AN INTERNAL report has shown the major difficulties behind trying to manage the contracts of medical consultants and ensuring they stick to the hours they are supposed to in public hospitals.
The document effectively admits that for many consultants, the HSE has no way of monitoring their earnings or private practice to ensure they fulfil their obligations.
The report was prepared by the HSE for the Department of Health and the Department of Public Expenditure amid concerns that some consultants were not doing all they were supposed to do in public hospitals.
The issue was highlighted in an RTÉ Investigates documentary last November which showed how some consultants were doing far below what their contract required, particularly in regional hospitals.
In one case, a consultant observed for an eight-week period was discovered to be doing just thirteen hours a week on average in the public system.
Documents obtained under FOI reveal the consultant contract issue was already a major concern of the HSE and Department of Health prior to the programme broadcast.
A report had been prepared highlighting the “key challenges” facing the HSE in guaranteeing that consultants met their obligations.
It said that it was impossible to keep tabs on 360 consultants with a specific type of contract.
“[Their contracts] posed unique challenges for this cohort as it left no effective basis for monitoring compliance,” the report explained.
Many contracts had no provision for monitoring offsite private practice generally, the report said.
“The HSE has audited hospitals in relation to this issue; however, it does not lend itself to a routine monitoring, and random checks through websites have limited benefit. There is a need to determine the most appropriate mechanism for establishing whether there is inappropriate off-site practice.”
The HSE also had no way to check how much consultants were earning from the private work they did while other problems around determining whether patients were public or private were also identified.
Another issue was also raised where some consultants were working more than required and “strict enforcement” for all could well bring those doing excess hours “into sharp focus”.
A separate briefing for Minister Simon Harris said measures were now needed to “actively monitor compliance” by consultants with their obligations.
Among the options being considered were audits of individual hospitals and the “pursuit of corrective action” if consultants were breaching their work conditions.
Also suggested was the possibility of creating a new “robust compliance framework” that could be used to make sure contracts were being fulfilled.
It said: “It is essential that a governance framework and related reporting and monitoring arrangements are put in place in respect of each consultant to ensure that they deliver their work commitment to the public system.
“[It should also ensure] that their private practice activity is in accordance with the levels permitted by their contracts and, where this is not the case, that the framework provides for the taking of corrective action.”
The Department of Health had flagged the issue over consultant contracts months before the RTÉ documentary was broadcast.
Secretary General Jim Breslin wrote a letter to the HSE last July raising the fact that consultants doing too much private work was an ongoing problem.
He said: “I understand that returns made … raise concerns that consultants may be exceeding their permitted level of private practice within the public hospital where they are employed, exceeding their off-site private practice rights or engaging in off-site private practice though holding a contract that does not permit any off-site private practice.”
Mr Breslin said he hoped all consultants would be reminded of their contractual obligations and that “processes were put in place” to make sure they met them.
Minister Simon Harris was also made aware of the letter at the time, the documents show.
In response, Director General of the HSE Tony O’Brien said that consultant contracts were a “high priority” for them.
They said they had intervened in specific instances where they were not satisfied that consultants were meeting the conditions of their employment.
In a statement, the Department of Health said they planned to hold a meeting with the HSE in the coming days to get an update on what has been done in the months since the RTÉ documentary.
They said: “The minister is very clear that consultants must deliver their work commitment to the public system.
“For some time now, the Department of Health has been working closely with the HSE to find a solution to ensure more effective monitoring of compliance by consultants to their contracts and that compliance is achieved in respect of all consultants.”
They said Minister Harris would be looking for “absolute assurances” that contracts were being enforced and that new more “robust measures” would be introduced this year.
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