IHCA Yearbook & Diary 2015

IRISH HOSPITAL

CONSULTANTS

ASSOCIATION

Yearbook & Diary 2015

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For patients with non-squamous NSCLC* continue first line to

Extend Survival without compromising tolerability

ESTABLISH SURVIVAL.

Alimta/cisplatin followed by Alimta showed prolonged overall survival without significantly worsening tolerability, compared to Alimta/cisplatin followed by placebo (16.9 v 14.0 months from induction, p=0.0191)1 *Adenocarcinoma, large cell carcinoma and other histologies.

†

ALIMTA* (PEMETREXED DISODIUM) REPUBLIC OF IRELAND ABBREVIATED PRESCRIBING INFORMATION. Presentation Type I glass vials with rubber stoppers containing pemetrexed disodium equivalent to 100 and 500mg of pemetrexed, as a sterile white to either light yellow or green-yellow lyophilised powder. Uses Alimta in combination with cisplatin is indicated for the treatment of chemotherapy naive patients with unresectable malignant pleural mesothelioma. Alimta in combination with cisplatin is indicated for first-line treatment of patients with locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology. Alimta is indicated as monotherapy for the maintenance treatment of locally advanced or metastatic non-small cell lung cancer, other than predominantly squamous cell histology, in patients whose disease has not progressed immediately following platinum-based chemotherapy. Alimta is indicated as monotherapy for the second-line treatment of patients with locally advanced or metastatic non-small cell lung cancer, other than predominantly squamous cell histology. Dosage and Administration Posology: The drug is to be administered intravenously, under the supervision of a physician qualified in the use of cytotoxic anti-cancer therapy. Alimta in combination with cisplatin: The recommended dose of pemetrexed is 500mg/m² of body surface area (BSA), given by ten-minute infusion, on day 1 of each 21-day cycle. The recommended dose of cisplatin is 75mg/m² BSA, given by two-hour infusion, approximately 30 minutes after completion of the pemetrexed infusion on day 1 of each cycle. Adequate anti-emetic treatment and hydration for cisplatin treatment must be given. Alimta as single agent: The recommended dose of pemetrexed is 500mg/m² BSA, given by ten-minute infusion, on day 1 of each 21-day cycle. Pre-medication: Supplement with 1000 micrograms intramuscular vitamin B12 and oral folic acid (350 to 1000 micrograms) to reduce toxicity (for full details see Summary of Product Characteristics [SPC]). To reduce the incidence and severity of skin reactions, a corticosteroid should be given the day prior to, on the day of, and the day after pemetrexed administration - this should be equivalent to 4mg of dexamethasone administered orally twice a day. Monitoring: Monitor prior to each dose for complete blood cell count, including a differential white cell count and platelet count. Absolute neutrophil count should be ≥1,500 cells/ mm3 and platelets ≥100,000 cells/mm3. Prior to each dose, collect blood chemistry tests to evaluate renal and hepatic function. Dose adjustments to pemetrexed and/or cisplatin at the start of a subsequent cycle should be based on nadir haematological counts or maximum nonhaematological toxicity. If necessary, delay or withhold treatment in the presence of haematological toxicity, neurotoxicity, and/or impaired hepatic/renal function.

(For full information on dose modification see SPC.) Paediatric population: There is no relevant use of Alimta in the paediatric population in malignant pleural mesothelioma and non-small cell lung cancer. Renal impairment: Patients with creatinine clearance ≥45ml/min require no dose adjustment other than those recommended for all patients. Use in patients with creatinine clearance below 45ml/min is not recommended. See also ‘Warnings and Special Precautions’. Hepatic impairment: Patients with hepatic impairment, such as bilirubin >1.5-times the upper limit of normal and/or aminotransferase >3.0-times the upper limit of normal (hepatic metastases absent) or >5.0-times the upper limit of normal (hepatic metastases present), have not been specifically studied. Method of administration: Precautions should be taken before handling or administering Alimta.

Alimta should be administered as an intravenous infusion over 10 minutes on the first day of each 21-day cycle.

For instructions on reconstitution and dilution of Alimta before administration, see SPC. Contra-indications Hypersensitivity to pemetrexed or to any of the excipients. Concomitant yellow fever vaccine. Breast-feeding.

Warnings and Special Precautions Myelosuppression is usually the dose-limiting toxicity. All patients must be instructed to take folic acid and vitamin B12 as a prophylactic measure. Pre-treatment with dexamethasone (or equivalent) can reduce the incidence and severity of skin reactions. Serious renal events, including acute renal failure, have been reported with pemetrexed alone or in combination with other chemotherapeutic agents.

Many of the patients in whom these occurred had underlying risk factors, including dehydration or pre-existing hypertension or diabetes. The effect of third space fluid, such as pleural effusion or ascites, on pemetrexed is not fully defined. A Phase 2 study of pemetrexed in 31 solid tumour patients with stable third space fluid demonstrated no difference in pemetrexed dose normalised plasma concentrations or clearance compared to patients without third space fluid collections. Thus, drainage of third space fluid collection prior to pemetrexed treatment should be considered, but may not be necessary. Serious cardiovascular events, including myocardial infarction and cerebrovascular events, have been uncommonly reported when pemetrexed is given in combination with other cytotoxic agents; most of these patients had pre-existing cardiovascular risk.

Concomitant use of live attenuated vaccines is not recommended. Radiation pneumonitis has been reported in patients treated with radiation either prior, during, or subsequent to pemetrexed therapy. Pay particular attention to these patients and exercise caution with use of other radiosensitising agents. Radiation recall has been reported in patients who received radiotherapy weeks or years previously. Interactions Concomitant administration of nephrotoxic drugs and substances that are also tubularly secreted could potentially result in delayed clearance of pemetrexed. If necessary, creatinine clearance should be closely monitored. Patients must avoid taking non-steroidal anti-inflammatory drugs (NSAIDs) with long elimination half-lives for at least 5 days prior to, on the day, and at least 2 days following pemetrexed administration. If concomitant administration of NSAIDs is necessary, patients should be monitored closely for toxicity, especially myelosuppression and gastro-intestinal toxicity. In patients with normal renal function (creatinine clearance ≥80ml/min), high doses of NSAIDs (such as ibuprofen >1600mg/day) and aspirin at higher dosage (≥1.3g daily) may decrease pemetrexed elimination and increase the occurrence of adverse events. Patients with mild to moderate renal insufficiency (creatinine clearance from 49 to 79ml/min) should avoid taking NSAIDs (eg, ibuprofen) or aspirin at higher

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MAINTAIN CONTROL. dosage, for 2 days before, on the day of, and 2 days following pemetrexed administration. In patients with mild to moderate renal insufficiency eligible for pemetrexed therapy, NSAIDs with long elimination half-lives should be interrupted for at least 5 days prior to, on the day of, and at least 2 days following pemetrexed administration.

There is a possible interaction between oral anticoagulants and pemetrexed; therefore, increase the frequency of International Normalised Ratio (INR) monitoring if treating with oral anticoagulants. Fertility, Pregnancy, and Lactation Contraception in males and females: Women of childbearing potential must use effective contraception during treatment with pemetrexed. Pemetrexed can have genetically damaging effects.

Sexually mature males are advised not to father a child during the treatment and up to 6 months thereafter.

Contraceptive measures or abstinence are recommended. Pregnancy: There are no data from the use of pemetrexed in pregnant women but pemetrexed, like other antimetabolites, is suspected to cause serious birth defects when administered during pregnancy. Animal studies have shown reproductive toxicity. Pemetrexed should not be used during pregnancy unless clearly necessary, after a careful consideration of the needs of the mother and the risk for the foetus. Breastfeeding: It is not known whether pemetrexed is excreted in human milk and adverse reactions on the suckling child cannot be excluded. Breast-feeding must be discontinued during pemetrexed therapy. Fertility: Owing to the possibility of pemetrexed treatment causing irreversible infertility, men are advised to seek counselling on sperm storage before starting treatment. Driving, etc It has been reported that pemetrexed may cause fatigue. Patients should be cautioned against driving or operating machinery. Undesirable Effects Summary of the safety profile: The most commonly reported undesirable effects related to pemetrexed, whether used as monotherapy or in combination, are bone marrow suppression, manifested as anaemia, neutropenia, leucopenia, and thrombocytopenia; and gastro-intestinal toxicities, manifested as anorexia, nausea, vomiting, diarrhoea, constipation, pharyngitis, mucositis, and stomatitis.

Other undesirable effects include renal toxicities, increased aminotransferases, alopecia, fatigue, dehydration, rash, infection/sepsis, and neuropathy. Rarely seen events include Stevens-Johnson syndrome and toxic epidermal necrolysis. Rare cases of anaphylactic shock have been reported. Infections and infestations: Common: Infection. Haematological: Very common: Anaemia, leucopenia, thrombocytopenia, neutropenia.

Common: Febrile neutropenia and infection without neutropenia. Uncommon: Pancytopenia. Rarely, haemolytic anaemia has been reported in patients treated with pemetrexed. Gastro-intestinal: Very common: Nausea, vomiting, stomatitis/pharyngitis, anorexia, diarrhoea, constipation. Common: Dyspepsia, abdominal pain, heartburn. Uncommon: Colitis (including bleeding, sometimes fatal, intestinal perforation, intestinal necrosis, and typhlitis). Oesophagitis/radiation oesophagitis has been reported during trials. General: Very common: Fatigue. Common: Fever, conjunctivitis, pain, oedema. Metabolism and nutrition: Common: Dehydration. Nervous system: Very common: Neuropathy - sensory. Common: Neuropathy - motor, dizziness, taste disturbance. Renal and urinary: Very common: Creatinine elevation, creatinine clearance decreased.

Common: Renal failure, renal disorders. Hepatobiliary: Common: SGPT (ALT) elevation and SGOT (AST) elevation, increased GGT. Rare: Cases of hepatitis, potentially serious, have been reported during trials. Skin and subcutaneous tissue: Very common: Rash/desquamation, alopecia. Common: Urticaria, allergic reaction/ hypersensitivity, erythema multiforme, pruritus. Rare: Radiation recall; bullous conditions have been reported, including Stevens-Johnson syndrome and toxic epidermal necrolysis, which in some cases were fatal.

Uncommon: Cases of peripheral ischaemia, leading sometimes to extremity necrosis, have been reported.

Cardiovascular and cerebrovascular: Uncommon: Myocardial infarction, angina pectoris, cerebrovascular accident, supraventricular arrhythmias, transient ischaemic attack, pulmonary embolism. (Usually when given in combination with other cytotoxic agents and with pre-existing cardiovascular risk.) Common: Chest pain.

Respiratory: Uncommon: Interstitial pneumonitis with respiratory insufficiency (sometimes fatal), radiation pneumonitis. For full details of these and other side-effects, please see the Summary of Product Characteristics, which is available at http://www.medicines.ie/. Legal Category POM Marketing Authorisation Numbers and Holder EU/1/04/290/001, EU/1/04/290/002 Eli Lilly Nederland BV, Grootslag 1-5, NL-3991 RA Houten, The Netherlands. Date of Preparation or Last Review November 2012 Full Prescribing Information is Available From Eli Lilly and Company Limited, Lilly House, Priestley Road, Basingstoke, Hampshire, RG24 9NL. Telephone: Basingstoke (01256) 315 000 E-mail: ukmedinfo@lilly.com or Eli Lilly and Company (Ireland) Limited Hyde House, 65 Adelaide Road, Dublin 2, Republic of Ireland. Telephone: Dublin (01) 661 4377 E-mail: ukmedinfo@lilly.com. ALIMTA® (pemetrexed disodium) is a registered trademark of Eli Lilly and Company.

Reference: 1. Paz-Ares LG et al. PARAMOUNT: Final Overall Survival Results. Phase III Study of Maintenance Pemetrexed plus Best Supportive Care (BSC) versus Placebo plus BSC Immediately Following Induction with Pemetrexed plus Cisplatin for Advanced Nonsquamous NSCLC. Presented at American Society of Clinical Oncology Annual Meeting, June 1-5 2012, Chicago, IL (oral presentation slide set).

Adverse events and product complaints should be reported. To report an adverse event or a product complaint about a Lilly medicine, please call Lilly on: 01 664 0446. Adverse events and product complaints may also be reported to the Irish Medicines Board. Reporting forms and information can be found at www.imb.ie then click “Online Reporting”.

IEALM00174b June 2014

14:24:29 2/9/14 14:22:30

While you take care of your patients our Full Cover Scheme takes care of the bills

For full details and to find out about our Schedule of Benefits for Professional Fees call our dedicated Medical Relations team on 1890 44 44 44 or email medical.relations@vhi.ie

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Proudly providing billing services to clients nationwide

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Irish Hospital Consultants a s s o ci a t i o n

2015 Yearbook & Diary

Heritage House, Dundrum Office Park, Main Street, Dundrum, Dublin 14.

Telephone: (01) 298 9123 Fax: (01) 298 9395 Email: info@ihca.ie Web: www.ihca.ie

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Revealing OLYSIO in Hepatitis C treatment

OLYSIOâ–ź 150 mg hard capsules PRESCRIBING INFORMATION ACTIVE INGREDIENT: Simeprevir sodium equivalent to 150 mg of simeprevir. Please refer to Summary of Product Characteristics (SmPC) before prescribing. INDICATION(S): For treatment of chronic hepatitis C (CHC) in combination with other medicinal products in adult patients. DOSAGE & ADMINISTRATION: Oral. To be initiated/monitored by physician experienced in CHC management. Not for use as monotherapy. Adults: Recommended one capsule once daily for 12 weeks, swallowed whole with food. See SmPC for full posology and treatment stopping rules, if inadequate on-treatment virologic response. Do not reduce or interrupt OLYSIO treatment. Do not restart OLYSIO treatment if discontinued because of adverse reactions or inadequate ontreatment virologic response. A missed dose should be taken with food as soon as possible, within 12 hours of the usual dosing time, the next dose of OLYSIO should be taken at the regularly scheduled time. If a dose is missed by more than 12 hours, the patient should not take the missed dose and should resume dosing of OLYSIO with food at the regularly scheduled time.

Caution in East Asian patients. HCV/HIV-1 co-infection; no dose adjustment required. Children: No data available. Elderly: No data >75 years; limited data >65. No dose adjustment required.

Renal impairment: Mild/moderate: No dose adjustment required. Severe: Caution; some evidence of increased simeprevir exposure. Hepatic impairment: Mild/moderate: No dose adjustment required. Severe: significant increased simeprevir exposure; no dose recommendation. CONTRAINDICATIONS: Hypersensitivity to active substance or any excipient. SPECIAL WARNINGS & PRECAUTIONS: OLYSIO should not be used in patients with HCV genotypes 2, 3, 5 or 6. Check co-medication SmPCs before starting Olysio. Discontinue OLYSIO if co-medications discontinued.

No data on use of OLYSIO in re-treating patients who have failed HCV NS3-4A protease inhibitor based therapy. Substantially reduced efficacy if hepatitis C genotype 1a with NS3 Q80K polymorphism at baseline, when in combination with peginterferon alfa and ribavirin; pre-treatment testing for Q80K is strongly recommended, also with sofosbuvir. Interferon-free regimens not investigated in phase 3 studies. Interferon free therapy with OLYSIO should only be used in patients who are intolerant to, or ineligible for, interferon therapy, and are in urgent need of treatment.

No data with telaprevir or boceprevir; expected to be cross-resistant, therefore not recommended. Lower SVR12 rates/viral breakthrough/viral relapse more frequent with peginterferon alfa-2b/ ribavirin than peginterferon alfa-2a/ribavirin. Photosensitivity reactions: advise use of sun protective measures, avoid sun exposure/tanning devices, if photosensitivity reactions occur, consider discontinuation. Rash: monitor patients for progression; if severe, discontinue. Hepatic impairment: safety/efficacy not studied in moderate/severe hepatic impairment (Child-Pugh class B or C) or in decompensated patients; caution recommended. Lab tests: monitor HCV RNA levels at wks 4 and 12; refer to co-medication SmPCs. Hepatitis B Virus (HBV) co-infection and organ transplant patients: not studied. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. SIDE EFFECTS: Very common: dyspnoea, nausea, rash, pruritus. Common: constipation, blood bilirubin increased, photosensitivity reaction. PREGNANCY: If benefit justifies the risk. No human studies.

Effective contraception required. Check co-medication SmPCs. LACTATION: Not known whether excreted in human milk. Check co-medication SmPCs, contraindications and warnings apply.

INTERACTIONS: Moderate/strong inhibitors/inducers of CYP3A4 not recommended. OATP1B1 inhibitors (eg eltrombopag, gemfibrozil) may mildly increase simeprevir concentrations. Plasma concentrations of medicines which are substrates for OATP1B1 and P-gp transport may increase if co-administered. Not recommended: carbamazepine, oxcarbazepine, phenobarbital, phenytoin;

OLYSIO DPS IHCA A3 Advert.indd 21 232717_1C_MMS_IHCA2015.indd

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Once Daily

80% SVR12* 79% SVR12 Early predictors of response

week 4

Well tolerated, simple, once daily

astemizole, terfenadine; systemic erythromycin, clarithromycin, telithromycin; systemic itraconazole, ketoconazole, posaconazole, fluconazole or voriconazole; rifampicin, rifabutin, rifapentine; systemic dexamethasone; cisapride; milk thistle (Silybum marianum), St John’s wort (Hypericum perforatum); efavirenz, other NNRTIs (elavirdine, etravirine, nevirapine); ritonavir, darunavir/ ritonavir, any HIV PI with/without ritonavir, cobicistat-containing products. Monitor levels: digoxin, ciclosporine, tacrolimus, sirolimus; warfarin (INR). Use lowest dose: rosuvastatin, pitavastatin, pravastatin, atorvastatin, simvastatin, lovastatin, sildenafil or tadalafil for pulmonary arterial hypertension. Caution/monitor: amiodarone, disopyramide, flecainide, mexiletine, propafenone, quinidine; oral amlodipine, bepridil, diltiazem, felodipine,nicardipine, nifedipine, nisoldipine, verapamil. Caution: oral midazolam or triazolam. Refer to SmPC for full details of interactions.

LEGAL CATEGORY: Prescription only medicine. PRESENTATIONS, PACK SIZES, MARKETING AUTHORISATION NUMBER(S): OLYSIO 150mg capsules; 7 capsules (1 week); EU/1/14/924/001.

MARKETING AUTHORISATION HOLDER: Janssen-Cilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium. FURTHER INFORMATION IS AVAILABLE FROM: Janssen-Cilag Ltd, 50100 Holmers Farm Way, High Wycombe, Buckinghamshire HP12 4EG, UK. © Janssen-Cilag Ltd 2014 Adverse events should be reported. ▼ This medicinal product is subject to additional monitoring and it is therefore important to report any suspected adverse events related to this medicinal product. Healthcare professionals are asked to report any suspected adverse events via: HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2. Tel: +353 1 6764971, Fax: +353 1 6762517, Website: www.hpra.ie, E-mail: medsafety@hpra.ie.

Adverse events should also be reported to Janssen-Cilag Ltd on +44 (0)1494 567447.

Prescribing information last revised: May 2014 References: 1. OLYSIO Summary of product characteristics. Available at www.medicines.ie. 2. Jacobson I et al. AASLD, 2013. Poster 1122.

3. Forns X et al., Gastroenterology, 2014, epub. http://dx.doi.org/10.1053/j.gastro.2014.02.051. 4. Manns M, et al. HEPDART 2013. Poster 57.

Triple therapy: OLYSIO, peg interferon and ribavirin. *SVR12 is defined as undetectable HCV RNA 12 weeks after end of treatment.

Week 4 on treatment virologic response is defined as HCV RNA undetectable at week 4.

†

#

PHIR/NO/0714/0004 | Date of Preparation: August 2014

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I r i s h

H o s p i t a l

C o n s u l t a n t s

a s s o ci a t i o n

PERSONAL DETAILS Name: Hospital: Address:

Tel: Fax: Email: MPS/MDU Reg. No.: Medical Council Reg. No.: Vhi Dr No.: Laya Healthcare Dr No.: Aviva Dr No.: Glohealth Dr No.:

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Steps to Better Hearing

STEP1 STEP1 STEP2 STEP2

Our Audiologists carry out a full case history which includes a brief medical history.

Otoscopy and Rinne and Weber tuning fork tests are carried out to BSA Standards.

Most branches have a video otoscope facility with is able to capture images of the outer ear and tympanic membrane.

STEP3

Sound Field Testing – statistical information on the ability to hear words reproduced both in quiet and in noise.

STEP4

Full audiometric test to BSA procedures, including air conduction and bone conduction testing and hearing thresholds are recorded.

STEP5

Prescription programmed instruments to allow the patient to experience hearing amplification are tested.

STEP6 STEP7

The patient is fitted with hearing aids, and is trained in their use and care.

Follow up visit and checking of the rehabilitation process and a repeat of sound field testing, usually resulting in improved scoring on word recognition.

Established over 27 years, Hidden Hearing is Ireland’s premier professional provider of hearing healthcare with over sixty five clinics nationwide. Every Hidden Hearing audiologist is a member of the Irish Hearing Society (IHS) / Irish Society of Hearing Aid Audiologists (ISHAA).

Free Full Audiometric Tests Free Wax Removal UNIQUE BENEFITS: 90 Day Money Back 4 Year Warranty Free Batteries for Life Complimentary Aftercare Digital Hearing Aids

www.hiddenhearing.ie Freephone 1800 370 000 Quote ref: IHCA9000

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I r i s h

H o s p i t a l

C o n s u l t a n t s

a s s o ci a t i o n

Contents 9

End of Year Checklist

11

Minister’s Address

12

President’s Address

15

Members’ Handbook

32

Consultants’ Common Contract 2008 – Enabling Circular

36

Consultants’ Common Contract 2008

71

Professional Directory

71

Medical Indemnity Organisations

72

Health Insurers

73

Medical Council

75

National Council 2014-2016

76

Council Executive (Focus Group)

77

Financial Services for Members of IHCA

78

Voluntary & Support Organisations

82

Charts & Tables

Errors and Omissions Disclaimer: While every effort has been made to ensure that all information contained in this yearbook is accurate and correct at time of publication, errors, omissions, or discrepancies may have occurred in preparation of the manuscript. Ashville Media Group and the Irish Hospital Consultants Association cannot accept any liability for loss, distress or damage resulting from errors or omissions. © 2014/2015

Published on behalf of The Irish Hospital Consultants Association by Ashville Media Group • Tel: (01) 432 2200 • www.ashville.com

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I r i s h

H o s p i t a l

C o n s u l t a n t s

a s s o ci a t i o n

End of Year Checklist Item

Check

Basic Salary Check that annualised salary is equal to that circulated by Department of Health & Children for your contract, category and geographic region.

B Factor Check that you are receiving the appropriate B Factor for your on-call rota and rate of call out. Note for those on 1:1 and 1:2 rotas, additional allowances are payable for higher numbers of call outs.

Structured Weekend Inputs and C Factor

Check that all structured weekend inputs and C Factor claims have been paid.

Rest Days Check that you have been paid at the daily rate or taken leave. The daily rate is calculated as 1/5 of the weekly rate.

Annual Leave Notify employer of any untaken annual leave for current year.

Travel & Subsistence Ensure all outstanding claims for travel and subsistence have been submitted and paid. Note: travel expense is claimable for out of hours calls.

CME Allowance Notify employer of any untaken CME allowance outstanding at year-end, so that it may be rolled over to next year.

Phone

Ensure that rental on mobile or land line is paid by employer when due.

Health Insurers Reconcile all outstanding payments with private health insurers, paying particular attention to pended claims.

Medico Legal Fees Review medico legal fees, taking account of inflationary factors since last review and notify requesting solicitors accordingly – see Pro Forma letter on page 24.

Direct Debit Payments Ensure that any payment made by Direct Debit is actually made by your bank. This is particularly important in the case of medical indemnity, Medical Council Registration and Medical Council fees.

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a s s o ci a t i o n

Minister’s Address

I welcome the invitation of the IHCA to contribute a foreword to their 2015 Diary. Consultants have a major leadership role and I welcome the openness and commitment you have shown to improve service quality and patient outcomes through the clinical programmes. I acknowledge that this is occurring at a time when resources have been significantly curtailed, yet demand continues to rise. I welcome this opportunity to outline to what I see as a number of key aspects of future health care delivery.

As Minister for Health, the recruitment and retention of doctors in the Irish public health system is a priority for me. That is why I am committed to the implementation of the recommendations of the Strategic Review of Medical Training and Career Structure completed earlier this year. The Strategic Review reports identify a range of issues impacting on the recruitment and retention of doctors in our system, and offer solutions and recommendations that will enable us to build a sustainable medical workforce for the future. It is imperative that we drive implementation of the recommendations of all three reports forward together in order to deliver quality, safe patient care to all our citizens. Consultants have a key role to play in relation to the training of our doctors and in supporting them in their work.

Another key issue for me is establishing a budget base that will support service delivery. I know that the IHCA at this time of year emphasise the need for adequate funding for the health services. This is also a priority for me. While I see UHI taking longer to implement than originally envisaged, it remains a cornerstone of Government policy. It is important to remember that, although the reforms are primarily designed to improve the system for patients and users of our health service, an efficient and effective health system will also benefit staff, including consultants.

One of my priorities as Minister for Health in 2015 will be to progress the Healthy Ireland Framework. Healthy Ireland, A Framework for Improved Health and Wellbeing 2013-2025 is the national framework for action to improve the health and wellbeing of the country over the coming generation. It is designed to bring about real, measurable change and is based on an understanding of the determinants of health. It provides for new arrangements to ensure effective cooperation between the health sector and other areas of Government and the public services, dealing with social protection, children, business, food safety, education, housing, transport and the environment.

Hospital Consultants have an important role to play in the delivery of Healthy Ireland in your roles as treating professionals, educators and advocates for change and I would welcome your support in the drive to achieve the very ambitious goals of Healthy Ireland. In addition to your role within the health system, you have a leadership role in society which can support and encourage other sectors of society to help build

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a healthier nation. While I believe that we must help people to take responsibility for their own Health and Wellbeing, I also believe that as a society we must make the healthy choice the easier choice and as health professionals we must play our part in creating a society where wellbeing is valued and supported at every level of society.

The establishment of Hospital Groups is the most significant reform of our hospital service since the establishment of the State. Hospital Groups are a ‘win win’ for both smaller and larger hospitals. The incorporation of both larger and smaller hospitals in Hospital Groups will provide an optimum configuration for hospital services to deliver more responsive and equitable access to services, with benefits relating to safety, quality, access and cost, sustainable medical staffing and compliance with the European Working Time Directive. Smaller hospitals will benefit greatly from being part of a bigger Group when sharing staffing and facilities, enabling appropriate care at local level to increase whilst the quality of complex work carried out in larger hospitals. The on-going development of services such as day surgery, acute medicine, a large range of diagnostic services, specialist rehabilitation medicine, palliative care and daytime Urgent Care Centres will ensure that as many services as possible can be provided safely and appropriately in smaller, local hospitals.

A key infrastructural development in the acute sector is the new children’s hospital, which is being planned for the St James’s campus in Dublin 8. Co-location with an adult hospital and, ultimately, tri-location on a single campus with a maternity hospital, will support the best possible outcomes for children. A design team is now in place for this major project with the aim of submitting a planning application to An Bord Pleanála in early 2015. All things going to plan, planning permission will be secured next year and construction on the new hospital and the satellite centres in Blanchardstown and Tallaght will then commence.

Given that the IHCA is the largest Consultant Association I want it to be fully involved in negotiations with the HSE and my Department on all matters that affect consultants. The Government has decided that the Haddington Road Agreement, involving collective agreements with the representative bodies of public servants is the way forward. I hope that the IHCA can find a way to be a party to this process.

I want to confirm my belief in the right of consultants to act as advocates on behalf of patients. I want to reaffirm that the advocacy right is not interfered with in any respect by the introduction of a pay structure for consultants that involves performance measurement in accordance with principles agreed when the 2008 Consultant Contract was negotiated. I do not see a conflict between performance management and the right of Consultants to act as an advocate for patients.

Leo Varadkar, Minister for Health

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President’s Address

Dear Colleagues, It gives me great pleasure to introduce the 18th edition of the IHCA yearbook and diary.

2014 has proven to be very challenging for consultants who too often are working with inadequate resources, at a time of increased demand for hospital care. The challenge has been exacerbated by a reduction in health care spending driven by the country’s economic difficulties and pressures on health insurance coverage. In addition, there has been a substantial increase in clinical indemnity costs which, if not addressed, will lead to some practices becoming unviable and a substantial increase in charges to patients. This represents a grave threat to the provision of care to patients, especially as the public hospital system does not have the capacity to absorb additional patients.

The unilateral 30% cut in the salary of new consultants of October 2012, and the additional salary cuts of July 2013 have resulted in hospitals being unable to recruit and retain the calibre and number of consultants required to provide quality care to the increasing number of patients who need care. The situation has been reached where a growing number of advertised consultant posts have received no eligible applications and consultant posts remain vacant despite hospitals’ best attempts to fill them. It is now widely acknowledged that the 30% cut in new consultant salaries was a mistake and that it is costing much more to fill an increasing number of vacant consultant posts on a temporary basis through agencies. The cut is clearly unsustainable and needs to be reversed. What is required is that the State honours the 2008 Consultant Contract, which was negotiated in good faith.

Acute public hospital budgets have been cut by almost a fifth since 2008. Despite this, 1.43 million inpatients and day-case patients were treated in 2013, a 15% increase on the figures for 2008. However, due to increasing patient demand, waiting times are still unacceptably high.

Consultants continue to lead the implementation of clinical care programmes in hospitals throughout the country and in future will play a key role in the re-organisation and development of hospital services. It is essential in this context that enhanced frontline acute hospital resources are provided to meet the increased demand.

Finally, I wish you and your families a peaceful and healthy 2015.

Dr Gerard Crotty President

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Members’ Handbook Contents

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INTRODUCTION IHCA - Brief History - Basic Rules - Services Offered

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PUBLIC APPOINTMENTS - Comhairle na nOspidéal/HSE - Consultants’ Common Contract - Retired Consultants - Probation - Joint Appointments - Pension Arrangements - Pension Benefits - Pension - Lump Sum - Early Retirement - Travelling & Subsistence Expenses - Continuing Medical Education (CME) - Out of Hours Service - Rest Days

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PRIVATE PRACTICE

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MEDICAL INDEMNITY

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MEDICO-LEGAL MATTERS

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POST-MORTEMS & INQUESTS

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REPRESENTATIONAL ASSISTANCE

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HEALTHY IRELAND FRAMEWORK

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MEDICAL COUNCIL

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GOVERNMENT HEALTH POLICY

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Members’ Handbook Introduction The Members’ Handbook is provided to all members of the Irish Hospital Consultants Association. It is a useful resource which will assist members to quickly identify key features and entitlements arising from their appointments, whether public or private.

It also provides an outline of the services that the Association offers to its members. Please feel free to avail of these services by contacting the Secretariat as and when necessary.

IRISH HOSPITAL CONSULTANTS ASSOCIATION Brief History Initial steps to establish the Irish Hospital Consultants Association were taken in 1988. Hospital consultants at that time felt that their needs were not being adequately represented by existing bodies and so formed their own Association.

Since then the organisation has thrived, representing members’ interests in contractual and broader medico-political matters. It is also steadfast in its advocacy of patients’ interests.

The Association currently represents in excess of 85 per cent of hospital consultants in Ireland. It is the single representative body that speaks solely for hospital consultants.

Basic Rules Membership of the Association is open to the following: (a) The members of the Association shall either: Hold a current enrolment on the Irish Register of Medical Practitioners or Irish Dental Register and be: (i) Hospital Consultants who have subscribed to and paid in full the annual membership fee to the Association at the date of adoption of these Rules; or (ii) Consultants who are holders of the Common Contract; or (iii) Medically qualified Consultants in hospital practice who though not holding the Common Contract, are eligible to hold a Health Service Executive structured public appointment; or (iv) Academic Dental Consultants referred to in Paragraph 8.8 of Report Number 36 of the Review Body on Higher Remuneration in the Public Sector; or (v) Consultant Orthodontists and Consultant Oral Surgeons in public hospital practice;

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(ab) be Top-Grade Bio-Chemists of Consultant status as defined in correspondence from the Department of Health of January 17 1972 (reference A155-42) and who hold posts structured by the Health Service Executive.

or (ac) be life members appointed by the National Council pursuant to Rule 3(d).

(b) In addition to the above, no person shall be eligible for membership of the Association unless they are either registered on, or eligible to be registered on, the Specialist Division of the Register of Medical Practitioners as maintained by the Irish Medical Council, save for the following groups of persons who are exempt from this requirement: (i) be Top-Grade Bio-Chemists of Consultant status as defined in correspondence from the Department of Health of January 17 1972 (reference A155-42) and who hold posts structured by the Health Services Executive; (ii) Academic Dental Consultants referred to in Paragraph 8.8 of Report Number 36 of the Review Body on Higher Remuneration in the Public Sector; (iii) Consultant Orthodontists and Consultant Oral Surgeons in public hospital practice; and (iv) Existing fully paid up members of the Association who were accepted as members by the Association prior to Oct 4 2008. (c) No person shall, for the purposes of these Rules, be deemed to be a member of the Association or be entitled to exercise or receive any of the benefits or privileges of membership (including the right to be present and vote at any general meeting of the Association) unless and until he has paid in full the annual membership fee as determined from time to time by the National Council in such manner as is determined by the National Council. (d) The amount of annual membership fee and the manner of payment thereof for Hospital Consultants who have reached retirement age under the Common Contract or who had they held such Contract would be deemed to have reached retirement age thereunder or academic Dental Consultants referred to in Rule 3(a) (aa)(iv) who have either reached or deemed to have reached retirement age shall be determined from time to time by the National Council.

The National Council shall have power to grant such members who have reached retirement age as outlined in this Rule 3(c) and who have been members of the Association for each of the five years immediately prior to reaching such retirement age life membership upon payment of a lump sum and upon satisfying such conditions as the National

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Members’ Handbook Council may in its discretion impose and such life members shall not be liable for annual membership fee of whatever nature thereafter.

The members of Council are representative of eight regions whose functional areas coincide with the corresponding former Health Board functional areas.

Retired consultants Members who reach retirement age under the Common Contract or who, had they held such a Contract, would be deemed to have reached retirement age thereunder, may become life members of the Association on payment of a once-off fee, provided they were fully paid up members during the preceding five years.

Life members are entitled to the same rights and privileges of membership as full members, including the right to vote at General meetings and in elections to National Council.

The National Council is obliged to co-opt a life member to membership of the National Council with effect from June 2000.

Termination of Membership A person shall ipso facto cease to be a member of the Association with immediate effect upon the happening of any of the following events: (a) upon resignation in writing; or (b) upon death; or (c) upon failure to pay the annual membership fee for the time being in force to the Association in the manner prescribed by the National Council; or (d) upon removal for whatever reason from the Irish Medical Register (other than pursuant to an order granted under the Medical Practitioners Act, 1978, or the Medical Practitioners Act, 2007); or the Irish Dental Register (other than pursuant to an application pursuant to Section 44 of the Dentist’s Act, 1985) where the decision of the Medical Council or the Dental Board (as appropriate) to remove the member from such register is not the subject of an appeal by such member to the High Court, prosecuted with due diligence; or (e) upon expulsion pursuant to Rule 5 hereof; or (f) upon ceasing to qualify for membership of the Association pursuant to Rule 3(a) or life membership referred to in Rule 3(d) of these Rules;

The co-opted members are appointed so that there is representation on Council from the following specialties: • Anaesthesia • Surgery • Obstetrics/Gynaecology • Paediatrics • Psychiatry • Medicine • Radiology • Pathology One of the co-opted members must be a life member of the Association.

In addition to the Council, a full-time Secretariat is employed. The Secretary General, Assistant Secretary General, Senior Executive Officer and Employment & Policy Executive are supported by an administrator and secretaries.

Services Offered The Association provides a broad range of services to members, including: • Contract negotiations with employers and other bodies; • The provision of legal advice to members with problems; • A range of financial services through leading banks, investment houses and pension advisers; • Seminars on topics such as revenue audits and medical indemnity matters; • Negotiations on behalf of individual members who encounter difficulties in their employment.

The Association represents the views of consultants through the formulation of policy documents and position papers on a wide range of issues affecting hospital services and patient care.

PUBLIC appointments National Council The National Council manages the affairs of the Association. The Council consists of 30 members. 25 members are directly elected and the remaining five are co-opted. Members of Council hold office for a period of four years. They may be re-elected for a further period of four years after which they must resign.

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Health Service Executive The number and range of consultant appointments in the public sector in Ireland are regulated by the Health Service Executive.

Presently there are in excess of 2,500 consultants with public contracts and an estimated 250 in full-time private practice in Ireland.

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Members’ Handbook The granting of admitting rights to consultants in private hospitals is a matter for each individual hospital.

If you hold a joint appointment, e.g. with a University and a hospital, your holding of one part of the post is contingent on you holding the other part also.

Consultants’ Common Contract Each consultant with a public appointment works under the consultants’ common contract. The terms of the 2008 Consultant contract have been agreed between the Health Service Executive, on behalf of all employers, and the Irish Hospital Consultants Association on behalf of Consultants. The terms and conditions of this contract apply to all new appointees with effect from 1st June 2008.

Each consultant and his employer sign a copy of the contract.

Sections 2(a), 5 and 8(a) along with the HSE letter of approval (Appendix I) and the Job Description (Appendix II) are unique to each individual consultant. These should be carefully checked prior to signing to ensure accuracy. The Association will assist in this process.

Section 2 gives the employer’s name and address, the Consultant’s name and address, the title for the post and the agreed start date.

Section 5 identifies the Type of contract being offered.

Section 8(a) identifies the employer and the location(s) in which the consultant will work. The location(s) should be a physical location and not the name of a service.

Probation Public sector appointments are permanent and pensionable.

Appointees are, however, subject to a 12 month probationary period. This may be extended at the employer’s discretion. At the end of your probationary period the employer shall certify that your service has been satisfactory and confirm your appointment or give stated reasons why it has not and you will cease to hold the appointment. In the event of a consultant moving from one public appointment to another, he or she will not be required to serve more than 12 months’ probation in the aggregate.

Joint Appointments A number of posts in Ireland are structured as joint appointments.

Consultants holding such posts have two employers with the commitment to be devolved to each employer being decided by the HSE. This will be indicated by way of sessional split in the letter structuring the post.

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Pension Arrangements All consultant posts in the Public Health Sector are pensionable. For those deemed new entrants taking up public appointments after 1st January 2013, they are superannuated under the Single Public Service Pension Scheme. Those who are not deemed new entrants continue to be superannuated under their existing scheme.

Single Public Pension Scheme Members: The main elements of the Scheme include; • career average earnings are used to calculate benefits (a pension and lump sum amount accrue each year and are up-rated each year by reference to CPI) • minimum pension age for most members is linked to the State Pension age (66 years initially, rising to 67 in 2021 and 68 in 2028) • compulsory retirement age of 70 applies for most members • post retirement pension increases are linked to CPI. Pension and lump sum are separately accrued each year using the following formula: Pension: Accruing rate of 0.58% pensionable remuneration up to a ceiling of 3.74 x State Pension Contributory (SPC) (currently €45,000) plus (where applicable) 1.25% of pensionable remuneration above that level.

Lump Sum: 3.75% of pensionable remuneration.

Contributions to the scheme are deducted at 3.5% of net pensionable remuneration plus 3% of pensionable remuneration.

During the scheme membership, the amounts accrued each year will be increased to reflect the CPI increase between that year and retirement. The annual pension and lump sum payable at retirement will equal the total of these CPI adjusted amounts.

The minimum retirement age under this scheme is 66 years and retirement becomes compulsory at 70.

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Members’ Handbook Members required to retire on medical grounds with less than 2 years’ service will receive a gratuity of 8.5% of pensionable remuneration per year of service. Those with more than 2 years’ service will receive an immediate payment of retirement benefits accrued to the point of retirement (with no actuarial reduction).

Where a member superannuated under the Scheme dies in service a lump sum becomes payable to the estate of the deceased member equal to twice the annual pensionable remuneration at time of death.

In those circumstances the spouse /civil partner will receive a pension equal to 50% of the member’s pension. Also children’s benefits become payable on the basis that total payments will not exceed 100% of the member’s pension.

Following retirement pension increases will be based on increases in the CPI.

Existing Superannuation Scheme Members Consultants who are not new entrants, i.e. Consultants who took up their public appointments before 1st January 2013, are deemed to be superannuated under their existing schemes. There are three schemes in place, namely: • The Voluntary Hospitals Superannuation Scheme • The Local Government Superannuation Scheme and the • Nominated Health Agency Superannuation Scheme.

There is interchangeability between each scheme. The scheme under which a member is superannuated is contingent on the employer’s status.

The pension payable on retirement is based on years of reckonable service. 1/80th of the final pensionable salary is payable for every completed year of reckonable service up to a maximum of 40/80th. A pro rata adjustment is made for parts of years. These latter schemes allow for the late entry age of consultants by adding on to the reckonable service up to 1/3 of actual service to a maximum of 10 years at no cost to the member. For new entrants recruited on or after 1st April 2005 an award of up to five years may be granted. Members must purchase all reckonable service i.e. temporary service, service for which refunds / gratuity was authorised before granting an award for professional added years.

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Following the death of a retired consultant, a pension of 50% of the member’s pension is payable to the spouse. One third of the member’s pension is payable to each dependent child up to a maximum of three children.

All service in a pensionable position, including that served during training, counts in arriving at the length of service. NCHD’s who leave with less than 5 years’ service, who leave after completion of training, are given a refund of their superannuation contributions. It is possible for the consultant to “buy back” the service when he is appointed to his post. The Department of Finance issues tables under which credits for these years and appropriate contributions are calculated.

A lump sum is payable to contributors to the scheme on retirement.

It is calculated at the rate of 3/80th of the final pensionable salary for each year of reckonable service up to a maximum of 120/80th.

This may be subject to abatement in respect of any period in which the person has not contributed to the Spouse’s and Children’s Pension Scheme. At the time of writing the first €200,000 is paid tax free whilst any balance of the €500,000 is taxed at 20% and any remaining balance is taxed at the individual’s marginal tax rate.

Standard Fund & Personal Fund Thresholds Budget 2014 introduced changes to the maximum allowable pension fund at retirement for tax purposes (the Standard Fund Threshold – the SFT). The SFT has been reduced from €2.3m to €2m from 1st January 2014. Pension savings and entitlements valued between €2m and €2.3m on 1st January 2014 can be protected at that value by applying to the Revenue for a higher threshold (a Personal Fund Threshold – PFT). Where the SFT or PFT is exceeded, the excess is subject to an effective income tax rate of 65% thus clawing back any tax subsidy which helped fund the excess.

Early Retirement A consultant, who joined the service prior to April 2004, may take retirement from age 60 onwards when in normal health. Retirement benefits are based on the salary at retirement and the length of completed service plus added years. Consultants covered by the SPSPS may retire on an actuarially reduced pension from age 55.

Where a consultant retires on grounds of ill health and has more than five years’ service, his pension and gratuity is based on completed reckonable service. Further years may be added to reckonable service as follows:

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Members’ Handbook • A consultant with between 5 and 10 years of service may add the equivalent amount of service actually served to a limit of his potential service at age 65.

• A consultant with between 10 and 20 years of reckonable service may add the more favourable of: (a) The difference between actual service and 20 years subject to a limit of potential service at age 65; or (b) 6.67 years subject to a limit of potential service at age 60.

• A consultant with more than 20 years’ service may add 6.67 years to a limit of his potential service at age 65.

A Consultant with less than five years’ service retiring on ill health grounds will receive a gratuity of 1/12th of salary for each year of service. In addition, if he completed service of more than two years, a further 3/80th of salary for every year of service is paid. No pension is payable in these circumstances.

Note: There are slightly different arrangements applying in respect of consultant psychiatrists working in certain registered mental hospitals.

Reckonable service in excess of 20 years may be counted at double and they may retire from age 55 onwards.

Travelling & Subsistence Expenses Travelling and subsistence expenses necessarily incurred in the course of a consultant’s work are paid according to the public sector rates for senior staff. Travel expenses are payable in respect of each emergency call-out and in respect of travel between locations when a consultant is scheduled to work away from his base.

The rates of reimbursement are attached to each consultant’s contract. They are updated periodically. Current rates are always available from the Association.

Continuing Medical Education In April 2014, the HSE issued a revised CME Guidance document with the following proposals: • Continuation of the existing €3,000 CME annual allowance, with provision for the relevant Clinical Director to apply for funding in excess of that amount on an exceptional basis.

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• Eligible costs would include registration fees for courses/ conferences, associated travel, e-learning courses, certain medical journals and text books, computer software that has a CME/ CPD component, annual registration fees for enrolment on a recognised Professional Competence Scheme in Ireland or outside Ireland where it is not possible for the Consultant to register on a professional competence scheme in Ireland for their specialty or subspecialty and the annual registration fee for professional memberships.

• In relation to computer hardware such as laptops, tablets and iPads, the Guidance provides that “HSE MET reserves the right to directly fund site purchase of computer hardware for CME/ CPD purposes. Such funding will be in line with national medical education and training policy and final decision on allocation rests with MET.” • Accrued but unutilised funding as at 1 January 2014 will roll over on a once-off basis but must be used by certain specified dates.

• “In very exceptional circumstances” a Clinical Director may apply prospectively for funding in excess of the €3,000 per annum figure or may apply for approval for an individual consultant’s fund to rollover for a maximum period of three years.

• Refusals to provide funding may be appealed initially to hospital management and subsequently under the Grievance and Dispute procedure provided for in Consultant Contracts.

The Association subsequently wrote to the HSE highlighting that the contract CME entitlements must be honoured. This includes the provision for the carryover of unused CME for up to five years, indexation of the €3,000 annual CME allowance, recognition of a wider range of CME activities, the extension of coverage of course types and the funding of a more extensive range of software and hardware.

The Association’s advice to its members is that the CME entitlements contained in their contracts cannot be diminished or restricted by unilateral communications from the HSE HR office.

Out of Hours Service Employers are responsible for arranging clinical cover for emergencies that arise within the hospital or for patients brought to the hospital for emergency treatment. The employers are

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Members’ Handbook responsible for arranging suitable rosters to provide this cover.

An allowance is payable in respect of this availability for duty. This Allowance (B Factor) is part of the pensionable remuneration.

The rotas used for this are those that have been formally ratified by the hospital management. Consultants who wish to operate a sub roster within a general specialty, e.g. vascular surgery within general surgery, need to have management approval in order to attract the additional allowance.

Consultants are paid additional monies (C Factor) in respect of instances where they are called to the hospital for emergencies. To qualify for these additional payments, a consultant must be: • Rostered for on-call duty and is contacted by another hospital doctor, by a senior nurse or other member of the hospital staff specifically designated for the purpose and attends at the hospital; or • Rostered for on-call duty and in the exercise of his professional judgement (EPJ) attends at the hospital and performs clinical work of an urgent nature or carries out urgent diagnostic or therapeutic procedures.

The rates of reimbursement are attached to each consultant’s contract. They are updated periodically. Current rates are always available from the Association. In addition, travelling expenses to and from the hospital are payable.

Rest Days The HSE in April 2014 circulated proposals for Consultants on 1:3 and 1:4 on-call rotas which can be summarised as follows: • Under the proposed arrangements, regardless of the rest assigned for each category of on-call incident (see the next bullet points), there will be a minimum of 15 rest days for Consultants on a 1:3 on-call rota and a minimum of 10 days for those on a 1:4.

• The amounts of rest assigned above will be doubled in circumstances where the on-call incident occurs on a Saturday, Sunday or bank holiday.

• Each Consultant will be responsible for recording each incidence of call-out and submitting the claim to the Clinical Director by a defined date.

• Rest will be taken where possible by the end of the next following month or, at the latest, within 8 weeks.

• When for operational reasons, a Consultant cannot take all or any of their compensatory rest within 8 weeks, the hours outstanding will be paid at the relevant hourly rate.

• Clinical Directors will have authority to assign additional rest to Consultants, where time spent providing on-call services consistently exceeds 3 call-outs per month. In such circumstances, the Clinical Director will assign up to 150% additional rest.

• Payment of B Factor and C Factor will continue as per existing contracts.

The Association’s advice to its members is that the rest day entitlements provided in their contracts cannot be diminished or restricted by unilateral communications from the HSE HR office.

Accordingly, members should continue to claim their rest day entitlements without any of the restrictions or reductions proposed by the HSE which have not been agreed.

Roster Rest Day Entitlement* 1:1 5 1:2 3 1:3 2 1:4 1 * Days in lieu per four-week period

• For attendance on site on weekdays, the amount of rest assigned with each on-call incident will be 2 hours before midnight and 3 hours after midnight, or the actual time if exceeded. In addition, travel time will be allowed to and from the location.

It is estimated that there are around 250 consultants in full-time private practice.

• For telephone consultations, the amount of rest assigned with each call will be 30 minutes before midnight and 60 minutes after midnight, or the actual time if exceeded.

Consultants wishing to establish admitting rights to a private hospital should apply, in the first instance, to the hospital management. The medical board normally considers the

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PRIVATE PRACTICE

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Members’ Handbook application and a recommendation is put forward for consideration by the hospital directors.

cover. Non-commissioned officers of the Permanent Defence Forces are not covered for private health care by the military authorities.

The terms and conditions under which consultants work in private hospitals vary from institution to institution. Consultants considering such a move should satisfy themselves in relation to these matters with the hospital directly.

All Consultants are obliged to indemnify themselves against claims arising from malpractice and negligence. The Clinical Indemnity Scheme provides some cover in respect of practice in public hospitals.

Ireland is unique in that circa 45 per cent of the population is covered by private health insurance. There are currently four significant providers in the market. The Voluntary Health Insurance Board (VHI) is by far the largest insurer followed by Laya Healthcare (formerly Quinn Healthcare), Aviva Health (the health insurance arm of Aviva) and Glohealth.

Consultants who propose treating patients privately should register with each insurance company at an early date. Insurers will recognise consultants who hold posts approved by Comhairle na nOspidéal/HSE. They will also recognise consultants in private practice who are eligible to hold permanent posts.

Each organisation publishes a scale of professional fees in respect of procedures that may be claimed when carried out for insured patients.

Other private health insurance schemes operating in Ireland are: • St Paul’s Garda Medical Aid Society • ESB Staff Medical Provident Fund • ESB Marina Staff Medical Provident Fund • The Goulding Voluntary Medical Scheme • Prison Officers Medical Aid Society • New Ireland/Irish National Staff Benevolent Fund • Sun Alliance Ireland Staff Medical Expenses Scheme • Irish Life Assurance plc Medical Aid Society • Irish Life Assurance plc Outdoor Staff Benevolent Fund • CIE Clerical Staff Hospital Fund Membership of these schemes is limited to employees and families of the relevant organisations only.

In addition, serving Officers of the Permanent Defence Forces are covered for private health insurance by the military authorities. Those of the rank of Lieutenant and Captain, or equivalent, are entitled to semi-private cover whilst officers of higher ranks are entitled to private

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MEDICAL INDEMNITY

It is the unequivocal advice of the Association that consultants maintain membership of a medical defence body, such as the Medical Protection Society for those aspects of practice not covered by the CIS. As a consultant undertakes full clinical responsibility for his patients, he could be held personally liable in the event of an adverse event occurring.

Indemnity may provide cover against such an eventuality, which may not materialise until many years after the incident that gave rise to the injury.

MEDICO-LEGAL MATTERS Consultants are regularly called upon to provide an opinion in medico-legal matters. This can vary from providing an examination and report in respect of an insurance policy application to acting as an expert witness in a court action arising from an accident. The Medical Council, in agreement with the Law Society, states that a doctor has a moral and professional responsibility to supply a medico-legal report on request from a patient’s solicitor as failure to comply may lead to a patient being deprived of benefits to which he/she may be entitled.

The Council has also indicated that under ordinary circumstances medico-legal reports should be provided within two months after the examination or receipt of the request, whichever occurred last.

Consultants are entitled to charge fees in respect of this work. The fee a consultant sets is entirely his/her own affair. Arising from possible implications under competition legislation, the Association no longer publishes a scale of medico-legal fees. The Revenue Commissioners issued guidance in 2012 to the effect that medico legal work may be liable for VAT. Members are advised to contact the Association and to consult with their financial advisors with regard to the appropriate treatment of such income and whether they are required to register with Revenue for VAT purposes.

You are strongly advised to respond to requests for medico-legal opinions using the pro-forma letter below. By so doing you will avoid any confusion or disagreement later in the matter of fees.

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EVERY EVERY YEAR YEAR FLU FLU EVERY EVERY YEAR YEAR FLU FLU CAUSES SEVERE CAUSES CAUSES SEVERE SEVERE C CAUSES CAUSES SEVERE SEVERE ILLNESS AND DEATH.

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PRO FORMA LETTER Re: Medico-Legal Fees: Terms & Conditions Dear Sir/Madam I write to you in response to your request to examine and prepare a medical report on behalf of your client, …………………….. I detail hereunder my fees for the following items for medico-legal work.

Examination and First Report € Follow up Report € Note: Reports will be dispatched on receipt of the appropriate fee Attendance at Court Half Day € Full Day € Travelling expenses at public service rate of € • Consultation with Solicitor or Counsel (other than at Court Hearing) € Consultation with other party’s medical advisor • By telephone € • By correspondence € • By attendance at examination € Cancellations - Courts • Standby for any reason, with less than 1 working day € • Standby for any reason, with less than 3 working days € • Attendance for any reason, with less than 1 working day € • Attendance for any reason, with less than 3 working days € These fees are subject to VAT at the prevailing rate. I would be grateful if you would provide me with your written undertaking that your firm will be responsible for the above fees, irrespective of the outcome of the Court case or the decision of any third party.

Yours faithfully,

It is acknowledged that Consultants are currently working in under resourced hospitals and attending to increased demand for patient care. Recognising your professional, ethical and contractual obligation to advocate on behalf of the patient and the service, see below a draft wording that may be used in the certain circumstances and to be addressed to Management. Please contact the Secretariat for further advices as it relates to the specific circumstances.

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Members’ Handbook

Private & Confidential Pro Forma Letter Re: Early Discharge/Bed Shortages/Resource Restrictions Dear , I wish to advise you that I had to discharge _______________ at ___________ to provide a bed for _______________ who required emergency/urgent admission on _________. I am not satisfied that ______________ was sufficiently well to be discharged and I would not have discharged him/her at this time except, as I have stated, the demand for beds from patients requiring emergency/ urgent admission had to take precedence.

I do not regard this practice as in the interest of patients and I am not satisfied that best standards are being observed as I am allowed to exercise my clinical judgement in an independent manner and in the best interest of my patients.

I am particularly concerned that several provisions of my contract, which I quote hereunder and paragraph 4.9 of the Medical Council’s Guide to Ethical Conduct and Behaviour have been breached as a result of my having to discharge a patient who should remain in this hospital until medically fit for discharge.

Note: You should quote the relevant extracts below from the Contract that you personally hold in the above letter.

2008 Consultant Contracts 10 (b) “The Consultant is clinically independent in relation to decisions on the diagnosis, treatment and care of individual patients. This clinical independence derives from the specific relationship between the patient and the Consultant in which the patient places trust in the Consultant personally involved in his/her care to make clinical decisions and to take continuing responsibility for their consequences.”

4 (b) “Services not provided as a consequence of a resource limit are the responsibility of the Employer and not the Consultant.”

4 (c) “The Employer recognises the Consultant’s obligations regarding the application of the Medical Council’s (or Dental

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Council, as appropriate) ethical and professional conduct guidance to the clinical and professional situations in which (s)he works.”

Buckley Contract 6.3.2 “Being a consultant involves taking responsibility in his own name for the diagnosis and treatment of his patients, or that aspect of care appropriate to him when consulted, without supervision of his clinical judgement. This is the essence of clinical independence.”

6.3.3 “Clinical independence derives from the concept of the specific relationship between the patient and the doctor in which the patient authorises and trusts the doctor(s) personally involved in his care to make clinical decisions in the patient’s best interest and to take continuing responsibility for their consequences.”

6.3.5 “The contract must, therefore, recognise and expressly protect the right of the patient to the independent judgement of his personal consultant except where appropriately transferred by that consultant.”

6.5.4 “Services not provided as a consequence of a resource limit is the responsibility of the Employing Authority and not the consultant”.

Medical Council Section 49 Healthcare Resources 49.2 “You have a duty to assist in the efficient and effective use of healthcare resources and to give advice on their appropriate allocation.”

I am obliged to inform you therefore, in accordance with the advice received from the MDU/MPS and IHCA, that should anything untoward devolve on (name) due to lack of resources or should anything untoward devolve on any patient who is discharged prematurely due to a shortage of beds, responsibility for same will rest with (name of board/hospital).

Yours sincerely,

Consultants and their colleagues are subject to Data Protection legislation and the obligations required of them in respect of patient data. The integrity of the health system relies upon defined and adhered rules regarding patient confidentiality.

Depending on the circumstances, the following draft letter may be relied upon in corresponding with Management on issues of patient data and confidentiality.

Please contact the Secretariat for further advices as it relates to the specific circumstances.

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Members’ Handbook POST-MORTEMS & INQUESTS Private & Confidential Pro Forma Letter Copying of Charts/Medical Notes Dear , It has come to my attention that the charts/medical notes belonging to (patient’s name) have been photocopied without my prior knowledge and I having had an opportunity to express an opinion. You will be aware that all patients are entitled to the maximum possible confidentiality in all matters concerning their medical management.

This requirement applies particularly to patients who attend the psychiatric services. Consultants are obliged by their contract, the Medical Council’s Ethical Guidelines and their binding contract with their patients to observe the strictest confidence regarding their treatment.

(1) I am extremely concerned that patients’ charts/notes are not always securely deposited so as to eliminate the possibility of their being perused by unauthorised personnel.

(2) I have equal concerns that patients’ charts/notes have been copied by personnel who may not be fully briefed on the need for adherence to strict confidentiality.

(3) I also wish to place on record my concerns that copying of charts/ notes of patients under my care has taken place without any reference to me. I acknowledge that these charts/notes are the property of the (employing authority) and I am aware that the final decision on the release of information under, for example the Freedom of Information Act, is a matter for the CEO and not the managing consultant. However, I wish to emphasise that it is prudent that the managing consultant should be advised that charts are to be copied and the consultant should be allowed the opportunity to study the chart/notes in order to advise on whether or not it is appropriate to provide copies or any or all documents in a chart, depending on the nature of the request.

I wish to advise that I cannot be held responsible for any action that may be taken by a patient/next of kin in the event of sensitive patient information falling into the possession of any inappropriate or unauthorised persons. This responsibility must lie with (name of employer).

REPRESENTATIONAL ASSISTANCE FOR CONSULTANTS The Association is always available to provide representational assistance to consultants in their dealings with employers and other service providers.

Requests for assistance can be made by writing or by telephone to head office. Should you require such assistance please be in a position to provide as much information as possible about the difficulty and have copies of any documentation pertaining to it available for head office files.

The provision of legal advice may be facilitated for members on request. Should a consultant decide to pursue legal action following such advice, it will be taken by the consultant himself and not by the Association.

Finally, members may be assured that any request for assistance is treated in the utmost confidence.

Healthy Ireland A Framework for improved Health and Wellbeing The Government published Health Ireland – A Framework for Improved Health and Wellbeing in 2013-2025. It describes four high level goals and 64 actions that will work together to help achieve these goals. The full document can be viewed at: http://www.dohc.ie/publications/pdf/HealthyIrelandBrochureWA2. pdf?direct=1

The four high level goals are: 1. Increase the proportion of people who are healthy at all stages of life 2. Reduce health inequalities 3. Protect the public from threats to health and wellbeing 4. Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland.

These goals will be delivered through a series of 64 separate actions grouped into six themes. The themes cover the following broad areas.

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Consultants are, on occasion, asked to perform post-mortems or to appear as witnesses at inquests. A revised scale of fees (SI 155 of 2009) has been published by the Department of Justice. Consultants wishing to acquaint themselves with the current scale may contact Head Office.

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Members’ Handbook Theme 1 – Governance and Policy The Cabinet Subcommittee on Social Policy will oversee the implementation of the plan and oversee, monitor and address common Government policy, agenda, targets and action plans to improve health and wellbeing.

All public sector organisations will be required to promote and protect the health and wellbeing of their workforce, their clients and the community they serve.

Theme 2 – Partnerships and Cross Sectoral Work This sets out a series of fourteen actions designed to ensure that health and wellbeing are devolved to local areas for implementation.

Theme 3 – Empowering People and Communities Action points within this theme are directed at supporting, linking and improving existing partnerships so that various sectors of society can improve their health and wellbeing.

Theme 4 – Health and Health Reform The most concrete action within this theme is one to establish multidisciplinary national teams that will lead and take responsibility for policy areas. The development of a health and wellbeing human resource plan with a view to building capacity for health and wellbeing activities is also envisaged.

Theme 5 – Research and Evidence The development of a Healthy Ireland research plan is at the core of this theme. It is also planned to work with the Health Research Board to implement a plan to build research capacity.

Theme 6 – Monitoring Reporting and Evaluating A series of nine actions are set out to ensure that the capacity and systems are in place to report and evaluate the success of Healthy Ireland. A high level implementation plan with associated timelines for a Healthy Ireland will be developed in 2013. This will be followed by detailed and more specific plans for priority policy areas will be published.

MEDICAL COUNCIL The Medical Council was established under the Medical Practitioners Act, 1978 as amended by the Medical Practitioners Act of 2007. It is the guardian of the public’s interest in relation to the Medical profession.

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The principal functions of the Council are: • To prepare and establish a register of medical practitioners that is known as the Register of Medical Practitioners; • To satisfy itself as to the suitability of medical education and training, the standards of theoretical and practical knowledge for primary qualifications, the clinical training and experience required for the granting of a certificate of experience, and the adequacy and suitability of postgraduate education and training; • To enquire into the conduct of registered medical practitioners for alleged professional misconduct or fitness to engage in the practice of medicine by reason of physical or mental disability.

The Council has 25 members including elected and appointed members. Under the provisions of the Medical Practitioners Act, 2007, the new Council is comprised of 13 non-medical members and 12 medical members representing a range of medical specialties, teaching bodies and members of the public and stakeholders, all of whose appointments have been approved by the Minister for Health and Children. The current Council’s period of office is 2013 to 2018.

Consultants are advised to be registered in the Specialist Division of the Medical Register. Details of this are to be found on page 68 of the yearbook.

The Medical Council publishes a Guide to Ethical Conduct and Behaviour and to Fitness to Practice. Consultants are strongly advised to acquaint themselves with the contents of the Guide. It lays out information on the operation of the Registers, on ethical conduct and behaviour and on the operation of the fitness to practice process.

GOVERNMENT HEALTH POLICY Future Health: A Strategic Framework for Reform of the Health Service 2012-2015 sets out the main healthcare reforms that will be introduced in the coming years, as key building blocks for the introduction of Universal Health Insurance in 2016.

Future Health contains a set of specific actions, with timelines, that will prepare the way for Universal Health Insurance. It is intended that Future Health will deliver a major reshaping of the health system by restructuring our service delivery, and improving our organisational, financial, governance and accountability systems across the board – in the primary, community and hospital sectors.

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To give clients what they want and need from their bank, our team at AIB Private Banking are available at a time and place that suits you to deliver an effective and efficient banking service. We are dedicated to follow-through on all commitments to clients, doing the small tasks exceptionally well and always being upfront about delivery times and expectations. AIB Private Banking clients can also benefit from the most advanced digital banking services in Ireland.

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A RETURN TO THE TRADITIONAL BANKING MODEL Patrick Farrell, AIB’s new Head of Private Banking, who is responsible for rolling out this new service, is clear in his motivations and aspirations for AIB Private Banking.“What we are aiming for is a return to the up-front values of trust and personal service that were traditional in the banking relationship. Our most highly valued clients are often those who have the least time to look after their financial affairs, such as those working in the medical profession, for example. Our goal is to help them to meet their life objectives, giving them the support and advice they need to plan their financial futures. We place the client’s long-term interests at the heart of the banking relationship, and are proactive in seeking opportunities that will serve their needs and the needs of their family members through all life stages. By delivering the highest level of day-to-day banking and the most advanced digital banking service, we can provide the premier banking experience for our clients.”

OUR MOST HIGHLY VALUED CLIENTS ARE OFTEN THOSE WHO HAVE THE LEAST TIME TO LOOK AFTER THEIR FINANCIAL AFFAIRS. UNDERSTANDING THE MEDICAL PROFESSION

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To find out more about AIB Private Banking, contact Patrick Farrell: Telephone 01-6417634 or email patrick.a.farrell@aib.ie

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Members’ Handbook

1. The Approach to Reform - Four Pillars 1.1 Health and Wellbeing There will be a new focus on the need to move away from simply treating ill people to a new concentration on keeping people healthy. Future Health recognises the need for a whole-of government approach to addressing health issues and commits to the development of a comprehensive Health and Wellbeing Policy Framework and the establishment of a Health and Wellbeing Agency.

1.3 Structural Reform The structural reform of the health service will be key to addressing the problems within our current health system and will also be critical in the journey to UHI. Getting the structure right will be a complex task and as such, each phase of the transition will be evaluated carefully as we progress towards UHI. The key concerns in terms of structural reform are to promote good governance, avoid duplication and ensure a strong regional focus in managing performance and delivering value for money.

1.2 Service Reform Future Health commits to service reform that will move us away from the current hospital centric model of care towards a new model of integrated care which treats people at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. This will help to reduce costs, improve access, and move away from the existing emphasis on episodic reactive care towards preventative, planned and well-co-ordinated care.

The first phase of reform will deliver a greater degree of accountability for the HSE. It includes abolition of the HSE Board, establishment of a Directorate and a new management structure in the HSE. Hospital groups will be established on an administrative basis, with Group CEOs having budgetary responsibility for both the HSE and voluntary hospitals in their group. There will be a review of Integrated Service Areas which will ensure maximum alignment between all service providers at the local level, review executive management and

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Members’ Handbook governance arrangements and inform new structures for the delivery of primary care. This phase will also see the establishment of the new Child and Family Support Agency. The legal status of the HSE will not change during phase one. The second and third phases, which are key to the implementation of UHI will involve: firstly, the development of a formal purchaser/provider split and effectively, the dissolution of the HSE and; secondly, a move from a tax-funded system to a combination of UHI and tax funding. The essential public nature of the health system will not be changed.

1.4 Financial Reform The financial challenges facing the health system are immense. Future Health measures aimed at addressing the financial control issues include the return of the Vote to the Department of Health from the HSE; the introduction of programme based budgeting; implementation of the recommendations of the 2012 Review of Financial Management Systems in the Irish Health Service; and the development and roll-out of a comprehensive financial management system as a matter of priority.

A new ‘Money Follows the Patient’ (MFTP) funding model will be introduced in order to create incentives that encourage treatment at the lowest level of complexity. The introduction of ‘MFTP’ will be used both to reduce costs and to achieve key quality and safety objectives.

The ‘MFTP’ system will be designed so that money can follow the patient out of the hospital setting to primary care and related services.

This, along with other initiatives such as the introduction of integrated payment systems, will help to support integration between primary, community and hospital care.

Important reforms of the private health insurance market are also planned, including a new permanent scheme of risk equalisation from 1 January next, an emphasis on cost control and a continuing examination of the options in relation to the future status of the VHI. 2. Reform of the Delivery System 2.1 Primary Care The vision for primary care is one where: no one must pay fees for GP care; GPs work in teams with other primary care professionals; the focus is on the prevention of illness and structured care for people with chronic conditions; primary care teams work from dedicated facilities; and staffing and resourcing of primary care is allocated in a planned manner to meet regularly assessed needs. Future Health commits us to retaining the community ethos of primary care, in

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which the patient’s needs are the first concern.

2.2 Hospitals Future Health identifies three main areas of reform for the hospital system: (i) delivering more responsive and equitable access to scheduled and unscheduled care for all patients through continued implementation of the Special Delivery Unit’s initiatives in this area; (ii) reorganising public hospitals into more efficient and accountable hospital groups that harness the benefits of increased independence and a greater control at local level; and (iii) publishing a Framework for the Development of Smaller Hospitals, in which they will play a vital role in service delivery.

2.3 Social and Continuing Care Future Health commits to the development of a social and continuing care system that maximises independence and achieves value for the resources invested. The measures include a reform of the Fair Deal scheme to allow many more people to continue living at home as they would wish. Disability services will be reformed in line with the findings of the recent Value for Money and Policy Review of Disability Services. Future Health also reaffirms our support for the move from the traditional institutional based model of mental health care, towards a patient-centred, flexible community based service.

Other important measures identified include the introduction of: a standardised framework to commission services from both public and non-public providers; individualised budgeting to bring about a closer alignment between funding and the outcomes of individuals; and a robust regulatory regime to ensure quality and safety. Social and Community Care will continue to be tax funded separately from UHI. 3. Approach to Implementation Future Health proposes that change will be implemented in a step by step manner, on the basis of good evidence. Further detailed actions will be built on the foundations of Future Health as the reform programme proceeds. A White Paper on Universal Health Insurance, to be published in 2013, will provide the basis for many of these actions and a preliminary document will be produced by the end of this year. A preliminary paper will be published this year.

Robust governance and management arrangements will be crucial to drive, manage and monitor implementation of the reform programme. A Programme Management Office will be established within in the Department of Health to act as a central, overarching, co-ordinating function for health reform.

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Consultants’ Common Contract 2008 Enabling Circular 25th July 2008

To: Hospital Network Managers, Assistant National Directors (PCCC), Health Agencies Please forward this circular and attached document to all HSE agencies, voluntary hospitals, relevant corporate bodies and other non-HSE agencies under your remit.

Please ensure the required form is completed in respect of each Consultant in your employment (i.e. hospital/agency).

1) General a) The purpose of this circular is to convey approval to the introduction with effect from 1st June 2008, of a revised contract for Consultant medical staff providing services under the Health Acts and to notify arrangements for the implementation of the provisions of the revised contract. A copy of the new contract is enclosed. The contract is hereafter referred to as ‘Consultant Contract 2008’. b) The terms of Consultant Contract 2008 follow negotiations with the representative bodies of the medical profession. c) Agencies should ensure that the name of the employer is inserted in the locations indicated in the document and that the appropriate deletions are made where indicated.

2) Consultants to be offered the Contract The Contract consists of the documentation specified in the preamble to the Consultant Contract 2008 document. The terms and conditions of Consultant Contract 2008 shall be offered to the following: a) Consultants currently in your employment holding permanent posts. b) Consultants currently in your employment holding fixed term (temporary) posts. The expiry date of their existing fixed-term (temporary) contract and/or its specified purpose must be incorporated into their new contract. c) Consultants currently in your employment holding locum posts.

The structure, time and attendance arrangements of their contract must be incorporated into their new contract.

3) Options for Existing Consultants Subject to Section 2 above: a) Category I Consultants may opt for a Type A or Type B contract. b) Category I Consultants in Emergency Medicine may also opt for a Type B* contract. c) Category II Consultants may opt for a Type A, Type B or Type B* contract. d) Geographical wholetime without fees Consultants may opt for a Type A or Type B contract.

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e) Consultants holding the Academic Consultant Contract 1998 on a Category 1 basis may opt for a Type A or Type B Contract. Section 15 of Consultant Contract 2008 will apply to such individuals. f) Consultants holding the Academic Consultant Contract 1998 on a Category 2 basis may opt for a Type A, Type B or Type B* Contract.

Section 15 of Consultant Contract 2008 will apply to such individuals. g) Regional Consultant Orthodontists may opt for a Type A, Type B or Type B* Contract on a pro-rata basis. Should such Consultants opt for a Type B or Type B* their entitlement to retained private practice is as described at Section 21 of the Consultant Contract 2008. h) Consultants (including Regional Consultant Orthodontists) holding Temporary or Locum appointments may opt for a Type A, Type B or Type B* Contract on a Temporary or Locum basis commensurate with their current Temporary or Locum post. i) Consultants who are not encompassed by the above should apply to the HSE Consultant Appointments Unit via the relevant Hospital Network Manager/Assistant National Director PCCC to be offered Consultant Contract 2008.

4) Atypical Work Arrangements a) Consultants who are currently engaged in atypical working (e.g. flexible working, job sharing, etc.) will be offered Consultant Contract 2008 on a pro-rata basis to their current working arrangements. Should such Consultants wish to restructure their commitments such restructuring shall be subject to approval from the HSE Consultant Appointments Unit in line with the provisions of the Consultant Contract. b) Consultants who opt for Consultant Contract 2008 and who wish to avail of atypical work arrangements (e.g. flexible working, job sharing, etc.) may do so with the prior agreement of the employer.

5) Joint Appointments a) The following wording should be used where the Consultant has a joint appointment at Section 2 of Consultant Contract: i) “This Contract is a contract of employment between (name(s) and address(es) of employer(s) for __ hours per week) and (name and address of employee)” or ii) “This Contract is a contract of employment between (name and address of employer) for __ hours per week and for __ hours per week with (name and address of other agency/agencies) and (name and address of employee)” b) Employers who are the contract holders for joint appointments should ensure at all times, and in respect of all aspects of the appointment, that they keep each other fully informed of any matter likely to affect the appointment. Particular attention

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should be paid to matters affecting probation and the confirmation or termination of appointments.

6) Making the Offer a) Employers should take great care in drawing up and issuing the contract documents. All of the bracketed spaces in the contract documentation should be filled by the employer before a contract is offered. b) Signed acceptances of the offer of Consultant Contract 2008 must be received by the employer on or before 31st August 2008. Only Consultants who accept the offer before 1st September 2008 will benefit from retrospective salary arrangements. c) Should the Consultant accept the offer of the Contract, the employer and the Consultant must sign the contract simultaneously. Under no circumstances should an employer issue signed blank forms of contract to Consultants. Where it is not possible to have the contract signed simultaneously, the Consultant must sign the Contract prior to the employer. The returned signed

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contract should be checked carefully to ensure that it is identical to that issued for signature. Any corrections, alterations, etc., should be made by the employer and fresh documents issued for signature.

7) Working Hours Consultant Contract 2008 provides – inter alia – for the following: a) The Consultant is required to undertake such duties/provide such services as are set out in the contract in the manner specified for 37 hours per week. This 37 hour commitment will normally be delivered across a span of 12 hours between the hours of 8am and 8pm Monday to Friday. The Consultant will not be obliged to work more than eight hours in any one day. b) The Consultant may be required to participate in the on-call roster as determined by the Employer. c) The Consultant rostered on-call may be required to provide an additional structured commitment on-site of up to five hours on a Saturday and/or five hours on a Sunday and/or five hours on a public holiday.

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Consultants’ Common Contract 2008 Enabling Circular 25th July 2008

8) Private Practice The private practice arrangements (where applicable) for the different contract types are set out in Sections 20 and 21 of Consultant Contract 2008. A joint management/union committee is currently devising a measurement system to support the new private practice arrangements.

9) Salary and Other Payments a) The remuneration provisions of Consultant Contract 2008 are outlined in Section 23 of the contract document. b) A schedule setting out the updated salaries and other payments (i.e. current) for the various contract types is attached to this circular. c) Serving Consultants who opt for Consultant Contract 2008 by 31st August 2008 shall be paid the applicable revised rate at the maximum point with effect from 1st June 2008 and 1st June 2009, as set out in the attached schedule. d) Serving Consultants who exercise their option to take the revised contract between 1st September 2008 and 31st December 2008 will be assimilated onto the applicable new salary scale, at the maximum point, from the date of their signing of Consultant Contract 2008. e) Applications for the offer of the Consultant Contract 2008 after 31st December 2008 should be made to the HSE Consultant Appointments Unit.

10) Superannuation a) The Consultant will be covered by the terms of the HSE/ VHSS/NHSS (as appropriate) Superannuation Scheme and the contributory associated spouses and children superannuation schemes. Appropriate deductions will be made from his/her salary in respect of his/her contributions to the scheme. In general, 65 is the minimum age at which pension is payable; however, for appointees who are deemed not to be ‘new entrants’ as defined in the Public Service Superannuation Miscellaneous Provisions Act 2004 an earlier minimum pension age may apply. b) Should: i) the Consultant be deemed to be a new entrant (as defined in the Public Service Superannuation [Miscellaneous Provisions] Act 2004), there is no specified retirement age in respect of his/ her appointment to this position. or

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ii) the Consultant be deemed not to be a new entrant (as defined in the Public Service Superannuation [Miscellaneous Provisions] Act 2004), retirement is compulsory on reaching 65 years of age.

11) Clinical Directors Consultant Contract 2008 provides at Appendix IV for the appointment and selection of Clinical Directors. Information on how these appointments and selections will be made will issue separately.

12) Rest Days a) Consultants with an on-call liability shall have an entitlement to avail of rest days on the following basis: i) 1 : 1 on-call roster entitles the Consultant to five days in lieu per four week period; ii) 1 : 2 on-call roster entitles the Consultant to three days in lieu per four week period; iii) 1 : 3 on-call roster entitles the Consultant to two days in lieu per four week period; iv) 1 : 4 on-call roster entitles the Consultant to one day in lieu per four week period. b) Rest days should be taken as soon as possible following the on-call liability to which they relate. Where service demands do not permit them to be taken immediately, rest days may be accumulated: i) for a maximum of six months from the earliest date of the on-call liability to which they relate and at that point they must be availed of or forfeited. or ii) for a maximum of three months from the earliest date of the on-call liability to which they relate. If it is not possible to avail of them at the end of the three month period the Consultant may seek to be compensated for them at a rate equivalent to the daily rate for the type of post which (s)he occupies. c) A Consultant who established an entitlement to historic rest days which was recognised under the 1997 Consultant Contract retains such entitlement.

13) Record of Transition to Consultant Contract 2008 The HSE Consultant Appointments Unit will forward letters to the Employer for issue to each Consultant who opts for the Consultant Contract 2008 noting his/her move to this contract and relevant terms.

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Consultants’ Common Contract 2008 Page No.

Preamble

Section A – Terms and Conditions 1) Core Principles 2) Appointment and Tenure 3) Probation 4) Mutual Obligations 5) Contract Designation 6) Reporting Relationship 7) Hours of Work 8) Location and Residence 9) Scope of Post 10) Role of Consultant 11) Professional Competence 12) Standard Duties and Responsibilities 13) Intellectual Property 14) Medical Education, Training and Research 15) Provisions Specific to Academic Consultants 16) Advocacy 17) Consultative Structures 18) Leave, Holidays and Rest Days 19) Locum Cover 20) Regulation of Private Practice 21) Contract Type 22) Change in Contract Type 23) Salary and Other Payments 24) Superannuation 25) Confidentiality 26) Records/Property 27) Clinical Indemnity 28) Grievance and Disputes Procedure 29) Role of Review Body on Higher Remuneration 30) Conflict of Interest/­­­Ethics in Public Office 31) Review by Employers and Medical Organisations 32) Acceptance of Contract

Section B – Appendices Appendix I – HSE Letter of Approval Appendix II – Disciplinary Procedure Appendix III – Clinical Directorate Service Plan Appendix IV – Clinical Director Appointment and Profile Appendix V – Extracts from Consultants Contract 1997 Appendix VI – Granting of Sick Leave Appendix VII – Correspondence Between the Parties Appendix VIII – Special Leave P rovisions for Consultants in Non-HSE Employment Appendix IX – Committees to Advise HSE on Consultant Applications

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37 37 38 39 39 39 39 40 40 40 41 41 41 42 42 42 43 43 43 44 45 45 47 48 49 49 49 50 50 51 51 51 51

52 52 56 58 64 65 65 67 67

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Consultants’ Common Contract 2008 Preamble This document is comprised of the following: a) Terms and Conditions; b) Appendices; c) Correspondence exchanged between the parties as set out at Appendix VII; d) Terms expressly incorporated.

The foregoing, constituting the contract documents, shall be read together and embody the entire understanding of the parties in respect of the matters contained therein.

Note 1: Throughout this document the use of the masculine pronoun is intended to also denote the feminine gender, save where the context does not admit of such meaning.

Note 2: Job descriptions for new appointees will form part of the Consultants’ Contract.

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Section A - Terms and Conditions 1) Core Principles The core principles of this Contract are: a) That both the Consultant and the Employer recognise that the relationship must be founded upon mutual trust and respect for each other and that any differences under the agreement should be processed expeditiously through the grievance and disputes procedure or such other procedures provided for herein; b) Recognition of the importance of the role of Clinical Director, which places Consultants within the leadership structure in the management of the health service; c) Recognition of clinical independence and the unique nature of the relationship between each Consultant and his/her patients; d) Recognition by the Consultant that (s)he must operate within a system in which policy and procedures are determined through the corporate entity in which staff at all levels must be accountable; e) Recognition of the Consultant’s role as an advocate and the concomitant responsibility, in the first instance, to express any

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Consultants’ Common Contract 2008 concerns within the employment context; f) Recognition of the Consultant’s role in the delivery of education and training and research.

2) Appointment and Tenure a) This Contract is a contract of employment between (name and address of Employer) and (name and address of employee). (name of appointee)* is appointed to a post of ___________ and accepts the appointment from (insert date). The Contract is: i) permanent, subject to the completion of probation (as set out in Section 2); or ii) for a fixed term/purpose; or iii) a locum appointment.

In the case of Consultants appointed on a fixed term / locum basis in accordance with Sections 2 a) ii) or 2 a) iii) above, Section 3 of this Contract (entitled ‘Probation’), other than paragraph 3 (f) thereof, does not apply. *Hereafter referred to as ‘The Consultant’

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b) A candidate for and any person holding the office must be in a state of health such as would indicate a reasonable prospect of ability to render regular and efficient service. c) The qualifications required for this post are set out in the Health Service Executive’s Letter of Approval as attached at Appendix I. d) Should the Consultant be required by the terms of the offer of appointment to comply with specified requirements or conditions (including a requirement or condition that (s)he shall acquire a specified qualification) before the expiration of a specified period the employment shall be terminated unless within that period the Consultant has complied with such requirements or conditions. e) With regard to resignation or retirement, the holder of a joint appointment* must act similarly in relation to each of his/her component commitments, e.g. (s)he cannot retire or resign from one participating Employer and not from the other(s). *A joint appointment is one which involves a commitment by the Consultant to two or more employing authorities. Consultants appointed on such a basis are entitled to a single contract or interdependent contracts (with reciprocal clauses). The Consultant’s total commitments should not exceed that which

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Consultants’ Common Contract 2008 is expected from Consultants in the same specialty who have a full-time commitment to one employer. f) If the Consultant wishes to terminate this employment (s)he shall provide the Employer(s) with three months notice of his/her proposed termination date. g) Except in cases of serious misconduct, the Employer will provide the Consultant with three months notice of the intention to terminate his or her employment.

3) Probation a) Appointment to a Consultant post (under Section 2 a) i) above) is dependent upon the satisfactory completion of a probationary period of 12 months. The probationary period may be extended at the discretion of the Employer for a period of not more than 6 months. In such event the specific reasons for the extension shall be furnished in writing to the probationary Consultant. b) At the end of the probationary period, the Employer shall either: i) certify that the Consultant’s service has been satisfactory and confirm the appointment on a permanent basis; or ii) certify, with stated specified reasons, that the Consultant’s service has not been satisfactory, in which case the Consultant will cease to hold his/her appointment. c) If the Employer should fail to certify in accordance with (b) above, the Consultant shall be deemed to have been appointed on a permanent basis. d) The Employer undertakes to advise the probationary Consultant on a timely basis of issues likely to result in the termination or extension of the probationary period. e) A Consultant who currently holds a permanent Consultant appointment in the Irish public health service will not be required to complete a probationary period should (s)he have done so already. f) A Consultant will not be required to complete the probationary period where (s)he has for a period of not less than 12 months acted in the post pending its filling on a permanent basis. g) During the probationary period, the probationary Consultant will be subject to ongoing review and a formal review will take place not more than six months after the date of first appointment on a probationary basis. h) In cases where an allegation of serious misconduct is made against a probationary Consultant, the matter will be dealt with in accordance with Stage 4 of the Disciplinary Procedure (attached at Appendix II). This does not affect the Consultant’s statutory rights under the Industrial Relations Acts, 1946-2004 or any other statute. i) In the case of joint appointments, the holding of any one part of

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the post is contingent on continuing to hold the other part or parts of the post. j) Employment may be terminated by either party during the probationary period. Should employment be terminated by the Employer, the Employer shall set out in writing the specific reasons for such termination.

4) Mutual Obligations a) Both the Consultant and the Employer recognise the need for mutual trust, confidence and respect in giving effect to the terms of this contract. b) Both the Consultant and the Employer shall co-operate in giving effect to such arrangements as are put into place to verify the delivery of the Consultant’s contractual commitments. c) The determination of the range, volume and type of services to be provided and responsibility for the provision of same within available resources rests with the Employer. Services not provided as a consequence of a resource limit are the responsibility of the Employer and not the Consultant. d) The Employer recognises the Consultant’s obligations regarding the application of the Medical Council's (or Dental Council, as appropriate) ethical and professional conduct guidance to the clinical and professional situations in which (s)he works.

5) Contract Designation This contract is designated as a Type ___ (insert in line with HSE Letter of Approval) Contract as set out in the HSE Letter of Approval for this post attached at Appendix I. Details regarding Type of Contract and change of Type of Contract are set out at Sections 21 and 22.

6) Reporting Relationship The Consultant’s reporting relationship and accountability for the discharge of his/her contract is: i) to the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) through his/her Clinical Director* (where such is in place). The Hospital Network Manager or Assistant National Director HSE PCCC Directorate may require the Consultant to report to him/her from time to time. or ii) in the case of Consultant Psychiatrists, to the Clinical Director and the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE)/Chief Executive Officer (where the Consultant is not employed by the HSE). *Details of the Appointment and Profile of the Clinical Director are contained in Appendix IV

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Consultants’ Common Contract 2008 7) Hours of Work a) The Consultant is contracted to undertake such duties/provide such services as are set out in this Contract in the manner specified for 37 hours per week. This 37 hour commitment will normally be delivered across a span of 12 hours between the hours of 8am and 8pm Monday to Friday. The Consultant will not be obliged to work more than eight hours in any one day. This will be structured as a single continuous episode. Scheduling arrangements may be changed from time to time within the 8am to 8pm period in line with clinical and/or service need as determined by the Clinical Director/Employer in consultation with the Consultant. b) The aggregation of the Consultant’s commitments in a given time period shall be on a cumulative basis of 37 hours per week.

This does not imply that the Consultant’s work is organised in equal periods of time. If the time worked consistently and significantly varies from the scheduled commitment, there will be a review of the commitment to ensure that the Consultant is not working regularly in excess of or less than the 37 hour weekly commitment. Where the commitment is being unavoidably exceeded for reasons of a temporary nature, local arrangements will be made to compensate the Consultant concerned. c) In addition to the contracted commitment per week specified at Section 7 (a) above: i) the Consultant may be required to participate in the on-call roster as determined by the Clinical Director/Employer. Payment arrangements for on-call liability are set out at Section 23 (i) and for the provision of call-out services when on-call outside scheduled commitments at Section 23 (j). ii) the Consultant rostered on-call may be required to provide a structured commitment on-site of up to five hours on a Saturday and/or five hours overtime on a Sunday and/or five hours on a public holiday. Consultants on onerous on-call rosters* shall not be expected to deliver the upper end of this requirement as determined by the Clinical Director. The Consultant’s liability for on-call outside such structured or other scheduled overtime hours will continue to apply. *Only on-call rosters of 1:4, 1:3, 1:2 or 1:1 are regarded as onerous d) As a senior professional employee, the Consultant may be required, from time to time, to work beyond his/her rostered period in line with the exigencies of the service. The Employer will endeavour to ensure that this will be an exceptional rather than a standard requirement. e) Where there is local agreement to implement different work patterns, (including any arrangements providing for up to 24/7 hour working) the involvement of any individual consultant in any such arrangement(s) shall be subject to his/her agreement.

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8) Location and Residence a) The Consultant’s appointment shall be to ___________________ (name HSE area/HSE-funded Hospital/Agency as set out in the HSE Letter of Approval). The Consultant’s employment location(s) is ____________ (as per HSE Letter of Approval for the post if relevant). b) The Consultant’s employment location may be changed within the functional area and service range applicable to his/ her Employer. In the first instance, this will be within the Hospital Network area/remit of the HSE-funded Hospital/Agency. The Consultant shall be consulted should (s)he be required to change to an employment location outside the (Hospital Network Area/ HSE-funded Hospital/Agency). In circumstances where a change of location is required, (e.g. hospital closures or major changes taking place in the character of the work being carried out there) the Consultant will be offered an appropriate alternative appointment without competition and consideration will be given to any request from the Consultant to change Contract Type or title of post. Subject to the provisions of the removal expenses scheme for the Health Service Executive, removal expenses shall be payable, if claimed. c) The Consultant shall be available to respond readily to clinical or service needs at the location(s) specified above. This will require the Consultant to reside convenient to the hospital/agency in which (s) he holds his/her appointment.

9) Scope of Post a) The scope of this post is as set out in the HSE letter of approval for this position at Appendix I and the Job Description as issued by the Employer. These describe the Consultant’s service commitments, accountabilities and specific duties. b) The Consultant’s annual Clinical Directorate Service Plan will detail how these are to be implemented and will be validated by a series of performance monitoring arrangements. c) Certain decision-making functions and commensurate responsibilities may be delegated to the Consultant by the Employer. These will be documented in the Clinical Directorate Service Plan. d) The Consultant may apply through the Employer to the Health Service Executive to change the structure of this post as set out in the HSE Letter of Approval. Any change in the structure of the post is subject to the determination of the HSE. e) The Consultant may apply for atypical working arrangements under the relevant health service scheme.

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Consultants’ Common Contract 2008 10) Role of Consultant a) For the purposes of this contract, a Consultant is defined as a registered medical or dental practitioner who by reason of his/her training, skill and expertise in a designated specialty, is consulted by other registered medical practitioners and who has a continuing clinical and professional responsibility for patients under his/her care, or that aspect of care on which (s)he has been consulted. b) The Consultant is clinically independent in relation to decisions on the diagnosis, treatment and care of individual patients. This clinical independence derives from the specific relationship between the patient and the Consultant in which the patient places trust in the Consultant personally involved in his/her care to make clinical decisions in the patient’s best interests and to take continuing responsibility for their consequences. c) The Consultant acknowledges that (s)he is subject to statutory and regulatory requirements and corporate policies and procedures. d) The Consultant has a substantial and direct involvement in the medical diagnosis, treatment and delivery of care to patients.

Each patient will have a named Consultant who has continuing responsibility for his/her diagnosis, treatment and care. e) The Consultant may discharge his/her responsibilities through: i) a direct personal relationship with the patient; ii) shared responsibility with other Consultants who contribute significantly to patient management; iii) delegation of aspects of the patient’s care to other appropriate staff.

Delegation of responsibility to other doctors or staff by a Consultant is subject to: (1) the Consultant being satisfied that the relevant staff member has the necessary professional capability and (2) the continued provision of a commensurate level of diagnosis, treatment and care to the patient.

The Consultant shall retain a continuing overall responsibility for the care of the patient. f) The Consultant will generally work as part of a Consultant team.

The primary purpose of Consultant teams is to ensure Consultant provided services to patients on a frequent and continuing basis.

In effect this requires that the Consultant provides diagnosis, treatment and care to patients under the care of other Consultants on his/her Consultant team and vice versa. This may include discharge and further treatment arrangements, as appropriate. g) The membership of the Consultant team will be determined in the context of the local working environment. The team may be defined at specialty/sub-speciality level or under a more broadly based categorisation, e.g. general medicine, general surgery.

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11) Professional Competence The Consultant shall maintain his/her professional competence on an ongoing basis pursuant to any Medical Council/Dental Council professional competence scheme applicable to the Consultant as a medical/dental practitioner. The Employer shall facilitate the maintenance of the Consultant’s professional competence pursuant to any Medical Council/Dental Council professional competence scheme applicable to the Consultant as a registered medical practitioner. Commitments in this regard will be reflected in the Clinical Directorate Service Plan.

12) Standard Duties and Responsibilities a) To participate in development of and undertake all duties and functions pertinent to the Consultant’s area of competence, as set out within the Clinical Directorate Service Plan*­­and in line with policies as specified by the Employer. *A sample Clinical Directorate Service Plan is attached at Appendix III. Appendix VII also refers. b) To ensure that duties and functions are undertaken in a manner that minimises delays for patients and possible disruption of services. c) To work within the framework of the hospital/agency’s service plan and/or levels of service (volume, types etc.) as determined by the Employer. Service planning for individual clinical services will be progressed through the Clinical Directorate structure or other arrangements as apply. d) To co-operate with the expeditious implementation of the Disciplinary Procedure (attached at Appendix II). e) To formally review the execution of the Clinical Directorate Service Plan with the Clinical Director/Employer periodically. The Clinical Directorate Service Plan shall be reviewed periodically at the request of the Consultant or Clinical Director/Employer. The Consultant may initially seek internal review of the determinations of the Clinical Director regarding the Service Plan. f) To participate in the development and operation of the Clinical Directorate structure and in such management or representative structures as are in place or being developed. The Consultant shall receive training and support to enable him/her to participate fully in such structures. g) To provide, as appropriate, consultation in the Consultant’s area of designated expertise in respect of patients of other Consultants at their request. h) To ensure in consultation with the Clinical Director that appropriate medical cover is available at all times having due regard to the implementation of the European Working Time Directive as it relates to doctors in training. i) To supervise and be responsible for diagnosis, treatment and care

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Consultants’ Common Contract 2008 provided by non-Consultant Hospital Doctors (NCHDs) treating patients under the Consultant’s care. j) To participate as a right and obligation in selection processes for non-Consultant Hospital Doctors and other staff as appropriate.

The Employer will provide training as required. The Employer shall ensure that a Consultant representative of the relevant specialty/ sub-specialty is involved in the selection process. k) To participate in clinical audit and proactive risk management and facilitate production of all data/information required for same in accordance with regulatory, statutory and corporate policies and procedures. l) To participate in and facilitate production of all data/information required to validate delivery of duties and functions and inform planning and management of service delivery.

13) Intellectual Property Intellectual property generated by the Consultant in the course of his/her employment shall be in the ownership of the relevant health sector/academic Employer(s). Due regard shall be given to national policy and national codes of practice*. *e.g. the National Code of Practice for Managing Intellectual Property from Publicly Funded Research (ICSTI, April 2004) and National Code of Practice for Managing and Commercialising Intellectual Property from Public-Private Collaborative Research (ASC, November 2005).

14) Medical Education, Training and Research a) The Consultant shall, as part of his/her standard contractual commitment, contribute to the education, training and supervision of students, non-Consultant Hospital Doctors and trainee professionals including members of the multi-disciplinary team. b) The Consultant shall, as part of his/her standard contractual commitment, contribute to the advancement of knowledge by facilitating and supporting research. c) Where the Consultant is employed by an Academic Teaching Hospital/Agency, the Employer(s) shall, through the Clinical Director, ensure that the Clinical Directorate Service Plan takes account of the academic schedule and related delivery of academic commitments. d) The Employer shall liaise with: i) The relevant University/Universities regarding local arrangements for the provision of undergraduate medical education and training, and research; and ii) The relevant University/Universities and the relevant recognised Postgraduate Training Body(ies) regarding local arrangements for the provision of postgraduate medical education and training e) The Consultant may, with the agreement of the Employer, within

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the 37 hour commitment, make an explicit further structured and scheduled commitment to educational activities commensurate with his/her role in conjunction with (i) the relevant affiliated Medical/Dental School(s) and (ii) training bodies for postgraduate medical education and training. Such structured and scheduled commitment, responsibility and accountability for same will be agreed with the relevant Medical/Dental School or training body and will be consistent with the agreed training principles for postgraduate medical education and training*. These structured commitments shall be set out in the Clinical Directorate Service Plan. *‘Training Principles to be incorporated into new working arrangements for doctors in training’, published by the Medical Education and Training Group, July 2004. f) The Consultant may, in line with Section 9, have the opportunity to restructure his/her commitments to facilitate structured research or educational programme development for a defined period, subject to the agreement of the relevant Employer; funding being identified to support such activity for that period and such research being subject to appropriate research governance and ethics.

15) Provisions Specific to Academic Consultants a) All terms of this contract are applicable to the holders of Academic Consultant posts which have been approved through the established HSE/HEA process in response to agreed submissions from the relevant University(ies) and clinical Employer(s). The provisions set out in this section are confined to holders of Academic Consultant posts approved by the HSE/HEA* and are additional and particular to Academic Consultants. *And previously Comhairle na nOspidéal. b) Academic Consultant posts are joint appointments between Universities* and the HSE or its funded agencies. They are structured to ensure a minimum 50 per cent commitment to the academic institution. *For the purposes of this document the term ‘University’ shall include the Royal College of Surgeons in Ireland. c) The HSE (or HEA, as appropriate), may, following consultation and agreement with the Employer(s), structure Academic Consultant posts at Senior Lecturer and Associate Professor level to reflect a lower commitment*, where: i) the nature of the clinical sub-specialty associated with the Academic Consultant post is such that a commitment to clinical duties in excess of 50 per cent is required for the appointee to maintain the required skills and competencies and/or ii) the academic department does not require an individual structured

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Consultants’ Common Contract 2008 commitment of 50 per cent to deliver its teaching and research programmes. *Structured Academic Consultant posts will have a minimum 30 per cent commitment to the Academic Institution. d) Academic Consultants are graded as follows: i) Professor/Consultant; ii) Associate Professor/Consultant; iii) Senior Lecturer/Consultant.

The Professor/Consultant, where appointed pursuant to the relevant statutes and regulations of the University, will act as head of the Academic Department or other relevant academic unit, with responsibility for the academic curriculum and administration of the Academic Department or unit*. *The academic governance and management structures in universities are subject to ongoing reform and change and the Academic Departments may no longer be the fundamental organisational unit within these structures. e) The Academic Consultant is accountable for the delivery of the clinical component of the post as provided for in the body of this Contract. f) The Academic Consultant is accountable via the management and governance structures in place in the University in relation to the delivery of their academic commitment. g) The Academic Consultant’s role in teaching and training on the University campus extends to the relevant clinical site(s) for both undergraduates and postgraduates and shall, where required include responsibility for relevant University students, teaching, training, assessment, modules and courses. h) Management and governance structures in respect of academic activities will be described in a framework developed by the Employer(s) which shall, inter alia, set out the relationship between academic and clinical activities; roles and responsibilities within these structures, including the respective roles of the Clinical Director and the Academic Head of Department(s) and/or other relevant academic unit; have regard to national policy on medical education and training, and standards of medical education and training for basic and specialist medical qualifications set and published by the Medical Council. i) The Academic Consultant will fully commit to and play a key role in the development and reform of medical education and training and research in alignment with Government policy. This may include a requirement to participate in and collaborate across University and clinical sites and with postgraduate bodies and the Medical Council on international, national and regional initiatives in academic and related activities. j) The rights and obligations implied in the exercise of academic independence are recognised.

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16) Advocacy a) The Consultant may advocate on behalf of patients/service users or persons awaiting access to service. b) In the first instance such advocacy should take place within the employment context through the relevant Clinical Director or other line manager. c) Information given to the public should be expressed in clear and factual terms. It must never cause unnecessary public concern or personal distress nor should it raise unrealistic expectations.

17) Consultative Structures It is recognised that Consultants organise themselves in groupings within hospitals/health agencies in order to deal with collegiate or non-executive matters. This representative system provides a mechanism to complement and inform the work of corporate management structures including Clinical Directorates. Where these representative structures do not exist, Employers will encourage and support their establishment, provide appropriate administrative support and encourage the fullest participation by all Consultants in the arrangements. The appropriate representative head (Chairperson or Secretary) of such a structure, e.g. Medical Board, Medical Advisory Board, Medical Committee will be accorded a consultative status regarding issues which have a significant effect on the delivery of clinical services within the hospital/health agency commensurate with their important representative function.

18) Leave, Holidays and Rest Days a) All leave or planned absences, other than those described under (e) and (f), must have prior approval from the Clinical Director/Employer. b) Leave and absences from work will normally be planned and scheduled in advance in conjunction with the Clinical Director/Employer. Leave will be approved by the Clinical Director/line manager in line with agreed rota and service requirements and notice is required in accordance with the Employer’s policy. c) Annual Leave: The Consultant’s annual leave entitlement is 31 working days per annum and as determined by the Organisation of Working Time Act 1997. d) Public Holidays Entitlement: Public holidays shall be granted in accordance with the Organisation of Working Time Act 1997 as follows: (i) In respect of each public holiday, an employee’s entitlement is as follows: (1) a paid day off on the public holiday; or

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Consultants’ Common Contract 2008 (2) a paid day off within the month; or (3) an extra day’s annual leave; or (4) an extra day’s pay as the Employer may decide. e) Sick Leave: The Consultant may be paid under the Sick Pay Scheme for absences due to illness or injury. Granting of sick pay is subject to a requirement to comply with the Employer’s sick leave policy. Details of the scheme are set out at Appendix VI. f) Other Leave: Details regarding Maternity, Adoptive, Paternity, Parental, Force Majeure, Compassionate and other leave in accordance with procedures can be obtained from the Employer. g) Sabbatical Leave/Career Breaks: The Consultant may apply for Sabbatical Leave or Career breaks in accordance with the terms of the relevant circulars. The Employer has the right to approve or refuse such leave. h) Leave to provide services abroad: The Consultant may apply for special leave to provide services in countries where health services are underdeveloped in accordance with the relevant circular. The Employer may grant or refuse such leave. i) Special Leave: (i) Leave for special circumstances shall be available to the Consultant in accordance with the relevant circulars and subject to the agreement of the Employer. (ii) In addition and unless otherwise addressed by circular, for Consultants employed by the HSE, the provisions below and those set out in the HSE Employee Handbook apply. For Consultants employed by non-HSE agencies, the provisions below and those set out at Appendix VIII apply.

The Employer may grant leave with pay for: (1) continuing education or attendance at clinical meetings of societies appropriate to the Consultant’s specialty of not more than seven days in any one year excluding travel time.

(2) attendance at courses, conferences, etc. approved by the Minister for Health and Children and which the Employer is satisfied are relevant to the work on which the Consultant is engaged.

(3) World Health Organisation or Council of Europe Fellowships. j) Rest Days: Consultants with an on-call liability shall have an entitlement to avail of rest days on the following basis: (1) 1 : 1 on-call roster entitles the Consultant to five days in lieu per four week period; (2) 1 : 2 on-call roster entitles the Consultant to three days in lieu per four week period;

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(3) 1 : 3 on-call roster entitles the Consultant to two days in lieu per four week period; (4) 1 : 4 on-call roster entitles the Consultant to one day in lieu per four week period.

Rest days should be taken as soon as possible following the on-call liability to which they relate. Where service demands do not permit them to be taken immediately, rest days may be accumulated: • For a maximum of six months from the earliest date of the on-call liability to which they relate and at that point they must be availed of or forfeited; or • For a maximum of three months from the earliest date of the on-call liability to which they relate. If it is not possible to avail of them at the end of the three-month period the Consultant may seek to be compensated for them at a rate equivalent to the daily rate for the type of post which (s)he occupies. k) Historic Rest Days: A Consultant who established an entitlement to historic rest days under the Consultant Contract 1997 (i.e. by 30th June 1998) retains such entitlement. l) Other HR Policies: All other generally applicable human resource policies, e.g. Flexible Working, Trust in Care, Dignity at Work, etc. shall apply to the Consultant. m) Travel and Subsistence: Travelling and subsistence expenses necessarily incurred in the course of a Consultant’s duties shall be met on the basis applicable to persons of appropriate senior status in the public sector. Consultants holding joint appointments or appointments involving a commitment at more than one location will be reimbursed expenses in respect of travel between locations specified in the Clinical Directorate Service Plan and agreed with the Employer(s).

19) Locum Cover a) In the event of the Consultant being absent on a scheduled or unscheduled basis, the Clinical Director/Employer will determine the requirement for locum cover and make necessary arrangements. b) The Clinical Director/Employer will work with the Consultant in the development and execution of such arrangements as required. c) In exceptional circumstances where either sufficient cover cannot be provided or appropriate locum cover obtained, the Clinical Director/Employer may request the existing Consultants to undertake the routine work of an absent colleague in addition to their scheduled commitment. In such circumstances, appropriate

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Consultants’ Common Contract 2008 compensation will be agreed with the Clinical Director.

20) Regulation of Private Practice a) Subject to the provisions of this section, the Consultant may engage in privately remunerated professional medical/dental practice as determined by his or her Contract Type as described at Section 21 below. b) The volume of private practice may not exceed 20 per cent of the Consultant’s workload in any of his or her clinical activities, including in-patient, day-patient and out-patient. c) The volume of practice shall refer to patient throughput adjusted for complexity through the medium of the Casemix system. d) The 80:20 ratio of public to private practice will be implemented through the Clinical Directorate structure. The Employer has full authority to take all necessary steps to ensure that for each element of a Consultant’s practice, s(he) shall not exceed the agreed ratio. e) The Consultant will be advised on a timely basis if his or her practice is in excess of the 80:20 ratio of public to private practice in any of his or her clinical activities. An initial period of six months will be allowed to bring practice back into line but if within a further period of three months the appropriate ratio is not established (s)he will be required to remit private practice fees in excess of this ratio to the research and study fund under the control of the Clinical Director. f) The Clinical Director may exercise some discretion in dealing with the implementation of the ratio either for an individual or a group of Consultants once the overall ratio in relation to the particular clinical activity is satisfied. g) The implementation of the 80:20 ratio of public to private practice shall be the subject of audit including audit by the Department of Health and Children.

21) Contract Type Consultant Contract Type A a) A Consultant holding Contract Type A may engage in professional medical/dental practice exclusively for the public Employer(s) or as provided for at (c) below. b) A Consultant holding Contract Type A shall not engage in privately remunerated professional medical/dental practice. (s)he can only be remunerated for professional medical practice by way of salary as an employee under this contract or as provided for in (c) below. c) Professional medical/dental practice carried out for or on behalf of the Mental Health Commission, the Coroner, other Irish statutory bodies*, medical/dental education and training bodies

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shall not be regarded as private practice. In addition, the provision of expert medical/dental opinion relating to insurance claims, preparation of reports for the Courts and Court attendance shall not be regarded as private practice.

The HSE may specify additional bodies* dealing with public patients or aspects of the public health system to which this provision will also apply. The use of public facilities for all such activities is subject to the prior agreement of the Employer. *An indicative list of such bodies is available from the HSE Employers Agency, 63-64 Adelaide Road, Dublin 2, Tel: 01 6626966, Web: www.hseea.ie.

Consultant Contract Type B a) A Consultant holding Contract Type B may engage in privately remunerated professional medical/dental practice only in hospitals or facilities operated by the Employer, as part of such activities that arise as part of the employment contract (e.g. home visits), colocated private hospitals on public hospital campuses and as described at (b) below. b) A Consultant holding Contract Type B who previously held a Category I or Category II Contract under the Consultants Contract 1997 may continue to hold the right to engage in privately remunerated professional medical/dental practice in locations outside the public hospital campus, subject to the Consultant fully discharging his/her aggregate 37-hour weekly standard commitment as required by the Employer and such private practice being commensurate with the entitlement to off-site private practice held by a Category I Consultant under the Consultants Contract 1997*; *Sections 2.9.4 to 2.9.7 inclusive of the Memorandum of Agreement attached to the Consultants Contract 1997 refer. These are attached at Appendix V. c) Where a Consultant holding Contract Type B cannot be provided with facilities on the hospital campus for outpatient private practice the Employer shall make provision for such facilities off-campus, on an interim basis, pending provision of on-campus facilities. d) The volume of private practice as described at (a) and (c) may not exceed 20 per cent of the Consultant’s clinical workload in any of his or her clinical activities, including in-patient, day-patient and out-patient. e) With respect to Emergency and Outpatient Departments specifically, the Consultant shall not charge private fees in respect of: i) patients attending Emergency Departments in public hospitals; or ii) patients attending Public Outpatient Services in public hospitals. f) A common waiting list operated by the public hospital will apply to both public and private patients undergoing diagnostic investigations, tests and procedures (including radiology and laboratory procedures)

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Consultants’ Common Contract 2008 on an out-patient basis in public hospitals (including referrals from General Practitioners). Status on the common waiting list will be determined by clinical need only. The list will be subject to clinical validation by the relevant Clinical Director.

The Consultant may charge private fees in relation to private patients undergoing diagnostic investigations, tests and procedures on an outpatient basis subject to: i) the common waiting list provisions described above; ii) all billing being processed by the Consultant in a manner that is satisfactory to the hospital and in the event that insufficient information is available for verification purposes recourse may be had to the measures provided for at Section 20 (d) and (e); iii) the volume of such private practice not exceeding 20 per cent. g) The Consultant may charge private fees in relation to diagnostic investigations, tests and procedures (including radiology and laboratory procedures) referred to the public hospital by private hospitals, private clinics or other sources outside of the public health system but only where all arrangements for such referrals are effected through the Employer. h) Professional medical/dental practice carried out for or on behalf of the Mental Health Commission, the Coroner, other Irish statutory bodies or medical education and training bodies shall not be regarded as private practice. In addition, the provision of expert medical opinion relating to insurance claims, preparation of reports for the Courts and Court attendance shall not be regarded as private practice.

The HSE may specify additional bodies dealing with public patients or aspects of the public health system to which this provision will also apply. The use of public facilities for all such activities is subject to the prior agreement of the Employer.

Consultant Contract Type B* a) Contract Type B* is immediately available to: i) A Consultant who held a Category II Contract under the Consultants Contract 1997; subject to the Consultant fully discharging his/her aggregate 37-hour weekly standard commitment as required by the Employer. ii) A Consultant who held a Category I or II Contract as a Consultant in Emergency Medicine under the Consultants Contract 1997, subject to the Consultant fully discharging his/her aggregate 37-hour weekly standard commitment as required by the Employer. b) A Consultant who held a Category I Contract under the Consultants Contract 1997 may apply to change Contract Type to Contract Type B* two years after taking up Contract Type A or B. c) A Consultant holding Contract Type B* may engage in privately remunerated professional medical/dental practice in:

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i) hospitals or facilities operated by the Employer; ii) as part of such activities that arise as part of the employment contract (e.g. home visits), and/or in colocated private hospitals on public hospital campuses; iii) in locations outside the public hospital campus, subject to such private practice being: (1) commensurate with the entitlement to off-site private practice of a Category II Consultant under the Consultants Contract 1997; and (2) confined to periods outside the aggregate 37 hour weekly commitment and other scheduled commitments to the public service. d) The volume of private practice as described at (c) (i) and (ii) may not exceed 20 per cent of the Consultant’s clinical workload in any of his or her clinical activities, including in-patient, day-patient and out-patient. e) With respect to Emergency and Out-patient Departments specifically, the Consultant shall not charge private fees in respect of: i) patients attending Emergency Departments in public hospitals, or ii) patients attending Public Out-patient Services in public hospitals. f) A common waiting list operated by the public hospital will apply to both public and private patients undergoing diagnostic investigations, tests and procedures (including radiology and laboratory procedures) on an out-patient basis in public hospitals (including referrals from General Practitioners). Status on the common waiting list will be determined by clinical need only. The list will be subject to clinical validation by the relevant Clinical Director.

The Consultant may charge private fees in relation to private patients undergoing diagnostic investigations, tests and procedures on an out-patient basis subject to: i) the common waiting list provisions described above; ii) all billing being processed by the Consultant in a manner that is satisfactory to the hospital and in the event that insufficient information is available for verification purposes recourse may be had to the measures provided for at Section 20 (d) and (e); iii) the volume of such private practice not exceeding 20 per cent. g) The Consultant may charge private fees in relation to diagnostic investigations, tests and procedures (including radiology and laboratory procedures) referred to the public hospital by private hospitals, private clinics or other sources outside of the public health system but only where all arrangements for such referrals are effected through the Employer. h) Professional medical/dental practice carried out for or on behalf of the Mental Health Commission, the Coroner, other Irish statutory bodies or medical education and training bodies shall not be regarded

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Consultants’ Common Contract 2008 as private practice. In addition, the provision of expert medical opinion relating to insurance claims, preparation of reports for the Courts and Court attendance shall not be regarded as private practice.

The HSE may specify additional bodies dealing with public patients or aspects of the public health system to which this provision will also apply. The use of public facilities for all such activities is subject to the prior agreement of the Employer.

Consultant Contract Type C a) A Consultant holding Contract Type C may engage in privately remunerated professional medical/dental practice in: (i) hospitals or facilities operated by the Employer; (ii) as part of such activities that arise as part of the employment contract (e.g. home visits), in colocated private hospitals on public hospital campuses; (iii) in locations outside the public hospital campus, subject to the Consultant fully discharging his/her aggregate 37-hour weekly standard commitment as required by the Employer. b) The volume of private practice as described at (a) (i) and (ii) may not exceed 20 per cent of the Consultant’s clinical workload in any of his or her clinical activities, including in-patient, day-patient and out-patient. c) With respect to Emergency and Outpatient Departments specifically, the Consultant shall not charge private fees in respect of: (i) patients attending Emergency Departments in public hospitals; or (ii) patients attending Public Outpatient Services in public hospitals. d) A common waiting list operated by the public hospital will apply to both public and private patients undergoing diagnostic investigations, tests and procedures (including radiology and laboratory procedures) on an out-patient basis in public hospitals (including referrals from General Practitioners). Status on the common waiting list will be determined by clinical need only. The list will be subject to clinical validation by the relevant Clinical Director.

The Consultant may charge private fees in relation to private patients undergoing diagnostic investigations, tests and procedures on an outpatient basis subject to: i) the common waiting list provisions described above; ii) all billing being processed by the Consultant in a manner that is satisfactory to the hospital and in the event that insufficient information is available for verification purposes recourse may be had to the measures provided for at Section 20 (d) and (e); iii) the volume of such private practice not exceeding 20 per cent. e) The Consultant may charge private fees in relation to diagnostic investigations, tests and procedures (including radiology and

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laboratory procedures) referred to the public hospital by private hospitals, private clinics or other sources outside of the public health system but only where all arrangements for such referrals are effected through the Employer. f) Professional medical/dental practice carried out for or on behalf of the Mental Health Commission, the Coroner, other Irish statutory bodies or medical education and training bodies shall not be regarded as private practice. In addition, the provision of expert medical opinion relating to insurance claims, preparation of reports for the Courts and Court attendance shall not be regarded as private practice.

The HSE may specify additional bodies dealing with public patients or aspects of the public health system to which this provision will also apply. The use of public facilities for all such activities is subject to the prior agreement of the Employer.

22) Change in Contract Type a) Consultants may apply to change Contract Type to Type A, B or C at five-yearly intervals. An appeals process is set out at Section 22 (d) below. b) Those Consultants who previously held a Category I or Category II Contract under the Consultants Contract 1997 may, 2 years after accepting the Consultant Contract 2008 and thereafter at 5 yearly intervals, make application to the Health Service Executive Consultant Applications Advisory Committee* to transfer to Contract Type B*. A decision on such application will be made by the HSE following the advice of the Committee. Applicants must demonstrate that the change in Contract Type is consistent with the public interest and that there is a demonstrable benefit to the public health system. *Please refer to Appendix IX. c) Where significant changes occur in a particular area in the delivery of acute hospital care (e.g. hospital closures or major changes taking place in the character of the work being carried out there*) or where the volume of private practice is significantly below 20 per cent of total clinical workload, the Consultant shall be entitled to have his/her Contract Type reviewed by the Health Service Executive Consultant Applications Advisory Committee/ Type C Committee within the five year period. *Please refer to Section 8. d) Applications for change of Contract Type A, B or B* will be considered by the Health Service Executive Consultant Applications Advisory Committee together with the Employer’s views on the application. A decision on such application will be made by the HSE following the advice of the Committee. Applications for change of Contract Type to Contract Type B* will be considered subject to the condition that the total number of Consultants

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holding B*, Type C and Category 2 Contracts will be subject to an upper limit of such posts within the system. In the event that the HSE does not accede to the request, the Consultant may refer the matter to the Independent Appeals Panel for a recommendation.

The Independent Appeals Panel shall be composed of: i) an Independent Chairperson, ii) a representative of the Consultant (e.g. from the relevant medical organisation), and iii) an Employer representative. e) Appointments for reclassification to a Type C post will be considered by the Health Service Executive Type C Committee*. A decision on such application will be made by the HSE following the advice of the Committee. Applications for change of Contract Type to Type C will be considered with reference to the total number of Consultants holding Type B*, Type C and Category II Contracts not exceeding the specified limit. In the event that the

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Type C Committee does not accede to the request the matter will be referred to Chief Executive Officer of the Health Service Executive for a final decision. *Please refer to Appendix IX. 23) Salary and Other Payments a) The Consultant’s annual salary shall be as follows (in June 2007 terms) and shall be implemented on a phased basis as set out at d) below: i) for Type A Contracts a salary scale in four points as follows will apply: €222,000, €228,000, €234,000, €240,000; ii) for Type B Contracts a salary scale in four points as follows will apply: €205,000, €210,000, €215,000, €220,000; iii) for Type B* Contracts a salary rate of €190,000 will apply. iv) for Type C Contracts a salary scale in four points as follows will apply: €160,000, €165,000, €170,000, €175,000.

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Consultants’ Common Contract 2008 b) The annual salary for Consultant Academics shall be as follows: i) For a Professor (Type A Contract) a salary scale in four points as follows will apply: €272,860, €280,240, €287,620, €295,000. ii) For a Professor (Type B Contract) a salary scale in four points as follows will apply: €265,650, €272,100, €278,550, €285,000 iii) For a Professor (Type B* Contract) a salary of €255,000 will apply. iv) For a Professor (Type C Contract) a salary scale in four points as follows will apply: €219,450, €226,300, €233,150, €240,000 c) All serving Consultants who take up the offer of the Consultant Contract 2008 by 31st August 2008 will be assimilated to the maximum point of the applicable new salary scale. d) The salary scales at a) and b) above will be phased on the following basis: i) a five per cent increase on the Consultant’s existing (June 2007) rate from 14th September 2007; ii) half the balance* from 1st June 2008; iii) the remaining balance from 1st June 2009. *The term ‘half the balance’ refers to the difference between the 14th September 2007 rate and the fully implemented salary scale.

These rates will attract a 2.5 per cent Towards 2016 general round increase from the 1st March 2008 and a further 2.5 per cent Towards 2016 general round increase from 1st September 2008. e) An allowance of €50,000 per annum will be paid to those Consultants appointed as Clinical Directors. f) Saturday, Sunday and Public Holidays: Structured on-site attendance at weekends and on public holidays will be subject to the following premium payments: i) Time + ½ on Saturdays. ii) Double time on Sundays and Public Holidays. g) Continuing Medical Education: The CME allowance will be increased to a3,000 with effect from the 1st June 2008. Payment will continue to be on a vouched basis, to be adjusted in line with the Consumer Price Index (CPI). This allowance may be carried over annually for a maximum of five years. h) Telecommunications: The Consultant shall be reimbursed either the cost of home or mobile phone rental. i) B Factor (On-Call) Payments: An increase in the flat annual payment to €6,000 will take effect from 1st June 2008. The payments for more onerous rosters will increase by five per cent from the same date. j) C Factor (Call-Out) Payments: The Consultant will be eligible for payment on a per call-out basis

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for the provision of on-site services when: i) rostered for on-call duty and is contacted by another medical practitioner in the hospital, by a senior nurse or other member of staff specifically designated for that purpose and attends on-site to provide emergency services; ii) rostered for on-call duty and who, in the exercise of his/her professional judgment, attends on-site and performs clinical work of an urgent nature or carries out urgent diagnostic or therapeutic procedures; iii) requested by another Consultant to provide on-site services in public hospital/agency to which the Consultant does not have a scheduled commitment and where such services cannot be provided within the Consultant’s scheduled commitment as adjusted by the Clinical Director/Employer. This payment shall be on the basis of the equivalent payment per call-out.

24) Superannuation a) The Consultant will be covered by the terms of the HSE/VHSS/NHSS Superannuation Scheme and the contributory associated spouses and children superannuation schemes. Appropriate deductions will be made from his/her salary in respect of his/her contributions to the scheme. In general, 65 is the minimum age at which pension is payable, however, for appointees who are deemed not to be ‘new entrants’ as defined in the Public Service Superannuation Miscellaneous Provisions Act 2004 an earlier minimum pension age may apply. b) Should: i) the Consultant be deemed to be a new entrant (as defined in the Public Service Superannuation (Miscellaneous Provisions) Act 2004), there is no specified retirement age in respect of his/her appointment to this position. or ii) the Consultant be deemed not to be a new entrant (as defined in the Public Service Superannuation (Miscellaneous Provisions) Act 2004), retirement is compulsory on reaching 65 years of age.

25) Confidentiality a) In the course of the Consultant’s employment (s)he may have access to, or hear information concerning the medical or personal affairs of patients and/or staff. Such records and information are strictly confidential and in whatever format and wherever kept, must be safe­guarded.

26) Records/Property a) The Consultant should take all reasonable measures to ensure that records are stored in such a manner that ensures confidentiality, security and ready accessibility for clini­cal staff when

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Consultants’ Common Contract 2008 required for patient management. b) The Consultant shall not remove from the employment location any records in any format, electronic or otherwise, belonging to the Employer/Health Service Executive at any time without having authorisation. Such authorisation will be issued in advance of the first instance and apply thereafter. c) The Consultant will return to the Employer/Health Service Executive upon request, and, in any event, upon the termination of his/her employment, all records and property and equipment belonging to the Employer/Health Service Executive which are in his/her possession or control.

27) Clinical Indemnity a) The Consultant will be provided with an indemnity against the cost of meeting claims for personal injury arising out of bona fide actions taken in the course of his/her employment. b) This indemnity is in addition to the Employer’s(s’) Public Liability/Professional Indemnity/Employer’s(s’) Liability in respect of the Consultant’s non-clinical duties arising under this contract. c) Notwithstanding (a) above, the Consultant is strongly advised and encouraged to take out supplementary membership with a defence organisation or insurer of his/her choice, so that (s)he has adequate cover for matters not covered by this indemnity such as representation at disciplinary and fitness to practise hearings or Good Samaritan acts outside of the jurisdiction of the Republic of Ireland. d) Under the terms of this indemnity the Consultant is required to report to an officer designated by the Employer in such form which may be prescribed, all adverse incidents which might give rise to a claim and to otherwise participate in the Employer’s risk management programme as may be required from time to time. In the event that an adverse incident is first reported by a third party, the Consultant/ Head of Department should be notified as soon as practicable.

28) Grievance and Disputes Procedure a) In the case of a dispute arising regarding these terms and conditions, the Employer and Consultant will have recourse to and, as necessary, complete the Grievance and Disputes Procedure below. b) The purpose of this procedure is to deal with problems arising under the Contract. To the greatest extent possible, such problems should be addressed and resolved within the normal structures of the employing authority and at the earliest possible point. The parties recognize the finite nature of resources and agree that issues involving the resourcing of services, roles of hospitals and other general service issues are not amenable to the Grievance and Disputes Procedure. However, the parties

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further agree that disputes may arise, which although touching on or concerning such issues, are essentially concerned with the operation of the individual contract and are therefore amenable to the procedure. c) Stage 1: Local level discussions must be undertaken and completed within three months from the date on which each party to a dispute indicates in writing that it wishes to avail of this procedure. Where individual issues of an urgent nature arise, such as difficulties in obtaining locum cover, the Consultant shall have the right to process the matter up to the level of the Chief Executive or his nominated representative/deputy. d) Stage 2 – Mediation/Adjudication: In exceptional cases where resolution at local level does not prove possible, the matter may be referred by way of written submission to the Mediator/Adjudicator by either party.

The said submission shall be transmitted in the first instance to the Secretariat who shall immediately forward the complaint to the Mediator/Adjudicator. It is prerequisite to the invocation of this procedure that local discussions have taken place prior to referral to the Mediator/Adjudicator.

The Mediator/Adjudicator shall decide whether all avenues at local level have been adequately explored and exhausted and further whether the matter is appropriate for his/her consideration. The respondent will have a period of six weeks within which to prepare and lodge a counter statement with the Secretariat and shall forward a copy of same immediately to the complainant. Mediation/Adjudication shall commence within two weeks of the expiry of the aforesaid time limit. Should the dispute not be resolved by mediation the Mediator/Adjudicator shall proceed to issue a recommendation within four weeks of the completion of the adjudication hearing or such further time as might be agreed between parties. i) disputes about the admissibility of particular cases shall be decided by the mediator/adjudicator; ii) hearings before the Mediators/Adjudicators shall be held in private; iii) both parties shall be entitled to representation at their own expense; iv) decisions of the Mediator/Adjudicator shall be non-binding but the parties agree that such decisions shall be afforded the status of a Labour Court Recommendation; v) the costs of the mediator/adjudicator process shall be borne by the employing authority; vi) the HSE Employers Agency shall provide the Secretariat; e) List of Mediators/Adjudicators:

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Consultants’ Common Contract 2008 A list of Mediators/Adjudicators have been agreed between the parties as suitable nominees for appointment in any individual case*. It shall be for the Secretariat, in conjunction with the parties, to determine the precise Mediator/Adjudicator to be employed in any given case. The Secretariat will have due regard in the appointment of Mediators/Adjudicators from the panel to any possible conflict that might arise. * These are available from the HSE Employers Agency at 63-64, Adelaide Road, Dublin 2, Tel: (01) 662 696, Web: www.hseea.ie. f) Review: The parties agree that the Grievance and Disputes procedure shall be reviewed within two years of date of implementation i.e. not later than 2010.

However, in the event that difficulties arise concerning individual issues of an urgent nature, then an earlier review may take place in respect of such matters at the election of any of the parties hereto not earlier than the end of June 2009.

29) Role of Review Body on Higher Remuneration The parties to this agreement accept that Consultants' remuneration and terms and conditions of employment should be reviewed on a regular basis. Accordingly, the Review Body on Higher Remuneration in the Public Sector should undertake such reviews as part of the general reviews undertaken by the Review Body from time to time.

30) Conflict of Interest/Ethics in Public Office a) Each Consultant should refrain from knowingly engaging in any outside matter that might give rise to a conflict of interest. b) If in doubt (s)he should consult the relevant Clinical Director/ Employer and subject to a right of appeal, any direction given must be followed.

The term ‘you’ is used in the remainder of this section to refer to the Consultant. c) Should you occupy a designated position of employment* under the Ethics in Public Office Acts 1995 and 2001, you are required, in accordance with Section 18 of the Ethics in Public Office Act 1995, to prepare and furnish an annual statement of any interests which could materially influence you in the performance of your official functions: • by Consultants employed by the Health Service Executive to the Chief Executive Officer Health Service Executive; • by Consultants employed by HSE funded agencies to the Chief Executive of the agency; not later than 31st January in the following year. * Applicable to those employees in public service whose remuneration is not less than the lowest remuneration for a Deputy Secretary in the Civil Service,

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i.e. €168,992 as at 14th September 2007. d) In addition to the annual statement, you must whenever you are performing a function as an employee and you have actual knowledge that you, or a connected person, has a material interest in a matter to which the function relates, provide at the time a statement of the facts of that interest. You should provide such statement to the Chief Executive Officer. The function in question cannot be performed unless there are compelling reasons to do so and, if this is the case, those compelling reasons must be stated in writing and must be provided to the Chief Executive Officer. e) Under the Standards in Public Office Act 2001, you must within nine months of the date of your appointment provide the following documents to the Standards in Public Office Commission at 18 Lower Lesson Street, Dublin 2: i) A Statutory Declaration, which has been made by you not more than one month before or after the date of your appointment, attesting to compliance with the tax obligations set out in section 25(1) of the Standards in Public Office Act and declaring that nothing in section 25(2) prevents the issue to you of a tax clearance certificate and either: i) a Tax Clearance Certificate issued by the Collector-General not more than nine months before or after the date of your appointment; or ii) an Application Statement issued by the Collector-General not more than nine months before or after the date of your appointment. f) You are required under the Ethics in Public Office Acts 1995 and 2001 to act in accordance with any guidelines or advice published or given by the Standards in Public Office Commission. Guidelines for public servants on compliance with the provisions of the Ethics in Public Office Acts 1995 and 2001 are available on the Standards Commission’s website www.sipo.gov.ie.

31) Review by Employers and Medical Organisations The terms and conditions of employment as set out in this contract will be reviewed in 2013 by the representatives of the Employers and the medical organisations.

32) Acceptance of Contract a) This Contract, the associated Terms and Conditions and Appendices and terms expressly incorporated by reference or by statute contain the terms of the Consultant’s employment with _____ (insert name of Employer). b) The Consultant confirms his/her agreement to the following declaration by signing below: i) I declare that I am not the subject of any investigation by

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Consultants’ Common Contract 2008 a medical registration or licensing body or authority in any jurisdiction with regard to my medical practice or conduct as a practitioner. I have not been suspended from registration nor had my registration or licence cancelled or revoked by any medical registration or licensing body or authority in any jurisdiction in the last ten years nor am I the subject of any current suspension or any restrictions on practise. Also, I confirm that I am not aware that I am the subject of any criminal investigation by the police in any jurisdiction. ii) I am aware of the qualifications and particulars of this position and I hereby declare that all the particulars furnished by me are true. I hereby declare that to the best of my knowledge there is nothing that would adversely affect the position of trust in which I would be placed by virtue of this appointment. iii) I understand that any false or misleading information submitted by me will render me liable to automatic disqualification or termination of employment if already employed. I understand that this appointment is subject to the receipt of appropriate registration with the Medical Council/ Dental Council, satisfactory references, Garda/Police Clearance and Occupational Health clearance.

Name (Block Capitals): __________________________________ Signature of Consultant: _________________________________ Date:_________________________________________________ _ iv) I have read and understood the Medical Council's 'Guide to Ethical Conduct and Behaviour'/Dental Council guidance on ethical conduct and behaviour and any other relevant guidance provided by the relevant Council in relation to ethical or professional conduct. I undertake to apply the relevant Council's ethical and professional conduct guidance to the clinical and professional situations in which I may work. v) I have read this document and I hereby accept the post of _____________ in accordance with the terms and conditions specified and I undertake to commence duty on: Name (Block Capitals): _________________________________ Signature of Consultant: ________________________________ Date:_________________________________________________ Employer (Block Capitals): ______________________________ Signature on behalf of Employer: _________________________ Date: _ _______________________________________________

Section B – Appendices

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Appendix I – HSE Letter of Approval The HSE Letter of Approval is individual to each post and will be inserted at this section of each contract.

Appendix II – Disciplinary Procedure Guidance Notes Guidance notes on the practical operation of this disciplinary procedure are set out below. These guidelines form part of the Disciplinary Procedure: i) Where it is proposed to bypass Stages 1 or 2 of the Procedure in any case not involving an allegation of serious misconduct, the Consultant shall be advised why it is so proposed. ii) With respect to the right to confront one’s accuser and to introduce witnesses, dealt with more particularly under Stage 4 and the Appendix to the Procedure, there should be consideration in each case of the most effective manner in which disputed facts might be determined, respecting principles of natural and constitutional justice, the right of a Consultant to his/her good name and the relevant provisions of any Code of Practice issued by the Labour Relations Commission. iii) Review of a decision to continue a Consultant on administrative leave, dealt with more particularly under the heading Protective Measures, should refer specifically to the reason(s) why continuation of the administrative leave is proposed. iv) In any investigation conducted under Stage 4 of the Procedure there should be close scrutiny of all of the evidence in arriving at any decision, having regard to the potentially serious consequences for the Consultant of a finding of misconduct. v) Disciplinary Proceedings should be confidential save where disclosure is required by law. All parties to such proceedings shall be advised that breach of such duty could itself give rise to disciplinary proceedings.

1. Purpose The delivery of a high quality health service is dependent on all staff meeting the highest standards of performance and conduct.

Where possible, and as appropriate, the Clinical Director/Line Manager or such person(s) as is/are determined by the Employer will deal with individual shortcomings through discussion, counselling and appropriate assistance. The key objective is to assist the Consultant to meet the required standards. If, however, the Consultant continues to fail to meet the required standards then the disciplinary procedure will be invoked.

The principles of natural and constitutional justice apply and the

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Consultants’ Common Contract 2008 Consultant will be afforded the right of representation at all stages of the disciplinary process.

Where the issue(s) of concern are of a clinical nature, appropriate clinical input will be obtained by the Employer in advance of any steps of the Procedure being undertaken.

Where it is alleged that a Consultant’s capability, competence or conduct does not meet the required standards, the matter will be dealt with under the following procedure.

2. Scope This procedure covers all Consultants.

3. Procedure in Operation While the disciplinary procedure will normally be operated on a progressive basis, in cases of apparent serious misconducts Stages 1, 2 and 3 of the procedure may be bypassed and in other cases Stage 1 and/or Stage 2 may be bypassed if appropriate.

In each instance where it is intended to invoke the Disciplinary Procedure, the Consultant shall be advised in writing of the specific grounds of the complaint(s) made against him/her and afforded an adequate opportunity to respond before any disciplinary action is imposed.

Stage 1: Oral Warning The Consultant will normally be issued with a formal oral warning by the Clinical Director/Line Manager. This shall follow prior notification of the purpose of the meeting at which the Oral Warning may be delivered. The Oral Warning will give details of the precise nature of the matter, the improvements required and the timescale for improvement.

S/he will be advised that the Oral Warning constitutes the first stage of the disciplinary procedure and failure to improve within the agreed timescale may result in further disciplinary action under Stage 2 of the disciplinary procedure. A record of the warning will be kept on the Consultant’s personnel file and will be removed after six months, subject to satisfactory improvement during this period.

The Consultant will have a right to appeal the Oral Warning to a more senior level of management*. Appeals must be made in writing setting out the grounds for appeal within 14 working days of the Consultant being notified of the decision. *Appeals will be to the Assistant National Director, NHO/National Director PCCC/CEO of the HSE-funded Agency, as appropriate.

Stage 2: Written Warning

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If the Consultant fails to make the necessary improvements, s/ he will normally be issued with a formal written warning by the Clinical Director/Line Manager. The written warning will give details of the matter, the improvements required and the timescale for improvement. The Consultant will also be advised that failure to improve within the agreed timescale may result in the issuing of a final written warning under Stage 3 of the disciplinary procedure.

The warning will be removed after 9 months, subject to satisfactory improvement during the specified period.

The Consultant will have a right to appeal the written warning to a more senior level of management*. Appeals must be made in writing setting out the grounds for appeal within 14 days of the Consultant being informed of the decision. *Appeals will be to the Assistant National Director, NHO/National Director PCCC/CEO of the HSE-funded Agency, as appropriate.

Stage 3: Final Written Warning If the Consultant fails to make the necessary improvements, s/he will normally be issued with a final written warning by the Clinical Director/ appropriate Line Manager. The warning will give details of the matter, the improvements required and the timescale for improvement. The Consultant will be advised that failure to improve within the agreed timescale may lead to dismissal or some other sanction short of dismissal under Stage 4 of the disciplinary procedure. The warning will be removed after a specified period, usually 12 months, subject to satisfactory improvement during this period. Where the warning relates to clinical practice there will be a peer review.

The Consultant will have a right to appeal the written warning to a more senior level of management*. Appeals must be made in writing setting out the grounds for appeal within 14 days of the Consultant being notified of the decision. *Appeals will be to the Assistant National Director, NHO/National Director PCCC/CEO of the HSE-funded Agency, as appropriate.

Stage 4: Dismissal or Action Short of Dismissal Failure to meet the required standards of performance/conduct following the issuing of a final written warning will lead to a disciplinary hearing under Stage 4. The decision-maker will be the relevant National Director, HSE or CEO/General Manager in other health agencies. The outcome of the disciplinary hearing may be dismissal or action short of dismissal. The delegation of such a decision should take place only in the most exceptional circumstances. i) Serious Misconduct: The following are some examples of serious misconduct which will be dealt with from the outset under Stage 4:

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Consultants’ Common Contract 2008 • Serious negligence/serious dereliction of duties; • Incapacity to perform duties due to being under the influence of alcohol, prescribed drugs or unprescribed medication; • Serious breach of the Employer’s policy(ies) on electronic equipment; • Serious bullying, sexual harassment or harassment (This would only arise where a complaint has been upheld following an investigation under the Dignity at Work policy); • Abuse of patients or clients (intellectual disability service users, relatives, etc.)*.

Note: The above list is not exhaustive. *This would only arise where a complaint has been upheld following an investigation under the Trust in Care policy. ii) Capability and Competence: Where possible, as made clear at ‘Purpose’ above and subject to the relevant provisions of the Medical Practitioners Act 2007, issues of capability and competence (including clinical competence and health) will be resolved through ongoing review and support and, where necessary, through the progressive stages of the Disciplinary Procedure. However, it is acknowledged that there may be exceptional cases where there has been an apparent serious failure on the part of a Consultant to deliver the required standard of care due to some lack capability on his/her part.

In such cases of apparent serious failure, the matter will be investigated and dealt with under this stage. The investigation will include appropriate clinical input. iii) Mechanism for dealing with complaints under (i) and (ii) above: Complaints under (i) and (ii) above will be dealt with as follows: a) Notifying the Consultant of the allegation: Upon being made aware of any instance of apparent serious misconduct, senior management/the Clinical Director/Line Manager will arrange for the gathering of preliminary facts relating to the issue in order for the precise allegation to be formulated. The Consultant against whom the allegation is made will be advised in writing of the precise details of the allegation and invited to make an initial response. When dealing with the allegation, management will ensure, insofar as possible, that confidentiality is maintained and the Consultant against whom the allegation is made is fully protected throughout the process. b) Protective Measures: Where it appears to the Hospital General Manager/Chief Executive, HSE Network Manager, Assistant National Director PCCC that by reason of the conduct of a Consultant there may be an immediate and serious risk to the safety, health or welfare of patients or staff the Consultant may apply for or may be required to and shall, if so required, take immediate administrative leave with pay for such time as may reasonably be

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necessary for the completion of any investigation into the conduct of the Consultant in accordance with this procedure. This investigation should take place with all practicable speed.

Placing the Consultant on paid administrative leave pending the outcome of the investigation will be reserved for only the most exceptional of circumstances. The Chair of the Medical Board or his/her deputy shall be consulted and his or her opinion considered before a decision is taken to place the Consultant on administrative leave. A review of the decision to place the Consultant on administrative leave shall be taken within two weeks of the decision and fortnightly thereafter until the matter is concluded. Where a review is sought by or on behalf of the Consultant, and the grounds for the review are stated, the review should take place immediately (the above two week limit is therefore an outer limit). The Consultant will be advised that the decision to place him/her on administrative leave is a precautionary measure designed to ensure his or her personal safety and well-being/the safety and well-being of patients and staff and not as a disciplinary sanction nor an indication of guilt.

Alternative protective measures may include: • Providing an appropriate level of additional supervision.

• Amendment or restriction of certain clinical duties.

• Other appropriate action.

The views of the Consultant and his or her response will be taken into consideration when determining the appropriate protective measures to take in the circumstances but the final decision rests with the Hospital General Manager/Chief Executive, HSE Network Manager, Assistant National Director PCCC or another equivalent person. This would also include the Masters of Maternity Hospitals, Chief Executives/General Managers of Intellectual Disability Agencies and Chief Executives of specific agencies. c) Investigation: An investigation will be conducted by person(s) who is/are acceptable to both parties.

The principles governing the conduct of the investigation and the steps in conducting the investigation are set out in Appendix 1.

If the findings of the investigation uphold the allegation of serious misconduct, a disciplinary hearing will be held as at Stage 4. Both the Consultant and the employing authority shall co-operate with the investigation team to ensure that any investigation is conducted as expeditiously as possible.

Investigations should normally be completed within one month of the commencement date. Both parties agree to full co-operation with the investigation process in order to ensure that it can be conducted

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Consultants’ Common Contract 2008 expeditiously. The timescale may be extended in exceptional circumstances and the Consultant will be advised of the reasons for the proposed extension and given the opportunity to comment.

Where an allegation is not upheld the Consultant is considered to be exonerated. d) Disciplinary Hearing: The decision maker will be the relevant National Director, HSE or the Hospital Chief Executive/General Manager as appropriate.

The Consultant will be provided with a copy of the investigation report and all relevant documentation and will be informed of the following in writing in advance of the disciplinary hearing: • The status of the hearing, i.e. that it is a formal disciplinary hearing under Stage 4 (Dismissal or Action Short of Dismissal) of the Disciplinary Procedure; • The purpose of the hearing, i.e. to consider representations on the Consultant’s behalf and to decide if disciplinary action is appropriate and the nature of the sanction if any; • The possible outcome of the hearing, i.e. it may result in a decision to terminate his or her employment; and • The right to be accompanied by a representative or work colleague.

The disciplinary hearing will be conducted as follows: • The Consultant will be informed of the purpose of the disciplinary hearing, the nature of the allegation and the findings of the investigation.

• The Consultant and his/her representative will have the opportunity to present his/her case in response to the findings of the investigation.

• The disciplinary hearing will allow the Consultant to raise any concerns regarding the investigation process if s/he feels that these concerns were not given due consideration by the investigation team.

• The hearing will be adjourned to allow the decision maker to carefully consider the representations made on the Consultant's behalf.

• The hearing will be reconvened and the Consultant will be advised of the outcome.

The outcome of the disciplinary hearing will be confirmed to the Consultant in writing and copied to his/her representative. The decision may be that the allegation was not upheld, to take no further action, to dismiss the Consultant or to take disciplinary action short of dismissal which may include final written warning, suspension without pay or such other lesser sanction as is deemed appropriate.

The Consultant will be advised of his/her right to appeal the decision. iv) Appeals under Stage 4:

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a) Appeals against Disciplinary Sanctions Short of Dismissal: Appeals against Stage 4 disciplinary sanctions short of dismissal will be heard by an independent adjudicator who is acceptable to the Consultant.

The Consultant will be required to submit the grounds for the appeal in writing within 14 days of being notified of the original decision. b) Appeal against Dismissal Decisions: If the outcome of the disciplinary hearing is a decision to dismiss, the Consultant may appeal the decision to a committee of three persons.

The Consultant will be required to submit the grounds for the appeal in writing within 14 days of being notified of the original dismissal decision.

An appeal against dismissal decisions will be heard by a committee comprising persons selected from a nominated panel which has been agreed between the HSE and the Consultant’s representative body. Membership of the panel will consist of: • An Independent Chairperson; • An Employee representative; and • An Employer representative.

Membership of the panel will be reviewed every three years.

The Chair will be selected from an agreed panel of appropriately qualified legal practitioners or other appropriate persons that may be agreed between the parties. The Committee will adopt its own procedures and may conduct such enquiries as it deems appropriate.

The Committee will decide whether to confirm or vary the original dismissal decision. If the original decision is confirmed, the Consultant will be removed from the payroll. c) Ad Misericordium Appeal: In the event of an appeal against the decision to dismiss being unsuccessful, the Consultant may make a final “mercy appeal” to the Hospital Chief Executive Officer, HSE, or other appropriate persons in the case of non-HSE agencies. The grounds for this appeal must be submitted in writing within 21 days of the employee being notified of the Committee’s decision.

Nothing in this Procedure affects the Consultant’s legal rights.

Appendix to Disciplinary Procedure – Investigation The investigation into allegations of serious misconduct will be carried out in accordance with the following principles: • The investigation will be conducted as expeditiously as possible and without inordinate delay; • The investigation will be carried out in strict accordance with

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Consultants’ Common Contract 2008 the terms of reference and with due respect for the right of the Consultant who is the subject of the allegation to be treated in accordance with the principles of natural justice, including a presumption of innocence; • Allegations of serious misconduct or allegations that there has been a breach of discipline sufficient to invoke Stage 4 of the Disciplinary Procedure should be made in writing so that there is clarity as to the allegation(s) faced by the Consultant; • Where an allegation of serious misconduct is denied the facts supporting an allegation must be proved and an opportunity afforded to the Consultant to confront any accuser(s); • The investigation team will have the necessary expertise to conduct an investigation impartially and expeditiously; • Confidentiality will be maintained throughout the investigation to the greatest extent possible, consistent with the requirements of a fair investigation. It is not possible, however, to guarantee the anonymity of the complainant or any person who participates in the investigation; • A written record will be kept of all meetings and treated in the strictest confidence; • The investigation team may interview any person who they feel can assist with the investigation. All employees are obliged to co-operate fully with the investigation process; • Employees who participate in the investigation process will be required to respect the privacy of the parties involved by refraining from inappropriately discussing the matter with other work colleagues or persons outside the organisation; and • It will be considered a disciplinary offence to intimidate or exert pressure, directly or indirectly, on any person who may be required to attend as a witness or to attempt to obstruct the investigation process in any way.

Steps in conducting the Investigation: • The investigation will be conducted by person(s) nominated by senior management and acceptable to both parties.

• The investigation will be governed by predetermined terms of reference based on the alleged misconduct (which will be set out in writing) and any other matters relevant to the allegation. The terms of reference shall specify the following:  The timescale within which the investigation will be completed; and  The scope of the investigation.  The Consultant against whom the allegation is made will be advised of the right to representation and given copies of all documentation prior to and during the investigation process,

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e.g:

 Details of alleged misconduct.

 Witness statements (if any).

 Minutes of any interviews held with witnesses.

 Any other evidence of relevance.

• The investigation team will interview any witnesses and other relevant persons. Confidentiality will be maintained as far as practicable.

• Persons may be required to attend further meetings to respond to new evidence or provide clarification on any of the issues raised.

• The investigation team will form preliminary conclusions based on the evidence gathered in the course of the investigation and invite the Consultant concerned to provide additional information or challenge any aspect of the evidence.

• On completion of the investigation, the investigation team will form its final conclusions and submit a written report of its findings to the Hospital General Manager/Chief Executive/HSE Network Manager/Director PCCC/Assistant Director PCCC, as appropriate.

• The Consultant against whom the allegation is made will be given a copy of the investigation report.

• On completion of the investigation, the investigation team will submit a written report in accordance with its terms of reference.

However, no decision regarding disciplinary sanction should be decided upon until the decision maker has held a disciplinary hearing with the Consultant.

Appendix III – Clinical Directorate Service Plan Clinical Directorate Service Plans – Consultant Assignment/Work Schedules 1. Introduction • Provisions for organisation and delivery of services at the front line at operational level are set out primarily in Directorate Service Plans.

• The Plan is concerned, inter alia, with specifying resources/ funding available (including workforce, facilities, etc.) and how these are deployed in delivering services. The plan specifies quantity of services to be delivered and quality/outcomes parameters to apply thereto.

• The Consultant is simultaneously the key directorate resource with respect to service delivery and the core decision-maker regarding utilisation of resources of the Directorate and the organisation generally.

• It is accordingly centrally important that the Consultant’s

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Consultants’ Common Contract 2008 contribution at individual level is scheduled into the Directorate Service Plan over designated parameters (i.e. assignments, services, etc.)

• This paper sets out high level provisions to apply in the regard.

These provisions are likely to develop considerably over time.

Further development of these issues will also be required at local level.

2. Directorate Service Plan • The Directorate Service Plan is developed and executed at two levels as follows:  Corporate level: As part of the overall Service Plan of the organisation. Set at high level. Progressed and reported on quarterly.  Directorate level: As part of the operations provisions of the Directorate. Set at directorate level. Developed, progressed and reported on monthly.

• Individual Consultant assignment/work schedules are incorporated as part of the latter.

• Responsibility for development and execution of the Directorate Service Plan lies with the Clinical Director. This is effected with the full participation of Directorate personnel.

• In developing the Directorate Service Plan the Clinical Director, inter alia,  Quantifies the total resources available to the Directorate for

the forthcoming year/month;  Specifies services to be delivered through these resources

in quantity and qualitative terms by the Directorate on an annual/ monthly basis;

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 Explores and determines with key Directorate personnel

(including Consultants) how to deploy resources in a manner which optimises service delivery, quantity and quality in the context of requirements set out in the Corporate Service Plan;  Determines the monthly assignment/work schedule for

Consultants and how each Consultant’s commitment will be discharged in achievement of the planned level of service determined for the Directorate.

3. Consultant Assignment/Work Schedules The Directorate Service Plan incorporates, inter alia, Consultant assignment and work schedules set at both Directorate and personal levels monthly. Sample assignment/work schedule documentation is found on the following pages.

4. Reporting on Directorate/Consultant Performance against Service Plans Reports on Directorate/Consultant performance against targets set in the Service Plan are produced on a monthly basis. Typically, these are provided at the following levels: • Directorate; • Specialty; and • Consultant.

A sample outline of a performance report can be found on page 74.

5. General This document addresses Directorate Service Plans at a high framework level. Detailed provisions in this respect will be developed at local level within the parameters set out herein.

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Appendix IV – Clinical Director Appointment and Profile Appointment of Clinical Directors 1) The post of Clinical Director is an Executive position, appointed by the Employer.

2) It is recognised that for an appointee to function effectively as a Clinical Director (s)he would require the general confidence and support of Consultant colleagues and management.

3) The normal appointment process for a Clinical Director is a follows: a) Applications are invited in a formal manner from all Consultants

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in the eligible Consultant grouping b) All applicants are interviewed c) Interview panel to comprise: i) Chair ii) Two management/board representatives iii) Two Consultant representatives of whom one will be a member of the directorate grouping and the other, a non-directorate grouping member.

In the case of academic appointments the interview board will include a Consultant Academic attached to the relevant Academic School.

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4) In recognition of the importance of securing confidence of all parties in these new provisions, appointment in the first instance will be for two years, made on the following basis: a) Applications are invited in a formal manner from all Consultants in the eligible Consultant grouping. b) The body of Consultants within the Directorate may nominate a candidate agreed by all members of the group for the post to the Employer. In the event of an agreed nomination being secured and submitted in writing, signed by all members of the grouping, the nominee, if acceptable to the Employer, will be appointed to the post. c) In the event that no such agreed candidate emerges, the normal process will apply.

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Clinical Director Profile 1) A Clinical Director may cover one speciality area or a range of specialities. Each Directorate is headed by a Clinical Director, generally supported by a Nurse Manager and a Business Manager.

2) A Clinical Director will be a Medical/Dental Consultant Contract holder of the relevant Clinical Directorate, appointed by the employing authority.

3) The primary role of a Clinical Director is to deploy and manage Consultants and other resources, plan how services are delivered, contribute to the process of strategic planning and influence and respond to organisational priorities. This will involve responsibility for agreeing an annual Directorate Service Plan, identifying service development priorities and aligning Directorate Service Plans with Hospital or Network Plans.

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Consultants’ Common Contract 2008 4) Executive power, authority and accountability for planning and developing services for and managing available resources (direct or indirect) by the Clinical Directorate are delegated from the Employer.

5) Clinical Directors report to (in a voluntary hospital or agency: the Chief Executive; under the Health Service Executive: Hospital Manager, the Hospital Network Manager, the Local Health Manager or the Assistant National Director, HSE PCCC Directorate, as appropriate.

6) The Clinical Director is accountable for resources used, directly and indirectly, by the Directorate and the transformation of these resource inputs into pre-planned and commensurate levels of service output in line with clinical need and as defined in patient service or other relevant terms and agreed with the Employer.

7) Each member of staff in the Directorate has a reporting relationship, through their line manager, to the Clinical Director.

Each Consultant reports to the Clinical Director.

8) The role of the Clinical Director is exercised within the framework of prevailing corporate policy in areas including clinical assurance and effectiveness, quality assurance, Personnel, Finance, ICT, Estates and subject to budgetary and allocation constraints.

9) The principal duties and responsibilities of the Clinical Director include: a) Provision of strategic input and clinical advice; b) Leading the development and execution of a Service Plan for the Directorate. c) Monitoring and controlling actual performance of the Directorate against planned clinical, business and budgetary performance indicators. d) Identifying service development priorities and annual budget bids. e) Implement the clinical audit function within the Directorate. f) Developing Practice Plans with individual Consultants and monitoring implementation. g) Fostering and implementing teamworking within the Directorate. h) Implementing the measures required to meet accreditation requirements i) Implementing and compliance with risk management policy and provisions. j) Participating in the grievance and disciplinary procedures in line with corporate policy. k) Ensure a consistency of approach across the Directorate in relation to application of corporate and ethical standards/clinical protocols in accordance with best practice. l) Contributing to effective communications within the

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Directorate, across the hospital/service and with external stakeholders. m) Supporting clinical training and continuing professional development throughout the Directorate. n) Fostering a culture of teaching and research within the Directorate. o) Participating in the recruitment of permanent, temporary and locum staff as required. p) Engaging with Service Users and Representatives and actively include the Service User perspective in Service Management. q) Clinical Directors in Psychiatry have specific duties pursuant to the Mental Health Act, 2001.

Appendix V – Extracts from Consultants Contract 1997 Sections 2.9.4 to 2.9.7 of the Memorandum of Agreement attached to the Consultants Contract 1997: “2.9.4 Each consultant will be entitled to engage in private practice within the hospital or hospitals in which he is employed.

The extent to which a consultant is entitled to engage in private practice outside the hospital or hospitals in which he is employed is determined by the category of post which he holds (see Section 3 of the Memorandum of Agreement) and subject to him satisfying the employing authority that he is fulfilling his contractual commitment to the public hospital(s).

2.9.5 Where a consultant is engaged in private practice within institution(s) financed from public funds, and with which he has a contract, then that private practice will be considered as on-site.

2.9.6 Conversely, where a consultant is engaged in private practice within institution(s) where the managing authority is separate from the public hospital and/or the hospital is financed from private funds, then that private practice will be considered as off-site.

2.9.7 Notwithstanding the provisions of paragraphs 2.9.4 and 2.9.5 above, a Category 1 Consultant who, by definition, devotes substantially the whole of his professional time to a public hospital cannot treat patients in a private hospital or clinic. He may, however, see private patients in consulting rooms which are not on the site of the public hospital. The nature and extent of the activities pursued in consulting rooms should not

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Consultants’ Common Contract 2008 extend beyond consultation, examination of patients and the performance of minor treatments, i.e. activities normally carried out in out-patient clinics. It does not encompass day-ward procedures involving anaesthesia. The principal criterion to be employed in assessing whether any particular activity falls within the permitted limits is the effect which it has on a consultant's ready availability to the public hospital. The long-term objective is to provide consulting rooms in the public hospital(s) which may be availed of by Category 1 Consultants to see fee paying patients. Occasional consultations at the request of another consultant are not precluded by the above provisions.”

Appendix VI – Granting of Sick Leave a) Sick leave may be granted to the Consultant if (s)he is incapable of performing their duties owing to illness or physical injury by the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) or in the case of Consultant Psychiatrists, the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE)/ Chief Executive Officer (where the Consultant is not employed by the HSE) only if he/she is satisfied that there is a reasonable expectation that the Consultant will be able to resume the performance of his/her duties and in the case of a fixed-term Consultant will be able to resume during his/her period of office. b) The Consultant may be required to submit him/herself to independent medical examination before (s)he is granted sick leave and at any time during the continuance of sick leave granted to him/her. c) The Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) or in the case of Consultant Psychiatrists, the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE)/Chief Executive Officer (where the Consultant is not employed by the HSE) may pay salary during sick leave to permanent officers in accordance with the following provisions. i) Except in the case mentioned at (c) (iv) below no salary shall be paid to a Consultant when the sick leave granted to such a Consultant during any continuous period of four years exceeds in the aggregate 365 days. ii) Subject to limitation mentioned in at (c) (i) above, salary may be paid to a Consultant at the full rate in respect of any days sick leave unless, by reason of such payment the period of sick leave during which such Consultant has been paid full salary would exceed 183 days during the twelve months ending on such day.

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iii) Subject to the limitation mentioned at (c) (i) above, salary may be paid at half the full rate after salary has ceased by reason of the provision at (c) (ii) above to be paid at the full rate. iv) If before the payment of salary ceases by reason of the provision at (c) (i) and the Chief Executive of the HSE (where the Consultant is employed by the HSE)/Chief Executive Officer/ Master of the hospital or other employing institution (where the Consultant is not employed by the HSE) so consents; salary may be paid to a pensionable officer with not less than 10 years service notwithstanding (c) (i) at either half the full rate or at a rate estimated to be the rate of pension to which such officer would be entitled on retirement, whichever of such rates shall be the lesser. d) For the purposes of these provisions every day occurring within a continuous period of sick leave shall be reckoned as part of such period. From the salary paid during sick leave to a Consultant who is an insured person within the meaning of the Social Welfare Acts, 1952 to 1968, there shall be deducted the amount of any payments to which such officer has become entitled under those Acts during the period of such sick leave. e) The Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) or in the case of Consultant Psychiatrists, the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE)/Chief Executive Officer (where the Consultant is not employed by the HSE) may make appropriate salary payments during sick leave to a fixed term/locum Consultant if (s)he considers that having regard to all the circumstances of the case, such payment is reasonable. f) Where a Consultant is suffering from tuberculosis and is undergoing treatment, the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) or in the case of Consultant Psychiatrists, the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE) or Chief Executive Officer (where the Consultant is not employed by the HSE) may extend the foregoing provisions to allow the payment of salary at three quarters the full rate to the Consultant for the second six months of his/her illness and at half the full rate during the third six months of his/her illness.

Appendix VII – Correspondence Between the Parties The following correspondence is incorporated into this contract as noted in the preamble:

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Consultants’ Common Contract 2008 Irish Hospital Consultants Association & Irish Medical Organisation 25th July 2008 I write to you in response to your request for written confirmation of our position on the following issues which have arisen during the negotiations on the proposed terms and conditions for a contract for consultants employed in the public health service. This letter now supersedes my earlier letter of 16th May 2008 in this regard.

Co-location In accordance with Mark Connaughton’s letter of 1st February 2008, discussions will take place on the practical issues arising from co-location, when appropriate.

Working Hours The normal span of the working day will be between the hours of 8am to 8pm, Monday through Friday (Section 7A of the contract refers). However some scheduled variations outside these hours will be permitted where this is demonstrably in the best interest of patient care. With respect to local agreements provided for under section 7 (e) any issues which arise around the implementation of this provision will be referred to the Contract Implementation Group. With respect to the more onerous requirements of the on-call arrangements provided for under the contract and particularly late night working, it is agreed that consideration will be given to the position of older consultants, having regard to the provisions of equality legislation.

Flexible Working Consultants are eligible to apply for flexible working under the “Health Service Flexible Working Scheme” which is designed to facilitate the retention and recruitment of staff and the maintenance of the workforce at the levels required to deliver and develop services into the future, while seeking to accommodate their work life balance.

Membership of Specialist Register New appointees to consultant posts must be either eligible for entry in the Register of Medical Specialists maintained by the Medical Council pursuant to the Medical Practitioners Act 1978, or be already entered in that Register. Once the relevant sections of the Medical Practitioners Act 2007 are commenced, new appointees to consultant posts must be either eligible for registration, or be already registered in the Specialist Division of the register of medical practitioners to be established and maintained by the Medical

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Council under that Act. Letter of Appointment Letters of appointment will stipulate that contracts to be offered to each individual consultant will be consistent with the nationally agreed contract.

1997 Contract Holders – Pension Adjustments Retired consultants will, in addition to the standard national pay round increases, have special increases applied to their pensions on the same basis as their serving counterparts who opt to remain on the 1997 contract.

Public Private Ratio – Serving Consultants Serving consultants whose public to private ratio in 2006 was greater than 20 per cent will be permitted to retain this higher ratio, subject to an overriding maximum ratio of 70:30, and this will endure for the lifetime of the agreement.

Separation vs. Aggregation of Clinical Activity While the HSE’s position is that the 80:20 ratio should apply to in-patient, day case and out-patient activity (i.e. the same ratio will apply in all cases but will be calculated separately for each type of activity), the Public Private Mix Measurement Group shall consider whether such activities can be aggregated to form a single 80:20 public:private ratio. However, this is subject to the implementation of Clause 20(b) with effect from 1st September 2008, in the absence of any agreed alternative measurement arrangement by that date.

Contract Implementation Committee A Contract Implementation Committee, comprising representatives of the HSE and the medical organisations, will be established. The Committee will be chaired by Mr Mark Connaughton, SC. Deadline Date for Contract Acceptance Consultants who sign for the new contract by 31st August 2008 will benefit from the enhanced pay rates with effect from 1st June 2008.

However, consultants who sign up for the new contract between 1st September 2008 and 31st December 2008 will only benefit from the improved pay rates from the date of sign up.

Eligibility Regulations I refer to Section 11.6 (Private Practice) of Mark Connaughton’s report of 4th October 2007 and again confirm our acceptance of the totality of Mr Connaughton’s Report.

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Consultants’ Common Contract 2008 Clinical Indemnity/Scope of Practice Document I can confirm that the revised Scope of Practice document, which is currently being finalised by the State Claims Agency will, when completed, be appended to the consultant contract.

Psychiatry/Clinical Directors The practice whereby Clinical Directors were appointed for up to 7 years and the method associated with such appointment may continue under the new contract. However, it’s important to understand that this arrangement is quite separate from the transitional arrangement under the new consultants contract (i.e. 2 year appointments).

The number of Category 2/Type B*/Type C appointments With reference to the number of Category 2/Type B*/Type C appointments, the approach to be adopted will be in line with Mark Connaughton’s document of 2nd May 2008 in which he expected “an upper limit in the order of approximately 700 appointments of Category 2/Type B*/Type C appointments within the system”.

week. Subsequent leave is without pay. j) For up to three days on the serious illness or death of a near relative. k) When the Consultant is a candidate for a post, advertised by the Public Appointments Service, a Government Department, the HSE, or a local or other public authority for a maximum of six days with pay in any one year, to enable him/her to appear before such selection board. l) To the Consultant for the purpose of attending clinical meetings of societies appropriate to his/her specialty of not more than seven days with pay, in any one year (exclusive of travel time).

Appendix IX – Committees to advise HSE on Consultant Applications Health Service Executive Consultant Applications Advisory Committee Type C Consultant Posts Establishment process

Practice Plans/Service Plans Consistent with Mark Connaughton’s letter dated 2nd May 2008, it is agreed that further discussions shall take place on this subject at the Contract Implementation Committee, informed by the general principles already agreed between the parties.

Yours sincerely, Gerard Barry Chief Executive

Appendix VIII – Special leave provisions for Consultants in non-HSE employment

1. Introduction • The proposal with respect to Type C Consultant posts is set out in the report of the Independent Chairman of the Consultant Contract negotiations – Mark Connaughton SC – dated 4th October 2007.

The report was fully adopted by the HSE and DoHC. • The requirement to be more specific with respect to how such posts might be established and be somewhat less rigid in its application than envisaged in the Chairman’s report and associated discussion was also recognised.

• This paper sets out, at a high level, the process to be pursued in establishing such posts.

These provisions are in addition to those set out in Section 18 (i).

2. Establishment process

The Employer may grant leave with pay: g) To a Consultant appointed by a Minister of State to be a member of any Commission, Committee of Statutory Board or a Director of a Company to enable him/her to attend meetings of the body in question. h) To a Consultant invited by the Public Appointments Service, a Government Department, the HSE, or a local or other public authority, to act on a selection board to enable him/her to serve on the Board. i) For annual training with the Defence Forces/Reserves for one

2.1 Application process • Applications for Consultant posts are generated through the pertinent hospital/network/PCCC agency/area in the prescribed format.

• The applicant organisation is required to specify its proposed post type (A, B or C) in its related submission.

• Where a Type C post is recommended, the applicant organisation will be required to satisfy a number of criteria pertinent thereto, which would include but not be limited to the following:  A clear indication as to why the post requirements

cannot be met through a Type A or B arrangement;

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Consultants’ Common Contract 2008  A clear demonstration as to the added patient, service and public system benefits and values to be achieved through establishment of the post as a Type C rather than a Type A or B position.

2.2 Decision process • The application will be submitted to the HSE Consultant Appointments Unit (CAU) for initial review. This review will be undertaken with input from NHO/PCCC Corporate. Where, following internal review, the CAU considers that the case for a Type C designation is not adequately made, by reference to the specified criteria, the proposal will be returned to the applicant source for further development and resubmission. Where the CAU considers that the proposal meets the specified criteria, the submission will be furnished to a Type C Consultant Committee for consideration and recommendation.

• Recommendations from the Type C Consultant Committee will be forwarded to the CEO of the HSE for approval/final decision.

3. Type C Consultant Committee • The Committee will be established by the CEO of the HSE. • Appointments to the Committee will be made by the CEO of the HSE. • Representation on the Committee will include:  Chairperson;

 HSE Corporate;

Modus Operandi

Terms of Reference Establishment The Consultant Applications Advisory Committee (CAAC) will be established by the CEO of the HSE. Purpose

The purpose of the CAAC is to provide independent and objective advice to the HSE on applications for medical Consultants and qualifications for Consultant posts. The CAAC provides a significant opportunity for Consultants to contribute their expertise and professional knowledge to the decision-making process for the development of Consultant services throughout the country.

Membership

Membership will comprise: (i) An independent Chair; (ii) Senior HSE planning officials from relevant Directorates (i.e. NHO, PCCC, Population Health, HR and Finance). The METR Unit

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band the Nursing Services Director will also be represented; (iii) Consultant representatives covering the nine relevant medical specialties (anaesthesia, emergency medicine, medicine, pathology, paediatrics, psychiatry, obstetrics & gynaecology, radiology, surgery). These members will be selected by the CEO from a pool comprising the Chairs of the Expert Advisory Groups and proposed nominees of the training bodies such as the Chairpersons and Honorary Secretaries; (iv) Patient advocacy groups; (v) Voluntary hospital CEO; (vi) Two representatives of each of the Irish Hospital Consultants Association and Irish Medical Organisation Members will be appointed by the CEO. Factors such as gender mix and geographic spread will be taken into account in the selection of members.

It is envisaged that the CAAC will meet every two months, or more often as required. The members of the CAAC will consider applications (new and replacement) submitted to it which have been processed by the Consultant Appointments Unit. All posts presented to the CAAC will have received financial clearance from the relevant service Directorate (NHO/PCCC).

The officials of the Consultant Appointments Unit (CAU) will prepare background information on and initial analysis of each application and will present this to the CAAC. The CAAC will consider each application in the context of information received from the officials of the CAU, published policy, workload statistics, precedent, literature review, professional advice and knowledge, developments in medical education and training, relevant local information, demography, workload statistics and any other relevant advice (e.g from Expert Advisory Groups). The CAAC will provide advice in relation to each individual application. Advice could include: (i)Recommendation to approve the post.

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Consultants’ Common Contract 2008

(ii)Recommendation to seek clarification of aspects of the post or aspects of policy not already clarified by the CAU. (iii)Recommendation to amend the structure, sessional commitment, etc. (iv)Recommendation to refuse approval to the post.

The CAAC will also provide advice to the HSE on the appropriate qualifications for Consultant posts.

Other functions may be assigned by the National Director, Human Resources, following discussion with the Committee. Advice provided by the CAAC will be forwarded by the Head of the CAU to the National Director, Human Resources, to whom responsibility for the regulation of Consultant posts has been delegated by the CEO of the HSE. The National Director will in turn regulate each post taking into account the advice provided. The recruitment and appointment of Consultants and related staff is approved by the National Employment Monitoring Unit (NEMU) in accordance with the Employment Control Framework approved by the Board of the HSE. The National Director, Human Resources, provides regular updates to the Board of the HSE on the Consultant posts recommended for approval.

Executive Support

The CAAC will be supported by the officials of the Consultant Appointments Unit (CAU).

Term

The CAAC will be appointed for an initial period of one year.

 DoHC;

 Public voluntary agencies;

 Members of the public;

 One representative of the Irish Hospital Consultants Association;

 One representative of the Irish Medical Organisation.

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HSE Sick Pay Changes Has now changed to:

3 months full pay & 3 months half pay We can make up the difference AND cover any private Income you have.

Private Practice Tax r at yoelief high ur mar est gin rate al

We can provide you with Day 1 Income Protection with tax relief.

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All illnesses are covered!

Callsave: 1890 260 261

email: info@omegafinancial.ie www.omegafinancial.ie OFM Ltd T/A Omega Financial Management is regulated by the Central Bank of Ireland

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Professional Directory Medical Indemnity Organisations

Medical Protection Society Granary Wharf House Leeds LS11 5PY Tel: 1800 509 441 * Fax: (0044) (113) 241 0500 *Freephone number from Republic of Ireland

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Medical Defence Union (MDU) 230 Blackfriars Road London SE1 8PJ Tel: (0044) (207) 202 1500 Fax: (0044) (207) 202 1666

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Professional Directory Health Insurers

Aviva Health One Park Place Hatch Street Dublin 2 Tel: 1890 718 718 Fax: (01) 898 5908 Head of Provider Affairs: Mr Colm O’Sullivan ESB Staff Medical Provident Fund PO Box 284 Rosbrien Limerick Tel: (061) 430523/430411 Fax: (061) 430500 Manager: Mr David McCabe Glohealth PO Box 12218 Dublin 18 Email: Providers@GloHealth.ie Tel: 1890 781 781 Laya Healthcare Eastgate Business Park Little Island Cork Tel: 1890 700890; (021) 202 2991 Medical Practice Manager: Ms Noreen Quinlan Prison Officers Medical Aid Society 397e North Circular Road Dublin 7 Tel: (01) 830 8963/6212 Fax: (01) 830 9420 Secretary: Mr Gerry Bracken Voluntary Health Insurance Board Vhi House 20 Lower Abbey Street Dublin 1 Tel: (01) 872 4499 Fax: (01) 799 4091 Medical Director: Dr Bernadette Carr Medical Relations Manager: Mr James Norton

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Professional Directory Medical Council

The Medical Council Kingram House Kingram Place Dublin 2 Tel: (01) 498 3100 Fax: (01) 498 3102 Chief Executive: Ms Caroline Spillane MEMBERSHIP Professor Freddie Wood (President) Dr Audrey Dillon (Vice-President) Dr John Barragry Dr Anthony Breslin Ms Katharine Bulbulia Mr Declan Carey Ms Anne Carrigy Dr Sean Curran Dr Rita Doyle Ms Mary Duff Professor Fidelma Dunne Dr Bairbre Golde Dr Ruairi Hanley Mr Sean Hurley Professor Alan Johnson Ms Marie Kehoe-O’Sullivan Professor Mary Leader Councillor Sally Mulready Ms Margaret Murphy Mr John Nisbet Professor Colm O’Herlihy Dr Michael Ryan Ms Cornelia Stuart Dr Consilia Walsh Ms Catherine Whelan

Medical Member Medical Member Medical Member Medical Member Non-Medical Member Non-Medical Member Non-Medical Member Medical Member Medical Member Non-Medical Member Medical Member Medical Member Medical Member Non-Medical Member Non-Medical Member Non-Medical Member Medical Member Non-Medical Member Non-Medical Member Non-Medical Member Medical Member Non-Medical Member Non-Medical Member Medical Member Non-Medical Member

Every doctor is responsible for ensuring that their registration is current within one of the following categories: (a) General Division, which shall include the names of those medical practitioners registered in that division pursuant to Section 46 and such other identifying particulars of those practitioners as the Council considers appropriate; (b) Specialist Division, which shall include the names of those medical practitioners registered in that division pursuant to Section 47 and such other identifying particulars of those practitioners as the Council considers appropriate; (c) Trainee Specialist Division, which shall include the names of those medical practitioners registered in that division pursuant to Section 48 or 49 and such other identifying particulars of those practitioners as the Council considers appropriate; and (d) Visiting EEA Practitioners Division, which shall include the names of those medical practitioners registered in that division pursuant to Section 50 and such other identifying particulars of those practitioners as the Council considers appropriate. (e) Internship Registration allows a doctor to carry out internship training in a hospital recognised by the Medical Council. Internship registration is open to both graduates of Irish and EU member State Medical Schools. (f) Supervised Division For doctors to be considered for registration within the Supervised Division they must have been offered a post with the HSE that has been approved as an individually numbered, identifiable post.

SPECIALIST DIVISION The following specialties are recognised in the Specialist Division of the Register: Anaesthesia • Anaesthesia • Pain Medicine Emergency Medicine • Emergency Medicine General Practice • General Practice

REGISTER OF MEDICAL PRACTIONERS The Medical Council maintains this Register in which every practising doctor must be registered. It is an offence to practise medicine, except in some strictly defined exceptions, if you are not registered.

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Professional Directory Medical Council

Medicine • Cardiology • Clinical Genetics • Clinical Neurophysiology • Clinical Pharmacology & Therapeutics • Dermatology • Endocrinology & Diabetes Mellitus • Gastroenterology • General (Internal) Medicine • Genito-Urinary Medicine • Geriatric Medicine • Infectious Diseases • Medical Oncology • Nephrology • Neurology • Palliative Medicine • Pharmaceutical Medicine • Rehabilitation Medicine • Respiratory Medicine • Rheumatology • Tropical Medicine Obstetrics & Gynaecology • Obstetrics & Gynaecology Occupational Medicine • Occupational Medicine Ophthalmology • Ophthalmology Paediatrics • Paediatric Cardiology • Paediatrics

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Pathology • Chemical Pathology • Haematology (Clinical & Laboratory) • Histopathology • Immunology (Clinical & Laboratory) • Microbiology • Neuropathology Psychiatry • Child & Adolescent Psychiatry • Psychiatry • Psychiatry of Learning Disability • Psychiatry of Old Age Public Health Medicine • Public Health Medicine Radiology • Radiation Oncology • Radiology Sports & Exercise Medicine • Sports & Exercise Medicine Surgery • Cardiothoracic Surgery • General Surgery • Neurosurgery • Ophthalmic Surgery • Oral & Maxillo-Facial Surgery • Otolaryngology • Paediatric Surgery • Plastic, Reconstructive & Aesthetic Surgery • Trauma and Orthopaedic Surgery • Urology

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Professional Directory IHCA National Council

Name Hospital Specialty Term Ending

2016 2018 Eastern Region Dr Tom Ryan St James Hospital Anaesthesia 1st Dr Roy Browne Phoenix Care Centre Psychiatry 1st Dr Anne O’Connell Dublin Dental Hospital/Tallaght Paediatric Dental Surgery

1st Dr Declan Keane Holles Street Hospital Obs/Gynae

2nd Prof Alan Irvine Crumlin Children’s Hospital Dermatology

1st Dr Gerard McVey St Vincent’s/St Luke’s Radiation Oncology

2nd Vacant Co-option 2nd South Eastern Region Dr Paul Kelly Dr Michael Fitzgerald Dr Phyllis O’Sullivan

Wexford General Hospital South Tipperary General Hospital, Clonmel St Luke’s General Hospital, Kilkenny

Emergency Med Radiology Radiology

1st 2nd

2nd

Midland Region Dr Gerard Crotty Dr John Connaughton

Midland Regional Hospital Tullamore Midland Regional Hospital Portlaoise

Pathology Medicine

2nd

2nd

North Eastern Region Dr Paul Keelan Dr Tripuraneni Prasad

Our Lady of Lourdes, Drogheda Our Lady’s Hospital, Navan

Cardiology Radiology

2nd

1st

North Western Region Dr David McSharry Dr Justin Lane

Letterkenny General Hospital Sligo General Hospital

Medicine Anaesthesia

2nd

1st

Western Region Mr Garrett Durkan Dr Cyril Rooney Mr Colm Fahy

Galway University Hospital Mayo General Hospital Galway Clinic

Surgery Medicine Surgery

2nd 1st

1st

Mid Western Region Prof Calvin Coffey Dr Patrick Dillon

Mid Western Regional Hospital Mid Western Regional Hospital

Surgery Anaesthesia

1st

Southern Region Mr John Rice Mr Peter Ryan Dr John O’Mullane Prof Ronan O’Sullivan

Kerry General Hospital Bon Secours Cork Cork University Hospital Cork University Hospital

Surgery Surgery Pathology Emergency Med

2nd

2nd 1st

2nd

1st

Co-Options Vacant

Vacant Vacant

Vacant Vacant

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Professional Directory

IHCA Council Executive (Focus Group)

President Dr Gerard Crotty Consultant Haematologist Midlands Regional Hospital Tullamore Co Offaly Vice Presidents Dr Michael Fitzgerald Consultant Radiologist South Tipperary General Hospital Clonmel Co Tipperary Dr Tom Ryan Consultant Anaesthetist St James’s Hospital Dublin 8

Membership Secretary Dr Phyllis O’Sullivan Consultant Radiologist St. Luke’s General Hospital Kilkenny Treasurer Dr Gerard McVey Consultant Radiation Oncologist St Luke’s Hospital Rathgar Dublin 6 Immediate Past President Mr Denis Evoy Consultant Surgeon St. Vincent’s University Hospital Dublin 4

IHCA Secretariat Heritage House, Dundrum Office Park, Dublin 14. Tel: 01 298 9123. Fax: 01 298 9395.Email: info@ihca.ie Secretary General: Martin Varley Tel: 087 2274099 Email: m.varley@ihca.ie

Assistant Secretary General: Donal Duffy Tel: 086 8176901 Email: d.duffy@ihca.ie

Senior Executive Officer: Aidan O’Reilly Tel: 086 1590733 Email: a.oreilly@ihca.ie

EMPLOYMENT & POLICY EXECUTIVE: Conall Bergin Tel: 086 3896314 Email: c.bergin@ihca.ie

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Professional Directory Financial Services

Banking

Cornmarket Group

AIB Private Banking

Financial services

Bankcentre

Christchurch Square

Ballsbridge

Dublin 8

Dublin 4

Tel: (01) 408 4000

Tel: (01) 641 2991

Contact: Mr Des Brannigan, Business Development Manager

Fax: (01) 660 5971

Email: des.brannigan@cornmarket.ie

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Professional Directory Voluntary & Support Organisations

Alcoholics Anonymous General Service Office, Unit 2, Block C, Santry Business Park, Swords Road, Dublin 9 Tel: (01) 842 0700, Fax: (01) 842 0703 Email: gso@alcoholicsanonymous.ie Web: www.alcoholicsanonymous.ie

Bodywhys – Eating Disorders Association of Ireland PO Box 105, Blackrock, Co. Dublin Tel: (01) 283 4963, Fax: (01) 205 6959 Helpline: 1890 200 444 Email: info@bodywhys.ie Web: www.bodywhys.ie

Alzheimer Society of Ireland Temple Road, Blackrock, Co. Dublin Tel: (01) 207 3800, Fax: (01) 210 3772 Helpline: 1800 341 341 Email: info@alzheimer.ie Web: www.alzheimer.ie

Brainwave – Irish Epilepsy Association 249 Crumlin Road, Crumlin, Dublin 12 Tel: (01) 455 7500, Fax: (01) 455 7013 Email: info@epilepsy.ie Web: www.epilepsy.ie

Arthritis Ireland 1 Clanwilliam Square, Grand Canal Quay, Dublin 2 Tel: (01) 661 8188, Fax: (01) 661 8261 Helpline: 1890 252 846 Email: info@arthritisireland.ie Web: www.arthritisireland.ie

Cheshire Ireland Central Office, Block 4, Bracken Business Park, Bracken Road, Sandyford Industrial Estate, Dublin 18 Tel: (01) 297 4100, Fax: (01) 205 2060 Email: info@cheshire.ie Web: www.cheshire.ie

ASH – Action on Smoking & Health 43/45 Northumberland Road, Ballsbridge, Dublin 4 Tel: (01) 231 0521 Email: ashire@iol.ie Web: www.ash.ie

Cleft Lip and Palate Association of Ireland c/o 36 Woodlands Avenue, Dún Laoghaire, Co. Dublin Tel: 087 131 9803 Email: info@cleft.ie Web: www.cleft.ie

Asthma Society of Ireland 26 Mountjoy Square, Dublin 1 Tel: (01) 878 8511, Fax: (01) 878 8128 Helpline: 1850 445 464 Email: office@asthmasociety.ie Web: www.asthmasociety.ie

Coeliac Society of Ireland Carmichael House, 4 North Brunswick Street, Dublin 7 Tel: (01) 872 1471, Fax: (01) 873 5737 Email: info@coeliac.ie Web: www.coeliac.ie

Aware 72 Lower Leeson Street, Dublin 2 Tel: (01) 661 7211, Fax: (01) 661 7217 Helpline: 1890 303 302 Email: info@aware.ie Web: www.aware.ie

Coolmine Therapeutic Community Coolmine House, 19 Lord Edward Street, Dublin 2 Tel: (01) 679 4822, Fax: (01) 679 4822 Email: davidmaddey@coolmine.ie Web: www.coolminetc.ie

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COPE Foundation Bonnington, Montenotte, Cork Tel: (021) 450 7131, Fax: (021) 450 7580 Email: headoffice@cope-foundation.ie Web: www.cope-foundation.ie Crisis Pregnancy Agency 4th Floor, 89-94 Capel Street, Dublin 1 Tel: (01) 814 6292, Fax: (01) 814 6282 Email: info@crisispregnancy.ie Web: www.crisispregnancy.ie Cuidiú – Irish Childbirth Trust Carmichael Centre, 4 North Brunswick Street, Dublin 7 Tel: (01) 872 4501 Email: generalenquiry@cuidiu.com Web: www.cuidiu-ict.ie Cura Tel: (01) 505 3040, LoCall: 1850 622 626 Email: curacares@cura.ie Web: www.cura.ie Cystic Fibrosis Association of Ireland CF House, 24 Lower Rathmines Road, Dublin 6 Tel: (01) 496 2433, Fax: (01) 496 2201 Email: info@cfireland.ie Web: www.cfireland.ie DeafHear Head Office, 35 North Frederick Street, Dublin 1 Tel: (01) 817 5700, Fax: (01) 878 3629 Email: info@deafhear.ie Web: www.deafhear.ie Diabetes Federation of Ireland 76 Lower Gardiner Street, Dublin 1 Tel: (01) 836 3022, Fax: (01) 836 5182 Helpline: 1850 909 909 Email: info@diabetes.ie Web: www.diabetes.ie

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a s s o ci a t i o n

Professional Directory Voluntary & Support Organisations

Down Syndrome Ireland FREEPOST, Citylink Business Park, Old Naas Road, Dublin 12 Tel: (01) 426 6500, LoCall: 1890 374 374 Email: info@downsyndrome.ie Web: www.downsyndrome.ie Enable Ireland 32F Rosemount Park Drive, Rosemount Business Park, Ballycoolin Road, Dublin 11 Tel: (01) 872 7155 Email: communications@enableireland.ie Web: www.enableireland.ie GROW – World Community Mental Health Movement in Ireland National Support Office, Apartment 6, Forrest Mews, Forrest Road, Swords, Co. Dublin Tel: (01) 840 8236, Infoline: 1890 474 474 Email: info@grow.ie Web: www.grow.ie Health Protection Surveillance Centre 25-27 Middle Gardiner Street, Dublin 1 Tel: (01) 876 5300, Fax: (01) 856 1299 Email: hpsc@hse.ie Web: www.hpsc.ie

Irish Cancer Society 43/45 Northumberland Road, Ballsbridge, Dublin 4 Tel: (01) 231 0500, Fax: (01) 231 0555 National Cancer Helpline: 1800 200 700 Action Breast Cancer: 1800 200 700 Action Prostate Cancer: 1800 200 700 Smokers’ Quitline: 1850 201 203 Email: www.reception@irishcancer.ie Web: www.cancer.ie Irish Deaf Society 30 Blessington Street, Dublin 7 Tel: (01) 860 1878, Fax: (01) 860 1960 Email: info@irishdeafsociety.ie Web: www.deaf.ie Irish Family Planning Association 60 Amiens Street, Dublin 1 Tel: (01) 806 9444, Fax: (01) 806 9445 National Pregnancy Helpline: 1850 495 051 Email: post@ifpa.ie Web: www.ifpa.ie Irish Haemophilia Society First Floor, Cathedral Court, New Street, Dublin 8 Tel: (01) 657 9900, Fax: (01) 657 9901 Email: info@haemophilia.ie Web: www.haemophilia.ie

The Hope Project St Joseph, Ballinabearna, Ballinhassig, Co. Cork Tel: (021) 488 8503 Email: info@hopeproject.ie Web: www.hopeproject.ie

Irish Heart Foundation 4 Clyde Road, Ballsbridge, Dublin 4 Tel: (01) 668 5001, Fax: (01) 668 5896 Helpline: 1890 432 787 Web: www.irishheart.ie

Huntington’s Disease Association of Ireland Carmichael House, 4 North Brunswick Street, Dublin 7 Tel: (01) 872 1303, Fax: (01) 872 9931 Email: hdai@indigo.ie Web: www.huntingtons.ie

Irish Hospice Foundation 4th Floor, Morrison Chambers, 32 Nassau Street, Dublin 2 Tel: (01) 679 3188, Fax: (01) 673 0040 Email: info@hospice-foundation.ie Web: www.hospice-foundation.ie

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Irish Kidney Association Head Office, Donor House, Block 43A, Park West, Dublin 12 Tel: (01) 620 5306, Fax: (01) 620 5366 LoCall: 1890 543 639 Email: info@ika.ie Web: www.ika.ie Irish Motor Neurone Disease Association Coleraine House, Coleraine Street, Dublin 7 Freefone: 1800 403 403 Email: info@imnda.ie Web: www.imnda.ie Irish Multiple Births Association Carmichael House, 4 North Brunswick Street, Dublin 7 Tel: (01) 874 9056 Email: info@imba.ie Web: www.imba.ie Irish Society for Autism Unity Building, 16/17 Lower O’Connell Street, Dublin 1 Tel: (01) 874 4684, Fax: (01) 874 4224 Web: www.autism.ie Irish Stillbirth & Neonatal Death Society Carmichael House, 4 North Brunswick Street, Dublin 7 Tel: (01) 872 6996 Web: www.isands.ie Irish Sudden Infant Death Association Carmichael House, 4 North Brunswick Street, Dublin 7 Tel: (01) 873 2711, Fax: (01) 872 6056 National Helpline: 1850 391 391 Email: isida@eircom.net Web: www.isida.ie

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a s s o ci a t i o n

Professional Directory Voluntary & Support Organisations

Irish Wheelchair Association Áras Chúchulainn, Blackheath Drive, Clontarf, Dublin 3 Tel: (01) 818 6400, Fax: (01) 833 3873 Web: www.iwa.ie La Leche League of Ireland – Breastfeeding Help and Information Email: leader@lalecheleagueireland.com Web: www.lalecheleagueireland.com Meningitis Research Foundation 63 Lower Gardiner Street, Dublin 1 Tel: (01) 819 6931, Fax: (01) 819 6903 Freefone 24hr Helpline: 1800 413 344 Email: info@meningitis-ireland.org Web: www.meningitis.org Mental Health Ireland 6 Adelaide Street, Dún Laoghaire, Co. Dublin Tel: (01) 284 1166, Fax: (01) 284 1736 Web: www.mentalhealthireland.ie Miscarriage Association of Ireland Carmichael House, 4 North Brunswick Street, Dublin 7 Tel: (01) 873 5702 Email: info@miscarriage.ie Web: www.miscarriage.ie MS Ireland National Office, 80 Northumberland Road, Dublin 4 Tel: (01) 678 1600, Fax: (01)678 1601 Helpline: 1850 233 233 Email: info@ms-society.ie Web: www.ms-society.ie

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Muscular Dystrophy Ireland Head Office, 71/72 North Brunswick Street, Dublin 7 Tel: (01) 872 1501, Fax: (01) 872 4482 Email: info@mdi.ie Web: www.mdi.ie National Council for the Blind Head Office, Whitworth Road, Drumcondra, Dublin 9 Tel: (01) 830 7033, Fax: (01) 830 7787 LoCall: 1850 334 353 Email: info@ncbi.ie Web: www.ncbi.ie OANDA – Out and About Association Cois Cua, 140 St Lawrence’s Road, Clontarf, Dublin 3 Tel: (01) 833 8252, Fax: (01) 833 4243 Pact – Caring Professional Services Arabella House, 18D Nutgrove Office Park, Rathfarnham, Dublin 14 Tel: (01) 296 2200, Fax: (01) 296 4049 Crisis Pregnancy Helpline: 1850 673 333 Email: info@pact.ie Web: www.pact.ie

Samaritans Ireland 4-5 Usher’s Court, Usher’s Quay, Dublin 8 Tel: (01) 671 0071, Fax: (01) 671 0043 Helpline: 1850 609 090 Web: www.samaritans.org Shine – Supporting People Affected by Mental Ill Health Head Office, 38 Blessington Street, Dublin 7 Tel: (01) 860 1620 Helpline: 1890 621 631 Web: www.shineonline.ie Spina Bifida Hydrocephalus Ireland National Resource Centre, Old Nangor Road, Clondalkin, Dublin 22 Tel: (01) 457 2329, Fax: (01) 457 2328 LoCall: 1890 202 260 Web: www.sbhi.ie St Michael’s House Ballymun Road, Dublin 9 Tel: (01) 884 0200, Fax: (01) 884 0211 Email: info@smh.ie Web: www.smh.ie

Rape Crisis Network Ireland The Halls, Quay Street, Galway Tel: (091) 563676, Fax: (091) 563677 Email: info@rcni.ie Web: www.rcni.ie The Rehab Group Beach Road, Sandymount, Dublin 4 Tel: (01) 205 7200, Fax: (01) 205 7211 Email: dara.duffy@rehab.ie Web: www.rehab.ie

www.ihca.ie

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Charts & Tables (as of December 2013)

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3/9/14 10:25:43

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www.ihca.ie

3/9/14 10:26:14

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www.ihca.ie

3/9/14 10:26:37

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www.ihca.ie

3/9/14 10:27:02

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