Bid to monitor consultants’ public hospital work is chaotic, reveals report
AN INTERNAL report has revealed the chaos behind trying to manage the contracts of medical consultants and ensuring they work all 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 some consultants were not doing all they were supposed
No provision for monitoring off-site
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.
In one case, a consultant observed for an eight-week period was found to be doing just 13 hours a week on average in the public system.
Documents obtained under Freedom of Information reveal the consultant contract issue was a major concern of the HSE and Department of Health before the RTÉ documentary was broadcast.
A report had been prepared highlighting the ‘key challenges’ facing the HSE in guaranteeing that consultants met their obligations. It said 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 off-site private practice generally, the report said. The HSE also had no way to check how much consultants were earning from the private work they did, while other problems around deter- mining whether patients were public or private were also identified. Another issue identified was that some consultants were working more than required and ‘strict enforcement’ for all could well bring those doing too many hours ‘into sharp focus’.
A separate briefing for Minister for Health 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.’ 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.’
Minister Harris was also made aware of the letter at the time, the documents show.
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. It also said Minister Harris would be looking for ‘absolute assurances’ that contracts were being enforced and ‘robust measures’ would be introduced this year.
One was doing 13 hours a week