Cian O'Callaghan: Rotunda rostering, Galway delays and patient risk

Tánaiste, in the rotunda there are consultants on public only contracts receiving payments for delivering babies while covering for their private colleagues. On Tuesday I told the Taoiseach that this was happening at Cork University Maternity Hospital too. Taoiseach admitted he didn't know anything about this. Today it has been reported in the Irish Independent that a long-standing professional fee arrangement had been in place among consultants in CUMH. Spokeswoman for the HSE said, and I quote, this is a private professional arrangement between some consultants in which Cork University Maternity Hospital plays no part. Tánaiste, while it's no doubt true that hospital management play no part in administering the payments, they organise the rosters that facilitate this practice. It appears from reports today that rosters are being changed and this practice has been stopped in Cork this week. However, no such confirmation has been forthcoming from the rotunda. Tánaiste, we also know there are major issues at Galway University Hospital where public consultants are being asked by management to do lab work for a private hospital. While some are refusing to do this, this is nonetheless leading to huge delays. This includes delays to tests for life-threatening conditions including cancer. As a result, lab work has been outsourced for both public and private patients to commercially run labs. This is at enormous expense to the public purse. Tánaiste, this is not just about consultants and public-only contracts getting extra payments for private work or billing insurers for work for private patients. It's also having a real and negative impact on the care of public patients. Patients whose lab work is being delayed while private work is done. Patients whose health and lives are being put at risk. Tánaiste, the whole point of the public-only contract is to improve our health system and level up care for public patients so they're receiving the same continuity and quality of care as private patients. Instead, at the rotunda and the CMH, rostering gaps were being filled for private consultants. This appears to be stopping at CMH, but what about rotunda? Tánaiste, my questions are, has the rotunda been instructed to stop this practice? Has University Hospital Galway been told to stop asking public consultants to do lab work for private hospitals? And what are you doing to ensure that the public-only contract is being enforced around the country? I want to thank Deputy O'Callaghan for raising the issue and at the outset I want to say I agree with him on the importance of the public-only consultant contract. Indeed, it's something that arose from one of the better days or better periods of time in this House where government and opposition worked together on a vision for the future of the health service. Col Sláinteachair, I was the Minister at the time, your own former party leader, chaired that committee, Deputy Shorthall, and it has produced a good blueprint that we're all working our way through and it's taken some of the, let's say, the day-to-day politics in terms of policy direction out of health and I think that is a good thing. And I want everybody who works in our health service, no matter what role they play, to understand that this Oireachtas speaks with one very clear voice when it comes to health policy, public health policy, and we all expect it to be followed. I also agree with you that there has been progress. We've seen the benefits of the public-only consultant contract and I won't go through them all but, for example, if you take St Vincent's University Hospital, it's brought about a Saturday hub with participation by 40 consultants. In Wexford General now we have weekend consultant covering emergency medicine, surgery, paediatrics, gynae services. Waterford, we've seen a minimum of 26 consultants rostered at weekend with outpatient diagnostics now running until 8pm in the evenings on certain weekends. I use that as an example of where, when this is applied correctly, we can see the real benefit in terms of public health care. I want to say in relation to some of what has emerged, and acknowledge your own work and Deputy Rice's on this, that the idea of anybody being given a gift or paid to do an ICSR effectively is not in line with the contract, it's not an approved HSE arrangement, it's not something the Department of Health, the Minister for Health, the HSE or the Government would condone and measures are now being taken to ensure that this practice ceases with immediate effect. My understanding is that the HSE Chief Executive is currently engaging with all of the regional health areas and the regional clinical directors in relation to this practice. Can I also make a couple of other points as well because sometimes, and certainly not you, quite the opposite to you, but sometimes people try to muddy the waters in relation to this, as would be the case for all specialties. Some maternity consultant on duty in any hospital is responsible for the care of all patients requiring attention, regardless of whether they're private or public. So this idea that if you're on call you have to be kind of given some sort of gift or payment to see that, that's not how it works and doctors know that too. Cross-cover between consultants is routine, it's an expected part of how our public health services are delivered, ensuring continuity of care and any suggestion of private financial arrangements in this context is inconsistent with contractual obligations, raises serious concerns and risks diverting time and resources away from treating public patients. I think we've seen no tolerance from the Minister for people who sign on the dotted line in relation to a contract and don't adhere by it and you can be sure the Minister Cara MacNeill is working intensively on ensuring the full implementation. Can I also say though as Minister for Finance, lest anybody be of any other view, any income, direct or indirect, gained from employment is taxable and revenue have standard audit compliance procedures which they operate across all sectors. So whether it's payment the traditional way or a gift or a nixer, please be aware of the taxable obligations on any income derived through that too. Go raibh maith agat. Tánaiste, there are patients waiting on test results who want answers in relation to lab work at the University Hospital in Galway. They want to know what's being done in terms of their test results. They need a quick turnaround on their health, their life depends on a quick turnaround. They want answers as to what the government is doing on that. So you haven't addressed that at all so you may address what is the government doing about that. It's welcome that the HSE is following up on this but when are people going to know that these payments, additional payments that are in breach of the public only contract, when are they going to know that that has stopped? And what are you doing generally? You know we're seeing more and more things emerge about breaches of the public only contract. So what is the government doing to ensure that the public only contract is actually being enforced? Are you waiting for a drip feed of things to emerge around the country? Are you being proactive ensuring that the taxpayer and the public is getting the service that they are paying for and deserve? Tánaiste? No, I can assure you there's a few more proactive ministers than Minister Carl MacNeill and the Minister is fully committed to the implementation and enforcement of the public only consultant contract. We've already seen strong national uptake of the contract. 3,416 consultants signed up as of the end of May including 1,220 new entrants but also over 2,000 consultants who switched from the older contract as well. So now we have a health service where 69% of all consultants working in our hospitals are now on the public only consultant contract and this represents a lot of progress in the time between now and 2023 when it was introduced. I know absolutely and we'll get to that, consultant numbers have also increased significantly as well. In terms of any breaches and I think we've shown this as a government, I think the Minister for Health has shown this, that they simply won't be tolerated and there's a process undergoing being and I've been briefed on this at the Cabinet Committee on Health underway within the HSE led by the Chief Executive, regional health area by regional health area, hospital by hospital to make sure there's full compliance and I also know that the Minister is very eager to keep engaged with your colleague Deputy Rice's Chair of the Oireachtas Health Committee on this and I would think the Oireachtas Health Committee is a useful place to continue to monitor that progress as well. This can be a game changer for the delivery of public health but when you sign on the dotted line, when you take the larger higher salary, you're expected to deliver on those terms just like anybody working in the public service.