Roll-out of consultant contract hits first significant controversy

For the moment, the conflict between the Minister for Health and the Rotunda Hospital has abated.

The dispute arose on 27 May after the Rotunda’s Master, Prof Sean Daly, told the Oireachtas health committee that consultants on the public-only consultant contract (POCC) treat patients privately at the site.

Following the political furore that followed Prof Daly’s comments, and the threat to withdraw funding, the Rotunda made a statement agreeing to bring its “arrangements into line with the Government’s policy” regarding the contract.

Given the difficult and protracted negotiation period, perhaps the lack of controversy that has occurred with the POCC roll-out is surprising.

Indeed, even as the POCC was about to come into force in March 2023, there was significant discontent among doctors about its terms. That month, the IMO announced that its consultant and NCHD members had voted to reject the POCC.

According to the ballot results, 57 per cent of contract holders at the time indicated they would not switch to the new contract, 64 per cent of NCHDs said they would not sign it, and 59 per cent of consultants working overseas stated they would not return to Ireland to take up the new contract.

The IHCA revealed similar findings in a survey of its members.

Yet despite this discontent, sign-up has been relatively steady, taking place alongside an increase in consultant numbers. Currently, about 70 per cent of consultants are on the new contract.

Medical representative bodies have been relatively quiet on the POCC since roll-out commenced, even though concerns continue to be expressed.

Medical representative bodies have been relatively quiet on the POCC since roll- out commenced…

Writing in the Medical Independent (MI) in advance of the IMO AGM in April, the new President Prof Matthew Sadlier noted that, in the past, much of the blame for problems within the acute sector was “put down to the persistence of private practice on public hospital sites and that consultants were allowed to engage in mixed practice”.

Following the implementation of the contract, Prof Sadlier pointed out that patients previously treated as semi-private within the public system continue to attend the public hospitals.

“But this time the hospital [receives] less money to treat them,” he wrote.

The impact of the POCC on the income of hospitals had been a concern since the concept was first proposed and implemented. Such concerns were held by the Rotunda.

MI reported in September 2023 that an update on the contract provided by Prof Daly to its board warned of “adverse outcomes” and financial losses to the hospital.

A document on the contract was being discussed at the Rotunda’s board meeting on 4 May 2023.

The meeting heard that there was currently no option for private obstetric care outside the publicly funded maternity hospitals.

The minutes noted that the contract was the only one available to new consultants. “Ultimately, a decision will be required by the board as the employer on the provision of private and semi-private care.”

This newspaper further reported that the heads of the four biggest maternity units – including the Rotunda – wrote to the then Minister for Health Stephen Donnelly in September 2023, stating that the quality of care for women in public maternity services “will never be the same” as that provided by private services.

So, while the recent controversy has been the most significant dispute over the contract since its introduction, tension had been brewing. 

It is clear Minister for Health Jennifer Carroll MacNeill believes the POCC is central to achieving reform across the health service. In that context, the Rotunda’s decision to back down from further escalation was perhaps inevitable.

However, speaking on RTÉ’s Today with David McCullagh after the Rotunda’s statement, Prof Daly was adamant that the fundamental issues involved with this dispute “had not gone away”.

And with the subsequent revelation that an internal HSE audit found there has been inadequate management of the removal of private work in public hospitals, the implementation of the POCC is likely to continue to receive political focus.