Consultant contract a “strong step” towards single-tier health system - Staines

Ireland has been “heading briskly” towards a US-style two-tier health system.
Michael Staines
Michael Staines

09.21 7 Dec 2022

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Consultant contract a “strong...

Consultant contract a “strong step” towards single-tier health system - Staines

Michael Staines
Michael Staines

09.21 7 Dec 2022

Share this article

The new hospital consultant contract is a “strong step” towards a European-style single-tier healthcare system, according to Professor Anthony Staines.

The DCU professor said Ireland has been “heading briskly” towards the US-style system in recent years – with quality care is reserved for those with private health insurance.

He said the only way to build a single-tier system is to ensure that Irish hospitals are attractive places to work for doctors, nurses and other healthcare staff.


The new contract will see hospital consultants offered salaries of between €209,915 and €252,150 a year – with on-call allowances of up to €38,000.

Doctors will also have access to a €20,000 fund for ongoing medical education.

Under the deal, consultants will be expected to work at least 37 hrs a week between 8am and 10pm, Monday to Saturday.

Professor Staines told Newstalk Breakfast the new contract is a “step forward” – but must go hand-in-hand with continued moves towards single-tier health service.

“At the moment, we’re heading briskly to an American model of healthcare where, if you have insurance, there is good access to excellent quality private healthcare,” he said.

“Now in the US, without insurance or with limited insurance, you have limited access to relatively poor public healthcare. Very stretched very underfunded public healthcare.

“That has been the direction of travel here over the last 20 years.”


He said private providers have a role in European systems – but they are largely available to everyone regardless of whether they have insurance.

“That is the direction we should be travelling in and I think this could be a strong step towards it,” he said.

“We have to make the health service attractive to doctors and I think this will help with that – but we also have to make it attractive to other staff grades.”

Private healthcare

The question now is whether the new contract will be enough to tempt consultants out of private practice.

“This may be an attractive contact to some existing postholders, but I think if you have a large private practice, it may not be so attractive at all,” he said.

“Also, from a hospital’s point of view, hospitals gain significant income from private patient care so where does that income go?

“Because of the way hospital accounting systems work, it is often quite difficult to figure out how profitable private patient care is to the hospitals, but it certainly makes a significant contribution to their income flow.

“That is a real practical issue for the government to address.”


Under Sláintecare, consultants will soon be barred from treating private patients in public hospitals.

They will be permitted to treat them off-site in their own time.

The new contract is going to Cabinet for approval this morning.

Medical representative bodies will then consider the final proposals.

You can listen back to Prof Staines here:

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