Labour Court Database __________________________________________________________________________________ File Number: CD89478 Case Number: LCR12564 Section / Act: S67 Parties: PUBLIC VOLUNTARY HOSPITALS - and - IRISH MEDICAL ORGANISATION |
Claim on behalf of Non-Consultant Hospital Doctors (N.C.H.Ds) for the re-imbursement of 90% of annual medical insurance.
Recommendation:
Having reviewed the submissions and the additional evidence
presented by the parties and notwithstanding the change in the
position of Community Medicine Doctors, the Court does not
consider that there are sufficient grounds for altering the
conditions of service of Non-Consultant Hospital Doctors, as
agreed in 1986. The Court therefore does not recommend
concession of the Organisation's claim.
Division: CHAIRMAN Mr Brennan Mr O'Murchu
Text of Document__________________________________________________________________
CD89478 RECOMMENDATION NO. LCR12564
INDUSTRIAL RELATIONS ACTS, 1946 TO 1976
SECTION 67
PARTIES: PUBLIC VOLUNTARY HOSPITALS
(REPRESENTED BY THE FEDERATED UNION OF EMPLOYERS)
and
IRISH MEDICAL ORGANISATION
SUBJECT:
1. Claim on behalf of Non-Consultant Hospital Doctors (N.C.H.Ds)
for the re-imbursement of 90% of annual medical insurance.
BACKGROUND:
2. Since 1976, it has been a condition of employment that
N.C.H.D.s have medical defence insurance against claims of
negligence or malpractice and up to now this cost has been borne
by the N.C.H.D.s. In February, 1987, the I.M.O. submitted a
claim that the employing authority re-imburse the N .C.H.D.s 90%
of the annual medical insurance subscription. The issue was
finally discussed at a meeting on the 20th April, 1989, and
following failure to agree it was referred to the conciliation
service of the Labour Court on the 26th April,1989. A
conciliation conference on the 29th May failed to resolve the
issue and on the 29th June it was referred to the Labour Court
for investigation and recommendation. The Local Government Staff
Negotiations Board(L.G.S.N.B.) which represents the health boards
attended the conciliation conference as observers and objected to
the referral. A Court hearing was held on the 31st August, 1989
(earliest suitable date). The L.G.S.N.B. again attended as
observers.
ORGANISATION'S ARGUMENTS:
3. 1. Medical grades in the health services are the only
grades who are required to be independently insured against
claims arising from negligence and malpractice.
Furthermore, N.C.H.D.s are the only salaried medical grade
who are required to meet the cost of such insurance.
2. While it is in the doctors' interest to have medical
insurance, it is also very much in the interests of the
employing authorities and p patients that such insurance is
obtained.
3. On the information provided by the Medical Defence
Union and the Medical Protection Society it is clear that a
N.C.H.D. can be sued in his/her own right and that the
number of claims brought against these doctors have
substantially increased in the past number of years. This
information is contrary to that provided by the Management
side to the Labour Court in 1982, when a similar claim was
rejected.(L.C.R. 7287 refers).
4. The arrangements agreed in 1976 have been superseded by
the agreements reached in the case of consultants and
community medicine doctors (details supplied to the Court).
As N.C.H.D.s are the only other salaried grade covered by
the 1976 arrangements, it is unjust that they are not
brought into line with their colleagues.
5. The increases in the cost of medical insurance have far
outstripped the salary increases to N.C.H.D.s in the period
1982 - 1987 (details supplied to the Court). In the
current year the medical insurance subscription will
account for approximately 6.3% of a registrar's gross
income.
6. N.C.H.D. s are now the only grade in the health
services who are required to be independently insured at
their own expense. All other grades are either reimbursed
or are covered under a general insurance policy by their
employing authorities. In the light of this the
Organisation contends that the continuation of these
arrangements would unjustly discriminate against the
N.C.H.D.s.
7. Since 1980 when the first claim on behalf of N.C.H.D.s
was referred to the Labour Court, the Management side has
consistently stated that N.C.H.D.s are a unique grade and
that the most appropriate comparison that can be made is
with their counterparts in the United Kingdom. Such a
comparison in this case would, in the view of the
Organisation, support its claim aim. The 18th report of
the Review Body on doctors and dentists remuneration
recommended, as an interim measure, that an amount
equivalent to two thirds of the medical insurance
subscription would be re-imbursed to all N.C.H.D .s working
in the National Health Services (N.H.S.). This interim
measure became operative on the 1st January, 1988 and will
continue to 31st December,1989 where upon alternative
measures would be established in the form of an "N.H.S.
Indemnity Scheme." The introduction of this scheme is
currently under discussion between the British Medical
Association and the employing authorities. It is intended
that under the new scheme the employing authorities will
meet the full cost of medical insurance for every doctor
employed in the N.H.S.
8. Contrary to Management's assertion concession of this
claim will not result in any "knock-on" effects with other
grades in the health services. This contention is
supported by two important points;
(i) N.C.H.D.s are the only salaried medical grade who are
required to meet the cost of their own medical insurance.
(ii) The medical grades are the only grades in the health
services (other than public dental surgeons employed by the
Health Boards whose Insurance subscriptions is
approximately #170.00 per annum) who are required under
their conditions of service to be independently insured
against claims arising from negligence and
malpractice.
MANAGEMENT'S ARGUMENTS:
4. 1. In the period 1975/1976 the Irish Medical Association
(I.M.A.) and the Irish Medical Union (I.M.U.) wrote to the
Department of Health requesting that it should for the
first time be included as a condition of employment that
medical staff should provide evidence of being insured
against claims for negligence or malpractice. The
Department of Health wrote to all Voluntary Hospitals in
August, 1976 indicating that this requirement should be
met. The letter went on to say:
"While it is regarded that each doctor should produce
evidence of being insured against claims arising from
malpractice or negligence,it is pointed out that this is
not to be taken as implying in any way that the hospital
should be obliged to meet the costs of such cover. This
will continue to be the responsibility of the doctor
himself as heretofore."
The Department of Health was clearly informing Voluntary
Hospitals that for the first time N.C.H.D.s were being
required as a condition of employment to provide evidence
of insurance and that the cost of such insurance should
continue to be borne by the doctor himself. The situation
for N.C.H.D.s has not changed since that time.
2.The Labour Court when it heard this claim in 1982
rejected it on the basis of the above agreement. Since
1982 the only group to have had special arrangements
applied are Health Board Community Care doctors. Under
Report No. 131 of the scheme for a National Joint Council
and Arbitration Board for Local Government and Health
Services, dated 17th June, 1988, the Arbitrator recommended
that such doctors should have the net cost of medical
defence fees recouped directly or in some other form. In
his report the Arbitrator stated:
" It is not considered that concession of this claim would
of itself provide a basis for any other similar claim by
other grades in the Health Services. The evidence before
the Board would seem to suggest that there are relevant
differences in the situation of other doctors not presently
indemnified in respect of insurance. But as these other
grades are not before the Board it is not thought proper to
specify such differences in these findings."
It is clear, therefore,that the arrangement for Health
Board Community Care doctors was a special arrangement and
would not be generally applicable. No other group has
achieved special arrangements in this regard.
3. Concession of this claim would result in a significant
loss to many N.C.D.H.s as tax relief is granted at the top
of the scale irrespective of the premium actually paid.
The vast majority of N.C.D.H.s would pay tax at the highest
rate and the following would be the position under the 1989
rates:
Net Gain/Loss
Sum on which Tax relief to individual
NCHDs relief granted @ 56% Premium NCHDs
90% # # #
1st year 1458 816 204 612
2nd year 1458 816 264 552
3rd year 1458 816 594 222
4th year 1458 816 738 78
5th year 1458 816 900 - 84
6th year 1458 816 1116 - 300
Standard rate 1458 816 1620 - 804
Under these favourable tax arrangements N.C.H.D.s with four
years or less service would actually lose money if the
claim is conceded. Currently approximately 950 N.C.H.D.s
would fall into this category. The most significant
current cost, i.e. #804, applies to approximately 550 of
the total complement of 2,000.
4. The annual cost of the claim is approximately #2
million in respect of N.C.H.D.s alone. A number of other
larger groups would see concession of this claim as a
strenghtening of their own bargaining position, e.g. G.P,
Dentists, Nurses, Para-medics etc. The knock-on
implications would be very considerable.
5. The additional burden of costs which concession of this
claim would place on the health services cannot be
separated from the wider financial and economic
considerations affecting the determination of public
service pay. The Labour Court will be familiar with the
substance of those considerations which must continue to
have a strong bearing on the determination of all cost
increasing claims.
RECOMMENDATION:
5. Having reviewed the submissions and the additional evidence
presented by the parties and notwithstanding the change in the
position of Community Medicine Doctors, the Court does not
consider that there are sufficient grounds for altering the
conditions of service of Non-Consultant Hospital Doctors, as
agreed in 1986. The Court therefore does not recommend
concession of the Organisation's claim.
~
Signed on be half of the Labour Court
Kevin Heffernan
___________________
20th September, 1989. Chairman
D.H./G .C.