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New faces, familiar themes

By Mindo - 30th Nov 2018

It may be a case of new faces, but some familiar themes at this year’s IHCA Annual Conference, which takes place in Kilkenny on Saturday, 1 October.

Significantly, two Government Ministers will be making an appearance, with Minister for Health Simon Harris and Minister of State for Mental Health and Older People Helen McEntee due to speak. The Association itself has a new President, Dr Tom Ryan, and he will deliver his address early on Saturday morning.

Former Minister for Health Leo Varadkar was listened to politely at last year’s conference. However, his attempt to paint an optimistic view of consultant recruitment trends were directly contradicted by the Association’s leadership and members.

Speaking to reporters at last year’s conference in Tullamore, Minister Varadkar also floated the idea of scrapping the current complicated consultant contract (based around exclusive public-only, private-only, or a combination of both) and introducing a single contract, along NHS lines.

It will be interesting to see if the new Minister comes to Kilkenny with similar contract proposals. But new contract talks may not be on the agenda. As IHCA sources have indicated to the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>), while there may be a need for a new contract sometime in the future, consultants are not likely to start negotiating a new agreement when they are still in dispute over the current one.

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<h3 class=”subheadMIstyles”>Message for the Minister</h3>

The IHCA will meet for its Annual Conference on 1 October in Kilkenny. Although outside the Haddington Road agreement process, the Association points to the influence it has through meetings with the Minister and also the significant number of consultants it represents.

Dr Ryan and the IHCA say it represents 85 per cent of hospital consultants. The Association claims over 2,400 members.

When Minister for Health Simon Harris is in Kilkenny at the Annual Conference, what does Dr Ryan think will be the big issues that consultants will raise with him?

“All of these issues, any of these issues would be big enough on their own,” he says, pointing at the IHCA’s pre-Budget 2017 submission.

“All of them together are an enormous problem.

“We would say to the Minister, ‘you need to engage with us so we can work together to improve healthcare for Irish patients’. That is what we want. We want to look after more patients, and we want to provide better care for the patients than we can provide at the moment because of capacity and other constraints.

<p class=”listBULLETLISTTEXTMIstyles”>“We understand that the need to provide care for patients in Ireland is going to increase dramatically over the next 10 years and we want to be actively engaged in ensuring that the health service is positioned to respond better, because we want to provide the care that Irish patients need.”


The anger regarding what the IHCA views as the serious “breaches” of the 2008 Consultant Contract has been a central focus of the Association’s conferences in recent years.

“The breach of contract and trust by the HSE has not created a great work atmosphere for consultants in Ireland,” Dr Ryan said bluntly in a pre-conference interview with <strong><em>MI</em></strong>. 

“The discriminatory salaries that they introduced for the new-entrant consultants just compounded that error. The profession by and large has lost trust with the State and health service employers.”

The soft-spoken Dr Ryan is sure to have a hard-hitting message for the Minister during his Presidential address to the conference. The IHCA has continuously warned that issues over the contract are leading to a flight of consultants from the country and a growing recruitment crisis. The issue is currently being played out in a number of cases before the courts, but there is also a political dimension to this.

While not part of the mainstream industrial relations process, IHCA negotiators will most likely take advantage of the Minister’s trip to the Kilkenny conference to raise this, and other concerns.

There will be plenty of opportunity as, unusually, the Minister is due to speak twice this year, once at a morning session and then at the banquet dinner in the evening. Given that the conferences in 2013 and 2014 were not addressed by a Minister at all, this double appearance is noteworthy, giving plenty of time for consultants to meet and bend the Minister’s ear.

<h3 class=”subheadMIstyles”>Concern</h3>

But while the IHCA often emphasises what it regards as a “crisis” in recruitment and retention of consultants following the contract controversy, the Association has been keen to also focus on other areas of concern this year.

At its pre-Budget 2017 submission launch earlier this year, Dr Ryan laid out the Association’s worries over obsolete equipment in the health service, chronic under-investment, especially in acute services, and also voiced concerns over the demographic challenges posed by an ageing patient population.

This year’s conference programme reflects these wider issues beyond contractual and recruitment challenges.

The morning’s scientific session will examine ‘planning and resourcing high-quality healthcare services’. It has an interesting panel of speakers, including Dr Ryan and Minister Harris, who will be joined by Dr Fergal Hickey, Consultant in Emergency Medicine, Sligo University Hospital, and Prof Terence Stephenson, Chair, UK General Medical Council and Specialist in Paediatric Medicine.

IHCA members will have time to question the Minister and other panellists following the presentation.

The afternoon scientific session looks at ‘governance and delivering better services’. Panellists include Prof Brendan Kelly, Consultant Psychiatrist, Trinity College Dublin and Tallaght Hospital; Dr Sam Coulter Smith, Consultant in Obstetrics and Gynaecology, Rotunda Hospital; and Mr Bill Prasifka, CEO, Medical Council.

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<h3 class=”subheadMIstyles”>Collaborating to curb mounting clinical costs</h3>

Clinical indemnity costs will be one of the big issues raised at the IHCA Annual Conference.

The IHCA “strongly recommends” that proposals on the lowering of the indemnity caps and the provision of indemnity on a commercial basis by the State Claims Agency (SCA) should be brought to Cabinet for consideration as a matter of priority.

“There is a pressing need to urgently adopt regulations and rules of court to give effect to the newly-enacted legislation on pre-action protocols to ensure more intensive case management of medical negligence cases, thereby resolving claims more efficiently,” says the Association.

“This must include a requirement for the exchange of information within defined time periods, with significant penalties where exceeded, to reduce delays and costs. It is essential that recently-announced initiatives concerning reform of Tort law and a separate review of court sittings are expedited without further delay.”

Dr Ryan says that “litigation is a huge problem in both the private and public hospitals”.

“While the number of claims has increased — but not that dramatically — the cost of the claims has increased dramatically, particularly because of the dramatic legal cost increase.

“They [the Government] have to recognise the problem. We have seen some early evidence of that, in that they have introduced pre-action protocols, to try and shorten the duration of the court cases associated with a claim.

“That should have, if it is properly implemented, some effect in reducing the quite extraordinary legal costs for a claim.

“The second step is about the amounts awarded. Now, clearly, if someone has been wronged or suffered an injury as a result of negligence, then they must receive adequate compensation. But the level of awards in Ireland is out of line with the level of awards internationally. This is not just in medicine, but in other forms of insurance as well.

<p class=”listBULLETLISTTEXTMIstyles”>“The Government and the legal system have to do something to standardise the level of awards.”


<h3 class=”subheadMIstyles”>Governance</h3>

Last year’s conference heard some debate regarding the role of Association members as clinical directors. Some members expressed concern over possible conflicts of interest when Association members become clinical directors and this issue is likely to come up again this year.

The Association recently called for increased clinical governance within hospitals. According to the IHCA, a clear set of measures is required to strengthen hospital, hospital group, CHO, HSE, corporate and clinical governance arrangements to ensure that they are fit-for-purpose and support best practice. 

“It is essential that the current focus of governance is rebalanced to facilitate increased clinical governance input at organisational board levels in order to prioritise the delivery of safe, high-quality, timely care to patients. In addition, CHO and Hospital Group geographic coverage must also be aligned without delay,” Dr Ryan said recently.

Other challenges facing consultants, such as mounting clinical indemnity costs, are also sure to be discussed during what is expected to be a very busy weekend in Kilkenny.

 <em>There will be extensive coverage of the IHCA 2016 Annual Conference in the next issue of </em><strong><em>MI</em></strong><em>, out on 6 October. <div style=”background: #e8edf0; padding: 10px 15px; margin-bottom: 15px;”>

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