Irish Times on Hospital Consultants pay and a few comments.

“Dr Reilly described the pay issue as the “elephant in the room”, and
said the Croke Park agreement had to be “expanded” to deal with
critical financial problems facing the health service.

He argued he could make no more savings in non-pay sectors and said
“some of the best-paid people in the State” should shoulder the

In reply, Labour’s Mr Howlin said Dr Reilly could cut hospital
consultants’ pay but “Minister Reilly’s stated preferred approach has
been to deliver savings from that group [consultants] other than
through pay reductions; it will be critical that engagement with that
group is pursued urgently by his department and the HSE to ensure
those savings are delivered”.

In what was interpreted in political circles as a carefully worded
admonishment, Mr Howlin said he was “strongly in agreement that the
highest-paid public servants, who are hospital consultants, should
form part of the solution to the issue of cost overruns in the health

The programme for government commits the Coalition to reducing
hospital consultants’ remuneration under a new contract.

The controversy began yesterday when Dr Reilly told reporters about
the options open to him when implementing required cuts.”

I am never sure whether the mediocrity in knowledge and analysis among
politicians means that most of these comments are just empty rhetoric
and verbiage. Because the number of patients treated per consultant
has soared which is the main reason hospitals are so over-budget.
There are other reasons but when more patients are treated, more money
is spent. Also each patient must receive the best available treatment
according to the courts and to medical ethics.

Mr Brendan Howlin should know that consultant salaries have been cut
already by about €50,000 from where the 2008 contract defined. This is
not nothing. Much of the contract is a patronizing affront to
professionalism and I have made my views on that issue public on many

Ironically, public hospitals now have a vested financial interest in
admitting private patients because the income goes up. When there are
no beds or OPD is closed or theatre sessions cancelled or operations
cancelled, the doctors then have a vested interest in heading out the
door to a private hospital to WORK. So the more dysfunctional the
public hospital, the greater the incentive to leave and work
elsewhere. It beats idleness. Meanwhile some ill-informed politicians
go on about consultant not doing the work etc. They haven’t a clue.

The unit cost then rises in the public hospitals because salaries
remain the same but work is curtailed because services are closed.
What an unadulterated mess. The negotiators of the 2008 contract on
behalf of the public should be keelhauled. Luckily, they are not
around still.

In summary- Consultants have improved the work throughput hugely in
public hospitals despite the anti-doctor propaganda. OPD goes from
8-8. But as cuts come, theatres are closed, wards close, ward rounds
happen early and often, discharges are accelerated, OPD gets closed in
some places and the incentive to get to private hospitals increases as
does the opportunity because the time available increases.

Meanwhile – don’t believe what “they” say. Who are “they”? You name them.