Martin Daly: Enforce Public-Only Consultant Contract Now

Whilst this amendment probably is and hasn't a place here, it raises many pertinent points and again to support what Deputy Conlan has said and Deputy Bourke said, but I do want to reflect that the person who took the strongest stance, including yourself, Taoiseach and Minister Chambers and a number of others in government in relation to the Public Only Contract, yours was an unequivocal stance and I can't say the same for the opposition, in all cases, yours was the leadership, there was no equivocation, there was no talk about talks and compromising that. You realised the importance of upholding the Public Only Contract because it would unravel Sláinte Cear and the whole government policy that has received all party support for the last number of years. So I think that that was extremely important. In saying that, what's happened I suppose in this transition period, it is exposing anomalies, it's exposing practices that were there and that were culturally built into the system and we need to ensure that it's not just about maternity hospitals, it's right throughout our system, that hospital by hospital, place by place, that these anomalies, these practices that built up are now to be seen off the pitch because if there's going to be an even pitch for everyone, and at the end of the day this is about taxpayers' money, it's about a contract that was freely entered into and it is also about the citizen at the end of the day, the patient who goes to receive that service. And as we know from all the reports around maternity, there is no difference between the safety of care, between public and private practice. We have very good maternity outcomes and that's because we have a hugely supported public service that supports those outcomes. And the same applies to many of our other hospitals. So we need to see those. And that's where too some of the insourcing and outsourcing ran into trouble. Certainly the insourcing ran into trouble because it created this moral hazard, it created conflicts of interest and we really, really need to see that off the pitch. So whilst I don't believe the amendment is appropriate here, I do accept what Deputy Conan has said and Deputy Burke has said. Deputy Burke made a very good point as well. If we're going to appoint more consultants, we have to look at the infrastructure too so that we get the commensurate productivity, that means human resources, physical infrastructure and digitalisation. Thank you very much. Thank you for raising the insourcing because it allows me to thank the committee for their support for the ending of that model at the time which I think was necessary but it was something that we all needed to do together. So I thank the committee for their support on that as I thank them for their support on the implementation of the public only consultant contract. I see it in two ways. The first is that what happened with the rotunda was a direct breach in my view of the terms of it. But may I separate the broader issue which is essentially a non-implementation or a tacit non-implementation to my mind is just as big a problem. It may not be a direct offence to the contract as such but the non-implementation of it is in my view an offence to the taxpayer generally who is paying for it. And if I had signed a contract in 2023 that had a specific salary and specific working hours and I had in the period the following two or three years never been asked to work those hours, I would have been going sorry, when am I working on Saturday? Because I have signed a contract that says I will be available to work on Saturday. I'm perfectly happy to receive the salary. And if I wasn't receiving the salary I'm sure I would be in touch with somebody pretty quickly. But what about the actual fulfilling of the terms of the contract and knowing what that meant and knowing what that change meant? So there are a couple of different elements to this that deputies have highlighted and I think it's important to bring it all together. The first is the consultant roster generally. It is until 10pm, to be available until 10pm and on Saturdays. I do not want to ever hear again the following argument, but that means we can't work on Wednesday. Yeah, we know. Everybody here is able to count. And if you work on Saturday that does mean that you don't work a different day. And it is better, as I think Bernard Gloucester said in this committee, that it is better if you have ten consultants that you have eight working during the week and two at the weekend and ten working during the week. That balance is important. So could we please stop hearing that argument repeated back to us from various quarters, that it is difficult because it means you're not there on Wednesday. I also don't want to hear it's difficult because the support staff need to be there. Because the unions agreed to work five days over seven, they have said explicitly that they will be there to support the implementation of the public only consultant contract. That does need to be stood up and managed and led by clinicians and organised. And everybody needs to play their part in relation to that. And sometimes to be honest, just to give you some side examples, I had one hospital manager who has told me that the support staff are there but she has a difficulty with the consultants, whereas I have a different site who says that the consultants want to work theatre hours on Saturday but they don't have the nursing support. So there is a little bit of implementation. It's everybody's responsibility to be there and to implement this. But we have an absolutely unique opportunity where we have a 41% uplift in consultants. We have the consultant roster. We have the union agreement, which has been in the public service agreement since 2008, but they committed to implementing it more than 12 months ago. An absolutely unique opportunity. And I think we should all, you know, it is an overwhelming moral obligation for every single person working in health to implement that, to get this state to a fully six day system in the first instance, recognising it's twice as expensive at the moment on Sundays and the contract is a six day contract. But if we could get to a full working six day system, that would transform healthcare in Ireland forever and we would never go back and we would wonder how did we ever just, one of the hospital managers said to me, her consultant said to her recently, do you remember when we used to just leave people on Fridays? Already the culture in that model four hospital in Dublin has changed so much because the consultants in that hospital are being rostered on Saturdays, not to come in and do rounds, but to do a full eight hour shift, to do a full proper working day. What does that mean? It means that if somebody comes into A&E and they need to see one of the ologies, for want of a better description, they see them on Saturday morning. And then they're either admitted, there's a plan for them, or discharged in an appropriate way, which keeps the hospital flowing better, but also uses the terms of the contract. As regards space, yes, Deputy Burke, you're absolutely right, as we grow the system, we're going to need more space, but we don't necessarily need it yet. And one of the reasons that we know that is because of two things, two reasons. One is the outpatient toolkit, which did a baseline analysis of the use of every room and every theatre, sorry, not theatres, every consultant, all of the outpatient clinics right around the country in 41 hospitals. And it showed us the room vacancy rate and how that changes over time. So in one model four hospital in South West, we saw that the room vacancy rate during the week was between four and 9%, but 24% on a Friday afternoon. That is not a hospital that needs more rooms, that is a hospital that needs to use the rooms on a Friday afternoon, and I haven't even seen what the figures are for Tuesday night at 9pm. But I've been in that hospital on Tuesday night at 9pm, and I can tell you that the hospital is not as busy as it was at 9am. So they are not using the rooms. In the same way, the Merlin Park, the outpatient clinic, they moved from two clinics a day to three clinics a day, and they are using the rooms much better. In NACE they have implemented the outpatient toolkit, and they are using their rooms much better. Theatre utilisation, if I hear again of different shifts starting, of a theatre nurse starting at this time, and a consultant starting at this time, and a porter starting at this time, which means that you don't get knife to skin until 8.30 or 9.15 when it could have been at 7.30 in the morning. Do you know what I mean? How can you stand over that? There is a certain measure of logical organisation to things that means that you get into theatre as early as possible. How many theatres does it take? Or how many surgeons does it take? If we used every single theatre, and Deputy Bourke is so correct, the idea of not being available after 4.00pm or that the theatre is only running from 9.00 till 5.00, why? Why? The hospital is still there. We have contracts that enable people to work in those hours. Why isn't it running from 8.00, 7.00 or 8.00 in the morning until 10.00 or 11.00 at night? Six days a week. We have all of these theatres which have been fit out all around the country. We are building more, we are building surgical hubs, we are building elective hospitals, but the idea, Deputy, you are so right about elective hospitals, but the idea that we are going to build them for them to sit there eight hours of the day that they could be used. The public-only consultant contract gave us the route to a public system, but also massively extended hours. So we need to fill the rooms that we have with activity before accepting the argument that we would do it if we could get the staff around us, and we would do it if we could only get the room. The rooms are there. Look at the baseline data on the outpatient toolkit, hospital by hospital by hospital. Look at the utilisation of diagnostics, and I'm having a specific project done on the NIMIS system so we can look at the utilisation of the diagnostic equipment that is there, and look at the utilisation of the theatres around the country. Because I've just heard so many different, I remember with endometriosis, a project around additional surgeries, and I was told that you couldn't, and I was pushing for an extra 100 surgeries in the last quarter of 2025. We got 142, and thank you to the clinical community for that. But at one point I was told we can't do elective surgeries in the Coombe after 5.00pm. Sorry, what? Why? Why? Because the theatre manager says so. I'm sorry. None of that makes sense. So what I'm saying is that we have more than we think we have. We have more resources and more infrastructure than we think we have, and we now have a contract that enables us to use it in a really structured, important way. We have it on outpatients, the rooms. We have it on theatres. We have it everywhere, but we need to utilise the contract, and so what's so frustrating to me, thank you for highlighting the audit. The audit was done in a period up to August 2025. You will recall that Bernard Gloucester and I gave a direction, I think in April 2025, to say that we were giving three months' notice, which is required in the contract, that the public-only consultant contract was to be implemented, i.e. Saturday rosters and in the evening. We have spent all year doing regional forums to investigate how that's being implemented, and it's not just the disappointing figures by the end of August. My figures, which haven't been published yet in a formal way, show that now that the DIME system has been stood up, which should have been done years ago, and the work plans are being uploaded to it, we now are at nearly 90% uploaded, but the level of planning in the workforce or planning to work in the evenings and at weekends is woefully low, and I have required that it be changed, you know, essentially within the next four weeks. you