Brennan Report - Department of Health and Children

Chapter 5 Accountability – Hospital and Non-Hospital ProgrammesRecommendation on the existing Consultants’ Common ContractR5.2 The Consultants’ common contract should be reviewed, for existing Consultants, to ensure that the followingprinciples are explicitly reflected in the contract:● Formal recognition and agreement by Consultants, as the key decision makers, of their responsibility tomanage resources to which they are entitled to conduct their practice 3 within agreed budgets atdepartment, specialty and individual Consultant level.● Participation in arrangements for collective representation of Consultants at hospital managementcommittee level.● Agreement of core hours of attendance.● Active management and optimisation by Consultants of resource allocation against agreed practice,specialty and department Service Plans and budgets.● Cooperation with arrangements for measurable and transparent systems of continuously monitoringadherence to public and private practice contractual commitments.● Where there are competing public and private practice demands on Consultants’ time and resources, theformer should have priority call on such time and resources at all times.The progressive implementation of the EU Working Time Directive over the coming years islikely to give rise to recruitment of a large number of additional Consultants. This presents aunique opportunity to recruit a substantial proportion of Consultants on a "public-only"contract. This would go a substantial way towards addressing the conflict of interest issueidentified above and make sufficient time available to Consultants to fully engage in financialmanagement and practice budgeting.In this context, we would emphasise that such a move would be consistent with Governmentpolicy, as reflected in the health strategy, to target public resources towards public patients. Inparticular in the health strategy 4 , the Government has decided that there will be aprogressive reduction in the proportion of private to public beds in the public hospital setting.It has decided that all new general hospital beds under the Bed Capacity Programme will bedesignated as exclusively for the use and treatment of public patients. Seven hundred beds arecurrently being put in place in public hospitals on this basis.Recommendation on Contract for New Consultant AppointmentsR5.3 All new Consultant appointments, covering new posts and the replacement of existing Consultants, should be onthe basis of contracting the Consultants to work exclusively in the public sector.Executive Management CommitteeIf clinical Consultants are to become central to the structuring of accountability for themanagement and control of resources in the general hospital programme, it will be essential tohave appropriate management structures and processes to enable them exercise thataccountability in ways that will benefit their patients through the more effective use ofresources. It is imperative that all hospital management structures include an ExecutiveManagement Committee that involves representation of clinical Consultants in themanagement of the hospital. The Executive Management Committee will provide a forum forclinicians to have an input into, and be accountable for, managing the hospital resources and todiscuss clinical and management concerns.3Section 6.4.4. - Consultant Common Contract 1997 (See Appendix 7).4”Quality and Fairness – A Health System for You” (page 107).67