Consultant contract showdown
See below for Medical Independent column from 17 April 2014 on the ongoing dispute between St Vincent’s Hospital and the HSE over consultants’ work
Financial gain stemming from the historical failure of politicians and policy makers to dismantle the public-private mix of public hospital care is at the heart of the messy row between St Vincent’s Healthcare Group and the HSE.
The HSE stance is that St Vincent’s is breaching the consultants contract by allowing consultants hired in the public hospital to practise publicly and privately in both the public hospital and in the co-located private hospital.
The St Vincent’s position and its legal advice takes a contrary view, that it is operating within the rules of the contract and is ready to take on the HSE.
This public showdown has its origins in the HSE’s push to ensure that all Section 38 organisations are compliant with public pay policy (Section 38 organisations are large, voluntary providers of healthcare which receive a large proportion of State funding). This process began in 2012 and reached a climax towards the end of 2013, when a HSE report identified organisations breaching the pay rules.
St Vincent’s was found to be one of the offending groups and as part of this process, appeared before the Public Accounts Committee. At this Committee, their pay and governance structures were examined and this issue of consultants’ practise emerged.
St Vincent’s engaged with the HSE to resolve these issues and had until 31 March to become compliant. They reached compliance on governance and public pay policy issues but not on the consultants contract issue.
As stated, the point of contention is whether St Vincent’s is breaking the rules by facilitating consultants hired for the public hospital (where they can practice publicly and privately) to practice in the private hospital. Central to this is the consultants contract.
In 2008, when Mary Harney was Minister for Health, a new consultants’ contract was agreed. Previously, there was a contract option that allowed consultants to practise in a public hospital and in an off-site private hospital. This was discontinued for new consultants in 2008 when Type A and Type B contracts were issued. Type A allows for public-only work and Type B facilitates private practice up to a maximum of 20 per cent of the workload in a public hospital.
According to HSE Director General Tony O’Brien, St Vincent’s misled the HSE, initially claiming just a handful of consultants were working in the private hospital until it revealed that many more consultants were in fact doing so (there are conflicting reports on the actual number but it is thought to be 80-plus). O’Brien specified the problem: “There is a private hospital which is effectively being run on the back of the public hospital, through consultants whose salaries are paid by the taxpayer” and warned that if not resolved, the situation put future public investment in the hospital in jeopardy.
St Vincent’s is taking a very hard line on this on the back of legal advice stating that a HSE task force as far back as 2011 was set up to deal with the issue and therefore the HSE was aware of the practice. Plus they point out that the consultants’ contract is between the consultant and the employer, ie the hospital, not the HSE.
The 2008 contract states: “A consultant holding Contract Type B may engage in privately remunerated professional medical/dental practise only in hospitals or facilities operated by the employer, as part of such activities that arise as part of the employment contract (eg home visits), co-located private hospitals on public hospital campuses…”
The timing of when this contract was drafted is relevant. It was when Mary Harney was Minister and her big idea of co-located hospitals was still Government policy. Therefore facilitating consultants to work in these hospitals was central to the success of co-location. The HSE was always a reluctant partner in the co-location plan and at the end of the day, it never happened.
St Vincent’s claims that stopping consultants practising in the private hospital would “exacerbate already high patient attendance volumes in the public hospital, as well as creating further access problems”.
However at the heart of this is money; St Vincent’s public hospital can attract consultants more easily, as they are facilitated to practise publicly and privately in the public hospital and potentially carry out unlimited work in the private facility. This means both the hospital and consultants are earning large sums of money on top of their public income.
Millions of euro are at stake here. It seems inevitable it will be an expensive fight that will only be resolved in the courts.