Labour Court Database __________________________________________________________________________________ File Number: CD94558 Case Number: LCR14704 Section / Act: S20(1) Parties: DUBLIN VOLUNTARY HOSPITALS - and - IRISH MEDICAL ORGANISATION (I.M.O. |
Claim for the removal of limits imposed on "C factor" payments to medical consultants.
Recommendation:
(ii) where in the exercise of their professional judgement,
attend and perform clinical work of an urgent nature or
carry out urgent diagnostic or therapeutic procedures.
The pricing report placed limits of #1,500 on the annual
amounts that could be earned under the "B" and "C" factor
headings.
In a memorandum dated March, 1981, the Department stated as
follows:-
"Review of the limits placed on earnings under the "B"
and "C" factors of remuneration:
Mr. O'Hanlon in placing annual limits on earnings under
these two factors stated that they were new departures
and that it was difficult to assess at this stage what
the additional cost to the health services might be in
the course of a year of funding such an operation. He
added that initially it seemed wise to impose some
limits on the amounts which could be claimed under
these headings by any one individual consultant until an
opportunity had arisen of seeing the system working in
practice. It is, therefore proposed that a review
system will commence in April, 1982 having regard to
detailed information on its operation collected in the
course of its first year of operation and any other
relevant factors."
In the period April, 1982 to late 1985 discussions took place
between the parties but no progress was made and the matter
was referred by the I.M.O. to the Labour Court under Section
20(1) of the Industrial Relations Act, 1969. On 21st March,
1986 the Court recommended as follows:-
"Having regard to the nature of the B and C factor
payments, and to the fact that a review of the Common
Contract is to be undertaken immediately, the Court does
not consider it wise that the outcome of the general
review should be prejudiced in any way by removing the
limits of the B and C factors in advance of the general
review. The Court recommends accordingly."
In the period 1988/1989 the parties failed to agree the
detail of the proposed contract review and the I.M.O.
referred the matter back to the Labour Court under Section
20(1) of the Industrial Relations Act, 1969.
A Labour Court hearing was held on 23rd June, 1989, at which
the management side referred to a Government decision on 5th
May, 1989 to refer the question of the remuneration of
consultant medical staff employed in the health services to a
Review Body on Higher Remuneration in the Public Sector. On
the basis of that referral, the Labour Court agreed to defer
issuing a recommendation.
The Review Body published its report (No. 32) in June, 1990.
Arising from the report negotiations between the management
side and the Union side (the I.M.O. and Irish Hospital
Consultants Association representing the hospital
Consultants) on a revised "Common Contract" began in October,
1990. In discussions, which saw the "Consultants' Contract
Documents 1991 emerge (details supplied to the Court), an
increase in 'C' factor payments and an alternative approach
to these payments was agreed.
It was further agreed that when the Review Body on Higher
Remuneration in the Public Sector examines the remuneration
and conditions of employment of consultants that management
were committed to making submissions, to propose that there
should be a more sensitive mechanism developed which had
regard to the nature and incidence of 'call-out'
requirements.
The Review Body was to deal with this matter two years form
the date of its report (No. 32). In the interim the Chairman
of the Review Body resigned and the Government has yet to
appoint a successor.
Further local level discussions took place in 1993 but no
agreement was reached and the I.M.O. referred the matter to
the Labour Court on 14th October, 1994, under Section 20(1)
of the Industrial Relations Act, 1969. A Labour Court
hearing took place on 26th January, 1995.
ORGANISATION'S ARGUMENTS:
3. 1. There appears to be universal agreement that the current
system of limits fails to meet the primary objective of
payments for emergency duties outside of the scheduled
commitment. As the Review Body itself in Report No. 32
pointed out ....
"(the limits) are not sufficiently sensitive to the
varying circumstances of individual consultants in that
two consultants with significantly different patterns of
attendance may both be paid up to, but not above these
monitory limits."
2. Management have already conceded in Paragraph 9.1 of the
"Revised Contract" that there should be a more sensitive
mechanism developed which has regard to the nature and
incidence of 'call out' requirements. The I.M.O. would
argue that as a first step toward the introduction of
such a sensitive mechanism, the full extent of the" out
of hours activity" requires to be assessed. Because of
the artificial "cap" placed on payments for these
services there is no accurate record of their extent.
3. Approximately #4.8 million is distributed to hospitals
in respect of 'C' factor payment limits which is made up
of #4,361 per consultant and a "special fund" of
#500,000 per annum. Under the terms of the revised
contract any sum unexpended from the #4,361 can be used
for additional payment to any consultant who has
exceeded the 'C' factor limit. The I.M.O. is unaware
that such monies have been distributed.
4. The removal of limits would provide the necessary
factual information on which to base a recommendation.
Hospitals have not co-operated in providing information
to enable arrangements to be made to introduce equitable
arrangements for consultants with high emergency
workloads.
5. The consultants involved are providing the highest
levels of emergency services to public patients. The
Organisation respectfully requests the Court to
recommend that the current 'C' factor limits be removed.
HOSPITAL'S ARGUMENTS:
4. 1. The Government has taken the decision that the Review
Body on Higher Remuneration in the Public Sector is the
appropriate forum for the examination of the
remuneration of consultant medical staff employed by
health boards, public voluntary hospitals and other
health agencies and the terms and conditions (other than
remuneration) which should attach to them and that
remains its position.
2. When the Review body on Higher Remuneration in the
Public Sector next examine the remuneration and
conditions of employment of consultants, management are
committed to making submissions to propose that there
should be a more sensitive mechanism developed which had
regard to the nature and incidence of "call out"
requirements.
3. The question of 'C' factor payments to consultants
cannot be considered in isolation from the overall
contract. The matter should be dealt with by the Review
Body as agreed by all parties.
RECOMMENDATION:
The Court has considered all of the views expressed by the parties
in their oral and written submissions.
The Court finds there is general acceptance that the current
system of limits fails to meet the primary objective of payments
for emergency duties outside of the scheduled commitment.
The Court notes the issue was to have been further considered by
the Review Body on Higher Remuneration in the Public Sector but
that this body has not been re-constituted. The Court finds it
totally unreasonable that an acceptable mechanism has not been
found which would help to address this matter in the absence of
the Review Body.
This inordinate delay can only affect the morale of staff, and be
unhelpful in maintaining a good industrial relations environment.
The Court is given to understand that the re-constitution of the
Review Body is imminent.
Accordingly the Court considers the issue should be raised at this
forum. Every effort should be made to have the matter considered
by the Review Body at an early date.
Given the delay that has occurred to date the Court at the request
of the parties is prepared to review progress of the issue in
December, 1995 with a view to making a substantive recommendation.
The Court so recommends.
Division: Mr McGrath Mr McHenry Ms Ni Mhurchu
Text of Document__________________________________________________________________
CD94558 RECOMMENDATION NO. LCR14704
INDUSTRIAL RELATIONS ACTS, 1946 TO 1990
SECTION 26(1), INDUSTRIAL RELATIONS ACT, 1990
PARTIES:
DUBLIN VOLUNTARY HOSPITALS
(REPRESENTED BY THE IRISH BUSINESS AND EMPLOYERS CONFEDERATION)
AND
IRISH MEDICAL ORGANISATION (I.M.O.)
SUBJECT:
1. Claim for the removal of limits imposed on "C factor"
payments to medical consultants.
BACKGROUND:
2. The dispute before the Court concerns the organisation's
claim on behalf of medical consultants for the removal of
limits imposed on earnings under the "C factor" heading of
the "Common Contract".
In 1977, the Minister for Health established a working party
to examine and report back to him on a form of contract of
employment which might be entered into between medical
consultants and their employers.
In September, 1978, the working party submitted an interim
report on the form of contract of employment. The "Common
Contract" based on this report issued in February, 1980. The
Minister approved the introduction of the "Common Contract"
with effect from 1st April, 1981, and the "Common Contract"
was offered to consultants holding appointments in Health
Boards and Public Voluntary Hospitals.
Together with the form of contract the working party produced
the "pricing report". The remuneration provided for under
the "Common Contract" is set out in the pricing report under
the following three elements:-
(a) the care of patients and the continuing responsibility
of the consultant for them with research, in service
teaching and administration;
(b) extended duty liability;
(c) emergency services.
These three groups of services are commonly referred to as
the A, B, and C factors.
Under the 'C' factor, the consultants are paid:
(i) for attendance at the hospital having being contacted by
another medical practitioner, a senior nurse or other
members of the hospital staff specifically designated
for that purpose;
or
(ii) where in the exercise of their professional judgement,
attend and perform clinical work of an urgent nature or
carry out urgent diagnostic or therapeutic procedures.
The pricing report placed limits of #1,500 on the annual
amounts that could be earned under the "B" and "C" factor
headings.
In a memorandum dated March, 1981, the Department stated as
follows:-
"Review of the limits placed on earnings under the "B"
and "C" factors of remuneration:
Mr. O'Hanlon in placing annual limits on earnings under
these two factors stated that they were new departures
and that it was difficult to assess at this stage what
the additional cost to the health services might be in
the course of a year of funding such an operation. He
added that initially it seemed wise to impose some
limits on the amounts which could be claimed under
these headings by any one individual consultant until an
opportunity had arisen of seeing the system working in
practice. It is, therefore proposed that a review
system will commence in April, 1982 having regard to
detailed information on its operation collected in the
course of its first year of operation and any other
relevant factors."
In the period April, 1982 to late 1985 discussions took place
between the parties but no progress was made and the matter
was referred by the I.M.O. to the Labour Court under Section
20(1) of the Industrial Relations Act, 1969. On 21st March,
1986 the Court recommended as follows:-
"Having regard to the nature of the B and C factor
payments, and to the fact that a review of the Common
Contract is to be undertaken immediately, the Court does
not consider it wise that the outcome of the general
review should be prejudiced in any way by removing the
limits of the B and C factors in advance of the general
review. The Court recommends accordingly."
In the period 1988/1989 the parties failed to agree the
detail of the proposed contract review and the I.M.O.
referred the matter back to the Labour Court under Section
20(1) of the Industrial Relations Act, 1969.
A Labour Court hearing was held on 23rd June, 1989, at which
the management side referred to a Government decision on 5th
May, 1989 to refer the question of the remuneration of
consultant medical staff employed in the health services to a
Review Body on Higher Remuneration in the Public Sector. On
the basis of that referral, the Labour Court agreed to defer
issuing a recommendation.
The Review Body published its report (No. 32) in June, 1990.
Arising from the report negotiations between the management
side and the Union side (the I.M.O. and Irish Hospital
Consultants Association representing the hospital
Consultants) on a revised "Common Contract" began in October,
1990. In discussions, which saw the "Consultants' Contract
Documents 1991 emerge (details supplied to the Court), an
increase in 'C' factor payments and an alternative approach
to these payments was agreed.
It was further agreed that when the Review Body on Higher
Remuneration in the Public Sector examines the remuneration
and conditions of employment of consultants that management
were committed to making submissions, to propose that there
should be a more sensitive mechanism developed which had
regard to the nature and incidence of 'call-out'
requirements.
The Review Body was to deal with this matter two years form
the date of its report (No. 32). In the interim the Chairman
of the Review Body resigned and the Government has yet to
appoint a successor.
Further local level discussions took place in 1993 but no
agreement was reached and the I.M.O. referred the matter to
the Labour Court on 14th October, 1994, under Section 20(1)
of the Industrial Relations Act, 1969. A Labour Court
hearing took place on 26th January, 1995.
ORGANISATION'S ARGUMENTS:
3. 1. There appears to be universal agreement that the current
system of limits fails to meet the primary objective of
payments for emergency duties outside of the scheduled
commitment. As the Review Body itself in Report No. 32
pointed out ....
"(the limits) are not sufficiently sensitive to the
varying circumstances of individual consultants in that
two consultants with significantly different patterns of
attendance may both be paid up to, but not above these
monitory limits."
2. Management have already conceded in Paragraph 9.1 of the
"Revised Contract" that there should be a more sensitive
mechanism developed which has regard to the nature and
incidence of 'call out' requirements. The I.M.O. would
argue that as a first step toward the introduction of
such a sensitive mechanism, the full extent of the" out
of hours activity" requires to be assessed. Because of
the artificial "cap" placed on payments for these
services there is no accurate record of their extent.
3. Approximately #4.8 million is distributed to hospitals
in respect of 'C' factor payment limits which is made up
of #4,361 per consultant and a "special fund" of
#500,000 per annum. Under the terms of the revised
contract any sum unexpended from the #4,361 can be used
for additional payment to any consultant who has
exceeded the 'C' factor limit. The I.M.O. is unaware
that such monies have been distributed.
4. The removal of limits would provide the necessary
factual information on which to base a recommendation.
Hospitals have not co-operated in providing information
to enable arrangements to be made to introduce equitable
arrangements for consultants with high emergency
workloads.
5. The consultants involved are providing the highest
levels of emergency services to public patients. The
Organisation respectfully requests the Court to
recommend that the current 'C' factor limits be removed.
HOSPITAL'S ARGUMENTS:
4. 1. The Government has taken the decision that the Review
Body on Higher Remuneration in the Public Sector is the
appropriate forum for the examination of the
remuneration of consultant medical staff employed by
health boards, public voluntary hospitals and other
health agencies and the terms and conditions (other than
remuneration) which should attach to them and that
remains its position.
2. When the Review body on Higher Remuneration in the
Public Sector next examine the remuneration and
conditions of employment of consultants, management are
committed to making submissions to propose that there
should be a more sensitive mechanism developed which had
regard to the nature and incidence of "call out"
requirements.
3. The question of 'C' factor payments to consultants
cannot be considered in isolation from the overall
contract. The matter should be dealt with by the Review
Body as agreed by all parties.
RECOMMENDATION:
The Court has considered all of the views expressed by the parties
in their oral and written submissions.
The Court finds there is general acceptance that the current
system of limits fails to meet the primary objective of payments
for emergency duties outside of the scheduled commitment.
The Court notes the issue was to have been further considered by
the Review Body on Higher Remuneration in the Public Sector but
that this body has not been re-constituted. The Court finds it
totally unreasonable that an acceptable mechanism has not been
found which would help to address this matter in the absence of
the Review Body.
This inordinate delay can only affect the morale of staff, and be
unhelpful in maintaining a good industrial relations environment.
The Court is given to understand that the re-constitution of the
Review Body is imminent.
Accordingly the Court considers the issue should be raised at this
forum. Every effort should be made to have the matter considered
by the Review Body at an early date.
Given the delay that has occurred to date the Court at the request
of the parties is prepared to review progress of the issue in
December, 1995 with a view to making a substantive recommendation.
The Court so recommends.
~
Signed on behalf of the Labour Court
22nd March, 1995 Tom McGrath
F.B./D.T. _______________
Deputy Chairman
Note
Enquiries concerning this Recommendation should be addressed to
Mr. Fran Brennan, Court Secretary.