates for consultant posts outside Ireland will take place soon.

The Department supplied MI with the most recent figures regarding consultant positions that are unfilled: “143 (including section 38s), a further 182 posts are filled on a temporary/locum basis,” the spokesperson explains.

And when is it expected that the positions will be filled?

“The first cohort of posts will be advertised this week — approximately 60 posts.”

Vacancies

The exact number of consultants who have chosen — or “forced”, as the IMO says — to leave the country because of the October 2012 cut in pay is not known. The IMO said the pay cut “forced 300 consultants to leave the country”. The IHCA looked at the number of consultant posts currently unfilled, and in acute services there is “in excess of 250 consultant vacancies that cannot be filled”.

But what of young doctors, those still in Ireland and those you have already departed these shores? When MI consulted its younger readership on social media, the response was fairly tepid to the new proposals, emphasising that the ‘push factor’ for young medics is not merely financial.

“Myself and about 15 other interns from my hospital have all applied to a brand new hospital in Perth,” said Dr Elizabeth Ahern-Flynn, a junior doctor in Dublin in response to MI.

“(It’s) not really to do with consultant pay. It’s more due to the quality of life and (we) don’t want to commit to a training scheme yet. Also, we’re young and want to travel/try a new health system.”

The Twitter account @EmigratingDoc is one of the most active online on the issues facing Irish doctors who have travelled abroad. The Irish doctor, who is based in Australia, replied to MI, saying: “Money is one piece of the jigsaw. A functional health service would be at least as big a pull factor.”

But the Minister has insisted in the Dáil in recent days that the new scales will allow the Irish health service to compete on the international scene.

The “revised salary scales for new entry consultants (are) to make it more attractive for them to take up posts in Ireland, to make sure that the salaries are competitive with those in Australia and England,” Minister Varadkar told the Dáil earlier this month.

“I hope that will result in more applications for the 200 or so vacant consultant posts in our health service.

“There are those who believe we should have income equality to the extreme, that nobody should be paid over €100,000 or should pay 60 per cent or 70 per cent tax on income over €100,000. The effect of that in Ireland would be to have virtually no hospital consultants and patients would suffer and die.”

The Minister’s hopes of encouraging Irish doctors to remain on the island, or for Irish consultants to return home, is consistent with the Government’s stated policy of ‘self-sufficiency’ in the health service.

The Government is publicly committed to lowering the health service’s reliance on non-EU doctors and has previously insisted that a high level of reliance on overseas doctors is not sustainable.

For the IMO, the recent ballot is not the end of the story. With further discussions between public service unions and Government on public service pay expected soon, the IMO Director of Industrial Relations Mr Steve Tweed has promised that the union will be raising “equal pay for equal work” at these negotiations.

We asked the question on Twitter:

Medical Independent @med_indonews

Is the Minister correct? Will the new consultant pay and career structures keep doctors in Ireland?

Gerard Crotty

No. It is discriminatory and does not represent a return to the agreed contract.

Emigrating Irish Doc

Money is one piece of the jigsaw. A functional health service would be at least as big a pull factor.

Elizabeth Ahern Flynn

Myself and about 15 other interns from my hospital have all applied to a brand new hospital in Perth. (It’s) not really to do with consultant pay. It’s more due to the quality of life and (we) don’t want to commit to a training scheme yet.

Also, we’re young and want to travel/try a new health system.

Who will benefit?

One of the more complicated and controversial matters arising under the new consultant pay structures is how the industrial relations situation will impact on its application.

The Department of Health has stated that the revised rates that were recently passed by the IMO arise from the Haddington Road Agreement (HRA).

So could this mean, in effect, that IMO members are covered, while IHCA members who are not members of the IMO are not?

The IMO confirms that a doctor can be a member of both organisations. However, the spokesperson cannot confirm or speculate on how many members that would involve.

“IMO would not have that information, as it is not requested for membership,” the spokesperson explains.

The IHCA claims a membership that covers 85 per cent of all consultants.

The Medical Independent (MI) posed a series of questions to the Department regarding how many consultants would be effected by this HRA stipulation — it had no figures.

We also enquired as to whether the action was legal under employment law or discriminatory.

“No, their membership of a union does not determine the salary they receive,” a Department spokesperson confirms.

“However, they will be required to confirm acceptance of the Haddington Road Agreement. The revised rates were negotiated pursuant to the HRA.”

A spokesperson for the HSE also outlines to MI that consultants who are not members of the IMO will be asked individually whether they agree to the HRA before they can avail of the new pay structure.

“Consultants who are members of the IHCA, or not represented by any organisation, will be invited to formally confirm their agreement to the HRA before becoming eligible for payment at the rates,” says the spokesperson.

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Consultant pay structure with effect from 1 September 2014

  1. Ronan on February 20, 2015 at 12:16 pm

    Why would I do the same job for €50,000 less ? My insurance premiums are hardly going to be reduced ? I am just astonished that the IMO vote was in favour. What was the reasoning of the consultant committee ? Are they much better doctors than their new consultant colleagues. I am glad that the IHCA are writing stern letters. This has undoubtedly been brave and highly effective. I have no doubt that their future colleagues will be very grateful for their solidarity. Why on earth would a cosultant in another country return to this miserable self- serving “I am alright Jack” joke of a republic ? When a similar situation arose in Queensland 2 years ago, all consultants signed a joint letter of resignation and wished the health service the best of luck – the inequality in pay was immediately reversed

  2. paul on February 19, 2015 at 7:30 pm

    So consultants who are members of the IHCA will be paid the old rates and IMO members will be paid the new rates?

    Why do they want them to sign up to the HRA, is it because it allows employers to change terms and conditions as they see fit?

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