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A year of ups and downs

The last 12 months have been a very busy time for the IMO as it has dealt with an increased industrial relations workload, major changes in its governance and structure, and has attempted to move beyond the legacy issues caused by the McNeice affair.

Last year the IMO celebrated 30 years in existence and it is fair to say that the last 12 months since the 2014 AGM in Maynooth have been a year of ups and downs for the Organisation.

The long shadow cast by the controversial retirement of former CEO George McNeice in late 2012 and his €9.7 million departure package, reduced down from contracted entitlements approaching €25 million, continued for the IMO in the last year.

One of the most notable instances of this was the very public sick pay and unfair dismissal case taken by Ms Maria Murphy, the IMO’s former Director of Communications. Ms Murphy had worked with the Organisation over 25 years and her last public appearance for the union was at the 2013 AGM in Killarney.

The IMO and Ms Murphy finally agreed a €250,000 settlement and her action was dropped

In August 2014, it emerged in the media that Ms Murphy had been on sick leave from the Organisation for over a year and was due to have a case regarding her pay and sick leave entitlements against the IMO held in public at the Labour Relations Commission, before a Rights Commissioner.

In a dramatic turn of events, Mr McNeice was to give evidence on her behalf, which he did, though the case was eventually held in private.

Legal battles

In her case, Ms Murphy claimed the IMO has paid her just 14 days’ sick pay, when she said she was entitled to six months’ full pay and six months on half pay, given her seniority in the Organisation and her contractual rights. The IMO maintained that the alleged sick pay entitlement was not stipulated in any contract.

The emergence of the case was embarrassing, as it dragged the issues surrounding the departure of Mr McNeice back into the spotlight, and as a trade union, the IMO is more used to defending its members over alleged failures of employers to honour contracts for doctors.

In January this year, it emerged that Ms Murphy had been informed she was being dismissed from the IMO for alleged breach of contract after returning to work that month. She consequently launched High Court proceedings aimed at preventing her purported dismissal from her post, as well as orders reinstating her to the position of Director of Communications.

There was again national media coverage of her return to work and her court case. However, later that month the IMO and Ms Murphy finally agreed a €250,000 settlement, and her action was dropped.

In a letter to members, which was reported in the media, the IMO said that a number of disputes arose between the IMO and Ms Murphy in early 2013 and another dispute later arose about her sick pay entitlements.

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Prof Trevor Duffy, IMO President

In the settlement, the IMO confirmed it had paid Ms Murphy an ex-gratia termination package of €135,000, plus €115,000 towards her legal costs. The payments were made strictly without admission of liability and bought finality to the situation. The IMO said the settlement was in the best interests of the Organisation and its members.

The letter from IMO President Prof Trevor Duffy did not set out what the IMO’s own legal costs in the case were. However, the Organisation’s total legal costs in 2014 increased significantly, rising to €499,021, compared to €334,063 in 2013, according to the recently-published IMO 2014 Annual Report.

Resignations

Since the departure of Mr McNeice and the resulting emergence of previously unknown details on spending and expenses, there have been a number of public letters from IMO members in the medical and mainstream press about their thoughts on the affair or to signal their resignation from the Organisation.

One of the most high-profile of these was a letter of resignation from the IMO by public health physician, Dr Paula GIlvarry, who was IMO President in 2007/2008, which was covered in the mainstream and medical press last October.

The last year has been very busy and successful on many fronts in relation to the IMO’s core business of IR and advocacy

Dr Gilvarry wrote to other former Presidents and trustees, outlining her reasons for resigning. She said she seriously doubted the Organisation could maintain the confidence of doctors and that she was concerned promises made by the IMO after the departure of Mr McNeice in December 2012 had not been fulfilled. “There has been no proper forensic review of the business of the IMO,” Dr Gilvarry said. “I believe the IMO will never recover until its history and the learning from its mistakes have been fully examined.”

Speaking to the Medical Independent (MI), Dr Gilvarry confirms she does not intend to rejoin the IMO presently, and that everything in her resignation letter stands. “It is time they got a proper, independent, new CEO,” she adds.

The IMO has not publicly commented on Dr Gilvarry’s letter or departure.

On the positive side, the IMO has also garnered significant publicity for its IR and advocacy work in the last year. The Organisation issued over 75 press releases and statements during the course of 2014, dealing with the full range of the IMO’s activities, and it received extensive coverage of the 2014 AGM.

Financial review

A decision on the controversial proposed retrospective financial review, which was to examine all matters connected with the employment contract, payments and pension entitlements for Mr McNeice in respect of any role held by him within the IMO and any of its associated companies, was finally reached in the last year.

In early 2013, an extraordinary general meeting of IMO members voted strongly in favour of carrying out the retrospective review, which was also to look at financial and governance arrangements in the IMO over almost 20 years.

The review was deferred by the Organisation’s council in October 2013 amid concerns it would be extremely expensive to carry out and would ‘open a can of worms’ with potential legal ramifications.

During the 2014 IMO AGM, attending members, a small proportion of the overall membership, voted to ballot the wider membership on whether to press ahead with the proposed review.

Finally, many months later, on October 3, 2014, the IMO announced the results of its ballot, which narrowly decided that the Organisation should not proceed with the review. The percentage of votes cast against holding a review was 52 per cent.

Prof Duffy acknowledged the closeness of the vote, saying it reflected the seriousness of the issue. “However, Council will now respect the outcome of the ballot and the democratic vote which has taken place.”

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Mr Steve Tweed, IMO IR

Prof Duffy said that the IMO had undergone huge change since the controversy erupted: “As an Organisation, we have gone through an enormous process of change, including an extensive consultation with the membership, the adoption of a completely new set of rules and the introduction of a new management and governance structure for the Organisation, which reflect the lessons learnt through this whole episode. We have readily acknowledged the shortcomings and failings which had taken place in the Organisation but we have addressed them and undertaken very important reforms. Now this matter has been decided, we can focus without distraction on the critical challenge of representing the interests of our members and our patients at a time of enormous stress and difficulty in the health services.”

However, the Organisation’s 2014 Annual Report revealed that the IMO has suffered a significant drop in membership, from 6,196 in 2013 to 4,900 at the end of 2014.

The Organisation has still also not advertised for the long-promised new CEO to replace Mr McNeice, more than two years after his departure. Financially, the Organisation remained stable in 2014, and sold the mews property at its Headquarters in 11 Fitzwilliam Place.

A busy year in IR

Despite the turmoil caused by internal issues, the last year has been very busy and successful on many fronts in relation to the IMO’s core business of industrial relations and advocacy. The IMO IR unit received approximately 7,300 calls in 2014, an average of over 600 calls a month.

Writing in the 2014 IMO Annual Report, Dr Peadar Gilligan, Chairperson Of the Consultant Committee, said: “The work of the IMO on behalf of consultants has never been more important, as the IMO is the only consultant representative body to have signed up to the Haddington Road Agreement and, therefore, the only consultant representative body with whom health service management must negotiate. The IMO expects that health service management remain cognisant of this fact, and also of their corresponding responsibilities under the Financial Emergency Measures legislation of July 2013.”

During 2014, the IMO solely negotiated with the HSE and Department of Health on reversing the 30 per cent pay cut to consultant salaries introduced in October 2012 by then Minister for Health Dr James Reilly.

After tough negotiations during 2014, a strong membership ballot rejection of a proposed pay package last October, and disagreement on the scales and criteria proposed to attain the higher levels of consultant pay, a second ballot was put to consultants and IMO NCHD members at the start of 2015. While not a full reversal of the original pay cuts, the revised package represented a claw-back of most of the original salaries, though on a more phased, scaled structure.

On January 27, the IMO announced consultant and NCHD members had voted to accept the revised proposals on pay and career structures for hospital consultants.

IMO Director of Industrial Relations Mr Steve Tweed welcomed the result: “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. We are warning the HSE and the Department not to overestimate the support they have received for these proposals.”

Mr Tweed said the IMO would continue to fight for equal pay for equal work as a key objective in the forthcoming discussions on public service pay, due to begin shortly. He tells MI that while the consultant pay deal is welcome, it is very disappointing that health management had let the consultant recruitment crisis get “near the edge of a cliff” before a deal could be achieved.

NCHDs

It has been a difficult number of years for NCHDs. In 2013, frustration with the lack of progress in properly implementing the European Working Time Directive (EWTD) came to a head.

In September of that year, 3,000 IMO NCHDs withdrew services from Irish hospitals in a one-day strike to protest the issue. In November, a ballot of IMO NCHD members voted 76 per cent in favour, 24 per cent against, in support of settlement proposals negotiated between the IMO and the HSE under the auspices of the Labour Relations Commission. Under the settlement proposal, the HSE agreed to a timeline for the elimination of shifts in excess of 24 hours and for the full implementation of the EWTD. The settlement also included new arrangements in respect of health and safety and a review of the current NCHD career structure to reduce the number of NCHDs emigrating for better working conditions abroad. However, HSE compliance with the agreement has been patchy, and it seems this issue is far from resolved.

There can be no real improvement until we have a new contract

In recent weeks, the Advocate General of the European Court of Justice (ECJ) released its opinion that the Irish Government is in breach of the EWTD by requiring NCHDs to work excessive hours. The IMO complained to the European Commission about excessive working hours faced by NCHDs in Ireland in March 2012, met with representatives of the EU Commission in 2013 and again in December last. The final decision will have major practical working and cost implications.

Commenting on the issue, Mr Eric Young, Assistant Director of Industrial Relations at the IMO, said that the ECJ decision was a significant vindication for NCHDs and their campaign and a significant rebuke for the HSE.

The IMO said it would use the ECJ decision to put further pressure on the Government to address this issue as a matter of urgency.

General practice

The complete shutdown in GP negotiations for almost a decade following the emergence of competition law complications has created a major headache for the IMO, with GPs complaining about the Organisation being powerless in the face of a succession of FEMPI cuts to GP fees and allowances and outdated GMS contracts. A court action between the IMO and the Competition Authority (CA) last year ended with a stalemate agreement in May 2014. It confirmed that the IMO could represent its members in respect of any proposed changes to publicly-funded contracts with GPs but that the Minister for Health must make the final decision on contract terms and conditions, including fees.

However, the controversial Government announcement of free GP care for under-sixes eventually opened the door for more meaningful discussions between the IMO and the HSE and Department of Health. Despite strong opposition to the plan by many GPs, especially to the controversial draft under-sixes contract, the IMO entered exploratory discussions with health management early last year on the issue. Around the same time as the CA agreement, it was announced on June 4 2014 that a Framework Agreement between the Minister of Health, the HSE and the IMO setting out a process for engagement concerning the GMS/GP contract and other publicly funded GP contracts had been signed.

Rival GP representative organisation, the NAGP, was not invited to participate in the discussions.

The IMO said the agreement allows for real negotiations as opposed to mere consultations. To prepare for the planned new GP contract talks, the IMO hosted a series of 18 nationwide meetings to obtain feedback from members as to what they would like to see in a new GP contract. It also conducted a survey on the costs involved in primary care.

In late February this year, in another major progression of GP negotiations between the IMO and health management, it was announced that the IMO, the HSE and the Department of Health had signed a Memorandum of Understanding (MOU) to start negotiations on a new GP contract, as well as further extension of universal GP care beyond the under-sixes and over-70s.

This Memorandum will allow substantive discussions to start on a new overall GP contract to replace the 1971 and 1989 contracts, with a start date no later than March 31, with a 12-month timeframe for the negotiations. Negotiations will be carried out within the terms of the framework agreement and the Memorandum also paves the way for reversing the succession of cuts to GP fees and allowances under FEMPI.

Speaking to MI, Mr Tweed acknowledges 2014 had been an exceptionally busy year for the IMO in relation to IR issues, with a number of notable successes.

“The highlight of the year had to the breakthrough in relation to GPs and being able to negotiate a new contract… What’s been agreed will allow us to negotiate the fees, and while the Minister will have the final decision, as would be the case anyway when dealing with the public purse, we have a process to negotiate the fees, a process to refer to arbitration if we can’t reach agreement on that… It is an enormous step forward after the last seven or eight years, which I don’t think has been fully appreciated by some commentators.”

Looking to the future

MI spoke with incoming IMO President Dr Ray Walley about his thoughts on the challenges and opportunities of the past 12 months and his hopes for the future.

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Dr Ray Walley, IMO Vice President

“It has been an extremely busy year — indeed, a busy two years as we fought for and ultimately succeeded in establishing the right of GPs to representation by the IMO through the High Court agreement and the framework agreement. That has led to negotiations on under-sixes, which I must point out is Government policy.”

He acknowledges that many GPs and the NAGP remain opposed to the notion of introducing free GP care under-sixes when other patients are more medically in need. “The IMO has always been against age cohorts in principle but through these negotiations, we have secured a commitment to talks on a new GP contract the terms of which are outlined in the MOU, “ Dr Walley says.

“There can be no real improvement until we have a new contract that is properly resourced, and that has always been our objective. A new contract must address patient services and ensure a sound, sustainable future for general practice — perhaps then we can stem the tide of GP trainees leaving, established GPs emigrating and the decimation of the core principles of general practice.

“I think we have been clear in our message to Government — universal GP care that is free at point of access is a good policy but can only be implemented with planning, resources and negotiation.“

Asked about the reduction in IMO membership at a time when the NAGP now has over 1,200 members and continues to grow, Dr Walley replies: “Our GP membership has remained relatively stable over the past few years, despite the challenging times we have been through, and I sincerely thank each and every one of them for their support and loyalty.

“The IMO has a proven track record of delivering for general practice and now that we are finally back at the negotiating table, we intend to fight for resources so that we can deliver upon the potential of general practice.”

Dr Walley says his priority as President will be to continue to advocate on behalf of patients and IMO members.

“As President, a position that I am very honoured to be appointed to, I will continue to ensure deficiencies in our health service are pointed out, whilst continuing to offer solutions and proactive engagement with the DoH/HSE so that we can progress from a reactionary health service to one offering prevention and maintenance of wellbeing. I will be a strong advocate for increased resourcing to deal with our ageing population and the unmet need of the exponential increase in chronic care morbidity. I will be a strong advocate for the appropriate resourcing of general practice and community care, but not at the expense of secondary or tertiary care, but equal increased resourcing for same. As a percentage of GDP, Ireland needs to achieve the same level of funding as the UK/France and Holland if we are serious about health prevention and the maintenance of healthcare wellbeing.

“I will be a strong advocate for universal healthcare, but not universal health insurance.”

So after a year of ups and downs, the next year looks bright for the Organisation.

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