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									Hospital Consultants Contract
Negotiations set to Resume
Following acceptance by the Board of the HSE and the Irish Hospital Consultants
Association (IHCA) of proposals put forward by the independent chairman of the
talks, Mr Mark Connaughton, S.C., negotiations on a revised contract for
hospital consultants are expected to resume shortly. However, the Irish Medical
Organisation (IMO) has yet to take a decision on the proposal.
The negotiations have been stalled since February last because of a
disagreement between the parties on a number of issues, including issues
relating to Category 2 appointments. The Chairman proposed that the parties
should enter into intensive negotiations for two months and that the prohibition
on making Category 2 appointments, which existed since January last, would be
put on hold for the defined two month period and that the other issues relating
to a discrete number of pre-January 2006 Category 2 applications should be
discussed as part of the negotiations.
A new Hospital Consultant Contract is pivotal to the reform programme for the
hospital service. As highly skilled clinicians who occupy key leadership
positions within the service, the working arrangements for Consultants have a
crucial bearing on both the quality and efficiency of how medical care is
delivered to hospital inpatients and outpatients. A succession of different
reports (Brennan, Hanly and Prospectus) have highlighted the need for changes
to the contract, including the need for greater accountability, more information
on how Consultants divide their time between their public and private patients,
and the need for national standards for clinical care.

European Working Time Directive
Pilot Projects Commence
Efforts are continuing to implement the European Working Time Directive (EWTD) for Non Consultant Hospital
Doctors (NCHDs). In this context fourteen pilot projects have been given approval by the National
Implementation Group. The commencement of these pilot projects is part of a substantial body of work by
Local Implementation Groups in the nine pilot sites to look at hospital activity in their area and devise ways
of implementing the provisions of the EWTD and reduce NCHD working hours whilst improving patient care.

The National Implementation Group, which is chaired by Dr Cillian Twomey, is a representative group which
has been asked to co-ordinate the work of the Local Implementation Groups in implementing the conditions
of the EWTD. Local Implementation Groups were requested to devise proposals and submit them to the
National Implementation Group for consideration. It was agreed at the outset that all projects would be
subject to final approval by the National Implementation Group and that those projects which received
approval would run for a limited time period and would be without prejudice to the industrial relations

A total of 43 pilot project proposals have been submitted to the National Implementation Group for
consideration to date. The projects which have been given final approval cover a broad range of specialities
and are derived from 6 of the pilot sites. The approved projects are as follows:

             Pilot Site                                         Project Proposal
  Cork University Hospital Group       The introduction of a shift system to the Anaesthesia first on call rota

                                       Introduction of Trauma Co-ordinator to CUH

                                       Clinical Specialist Physiotherapist-led Practioner Fracture Clinic

Galway University Hospital Group Introduction of Nurse led 'PICC Line' Service

                                       IV Cannulation

                                       Discharge Lounge

                                       Clinical Nurse Specialist Haematology/Oncology

   Letterkenny General Hospital        Review of the on-site on-call arrangements within psychiatric speciality
                                       at LGH with objective to convert to off-site working during out of hours

                                       Development of a model for measurement and analysis of NCHD time
                                       dedicated to education and training activities currently designated as
                                       working time.

 Mid Western Regional Hospital Group Paediatric Phlebotomy & Reduction of working time of neonatal senior
                                       house officer

                                       Ophthalmology Casualty Service

 Midland Regional Hospital Mullingar   To achieve EWTD compliance and enhance education and training in the
                                       Department of Surgery

                                       To develop consultant provision of service, reduce NCHD hours and
                                       protect scheduled teaching in the Department of Paediatrics

  St Loman’s Hospital Mullingar        Achieving EWTD compliance at St Loman's Mullingar

European Working Time Directive Pilot Projects
Commence continued
The approved pilots have already commenced or are in the process of commencing. Pilot
projects will be evaluated according to agreed criteria by Evaluating Teams comprised of
project participants, Local Implementation Group representation and nominee(s) from the
relevant postgraduate training body (medical, surgical and/or paediatric etc) to provide
independent adjudication of the projects.

The remaining project proposals are still under consideration by the National
Implementation Group and other pilot sites are awaiting approval. Further clarification has
been sought on a number of proposals and will be discussed at the next meeting of the
National Implementation Group.

Discussions between management and the IMO under the auspices of the Labour Relations
Commission are to resume on the 16th October 2006. Previous discussions had focused on
devising a new contract of employment for NCHD’s and the development of principles for
rostering NCHD’s. These topics will remain the focus of attention for the next round of

European Social Dialogue in the Hospital
For the past number of years the European                The Ageing workforce in the hospital sector.
Hospital and Healthcare Employers Association
(HOSPEEM) and the European Federation of Public          Assessing new skill needs in the hospital sector
Service Unions (EPSU) have been working on the           with a view to developing training and
establishment of a formal social dialogue                development programmes for hospital
programme in the hospital sector, with the               professionals.
assistance of the European Commission. On the 20
September 2006 the European Commission                 Following agreement on the work programme a
formally launched a work programme known as            more detailed programme will be drawn up with
The European Sectoral Dialogue for the Hospital        the European Commission setting out a timetable
Sector, which will be progressed jointly between       and arrangements for implementation of the
HOSPEEM and EPSU. The work programme will be           agreed outcomes.
progressed by the establishment of working groups
which will operate under the aegis of a Steering
Group and will cover the following issues:
  Recruitment and retention in the context of
  increased mobility of workers and addressing
  skill gaps and labour shortages in certain       The HSE-Employers
  regions and occupations.                         Agency is a member of
                                                   HOSPEEM and is
                                                   represented by Brendan
                                                   Mulligan, Assistant Chief

Roman Catholic Hospital Chaplains
The Catholic Healthcare Commission, which acts on behalf of ordained and non-ordained
Chaplains, lodged a claim for a pay review for Roman Catholic Hospital Chaplains in 2004.
This group was not included in the last Benchmarking process as their employment status was
not clear. Proposals to regularise the terms and conditions of employment of Chaplains and
the position of Chaplaincy Service Coordinator in the larger teaching hospitals (MATHs/DATHs)
were accepted by the Catholic Healthcare Commission. Acceptance of these proposals have
de-facto confirmed the status of Hospital Chaplains as employees and the implications for
superannuation and the normal terms and conditions of employees have been discussed and
agreed in the context of implementation of this agreement.

A circular putting in place the proposals and a revised contract has issued. This contract
should be issued to all Roman Catholic Chaplains in approved positions, including part time
chaplains who heretofore have been paid on a pro-rata basis to their full time counterparts.
Payment of the revised rates outlined in the circular is dependent on acceptance of a revised
contract of employment by the Hospital Chaplain.

It has also been agreed to sanction the introduction of the position of Coordinator of
Chaplaincy Services in the larger teaching hospitals:

   St James Hospital
   Beaumont Hospital
   St Vincent’s Hospital
   James Connolly Hospital
   Galway University Hospital
   Cork University Hospital

Note-The Adelaide & Meath Hospital has alternative arrangements in place.

Benchmarking Phase II
The Public Service Benchmarking Body is continuing its evaluation of the pay of public service
employees vis-à-vis employees in the private sector. Oral hearings are currently being held in
respect of each grade that is being reviewed. The HSE Employers Agency is representing the
health services management at these hearings, having previously provided the factual
information on all aspects of the employment of the 38 health sector grades under
examination, including details of numbers in each grade, salary, organisation of work,
conditions of employment, structure of grade and entry requirements.

Protection of Employees (Fixed Term
Work) Act 2003
The HSE-EA has recently circulated updated guidelines on the Protection of Employees (Fixed Term
Work) Act 2003. This legislation has proved to be relatively complex for the health services,
particularly in the management of fixed term contracts. Section 8 of the legislation stipulates that
certain information must be provided to all fixed term employees in their contracts of employment,
both at their initial appointment and in circumstances where their contracts are being renewed.
However, the purpose of this Section is not just to ensure that a fixed term employee is informed
about the objective reason that will terminate his / her contract, in the case of a contract renewal it
specifies that there must be an objective ground justifying its renewal which is based on
considerations other than the temporary status of the employee. This means that the practice of
automatic renewal of temporary contracts without real regard to the circumstances which give rise to
the renewal is no longer permitted. Employers must examine the circumstances of all fixed term
employees and must be able to show that they gave proper consideration to granting the employee a
contract of indefinite duration, but real and objective reason exist for continuing the employee on a
fixed term basis. The renewed guidelines are intended to inter alia aid employers with this particular
aspect of the Act.

It is intended that regional workshops will be held within the HSE to discuss the guidelines with
relevant managers and ensure that the Act is properly implemented within health services.

Employment of People with Disabilities
The Disability Act 2005, which came into effect from 31 December 2005, places significant
obligations on public bodies to be pro-active in employing people with disabilities. The HSE-EA
Equal Opportunities Working Group is progressing a number of initiatives to assist health service
employers to meet their obligations under the Disability Act 2005 and the Employment Equality
Acts 1998 and 2004 in relation to the employment of people with disabilities.

The Working Group is currently preparing a strategy and action plan for the employment of
people with disabilities. The aim of this strategy and action plan is to assist employers to attract
and retain people with disabilities by outlining practical initiatives to improve access to job
opportunities in the health service, to facilitate their integration into the workplace and ensure
that they are provided with a working environment that respects their dignity. It also provides
for measures to accommodate employees who acquire a disability during their working life. The
strategy and action plan are included in the Department of Health and Children’s Sectoral Plan,
which outlines the actions which will be undertaken to meet the HSE’s obligations under the Act.
The HSE-EA is also participating on the HSE Implementation Overseeing Group which is
responsible for overseeing the HSE’s compliance with the actions outlined in the Sectoral Plan.

Proposed Disciplinary Procedure for the
Health Service
It is hoped that the proposed disciplinary          The revisions to the disciplinary procedure
procedure for the HSE, which has been agreed        were negotiated against the background of
in principle with the health service unions, will   legislation which provided HSE staff with
be signed off at a final meeting on 27th            equivalent protections to those which they had
October 2006. In the meantime the procedure         enjoyed under the Health Act, 1970. In
is being operated on an interim basis. It is        addition agreement was reached on the levels
also intended to prepare a set of operating         of management which will have authority to
guidelines to accompany the procedure.              decide on disciplinary action at the dismissal
                                                    stage. The procedure also provides for the
The original Disciplinary Procedure for the         establishment of a committee to hear appeals
Health Service which issued in May 2004             against dismissal decisions and an ad
covered all staff employed in the publicly          misericordium appeal (or final “mercy appeal”)
funded health service. However, permanent           to the Chief Executive Officer in the event of an
officer grades in the former health boards were     appeal against the decision to dismiss being
excluded from the dismissals stage of this          unsuccessful.
procedure as they were covered by sections
22,23 and 24 of the Health Act 1970 for the         The revised procedure will only apply to HSE
purposes of suspensions and dismissals. The         staff. Agencies in the Voluntary Hospital and
Health Act, 2004 established the Health Service     Intellectual Disability sector will continue to be
Executive which replaced the health boards and      covered by the Disciplinary Procedure agreed in
subsumed a number of agencies. It also              May 2004.
repealed sections 22, 23 (i) (ii) (iii) and 24 of
the Health Act, 1970 which dealt with the
suspension and dismissal of permanent health
board officers.

Policy on Workplace Disclosure
Following a claim served by the INO at the          consideration is being given to issues such as
National Joint Council for the development of a     the degree of confidentiality which can be
policy on workplace disclosure for the health       afforded to staff who raise concerns and the
service, a Working Group comprising                 reporting procedure to be followed by staff. A
representatives from health service employers       sub-committee of the Group has been formed
and unions was established to develop a             to progress the drafting of the Policy. It is also
policy to encourage and enable staff to             intended to meet with the UK independent
disclose internally any matter that arises in the   charity, Public Concern at Work, who have
workplace and is a genuine cause of concern         issued guidance to employers on how to
to the staff member.                                introduce an effective workplace disclosure
Following a review of sample ‘whistle blowing‘
policies from other jurisdictions, the Working
Group prepared a draft document which is the
subject of ongoing discussions. Particular

Conference on SKILL Initiative
A one-day conference took place on the 27th September 2006 on the SKILL initiative. The SKILL
initiative aims to train, educate and up-skill support staff in order to progress the “skill mix”
requirements of the health service. The trade unions SIPTU, IMPACT and the ATGWU are fully
supportive of the SKILL project and have embraced it as a proactive example of partnership in
operation in the health services.

The chair of the SKILL Steering Group, Mr Bill Attley, stated that the success of the initiative is
dependent on top-level management support. He also commented on the serious commitment given
by Government to up-skill significant numbers of workers in the health service.

The CEO of the HSE, Professor Brendan Drumm, together with Mr Tim O’Malley, Minister of State at the
Department of Health and Children, Mr Michael Scanlan, Secretary General, Department of Health and
Children, and Mr David Begg, ICTU General Secretary, were among the speakers at the conference. A
number of guest speakers from abroad also addressed the conference, namely Professor Debra
Humphris from the Health Care Innovation Unit in the University of Southampton and Ms Deborah
King, Executive Director of the Employment, Training and Job Security Program in New York.

Professor Drumm stated that while it is important to up-skill these workers, it is also important to put
structures in place to enable them to utilise these skills and break down traditional hierarchies and
job demarcations.

On the issue of “skill mix” and job demarcation, Professor Debra Humphris referred to the myth and
reality of who undertakes various aspects of healthcare in practice and identified 80% of interventions
as “generic”. She identified the introduction of new technology and improved training techniques as
being instrumental in broadening the role of the healthcare assistants.

Ms Deborah King has advised and worked with the Irish health services and unions in developing the
SKILL initiative over the past number of years. She spoke of her experience with the Training and
Employment Funds in New York and told of how trade unions and management worked together to
develop strategies for dealing with various healthcare challenges, including projects on improving
patient care, productivity and job satisfaction.

Mr Michael Scanlan spoke on “System wide improvement and return on investment” and identified
three objectives for the SKILL project to make a system wide improvement, namely:
  Measuring what is produced,

  Integrating Services and

  Reforming to do things better.

He also spoke of the need to move away from the traditional job demarcation.

Mr David Begg in his closing address stated that he hoped the SKILL project will become a flagship
model for up-skilling, adding that it is a clear signal that reform can be achieved with the right

Midwifery and Paediatric Nurse Education
Agreement has been reached between the Health Service Employers, the Irish Nurses Organisation
and the Third Level Sector regarding the transfer of the Pre-Registration Midwifery and Children’s
Nursing Education to the third level sector.

Under the agreement, all eligible Nurse Teachers and Principal Nurse Teachers were offered one of
the following options:

  Resign from employment with their current employer and commence employment with the
  third level sector
  Remain in current employment
  Apply for early retirement

The following arrangements are being put in place to ensure ongoing provision of continuing
education programmes to nursing staff which were previously delivered by the Schools of
Midwifery and Schools of Children’s Nursing:

a)      Provision of Continuing Midwifery Education, Dublin Area
A Dublin Centre for Midwifery Education is being established to provide for continuing education
and professional development for staff employed in the National Maternity Hospital, the Coombe
Women’s Hospital and the Rotunda Hospital, and service the general requirements for midwifery
education in the Dublin Catchment area. The Centre will be based in the Coombe Hospital with
satellite sites in both the Rotunda Hospital and the National Maternity Hospital.

b)     Provision of Continuing Midwifery Education, Outside Dublin Area
Continuing Midwifery Education outside the Dublin area, i.e. Cork, Galway, Limerick and
Drogheda, will be provided through the existing Centres of Nurse Education which will be
designated as Centres of Nursing Midwifery Education.
c)     Provision of Continuing Children’s Nurse Education
A Centre for Children’s Nurse Education is being established in Our Lady’s Hospital, Crumlin to
service the existing Children’s service providers of the University Hospital Temple Street, Our
Lady’s Hospital for Sick Children, Crumlin and the Adelaide and Meath Hospital Incorporating the
National Children’s Hospital, as well as the general requirement for children’s nursing education.

Team Based Performance Management

The roll out of the Team Based Performance Management System is one of the specific
targets of the modernisation agenda for the health services as set out in the new Social
Partnership Agreement, Towards 2016.

A National Steering Group is being established to oversee and support the on going
mainstreaming of Team Based Performance Management in the health service. Professor
Brendan Drumm has written to all Senior Managers within the H.S.E. and to the Chief
Executive Officers of the Voluntary Hospitals and Intellectual Disability Sector calling for “a
renewed commitment to roll out this system to the maximum possible level”. Each senior
manager and staff member has a responsibility to ensure that Team Based Performance
Management is operating within their area of responsibility, particularly across multi-
disciplinary teams, and to ensure that arrangements are put in place for its continued
expansion and sustainability into the future. In this context each manager will be required to
report significant progress in this area throughout 2006 and beyond.


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