A new contract, but many concerns unresolved

Chair of the IMO consultant committee Prof Matthew Sadlier believes the new consultant contract represents a missed opportunity by Government to work with consultants

“A poem is never finished, only abandoned.”
Clive James – ‘Cultural Amnesia’

In the myopic world of consultant politics, there was one issue dominating 2022 and that was the ongoing consultant contract talks. These were a holdover from the talks in 2021, which were themselves a holdover from the talks in 2020.

To get from the original, frankly shocking, document that was presented in the summer of 2021 to the document that is now to be offered took an inordinate amount of work. Like the irreplaceable Clive James’s view on poetry writing, the end of the process was more of an abandonment than a conclusion. There were definitely some gains made: Keeping the contract a common one across all specialties with a single salary scale, giving freedom back to consultants in what they want to do once their commitments to their employer were met, scrapping the ties over intellectual property and minimising the impact of supposed ‘gagging clauses’.

However, many problems remain in the contract which may affect some, all, or none. For example, the lack of explicit guardrails around the number of unsocial hours and weekends individual doctors can work, the ongoing bizarre cap on C factor payments, without a similar cap on hours, as well as the ongoing lack of clarity as to what happens when a consultant takes leave. Protections around location of work were easily resolved, but the HSE and Department refused to recognise the negative impacts and consequences of pursuing such a policy. These are all issues that we felt were solvable in some way if we were allowed to conclude the talks rather than have them abandoned.

Negotiations are hard work and those on the team often had to put in incredible efforts to attend, coming from early morning rounds and then returning to the hospital to finish up late into the night. While all the committee contributed with multiple online meetings, often at short notice, special thanks has to go to Dr Peader Gilligan, Prof Anthony O’Connor, Dr Clive Kilgallen, Dr Aisling Snow, and Dr Gabriel Beecham. In particular I would like to single out Mr Sean Tierney, whose experience, insights, and solution-based approach kept us all sane during the process. On behalf of all our members, I would like to thank the secretariat of the IMO for their work during this very challenging process.

Member advisory unit

While the contract talks were the behemoth that bestrode the year, other activities continued to roll. Our member advisory unit was kept busy dealing with many personal cases and contract issues on behalf of our members, solving problems and giving support where it is most needed. While national negotiations tend to grab the headlines, it’s the individual cases that drive the service to our members.

CAMHS

The consultant recruitment and retention crisis continued during the year and this was highlighted in the ‘Maskey’ report into the failings in the child and adolescent mental health services (CAMHS) in South Kerry. Community consultant posts, especially in CAMHS, have proven the hardest to fill and it is not possible to read the report without seeing the system design flaws that caused the problems. Teams being too geographically dispersed, lack of IT systems and unattractive working conditions. The IMO has highlighted these issues for many years and we have been calling for solutions.

Winter surge

As the year drew to a close, rather than engaging in Christmas celebrations, we got an all too predictable winter surge and consequent bed crisis. However, this was neither unprecedented nor unexpected but rather the expected outcome of the significant deficit in bed capacity that we have in our acute system.

In regards to solutions all we hear, from the opposition and Government, is the word “Sláintecare”. The problem always with Sláintecare, outside of a few core principles, was that it is largely a vague set of aspirations at a time when we need a concrete set of plans. Community care does not replace acute care nor in fact reduce the need for acute beds. By offering diagnostics in the community, it is as likely that a problem that may never have emerged will be unearthed and require acute care than a case of acute care will be averted. We need more beds, we need more clinic spaces, we need more diagnostic facilities and we need an integrated IT system that allows care in multiple locations to be coordinated.

The final act of the year was a return to the contract and the result of our ballot. As we expected, a majority of existing and future consultants replied that they would not take the new contract. When asked why, it was interesting that despite the public perception of consultants, patient safety and work/life balance were the main reasons, not remuneration. Despite all the reservations, it looks like the contract is going to be offered on the principle of “testing the market”. Truly, this was a missed opportunity by Government to work with consultants and to finally take a step towards resolving our chronic workforce crisis.

So, in many ways, the Department of Health is following the philosophy of the early 1990s.

“I like a manifesto, put it to the test-o.” Sultans of Ping FC – ‘Where’s me jumper?’