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After four years of negotiations, critical core issues remain essentially unresolved, to the extent that even where areas have been agreed, the central nature of those which have not, means a deal may not be struck. The question then is what happens next?

We may have a flavour of what to expect, given the intervention by Taoiseach, Bertie Ahern, last week, when he berated hospital consultants for complaining constantly about their place of work instead of taking the time to actually work there.

It was an intemperate remark, notwithstanding the audience to which he made it, but indicative of the generally more forthcoming attitude in his public remarks, which Mr Ahern has displayed increasingly since election night.

What was surprising about that whole episode was that it surprised anyone at all. Ministers often use the occasion of a speech to call on some interest group or other to change its ways for the sake of the ‘common good’, or to announce a policy that has been cooking in their department.

The Taoiseach’s political speech-writers did what all speech-writers do in this situation: they had a look at what health service managers would like to hear, worked out pretty quickly that they would be happiest having an old friend for dinner, and handed Bertie the bottle of Chianti.

Parallel worlds

The coverage that followed the chairman’s final report showed once again that the minister and the medics have vastly different interpretations of what appears to be agreed and how much further there may be to go.

Ms Harney seemed to find comfort in the position that the principal outstanding issue, namely the length of the working week, might take a few weeks or months longer to resolve, but not “another four years”; whereas the IHCA President, Dr David O’Keeffe, saw only “a framework that allows us to put the bones on a contract that we hope to subsequently agree”.

Perhaps I’m being unduly pessimistic, but when you look behind the spin from both sides and into the detail of the report, it’s hard to detect anything which suggests that a deal is near, feasible or even possible.

Little ground for hope

That is not to say that either side has nothing more to give in further talks, or even to downplay the significance of what both may have already conceded to get to this point, only that the report itself gives little ground for hope that the parties can bring themselves to yield on crunch issues. The chairman makes it clear in the very first line of his report that this is the very last time he can try realistically to break the deadlock.

Mr Connaughton recommends an interim committee to work out how future posts should be structured; proposes a clear and explicit definition of the concept of clinical independence; and clarifies the right of consultants to advocate on behalf of their patients in directorates and in public.

Further negotiations

He comes down in favour of a 37-hour week, with services to be provided from 8am to 8pm, consultants to be on site for five hours each day during Saturdays and on Sundays, and further negotiations between the parties to work out precise requirements for 24-hour cover.

However, things get sticky after that. An 80:20 public/private split with a three-year lead time for existing consultants is endorsed, but there is no agreement on the price or the mechanism for valuing the new contract.

On the Category 2 issue, he suggests a limited Category 3 option to permit some off-site private work, but it is not clear how this would work in practice, or what kind of rows might blow up if HSE tried to limit it.

Calm before storm?

If the parties are unable to resolve these issues, the chain reaction is easy to see. In the event the consultants refuse to agree a new contract, the employers are likely to, at a minimum, seek to make new appointments on those terms which appear to have found favour in the talks to date.

That would cause the representative organisations to cry foul, to accuse government employers of breaking both the spirit of partnership and the letter of the current contract and memorandum, just as the talks, which they had voted overwhelmingly to continue, were about to bear fruit.

The employers, in their turn, would condemn the whole process as a ridiculous charade – one in which consultants would happily talk for years, but ultimately refuse to compromise. With everyone back at square one, there would be no chance of an amicable, acceptable, all-party agreement. Such an outcome would carry great risk and must be avoided.