Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health ServiceConsultants’ average pay (¤ 151,694), as shown in Table 7.3, refers to remuneration in respectof their 33-hour public contract only. Consultants often work on-call and/or for lengthyperiods outside their core hours as part of their public contract commitment. Many Consultantsalso have income from private practice. The Department of Health and Children estimatespayments to Consultants from private insurers in respect of private practice in 2002 amountedto some ¤ 192.5 million. Averaging this over an estimated 1,515 Consultants with privateearnings, including those engaged solely in private practice, suggests an average gross feeincome (before practice and other expenses) from private practice in excess of ¤ 127,000 perConsultant per annum (this figure does not include fee income paid directly to the Consultantby the patient in the context of out-patient visits). Of course, some Consultants have little orno private practice while others will earn a multiple of this average.International comparisons of pay rates are fraught with difficulty due to a wide variety offactors such as differing job specifications and terms of contract. However, we consider that itis nonetheless instructive to give some indication of how the reward structure in Irelandcompares with, for example, the UK. Consultants in the UK earn a basic salary in the range of¤ 80,000 to ¤ 105,000 (Stg£52,640 - £68,505) 4 . A small proportion of Consultants in the UKcan earn in excess of this through a complex system of distinction/merit payments and awards.This can bring pay rates up to around ¤ 204,000 (Stg£133,585) based on an A+ distinctionaward. However, considerably less than 1% of Consultants employed in the UK’s National HealthService receive payment at the A+ distinctions level – in 2001, just 36 consultants. 5Having regard to the foregoing, we fully acknowledge the long and unsocial hours worked byhealth care staff in caring for patients. Patients have no control over the time at which theybecome ill and are entitled to expect treatment out of hours when they need it. Equally, staffare entitled to be recompensed for working unsocial hours.Nevertheless, we believe that the payment of overtime and other on-cost remuneration on thescale shown in the preceding tables is unsustainable. A significant proportion of the work of thehealth service is planned, non-emergency work. It should be possible to organise and managethis work within core hours. In addition, it has been suggested to us that a much greaterproportion of hospital work could be undertaken in day facilities, for example.We consider that a key task for the proposed Executive will be to examine the drivers of paycosts with a view to achieving more efficient working arrangements and cost savings throughstrategies to reschedule work within core hours and tighter control of basic pay costs throughthe introduction of improved systems of manpower deployment and control.7.3 NEGOTIATING AND IMPLEMENTING PAY AGREEMENTSThe Health Service Employers Agency (HSEA), on behalf of health employers, takes the lead rolein negotiations with trade unions and representative bodies on the pay and conditions ofemployment of health service personnel and in solving industrial relations problems in thehealth sector. The HSEA was established in 1996. It is a representative body for all publiclyfundedhealth service employers. Its membership includes the health boards, public voluntaryhospitals, intellectual disability agencies and such other corporate bodies in the health sector asare admitted to membership. The HSEA provides its services through a Board that isappointed by the Minister for Health and Children. The Board consists of nine persons drawn4Source: UK, Department of Health (April 2002). Euro/Sterling exchange rates as at 31 January 2003.5Source:Advisory Committee on Distinction Awards,Annual Report 2001, page 6.92