Department of Health documents on difficulties in monitoring medical consultants and their work in public hospitals

AN INTERNAL report has revealed the chaos behind trying to manage the contracts of medical consultants and ensuring they work all the hours they are supposed to in public hospitals.

The document effectively admits that for many consultants, the HSE has no way of monitoring their earnings or private practice to ensure they fulfil their obligations.

The report was prepared by the HSE for the Department of Health and the Department of Public Expenditure amid concerns that some consultants were not doing all they were supposed to do in public hospitals.

The issue was highlighted in an RTÉ Investigates documentary last November which showed how some consultants were doing far below what their contract required, particularly in regional hospitals.

In one case, a consultant observed for an eight-week period was discovered to be doing just thirteen hours a week on average in the public system.

Documents obtained under FOI reveal the consultant contract issue was already a major concern of the HSE and Department of Health prior to the programme broadcast.

A report had been prepared highlighting the “key challenges” facing the HSE in guaranteeing that consultants met their obligations.

It said that it was impossible to keep tabs on 360 consultants with a specific type of contract. “[Their contracts] posed unique challenges for this cohort as it left no effective basis for monitoring compliance,” the report explained.

Many contracts had no provision for monitoring offsite private practice generally, the report said.

“The HSE has audited hospitals in relation to this issue; however, it does not lend itself to a routine monitoring, and random checks through websites have limited benefit. There is a need to determine the most appropriate mechanism for establishing whether there is inappropriate off-site practice.”

The HSE also had no way to check how much consultants were earning from the private work they did while other problems around determining whether patients were public or private were also identified.

Another issue was also raised where some consultants were working more than required and “strict enforcement” for all could well bring those doing excess hours “into sharp focus”.

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