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THE UNIVERSITY OF DUBLIN

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  • 1. THE UNIVERSITY OF DUBLIN Trinity College PROFESSOR OF NEPHROLOGY / CONSULTANT NEPHROLOGIST & GENERAL PHYSICIAN at The Adelaide & Meath Hospital, Dublin Incorporating the National Children’s Hospital (AMNCH) FURTHER PARTICULARS 1
  • 2. Table of Contents Page 1. Background 3 2. University of Dublin / Trinity College 3 3. The Faculty of Health Sciences 4 4. The Adelaide & Meath Hospital, Dublin Incorporating 5 the National Children’s Hospital 5. Trinity College, Dublin - Department of Medicine 10 at The Adelaide & Meath Hospital, Dublin Incorporating the National Children’s Hospital 6. Position of Professor / Academic Consultant 14 7. Contact Information 17 8. Applications 17 Appendix 1 HSE Approval Letter 18 Appendix 2 Teaching Facilities in the Trinity Centre for Health Sciences and the Hospital’s Education Centre 21 Appendix 3 Hospital Statement 23 Appendix 4 Renal Dialysis Expansion in Dublin, Mid Leinster HSE 25 Area with Particular Reference to AMNCH Appendix 5 Strategic Plan – Trinity College Dublin 31 Appendix 6 School of Medicine Staff List 32 Appendix 7 Draft Consultants Contract 33 2
  • 3. 1. Background Trinity College, Dublin and the Adelaide & Meath Hospital, Dublin Incorporating the National Children‟s Hospital (AMNCH) seek to appoint a Professor of Nephrology / Consultant Nephrologist & General Physician with a distinguished reputation in research and teaching to provide leadership in both the University and the Hospital. The appointment of Professor of Nephrology/ Consultant Nephrologist & General Physician based in the AMNCH should be seen in the context of an unprecedented rate of development in the national economy, the University, and, within it, the Faculty of Health Sciences and the Medical School. The College has invested heavily in teaching and research facilities and Medicine at Trinity College, Dublin is the most sought after university course in the country. In recent years, the University has embarked on a building programme which has transformed its city centre campus. In addition, €38.09m has been invested in the Trinity Centres at St. James‟s and the Adelaide & Meath Hospital, Dublin Incorporating the National Children‟s Hospital. Planning for a Phase II building at AMNCH has commenced. 2. The University of Dublin/Trinity College Dublin Trinity College is the single constituent college of the University of Dublin, founded in 1592 by Royal Charter of Queen Elizabeth I. The College has grown rapidly in recent years in response to the high demand in Ireland for third level education and to government policies designed to meet this demand. Today there are some 15,000 students and 2,000 full-time staff of which about 600 are tenured academics. There is, in addition, a large number of part-time staff, particularly in the Faculty of Health Sciences. In recent years the University has embarked on a €200m building programme and has a current external research income of some €70m per year. The College has implemented fundamental structural reform. In excess of 60 departments have been combined into 24 schools and are grouped into three faculties. These reforms have been complemented by the introduction of a new academic resource allocation model (ARAM) based on teaching/education and research activities. In Health Sciences the original seven schools have been restructured into three: School of Medicine School of Dental Sciences School of Nursing and Midwifery The School of Pharmacy and Pharmaceutical Sciences has also been incorporated into the Faculty of Health Sciences. In the School of Medicine nineteen departments/academic units have been restructured into six academic divisions. One of the Divisions is devoted to education and the other five are interdisciplinary and research driven. It is envisaged that departments will be replaced by disciplines and that disciplines may be involved in more than one division. 3
  • 4. Funding for university research has received significant government support in recent years. The new National Development Plan (2000 – 2006) included approximately €2.53bn for research, development and innovation and the College has been very successful in competing for these funds particularly from Science Foundation Ireland. Trinity has also been highly successful in securing funds under the Programme of Research in Third Level Institutes (PRTLI) funded through the Higher Education Authority, winning €101.57m to date, including €15.4m for an Institute of Molecular Medicine to conduct a programme of research with University College Dublin as the Dublin Molecular Medicine Centre. In the most recent round of HEA funding, Trinity was awarded €25.39m for the Trinity Institute of Neurosciences. In 2006, the College updated its five-year Strategic Plan launched in July 2003 which further outlined commitments to build on current strengths, to further develop an internationally competitive research and scholarship programme and an education programme characterised by quality and innovation. 3. Faculty of Heath Sciences and the School of Medicine The Faculty of Health Sciences at Trinity College Dublin has four constituent Schools. The School of Medicine. The School of Dental Sciences. The School of Nursing & Midwifery. The School of Pharmacy & Pharmacological Sciences. Within the School, the Professor of Nephrology post is associated with the Clinical Medicine academic unit in The Adelaide & Meath Hospital, Dublin incorporating The National Children‟s Hospital. The Faculty of Health Sciences provides education and training for medical doctors, dentists, nurses, midwives, physiotherapists, occupational therapists, radiotherapists and pharmacists. The Faculty has a strong graduate programme with over 170 students registered for research degrees (Ph.D. /M.D.) and over 250 participating in the wide range of taught M.Sc./Diploma programmes. The Faculty promotes an environment which fosters a team approach to the delivery of healthcare in the hospital and the community. This multi-professional ethos seeks to encourage mutual respect and understanding between health professionals and the sharing of knowledge and skills, which facilitates efficient teamwork and healthy professional relationships. This shared experience also promotes co-operation in education and research within the professions and allows more efficient use of expertise and educational facilities. The Faculty is actively working with its teaching hospitals on joint initiatives in postgraduate education and research. These initiatives complement and underpin the Faculty‟s own developments in the area of postgraduate studies. A wide range of over 25 taught courses leading to Postgraduate Diplomas and M.Sc. degrees have been developed in recent years and a number of further courses are in the process of development. Some of these courses are targeted at a specific profession, such as the M.Sc. in Physiotherapy; others are directed towards research such as the M.Sc. in Molecular Medicine and the 4
  • 5. M.Sc. in Molecular Pathology, whilst others are of an interdisciplinary nature, such as the M.Sc. in Health Services Management. Some courses are part- time, providing opportunities for individuals to continue in their professional work and others are full-time. There are 291 students registered on taught postgraduate courses (M.Sc./Diploma) in the School of Medicine for 2007/08 and 199 students registered for postgraduate research degrees. Educational facilities for the professional schools in the Faculty are situated both on the city centre campus and in the Trinity Centres associated with affiliated hospitals. In 1994 the College opened major new academic facilities at St. James‟s Hospital located approximately 2 miles from the main campus, and it has a complementary facility at the new Hospital at Tallaght, approximately 7 miles from the main campus. In all, the College undertook a €39m capital programme in Health Sciences in the ten-year period to 2004. A new Biosciences Building will be opened in 2011. The building is situated on Pearse Street as part of the main campus of Trinity College Dublin. It will house the School of Medicine including Anatomy, Physiology, lecture theatres, seminar/teaching areas and an administration block. This will be a significant contribution to the School of Medicine in the University. At present, the majority of didactic clinical lectures and teaching in the clinical laboratory sciences is based at the Trinity Centre for Health Sciences at St. James‟s Hospital where there are lecture theatres, seminar rooms and the John Stearne Medical Library The Trinity Centre in the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital, Tallaght contains office accommodation, a lecture theatre, seminar rooms, a 40 workstation computer-teaching laboratory and research space. Discussions have commenced aimed at devising specific computer-based modules in pathology that can be delivered at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital using this technology. Clinical teaching takes place on both hospital sites. Students are also accepted in the Faculty to work towards the degrees of M.D., M.Ch., M.A.O., M.Sc. and Ph.D. by research. Such students work under the supervision of a designated member of the Faculty. There are ongoing discussions in respect of shared governance/partnership between the College and its teaching hospitals. The School will celebrate its Tercentenary in 2011. A Tercentenary Committee has been established and it will focus on fund-raising, emphasising the central role of the medical school in the scientific and cultural life of the city. The primary focus will be on resourcing the capital development of building programmes on the College Green campus, St James‟s Hospital campus and the campus at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital, Tallaght. Emphasising the key role of the Meath and Adelaide Hospitals in the history of medicine and of medical education, it is proposed to work towards establishing a facility incorporating clinical skills coupled with integrative medicine and surgery and preventative medicine on the Tallaght campus. Translational medicine will be primarily based at the St James‟s campus, and central administration and non-clinical teaching at the College Green campus. All three strands will be integrated in a historical sense 5
  • 6. with particular emphasis on: (i) marrying traditional and new technologies; and (ii) complementary developments on the three sites. The current Strategic plan for the School of Medicine is available via the following link http://www.medicine.tcd.ie/about/strategicplan/FINAL_School_Of_Medicine_Str ategic_Plan.pdf 4. The Adelaide & Meath Hospital, Dublin Incorporating the National Children’s Hospital, Tallaght, Dublin 24. 4.1 Introduction The Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital (the Hospital) has been developed as a result of the merging of three distinguished city-centre teaching hospitals: the Meath Hospital (founded 1753), the National Children‟s Hospital (founded 1821) and the Adelaide Hospital (founded 1839). Some of the internationally known medical names associated with the history of the Hospital include Robert Graves (1796-1853), William Stokes (1804-1877) and Denis Burkitt (1911-1996). The famous Adelaide School of Nursing was founded in 1859 in the Nightingale tradition. The three former hospitals continue their tradition through their legally constituted successors (Foundations): The Adelaide Hospital Society, The Meath Hospital Foundation and The National Children's Hospital which support the Hospital through Board representation and fund-raising activities. The three hospitals moved from their existing locations in 1998 to a newly built state-of-the-art Hospital on a 38 acre campus in Tallaght, South County Dublin. The new hospital represents the largest single hospital project ever commissioned by the State and was incorporated under Charter on 1 August 1996, bringing together over 600 years of renowned medical training, research and nursing excellence. The Hospital provides a comprehensive range of diagnostic and treatment services, many with national or regional status commensurate with a university teaching hospital. The Hospital delivers medical and surgical services to children, adolescents, adults and the elderly. There are designated accident and emergency, out-patient, in-patient, theatre and diagnostic services for children. In addition to these services the Hospital embraces the acute in- patient psychiatric services hitherto provided by St. Loman‟s Hospital. The Hospital operates under the unique legal framework of the Charter which was enacted by Dáil Eireann on 1st August 1996. The voluntary and independent character of the Hospital, which stems from the Charter, will ensure an imaginative, innovative atmosphere for fulfilling the objectives of the Charter in respect of university teaching, medical research and flexibility in responding to new developments. The Hospital in partnership with other Irish major academic teaching hospitals, has embarked on an accreditation programme and has achieved Pre-Accreditation Advanced. The Hospital also has a comprehensive range of Information Technology / Information Systems. All areas within the hospital are computerised and networked. Facilities available on the system include Patient Information 6
  • 7. Management System (PIMS), Accident and Emergency System (Footman Walker), Order Communications, Laboratory Information System (LIS), Electronic Mail, Intranet, and the Hospital‟s own web site www.amnch.ie . The Board of Management of the Hospital, of which the Dean of the Faculty of Health Sciences, Trinity College, is a member, has an explicit commitment to academic excellence and a Teaching Agreement between Trinity College and the Hospital, agreed on 26th October 1995, recognises the Hospital as one of the College‟s two main clinical teaching centres. There is a strong academic commitment between the Hospital and the Trinity Centre for Health Sciences which opened in 2000. The Adelaide Hospital Society, The Meath Hospital Foundation and The National Children's Hospital and St James‟s Hospital are partners in their development of education and research facilities for the School of Medicine and Faculty of Health Sciences. This building is interlinked with the Hospital's Education Centre and together they accommodate the Medical School, the Postgraduate Medical Centre, the Hospital's School of Nursing and Midwifery, the library and research facilities. 4.2 Corporate Strategy The Hospital has completed the exercises of transferring the services from the four hospitals and of integrating them into a functioning whole at Tallaght. It has now embarked on a planning exercise to delineate a corporate strategy which will guide the development of services for the next three to five years. It is very much hoped that the Professor appointed would be able to share in this planning process. The objective is to improve the way patients are dealt with and treated, bearing in mind quality, timeliness and cost. 4.3 Catchment Area The Hospital serves a rapidly growing catchment population (currently 550,000+) and also continues its national tertiary referral and regional services. The catchment area includes North Kildare area, which is the fastest growing “young family” area in Europe. Approximately 40% of the population are less than 15 years old. The Hospital also has a unique clinical and executive relationship with Naas General Hospital which has undergone a major re- building programme (€63.49m) to provide Accident and Emergency, Surgical and Medical Services with a number of joint Consultant appointments in medicine and other specialities. There are shared lecturers posts in medicine and surgery between Tallaght and Naas. The holders of these posts co- ordinate teaching for undergraduate students and are involved in research in the surgical and medical professorial departments. There is also a unique clinical and executive relationship with Peamount Hospital with a number of joint appointments. 4.4 Surgical Facilities There are twelve major operating theatres, including state of the art instrumentation, laparoscopic facilities and extensive clinical support services. There are also two minor operating theatres in the day area for ambulant procedures performed under local anaesthetic. The Endoscopy Unit consists of three endoscopy suites and a 13 bed day-ward area. A comprehensive diagnostic and therapeutic service is provided including therapeutic ERCP, 7
  • 8. endoscopic ultrasound, haemostatic techniques, enteral stenting and laser therapies. The Hospital has been at the forefront in developing rapid access day surgery. 4.5 Nephrology Facilities The Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital (AMNCH) is the principal Nephrology service in the Dublin and South Leinster HSE area (Population 1.2 million). The hospital has a 12 station dialysis unit with two isolation rooms. It operates a satellite dialysis facility in Beacon Renal Unit, Sandyford in conjunction with St. Vincent‟s Renal service (30 Stations). AMNCH provides chronic Haemodialysis dialysis services for its own population, Naas and St. James‟s Hospitals. It also provides a supra- regional peritoneal dialysis service and has the largest peritoneal dialysis programme in Ireland. The unit is the second largest non- transplant centre in Ireland and as of the end of June 2008 was treating 190 Dialysis patients and 223 renal transplants. It supervised in excess of 15,000 dialysis sessions in 2007. The hospital is actively pursuing the establishment of a Regional Renal Medicine Clinical Network with St. Vincent‟s University Hospital and the Midlands Regional Hospital in Tullamore. 4.6 Initiatives in Planning Currently there are four groups planning interdisciplinary initiatives in clinical service, education and research. These include an Institute of Preventative Health, “Cancer Prevention Institute” involving six major disciplines, a Neurosciences Axis involving 12 disciplines and a Cardiovascular Institute which also involves a large number of disciplines. All involved consider that these strategies will provide significant opportunity to make a notable contribution to the international field of research and science. 4.7 Emergency Medicine The Hospital plays an integral part in the provision of Emergency Medicine services together with the other major Dublin hospitals. There is a separate designated Emergency Medicine Department for children. 4.8 Diagnostic Services Radiology All conventional X-Ray services are available including Magnetic Resonance Imaging (MRI), CT Scanning, Ultrasound, Nuclear Medicine, Angio- Interventional and Mammography. The Hospital has incorporated a fully filmless PACS and Radiology Information System (RIS) integrated with the Hospital's Information System. Development plans for the department include an increase in Consultant manpower and expansion of links with Naas General Hospital. Pathology There are comprehensive pathology laboratory services encompassing all 8
  • 9. laboratory medicine disciplines: Clinical Chemistry, Haematology, Histopathology / Cytopathology and Medical Microbiology. The laboratory is equipped to a high standard and offers all routine diagnostic modalities including flow cytometry, computerised image analysis and molecular techniques (in-situ hybridisation, FISH, PCR). The laboratory is fully computerised and on-line result reporting is available in ward and out-patient areas over the hospital network. Clinicopathological meetings take place on a regular basis including a weekly gastroenterological conference and a weekly multidisciplinary meeting with pathologists, radiologists, surgeons and gastroenterologists. Integration of laboratory services with Naas General Hospital is proposed, including referral of samples from Naas to the Hospital for specialised tests together with a number of joint Consultant appointments. There are active research programmes in many disciplines and collaborative research with clinical services is facilitated. Areas of research include cystic fibrosis and Helicobacter pylori (microbiology), apolipopotein and homocysteine metabolism and medical informatics (clinical chemistry), myelodysplasia and haematological malignancy (haematology), Inflammatory Bowel Disease, colorectal carcinogenesis, breast cancer prognostic indices, urologic malignancies (histopathology). 4.9 Clinical Support Services The full range of clinical support services is available on site in the Hospital. These include physiotherapy, psychology, occupational therapy, speech and language therapy, clinical nutrition and dietetics, social work, pastoral care, medical physics and clinical engineering and pharmacy. 4.10 Education Facilities The Hospital has a long and distinguished history in medical education and research and with the support of funding from the three base hospital foundations, built and equipped the Trinity Centre for Health Sciences which is intimately linked with the Hospital's Education Centre. The two together provide a significant academic and educational presence on the hospital site. Strong research and teaching in laboratory-based medicine is seen as essential for the development of the Hospital. The Laboratories in Phase One of the Health Sciences Building provide research space which requires expansion. Phase Two development provides for a dedicated Research Centre which is presently at advanced planning stages. A state-of-the-art integrated audio-visual system has been commissioned which supports education and training to all students of various disciplines in the Hospital. This system provides links between the main Operating Theatres and Endoscopy and Angiography to the Education Centre and the Trinity Centre for Health Sciences building as well as Tutorial rooms dispersed throughout the Hospital. The Robert Graves Centre is located in the Education Complex and represents a joint initiative between the Postgraduate Medical and Dental Board, the Hospital and Trinity College, Dublin. In conjunction with its sister centre, the 9
  • 10. William Stokes Postgraduate Centre in St James‟s Hospital, it provides postgraduate facilities and resources for doctors in South and South-West Dublin. The Hospital currently provides local, regional or national services in the following areas: Emergency Medicine Services Medical Oncology Anaesthesia, Intensive Care, and Nephrology Pain Clinic Neurology Cardiology Neurophysiology Dermatology Orthopaedic Surgery - Elective Diabetic and Metabolic Disorders Orthopaedic Surgery - Trauma Diagnostic Services - Laboratory Otolaryngology Medicine, Radiology Palliative Medicine Endocrinology Paediatric Medicine Gastroenterology Paediatric Surgery General Medicine Psychiatry General Surgery Rehabilitation Medicine Geriatric Medicine: Assessment Respiratory Medicine Rehabilitation and Day Hospital, Rheumatology Stroke Service, Dysphagia, Driver Urological Referral and Stone Assessment Centre Gynaecology Vascular Surgery 5. Trinity College, Dublin - Department of Medicine at the Adelaide & Meath Hospital, Dublin Incorporating the National Children’s Hospital (AMNCH) The Trinity Centre for Health Sciences at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital includes in-whole or in-part many of the Faculty‟s clinical departments, including Paediatrics, Clinical Medicine, Surgery, Public Health and Primary Care and Psychiatry. These areas combine with a number of key hospital strengths to provide a unique opportunity for interdisciplinary research. Fifty percent of the TCD medical students rotate through the hospital at any one time. In common with all clinical departments, the Professorial Surgical Unit has a significant responsibility both to its students and to its patients at the hospital. The Hospital has a very large local catchment population of approximately 500,000 and has also patients referred nationally. 5.1 Staff The Trinity College Professor and senior lecturers/lecturers based in AMNCH together with their areas of interest is listed below. Academic Head and Dean of Faculty of Health Sciences: Professor Colm Ó‟Moráin Professors/Associate Professors: Cardiology (I. Graham); Age Related (D. O‟Neill), General Practice (T.O‟Dowd); Clinical Public Health Medicine (J. Barry); Clinical General Practice (F. O‟Kelly) 10
  • 11. Senior Lecturers & Lecturers: Age Related Health Care (R. Collins, T. Coughlan, A. O‟Driscoll, P. O‟Brien); Cardiology (D. Mulcahy, D. Moore, D. O‟Gorman); Dermatology (M Connolly); Emergency Medicine (J. Gray, G. Little, J. O‟Sullivan, M. Rochford); Endocrinology (J. Barragry, J. Gibney, K. Moore); Gastroenterology (N. Breslin, B. Ryan, H. O‟Connor); Gynaecology (P. Crowley, P. Bowman, C. Murphy, G. von Bunau, W. Prenderville); Haematology (H. Enright, N. O‟Connell); Medical Oncology (R. McDermott, J. Walshe); Nephrology (G. Mellotte, C. Wall, A. Watson); Neurology (R. Murphy, D. McCabe); Neurophysiology (M. Alexander); Palliative Medicine (S. Higgins), Respiratory Medicine (S. Lane, E. Moloney, J. Power); Rehabilitation Medicine (J. McElligott), Rheumatology (D. Kane). 5.2 Physical Facilities The Department of Medicine has office space and research space in the Trinity Centre at the AMNCH Education Centre for the Professor and secretary and associated academic staff. 5.3 Departmental Governance and Headship The Head of the Department of Medicine at AMNCH, Tallaght is Professor Colm Ó‟Moráin. The Professor of Nephrology will play a major role in education, research, administration and ongoing audit and development within the Department. Academic Staff and individual consultant hospital staff and heads of specialist departments contribute substantially to the Department as part-time members of the academic staff. Regular departmental meetings are held with integration of its part-time members into the decision making process, good communication and close contact between the staff in both hospitals. 5.4 Teaching The Department of Medicine engages in a wide range of teaching to undergraduates and postgraduates. It makes significant teaching contributions to other departments, to the clinical staff of the hospital and to other institutions both nationally and internationally. Undergraduate Teaching The Departments of Medicine, located at AMNCH and St James‟s Hospital are responsible for the teaching of medical undergraduates of Trinity College, Dublin. Small group clinical bedside teaching is the cornerstone of surgical undergraduate teaching. Wide spread curricular reform has improved the quality of surgical rotations in the hospital. The course content is delivered via a small group clinical bedside teaching, clinical skills laboratory, problem based learning sessions. A research project is encouraged in order to develop scientific methods, analytical skills and encourage student collaboration skills. This is supported by the Health Research Board. Student progress is assessed by continuous assessment, clinical examination, multiple choice examination, case report, individual project, group project, 11
  • 12. OSCE (Objective Structured Clinical Examination). Currently the final exit exams are organised and managed from the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital. In our undergraduate surgical training we aim to foster a supportive, enthusiastic attitude among staff and students. This has been commented on favourably by the Irish Medical Council. We involve our students in the working life of the hospital and foster an environment where the students are free to express their ideas, ask questions and seek help where needed. Arrangements for elective exchanges have been concluded with several Medical Schools both nationally and internationally. Postgraduate Teaching and Research The Department of Medicine offers the following degree programmes by research: The Doctor of Medicine (MD and Ph.D) The Professor of Nephrology will be actively involved in the development of the undergraduate and post graduate curricula, their delivery, assessment and ongoing development and will also promote and support research. The School of Medicine is continuously reforming the undergraduate curriculum, a process which is being monitored and encouraged by the Medical Council. To date, the first three years have been restructured and a comprehensive course in medical ethics has been introduced commencing in year three. The task of reforming the clinical years and increasing the linkage with the pre-clinical curriculum is still in progress and it is expected that the successful candidate will play a role in this reform. Students rotate equally between the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital and St. James‟s Hospital for their medical and surgical attachments in the third and fifth years thus experiencing the particular features of both hospitals. The School is currently exploring computer based teaching using expertise and resources at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital. In the past three years there has been an investment in clinical skills facilities located in the Trinity Centre at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital and this facility is used heavily by students. There is also an emphasis on providing students with good research skills. Foundations are laid in the first year and project work and special study modules are provided in the fourth year. There is still a strong emphasis on clinical bedside teaching in all the clinical disciplines. 5.5 Research The Department of Medicine at AMNCH has developed a successful research programme since the hospital opened in 1998 and is involved in a wide variety of collaborative research projects with many institutions nationally and internationally. Existing research interests and strengths include such areas as cardiovascular, 12
  • 13. neurosciences and aging, rheumatology, gastroenterology. Potential areas of collaboration for research and education exist due the on-site presence of Departments of Surgery, General Practice, Public Health, Medicine and Psychiatry. With the relocation of the Coombe Women‟s & Infants University Hospital to the Tallaght campus, research opportunities are further enhanced. . There are significant opportunities in our catchment area for important research with practical and useful outcomes and analysis of the specific population characteristics including higher than average birth rate, large numbers of asylum seekers, of the unemployed, and of single parent families. The development of an Institute of Preventive Health has been agreed by the Board of the AMNCH and has been included as part of the School‟s strategic plan in order to promote the early detection and screening and assessment of risk factors for a wide spectrum of medical disease. 5.6 Department of Public Health and Primary Care The department is located at the Trinity College Centre for Health Sciences at the Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH). The mission is to foster the study and understanding of health issues through teaching, research, advocacy and clinical care, with particular emphasis on health deprivation and chronic disease, and societal health problems such as alcohol, tobacco, and illicit drug dependency. The Department came into being with the establishment of the Chair of Social Medicine in 1952. The establishment of the Chair recognised the contribution of the social environment to people's health or ill-health, and that medical students needed a perspective beyond their traditional hospital oriented training. Departmental staff form a multi-disciplinary team with public health, general practice, epidemiology, biostatistics, medical ethics and psychology all contributing to our research and teaching agenda. The department contributes to the 5-year medical undergraduate curriculum with courses in the 1st and 4th years. The 1st year course is the Human Development and Behavioural Science Course, incorporating Medical Ethics. This is an early patient contact course, as part of which students are assigned in pairs to visit families with young babies in the families' own homes. The People, Practices and Populations course is delivered in the 4th medical year. As part of this course the students are attached to two different general practitioners for a total of four weeks, where they can observe the wide range of ill health presenting in the community setting. The department incorporates the Small Area Health Research Unit (SAHRU) (www.sahru.tcd.ie) which provides in-house statistical expertise, along with statistical consultancies for external bodies and web based distance learning courses in biostatistics. The TCD/HSE Specialist Training Programme in General Practice is also part 13
  • 14. of the department, providing us with a network of training practices which contribute to our teaching and research. 5.7 College and Other Funding The Department of Medicine receives a budget from the College designed to meet its teaching and routine administrative commitments. The Department or its members compete for major equipment funding to the Higher Education Authority (HEA), the EU, the Wellcome Trust, the Provost‟s Fund, the Irish Heart Foundation, the Cancer Research Fund, the Arthritis Foundation and the Health Research Board (HRB). The HRB has significantly increased its commitment to a strategic research policy that is expected to increase the level of funding available. The Faculty of Health Sciences is a member of the newly established EUROLIFE EU Network of long established European Medical Schools. The Department of Health and Children has also made a strong commitment to quality in the Health Service, and has introduced a structured programme for speciality training and research infrastructure. The State‟s direct contribution to the Health Research Board has almost doubled in two years which coupled with matching funds creates a positive environment for active researchers. Finally the Faculty and the College are exploring the possibilities of new funding models for the academic developments with the service agencies as well as with the educational authorities. 6 Position of Professor of Nephrology / Consultant Nephrologist & General Physician The College is seeking to appoint an innovator to provide strong leadership in research and teaching. A clinical team with secretarial staff will be available to support the clinical interests of the incoming Professor of Nephrology/ Consultant Nephrologist & General Physician . In addition, Trinity College may contribute to providing essential research equipment. Person Specification The following professional qualifications shall apply to this appointment (a) Registration as a specialist in the Specialist Division of the Register of Medical Practitioners maintained by the Medical Council in Ireland in the specialities of nephrology and general (internal) medicine. The appointee will: co-ordinate the development of an integrated teaching program in Clinical Nephrology that will include integration of undergraduate lectures, tutorials and examinations in the biomedical sciences, together with the teaching of clinical nephrology in the hospital setting. develop and maintain an internationally competitive research group in a recognized area of research in Clinical Nephrology including acquiring the necessary funds and recruiting, supervising, and supporting through to successful completion of post-graduate degrees of research students and/or post-doctoral fellows. be expected to contribute to ongoing curricular reform in the context of an expanding molecular medicine knowledge base and developing a 14
  • 15. structured teaching programme incorporation an e-learning platform for undergraduates in TCD and IUMC Medical Schools and contribute to the development of a curriculum. represent the Faculty of Health Sciences at Trinity College Dublin, on appropriate national and international advisory boards and professional bodies. be expected to assume a leadership and managerial role within the Faculty of Health Sciences at Trinity College Dublin. work with the officials in the Medical Education, Training & Research (METR) Unit and will collaborate with senior officials throughout the HSE and externally to ensure an integrated and multidisciplinary approach to education, training and research, in line with HSE Board policy. develop interactive teaching programmes for graduates studying for membership of the Royal College of Physicians in Ireland and for those engaged in the Specialist Registrar training schemes in Ireland have an appointment as a consultant at AMNCH and be expected to contribute to the teaching, assessment and research activities in the Hospital have an opportunity to pursue their clinical interest in the department by holding Outpatient clinics, participate in the dialysis unit service and nephrology on call rota. be expected to develop a sub-speciality nephrology clinic in Beaumont Hospital which will be provided on an alternative week basis be expected to take a national role in renal transplantation medicine that will be provided by access to the national transplant centre in Beaumont Hospital be expected to participate in monthly transplant multi-disciplinary meetings held in Beaumont Hospital and actively contribute to and participate in the formulation of policies and protocols governing all aspects of renal transplantation medicine working with the transplant team in Beaumont be expected to contribute to the overall development of National Renal Programme and to support and contribute to the development of multidisciplinary education, training and research within the HSE. The normal duties for the post will include inter alia; Trinity College Dublin 8.5 hours per week for teaching duties 8 hours per week for research activities Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital 3 hours per week for out-patient clinics 3 hours per week for consultation services 3 hours per week for dialysis Participation in the nephrology on-call rota 6.5 hours per week for administrative / management duties and clinical interaction with the national Renal Programme and National Renal Registry 15
  • 16. Beaumont Hospital 3 hours every second week for out-patient clinics 3 hours per month for multi-disciplinary meetings The foregoing list of duties will form part of the Clinical Directorate Service Plan. The remaining commitments are to be assigned by the employers and may be adjusted by the Clinical Director of AMNCH / Trinity College Dublin in consultation with the Consultant appointed to this post. The Academic Consultant is accountable for the delivery of the clinical component of the post as provided for in the body of the Consultant Contract 2008, and s/he is accountable via the management and governance structures in place in the University in relation to the delivery of their academic commitment. Commencement: by mutual agreement Hourly Commitment: 18.5 Clinical/18.5 Academic (week) Salary Scale New Entrant Academic Consultants on Type B contract: Point 1 - €254,896 (please note candidates must enter at point 1) Further Information Further information on the College may be obtained at the following web address: http://www.tcd.ie Further information on the School may be obtained at the following web address: www.medicine.tcd Conditions of Employment: The Consultant Contract 2008 for HSE approved Consultant appointments (Category Type B whole-time) apply to this post. 16
  • 17. 7. Contact Information Interested applicants should contact in the first instance: School of Medicine, The Adelaide & Meath Staff Office – Trinity Trinity College Dublin Hospital, Dublin College Dublin Incorporating the National Children's Hospital Professor Shaun Professor Kevin C. Conlon Ms Ann-Marie Farrell McCann Chief Executive Officer Recruitment Officer Professor of Academic The Adelaide & Meath House 4 -Staff Office Medicine Hospital, Dublin Trinity College School of Medicine Incorporating the National Dublin 2 Trinity College Children's Hospital Dublin 2 Tallaght Telephone: +353-1-896 Dublin 24 1030 Telephone: +353-1- Email: 896 3069 Telephone: +353-1- annmarie.farrell@tcd.ie Email: 4142845 srmccann@tcd.ie Email: anne.mckenna@amnch.ie 8. Applications Applicants should provide the following information in applying for the Chair: A comprehensive curriculum vitae including full data on publications Names and contact details (i.e. addresses, e-mail etc) of five referees Completed applications should be submitted to: Ms. Ann-Marie Farrell Recruitment Officer House 4 – Staff Office Trinity College Dublin 2 Ireland Telephone: +353-1-896-1030 Email: annmarie.farrell@tcd.ie The closing date for receipt of applications for all posts is noon, Friday, 15th January 2010. 17
  • 18. Consultant Appointments Unit Room 1.32 Dr. Steevens‟ Hospital Dublin 8 Aonad Cheapacháin na nDochtúirí Comhairleacha Seomra 1.32 Ospidéal an Dr. Steevens Baile Átha Cliath 8 Tel / Guthán: (01) 635 2500 E-mail: consultant.applications@hse.ie Appendix 1 – HSE Approval Letter Mr. John Bulfin Hospital Network Manager Our Ref: TTGMNF12 Health Service Executive Arden Road Tullamore Co. Offaly 11th September 2009 Dear Mr. Bulfin, I refer to Ms. A. Larke‟s e-mail of 3rd November 2008, attached application and all related documentation. This letter supercedes the previous letter of 22nd January 2009. The Health Service Executive has approved the appointment of a: PROFESSOR OF NEPHROLOGY / CONSULTANT NEPHROLOGIST & GENERAL PHYSICIAN This is a joint academic appointment on a Type B basis under the Consultants‟ Contract 2008 by the University of Dublin, Trinity College (18.5 hours per week) and the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital (18.5 hours per week). This is a new post. It is noted that the appointee will be expected to develop a sub-specialty nephrology clinic in Beaumont Hospital, which will be provided on an alternative week basis. The postholder will also be expected to participate in the monthly transplant multi-disciplinary meetings held in Beaumont Hospital, and actively contribute to and participate in the formulation of policies and protocols governing all aspects of renal transplantation medicine, working with the transplant team in Beaumont. Arising from a national programme to increase the number of academic clinicians in Ireland, funding for this post is being provided on a 50:50 basis between the Health Service Executive and the Higher Education Authority. The appointee will be expected to contribute to the overall development of medical education and training from a national perspective and to support and contribute to the development of multidisciplinary education and training within the Irish health service. In particular, the appointee will be expected to actively contribute to the development of a national core curriculum that will be developed by, and available to, all Irish medical schools. The Consultants‟ Contract 2008 provides for a normal working week of 37 hours. 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 normal duties for the post as outlined in the documentation and agreed by the HSE, will include inter alia: 18
  • 19. University of Dublin, Trinity College 8.5 hours per week for teaching duties 8 hours per week for research activities Adelaide & Meath Hospital, Dublin incorporating the National Children’s Hospital 3 hours per week for out-patient clinics 3 hours per week for consultation services 3 hours per week for dialysis Participation in the nephrology on-call rota 6.5 hours per week for administrative / management duties and clinical interaction with the national Renal Programme and National Renal Registry Beaumont Hospital 3 hours every second week for out-patient clinics 6 hours per month for multi-disciplinary meetings The foregoing list of duties will form part of the Clinical Directorate Service Plan. The remaining commitments are to be assigned by the employer(s) and may be adjusted by the Clinical Director / Employer in consultation with the Consultant appointed to this post. If a significant change to this post is contemplated e.g. location, structure, title, contract type etc. the prior approval of the Health Service Executive is required. Approval to this post is subject to the following conditions Total employment remaining within your approved ceiling. That normal recruitment procedures for the filling of consultant posts are applied. That there are no additional non-consultant hospital doctor posts attached. This post may be subject to restructuring in the future to facilitate the reorganisation of acute services in line with new clinical models of acute and community services. The following qualifications shall apply to this appointment:- 1. Professional Qualifications, experience etc Registration as a specialist in the Specialist Division of the Register of Medical Practitioners maintained by the Medical Council in Ireland in the specialties of nephrology and general (internal) medicine. 2. Age Age restriction shall only apply to a candidate where he/she is not classified as a new entrant (within the meaning of the Public Service Superannuation (Miscellaneous Provisions) Act, 2004). A candidate who is not classified as a new entrant must be under 65 years of age on the first day of the month in which the latest date for receiving completed application forms for the office occurs. 3. Health A candidate for and any person holding the post must be fully competent and capable of undertaking the duties attached to the post and be in a state of health such as would 19
  • 20. indicate a reasonable prospect of ability to render regular and efficient service. 4. Character A candidate for and any person holding the post must be of good character. 5. Entry to competition / recruitment process For the purposes of eligibility for entry to any competition or recruitment process associated with this post, applicants currently in employment as Senior or Specialist Registrars in HSE or HSE-funded agencies may participate in the competition on the basis that, on the latest date for receipt of applications, they are within 6 months (26 weeks) of certification of completion of specialist training and that evidence for same is provided from the relevant recognised postgraduate medical training body in writing. Requirements vis-à-vis approval letter All documentation relating to this post, including the job description, should be consistent with the contents of this letter. The Contract offered to the appointee should be consistent with the Consultant Contract 2008. This letter of approval shall be made available to all applicants for the post. This letter of approval must be attached at Appendix 1 to the contract to be made with the successful candidate as per the Consultants‟ Contract 2008. The regulation of consultant appointments transferred from Comhairle na nOspidéal to the Health Service Executive with effect from 1st January, 2005. In the event of the above post becoming vacant at any future date, whether by reason of resignation, retirement or death, the vacancy must be notified to the Health Service Executive which will then review the position and decide whether to ratify the continuation of the post. I would be grateful if, in due course, you would let me have, for record purposes, details (the name, date of birth and date of appointment) of the person appointed to the above permanent position. Yours sincerely, ---------------------------------------- Andrew Condon General Manager Office of the National Director of Human Resources 20
  • 21. Appendix 2 - Teaching Facilities in the Trinity Centre for Health Sciences and the Hospital’s Education Centre include: a health sciences/medical library a 300 seat lecture theatre a 130 seat lecture theatre College of Nursing with 4 seminar rooms and three partitionable tutorial rooms four seminar rooms including a clinical skills laboratory a 40 workstation computer teaching laboratory a suite of clinical teaching, observation and treatment rooms for multidisciplinary clinical teaching a canteen and common room area departmental accommodation for Community Health and General Practice, Clinical Medicine, Surgery, Psychiatry, Paediatrics, Clinical Microbiology, Obstetrics and Gynaecology wet and dry research laboratories and associated instrument rooms (300sq.m.) postgraduate study space the Robert Graves Postgraduate Centre for continuing medical education. Audiovisual links between a number of operating theatres and the main lecture theatre(s). 21
  • 22. Appendix 3 Hospital Statements II.1 MISSION STATEMENT In accordance with the Charter of the Hospital our mission is to be a public, voluntary and teaching hospital operated in the interests of our patients in which we - identify and meet the health care needs of the communities we serve so that our Hospital is a Hospital for everyone provide for all patients the highest quality health care undertake and support research in health care educate all staff and students to highest international standards in health care seek for each member of staff and each student equal opportunity to fulfil their potential in health care Develop voluntary involvement and support for our hospital to the maximum extent possible. II.2 VISION STATEMENT Our Hospital is for Everyone Patients, especially those from minorities, will choose to be cared for in our Hospital because we will approach them as a whole person with our innovative and inclusive pastoral care support. We will be international experts on inclusive pastoral care for patients. A Centre of Quality and Excellence in Healthcare Our Hospital will be the best academic teaching community Hospital with a reputation as a centre of healthcare excellence locally, nationally and internationally. Leading edge technology and patient focused caring systems will be constantly reviewed to provide the best care for patients. World Class Research Our state of the art research facilities will enable us to pursue ground- breaking research in Health Sciences and Health Services earnin0g our Hospital world-wide recognition. 22
  • 23. Our Staff will be Renowned for their High Standard of Education This Hospital will focus on continuous learning and development for our staff. Our educators will continuously update themselves with new trends to achieve the highest international standards of healthcare education. Students will seek our educational programs above all others. We Will Treat our Staff Respectfully and Equally Our secure, confident and competent staff will meet our patients‟ needs in an exemplary fashion. We will respect and encourage our staff by recognising their input and dedication. The most highly qualified and motivated healthcare professionals from Ireland and abroad will want to work in our Hospital. We Will be Partners With Our Community The partnerships we create with our enthusiastic and motivated community will rapidly materialise through dialogue and voluntary support for our Hospital. Through partnerships with the Department of Health and health providers in our area we will support the health system and achieve lasting respect for our Hospital. We will support and will be fully accessible to healthcare professionals. III.3 VALUES STATEMENT RESPECT I respect myself and value my integrity. Consequently each person I meet, my work colleagues, my patients, their families, and the environment I work in deserves, and will have, that same respect. CARING We wish to provide an excellent standard of care to everyone in our Hospital. Within a supportive and friendly environment we aim to meet the physical, emotional and spiritual needs of:- Our patients Their families and carers Staff members The communities we serve 23
  • 24. OPENNESS We will always communicate and share information with patients, the public and each other in an open, friendly and truthful manner. By aiming to build and maintain trust at all times. We will ensure an environment that is free of hidden agendas and without fear of speaking the truth. FAIRNESS AND EQUITY We are committed to ensuring that everyone is treated as an individual with fairness and equity. The same high standards of care will be provided for all patients, relatives and staff throughout our Hospital. PARTNERSHIP AND TEAMWORK Co-operation in building a wide range of partnerships will be the hall-mark of our Hospital. This requires combining our effort with voluntary and statutory agencies to raise the health status of the communities we serve. Sharing with others in teams to provide all our Hospital‟s services is essential. This will ensure - effectiveness efficiency accountability in providing the highest quality of care to our patients. 24
  • 25. Appendix 4 - RENAL DIALYSIS EXPANSION IN DUBLIN MID LEINSTER HSE AREA WITH PARTICULAR REFERENCE TO AMNCH The aim of this submission is to address the medium to long term needs of patients with End Stage Renal Disease (ESKD) in South Dublin, Kildare and West Wicklow with a particular focus on AMNCH (Tallaght) Hospital. OVERVIEW: For the past three years the hospital has been operating at capacity with the result that all newly diagnosed patients have had to be referred to the private sector for their dialysis treatment. There are currently 38 AMNCH patients being treated in Beacon Dialysis in South Dublin. RENAL SERVICES AMNCH: The Adelaide & Meath Hospital (AMNCH) is the principal Nephrology service in the Dublin & South Leinster HSE area. The hospital has a 12 station dialysis unit with two isolation rooms. In additional the unit has to accommodate acute dialysis for in-patients with renal failure. AMNCH provides chronic dialysis services for its own population and for St. James‟s Hospital. The unit is the second largest non- transplant centre in Ireland and as of the end of June 2008 it was treating 190 ESKD patients. It has the largest peritoneal dialysis programme in the country. AMNCH is one of the five most congested Haemodialysis facilities as demonstrated in recent HSE national renal surveys. The unit operates three shifts with all 14 stations fully utilised. International recommendations also advise that the dialysis of chronic stable haemodialysis patients be delivered separately from the treatment provided to acutely unwell patients. This minimises the risk of cross infection and, from a patient perspective, separates stable, well ESKD patients from those acutely ill patients receiving the same treatment as themselves. In the immediate term, over 30 additional haemodialysis stations are needed in the catchment area. Each year will bring a requirement for up to 10 additional stations. In line with national projections it is expected that it will need to treat up to 400 such patients by 2011. The hospital is actively pursuing the establishment of a Regional Renal Medicine Clinical Network with St. Vincent‟s University Hospitals and the Midlands Regional Hospital in Tullamore. In addition has seen the unit has expanded by 300% since its opening ten years ago. RENAL DISEASE The term renal disease typically refers to diseases of the kidney other than cancers of either the kidney or associated organs of the urinary tract. Renal failure refers to the ability of the kidneys to clear blood of waste products per unit of time. Renal replacement therapy (RRT) is the treatment for renal failure in which removal of waste products from the body is achieved by haemodialysis, peritoneal dialysis or renal transplantation. 25
  • 26. Epidemiology The number of patients suffering from chronic kidney disease (CKD) in Ireland is rising and will continue to rise. As the population ages, the number of patients with chronic kidney disease will escalate further, as the incidence of the disease rises steeply with advancing age. The increase in diabetes in the population is an important determinant of this escalation. Between 20-40% of people with diabetes ultimately develop renal complications. Work undertaken by the as yet unpublished National Renal Strategic Review (NRSR) estimates that the number of people needing dialysis will double by 2011 because of ageing of the population and the current number of people with diabetes and high blood pressure. This increase in the number of patients developing renal disease, coupled with increased survival and improved treatments for those with established disease, poses unprecedented challenges for renal services in this country. DIALYSIS PROVISION: Within the HSE Dublin Mid Leinster region dialysis services are currently provided in the following units. HSE Area Dialysis Unit Satellite/Other Capacity Routine & isolation Stations Dublin Mid Tullamore 10+2 Leinster St. Vincent's 16+2 University Hospital AMNCH/Tallaght 12+2 Beacon 30+1 NATIONAL RENAL STRATEGY REVIEW A National Renal Strategy Review (NRSR) was commissioned by the Department of Health and Children (DOHC), following the publication of the Health Strategy, ‘Quality and Fairness – A Health System for You’ in 2001. The Health Strategy made a commitment that „A national review of renal services will be undertaken‟ (Item 60) . The purpose of this Review was to develop a framework to meet anticipated growth in demand for renal services. Responsibility for delivery was initially with the DOHC and was later devolved to the HSE in 2005. The final report of the National Renal Strategic Review Group was presented to the HSE in December of 2006. It was at the time not endorsed by the Management Team. The Renal Strategy Review Group undertook its work before the commencement of the HSE Transformation Programme. It has since been decided that it is now appropriate that the report would be reviewed by an external expert/consultancy working with the NRSR Chairman to ensure that the Strategy is aligned with the HSE Transformation Programme and that work practice recommendations reflect the integrated model of care particularly in terms of services that people with chronic illness might receive from primary care with disciplines working across the community / hospital divide. This external review is currently under consideration and is expected to be completed by the end of 2008. 26
  • 27. POLICY ASSUMPTIONS NRSR has reviewed epidemiological data regarding the projected number of patients on dialysis and the need for additional dialysis stations. A priority is to avoid overcrowding dialysis units as the consequences are significant with patients travelling long distances for dialysis treatments often at unsociable hours. Patients are at increased risk of transmission of infection and at increased risk of receiving an inadequate dose of dialysis. While the external review of the NRSR has not yet begun at the time this submission was being compiled, many of the best practice recommendations identified by the NRSR have been used as a basis for this business case. It is unlikely that these assumptions will be changed in any review as they are all in line with international best practice and the HSE Transformation programme. NRSR recommends that HD facilities should avoid exceeding a ratio of 2.5 treatments per HD station per day on 6 days per week. Minimise travel time to achieve target whereby 90% of patients receive dialysis at a facility within a one hour travelling time of their home, and majority of these journeys should be within 30 minutes Each HSE area should have the capacity to provide a haemodialysis service for its own population NATIONAL PROJECTIONS Data from the work of the NRSR Group indicate that the prevalence of ESKD treated by dialysis has increased by 50% in the 4 years to 2007. The prevalence of ESKD treated by haemodialysis has increased by 61% in that interval. On 31st December 2007 there were a total of 1,520 patients with ESKD receiving dialysis treatment, an increase of almost 12% on December 2005. Of these, 1328 were on HD and 192 were on peritoneal dialysis. The incidence of ESKD was 103 per million of the population (p.m.p.) in 2007. The prevalence of ESKD was 741 p.m.p. 1623 (52%) of prevalent patients have a functioning renal transplant (TX), 1329 (42%) are treated with haemodialysis (HD), and 191 (6%) with peritoneal dialysis (PD). Based on analysis of national data and on the observed increment in prevalent dialysis patients between 2004 and 2007 it is probable there will be an annual national increase in haemodialysis dialysis patients of between 20 and 45 per million of the population. However there may be a wider spread in this figure if treatments are focused on smaller population areas. REQUIREMENTS FOR DUBLIN MID LEINSTER It must also be recognised that AMNCH also provides chronic dialysis services for St. James‟s Hospital (SJH). Both hospitals have seen a considerable expansion of their services over the past 10 years. This has been driven by a number of factors including an increase in absolute numbers living in the local area, an ageing population and the establishment of a number of new services. The area served by AMNCH Renal Unit has specific demographic risk factors that are associated with an increased prevalence of renal disease. SJH serves an inner city area with the largest absolute number and the highest 27
  • 28. percentage of deprived elderly (IMJ 2004) in the Dublin area. Many patients are diabetic. There is also sizeable African and Asian population living locally and these ethnic groups have a higher than average prevalence of renal disease. The Tallaght GP study identified a higher than average prevalence of premature vascular disease and diabetes in Tallaght. Kildare in the 2006 census experienced a 13.5% increase in its population. Predicted future requirement for HD Stations in each HSE Area, 2006 Census Data (adapted from NRSR 2006) Provision 200 201 201 201 Year 2008 9 0 1 2012 3 2014 2015 Dublin NE 90 99 107 116 124 132 141 Dublin Mid Leinster 32 20* 99 110 121 132 143 154 165 South 103 112 122 132 142 152 161 West 92 101 110 119 128 137 146 Total 382 421 459 497 535 573 612 *Virtual equivalent provided by Beacon (was 8 in 2006) Local demand for services has led to the expansion of many services. Certain specialities manage patients who are at an increased risk of developing renal disease. Chief among these are Diabetes/ Endocrinology, Geriatric Medicine, Cardiology, Vascular Surgery, Cardiac Surgery, Urology, Rheumatology, Haematology/Oncology and Genito-Urinary Medicine. In all of the specialities mentioned above, there has been an increase in consultant numbers (in some a 400% increase!) in the past 10 years. While these developments have improved patient survival, it has also increased the need for specialist renal input and for dialysis provision. It is recognised that expansion of renal services will leads to demands on other medical specialities. Other disease processes almost always complicate renal failure either due to the underlying disease (e.g. diabetes) or as a consequence of renal failure itself such as ischaemic heart disease and peripheral vascular disease. An ESKD program placed demands on Urology, Vascular Surgery, Radiology, and Laboratory Medicine. Most patients spend 10 -15 days as inpatients per year. An initiative to identify and prospectively manage patients with renal failure in SJH has been in place since 2002. Screening has identified >600 patients with significant renal failure (stage 3). Currently (2007) 245 patients are attending SJH with severe renal failure (stage 4 or 5), of which at least 100 are likely to require dialysis within 2-3 years. A similar project in AMNCH was recently commenced concentrating on stage 4/5 only due to the larger numbers. Already 372 patients are being monitored with 24 already being worked up for pre-emptive renal transplant. Typically, each year 40-50 patients commence chronic dialysis. Losses to transplantation and death has resulted in a net increase in dialysis number of 10-15 patients per annum. These receive their dialysis in Beacon (35) or Tallaght (100 which is over maximal capacity) with 56 on peritoneal dialysis UNIT ACTIVITY Unit activity in 2007 was 11,625 OPD haemodialysis sessions in Tallaght, 4723 OPD haemodialysis sessions in Beacon Renal, and 1,800 inpatient sessions. 28
  • 29. The total number of dialysis sessions (in & out patients) in 1999 was 5,574. CAPTIAL REQUIREMENTS The following Capital elements are required. Some are in situ or can be adapted;.  Chronic dialysis unit(s) for well out patients- between 40 - 60 stations are required o This would set out in a number of bays with 3 / 4 stations per bay, with appropriate hand washing and isolation facilities in each bay.  Dialysis machines, water treatment plant, dialysis machine maintenance workshop and Hepatitis dialysis machine storage area.  Appropriate IT systems to monitor dialysis treatments and provide adequate documentation in case of look back requirements for Blood Borne Viruses  Appropriate office space to accommodate the staff employed to run the service  Staffing as per national recommended guidelines. (appendix 1) AMNCH can provide the remaining elements  8-single bedded acute dialysis isolation unit – for acutely ill inpatients, and with patients with blood borne viruses (Hepatitis B, Hepatitis C or HIV) o The current unit can be reconfigured to an 8 station acute dialysis unit.  Dedicated Out-Patient/Day ward treatment area for dialysis related complications (In situ)  A 35 bed inpatient ward in close proximity to the acute dialysis unit for inpatient care. These need to be ring fenced to support the proposed the regional Renal Medicine Clinical Network. (In situ but beds are not protected)  A CAPD Treatment area. – This is to provide outpatient care for patients on peritoneal dialysis. (In Situ) This will allow a total of between 240 – 300 patients to receive dialysis This will require approximately 3,000m2 to accommodate the above and assumes a new build for the chronic unit. This can be physically separate from the inpatient treatment and/or acute dialysis unit. A two phase or two site approach to utilisation could be employed, i.e. additional stations would open when the number on dialysis warrants such expansion. Access to the facility is required by car and taxi, as many patients are not very mobile. Parking facilities will be required for patients who use their own transport. The dialysis company typically deliver consumables directly once- twice weekly and will need a service entrance. RECOMMENDATIONS: In order to address the capacity shortfall for renal patients in AMNCH the following are recommended. 1. The HSE should immediately tender for the provision of a satellite 29
  • 30. dialysis unit of 16-20 stations in Kildare/Naas. This will accommodate 64 patients (2 shifts) and could immediately facilitate the 38 patients from Kildare to have their treatment locally. Options include use of the existing hospital in Naas stations or allowing the private sector to find a suitable location & secure planning permission (preference for the former). The viability of tendering for this facility on the grounds of Naas hospital is currently being examined by the network. 2. In parallel with this AMNCH needs to embark on an expansion of the existing chronic dialysis facility which would be the main chronic renal facility for the South West Dublin Area. This could be on site or in the immediate vicinity of the hospital. In order to accommodate growth the unit should provide 30 stations. AMNCH are to consider this further in line with the hospital development control plan which is currently being reviewed. There are options to include this unit (which could be a public or privately provided facility) as part of capital expansion programmes which are currently underway. Should this be a commercial unit the existing tender specifications could be used & the tender run by AMNCH itself or by the HSE. 3. The existing dialysis unit should be converted to an acute renal unit with 8 renal stations which would serve as the regional dialysis centre. 4. Further discussions are being progressed to establish a south Dublin dept of renal medicine which would incorporate SVUH, AMNCH, and all associated satellite units. 5. The establishment of a renal south Dublin department/division of renal medicine would provide an appropriate opportunity to address the governance issues relating to Beacon 6. AMNCH should be the regional centre for provision of vascular access for the Dublin Mid Leinster area 7. On an immediate basis additional capacity may be required in the commercial sector pending local expansion 8. Consideration must be given to addressing staffing needs in terms of nephrologist, clinical nurse specialists and dietetic support for both AMNCH as a parent renal unit and the supporting satellite units. 9. Posts of CNSs for management of early kidney disease, dialysis access and vaccinations needs to be prioritised. 30
  • 31. Appendix 5 – Strategic Plan – Trinity College Dublin http://www.tcd.ie/about/content/pdf/TCDStrategicPlan2006_English.pdf The current Strategic plan for the School of Medicine is available via the following link http://www.medicine.tcd.ie/about/strategicplan/FINAL_School_Of_Medicine_Str ategic_Plan.pdf 31
  • 32. Appendix 6 Staff List Head of School and Vice-Provost for Medical Affairs 1.2.06 Dermot Patrick Alfred Kelleher, B.A., M.D., F.R.C.P.I., F.T.C.D. (2004) (first term expires 2009) Professor of Academic Medicine/Director of Teaching and Learning (Undergraduate) (2005-10) Shaun Richard McCann, M.B. (N.U.I.), F.R.C.PATH., F.R.C.P.I., F.R.C.P.ED., HON. F.T.C.D. Director of Teaching and Learning (Postgraduate) (2008-11) Thomas Joseph Connor, B.SC. (N.U.I.), M.A., PH.D. (N.U.I.), F.T.C.D. (2007) Director of Research (2008-10) Aiden Corvin, M.B. (N.U.I.), PH.D., M.R.C.PSYCH. School Administrator 1.12.05 Fedelma McNamara, B.B.S. (LIMERICK) Nephrology Senior Lecturer in Nephrology 1.10.02 * George Joseph Mellotte, M.B. (N.U.I.), M.SC. (LOND.), M.R.C.P.I. Neurology Clinical Professor of Neurology 1.1.07 * Orla Hardiman, B.SC. (N.U.I.), M.B. (N.U.I.), M.D. (N.U.I.), F.R.C.P.I. Senior Lecturer in Neurology 1.10.98 * Raymond Murphy, B.A., M.B., M.R.C.P.I. Clinical Senior Lecturer in Neurology 1.10.07 * Dominick McCabe, M.B. (N.U.I.), PH.D. (LOND.), F.R.C.P.I. Lecturers in Neurology 1.10.92 * Janice Redmond, M.D. (N.U.I.), DIPL.A.B.P.N., DIPL.A.B.E.M., F.A.C.P., M.R.C.P.I. 1.8.05 * Colin Doherty, M.B. (N.U.I.), M.D. (N.U.I.), M.R.C.P.I. 1.2.07 * Ronan Walsh, M.B. (N.U.I.), F.R.C.P.CAN., M.R.C.P.I. 32
  • 33. Appendix 7 Draft Consultants’ Contract Table of Contents Preamble ...................................................................................................................... 34 Section A - Terms and Conditions ............................................................................ 35 1) Core Principles ................................................................................................................ 35 2) Appointment and tenure .................................................................................................. 35 3) Probation ......................................................................................................................... 36 4) Mutual Obligations ......................................................................................................... 37 5) Contract designation ....................................................................................................... 37 6) Reporting relationship ..................................................................................................... 37 7) Hours of work ................................................................................................................. 38 8) Location and Residence .................................................................................................. 39 9) Scope of post ................................................................................................................... 39 10) Role of Consultant ..................................................................................................... 40 11) Professional Competence ........................................................................................... 41 12) Standard Duties and responsibilities ......................................................................... 41 13) Intellectual Property ................................................................................................... 42 14) Medical Education, Training and Research ............................................................... 42 15) Provisions specific to Academic Consultants ............................................................ 43 16) Advocacy ................................................................................................................... 45 17) Consultative structures ............................................................................................... 45 18) Leave, holidays and rest days ..................................................................................... 45 19) Locum Cover............................................................................................................... 47 20) Regulation of private practice ................................................................................... 48 21) Contract Type .............................................................................................................. 48 22) Change in Contract Type ............................................................................................ 53 23) Salary and other payments .......................................................................................... 54 24) Superannuation............................................................................................................ 56 25) Confidentiality ............................................................................................................ 57 26) Records / Property ....................................................................................................... 57 27) Clinical Indemnity....................................................................................................... 57 28) Grievance and Disputes Procedure ............................................................................. 58 29) Role of Review Body on Higher Remuneration ......................................................... 59 30) Conflict of Interest / Ethics in Public Office ............................................................... 59 31) Review by Employers and medical organisations....................................................... 61 32) Acceptance of Contract ............................................................................................... 61 Section B – Appendices .............................................................................................. 63 Appendix I – HSE Letter of Approval ..................................................................................... 63 Appendix II – Disciplinary Procedure ..................................................................................... 64 Appendix III – Clinical Directorate Service Plan .................................................................... 74 Appendix IV – Clinical Director Appointment and Profile ..................................................... 77 Appendix V – Extracts from Consultants Contract 1997 ......................................................... 80 Appendix VI – Granting of Sick Leave ................................................................................... 81 Appendix VII – Correspondence between the parties .............................................................. 83 Appendix VIII – Special leave provisions for Consultants in non-HSE employment ............. 86 Appendix IX – Committees to advise HSE on Consultant Applications ................................. 87 33
  • 34. 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. 34
  • 35. 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 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 XXXXXXXXXXXX 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 1. 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 appointment2 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). f) If the Consultant wishes to terminate this employment (s)he shall provide the Employer(s) with 3 months notice of his/her proposed termination date. g) Except in cases of serious misconduct, the Employer will provide the Consultant 35
  • 36. with 3 months notice of the intention to terminate his or her employment. 3) Probation a) Appointment to a Consultant post 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. 2 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 is expected from Consultants in the same specialty who have a full-time commitment to one employer. 36
  • 37. g) During the probationary period, the probationary Consultant will be subject to ongoing review and a formal review will take place not more than 6 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 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 XXX 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: 37
  • 38. i) to the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) through his/her Clinical Director3 (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). 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 8 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 5 hours on a Saturday and / or 5 hours overtime on a Sunday and / or 5 hours on a public holiday. Consultants on onerous on-call rosters4 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. 3 Details of the Appointment and Profile of the Clinical Director are contained in Appendix IV 4 Only on-call rosters of 1:4, 1:3, 1:2 or 1:1 are regarded as onerous. 38
  • 39. 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. 8) Location and Residence The Consultant‟s appointment shall be to the XXXXXXXXXXXXXXXX a) 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 1 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. 39
  • 40. 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. 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 40
  • 41. 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. 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 5 and in line with policies as specified by the Employer. 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. 41
  • 42. 5 A sample Clinical Directorate Service Plan is attached at Appendix III. Appendix VII also refers. 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 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 practice6. 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. 6 e.g. the National Code of Practice for Managing 42
  • 43. 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). 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 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 training7. These structured commitments shall be set out in the Clinical Directorate Service Plan. 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 8 and are additional and particular to Academic Consultants. b) Academic Consultant posts are joint appointments between Universities9 and the HSE or its funded agencies. They are structured to ensure a minimum 50% commitment to the academic institution. 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 10, where: „Training Principles to be incorporated into new 7 working arrangements for doctors in training‟, published by the Medical Education and Training Group, July 2004. 43
  • 44. 8And previously Comhairle na nOspidéal. 9For the purposes of this document the term „University‟ shall include the Royal College of Surgeons in Ireland. 10 Structured Academic Consultant posts will have a minimum 30% commitment to the Academic Institution. 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% is required for the appointee to maintain the required skills and competencies and/or ii) the academic department does not require an individual structured commitment of 50% to deliver its teaching and research programmes. 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 unit11. 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 44
  • 45. are recognised. 11 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. 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. 45
  • 46. 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 (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. 46
  • 47. 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 5 days in lieu per 4 week period; (2) 1 : 2 on-call roster entitles the Consultant to 3 days in lieu per 4 week period; (3) 1 : 3 on-call roster entitles the Consultant to 2 days in lieu per 4 week period; (4) 1 : 4 on-call roster entitles the Consultant to 1 day in lieu per 4 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. 47
  • 48. 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 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% 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 3 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 48
  • 49. 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 bodies12, medical/dental education and training bodies 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. 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 t o 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 199713; 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% 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 12 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 13 Sections 2.9.4 to 2.9.7 inclusive of the Memorandum of Agreement attached to 49
  • 50. the Consultants Contract 1997 refer. These are attached at Appendix V. 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%. 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. 50
  • 51. c) A Consultant holding Contract Type B* 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), 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% 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) 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%. 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. 51
  • 52. 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 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% of the Consultant‟s clinical workload in any of his or h er 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%. 52
  • 53. e) 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. 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 Advisor y Committee14 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. 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 15) or where the volume of private practice is significantly below 20% 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 5 year period. 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 holding B*, Type C and Category 2 Contracts will be subject to an upper limit 14 Please refer to Appendix IX 15 Please refer to Section 8 53
  • 54. 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 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. 23) Salary and other payments a) 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 b) All serving Consultants who take up the offer of the Consultant Contract 2008 by [date] will be assimilated to the maximum point of the applicable new salary scale. c) The salary scales at above will be phased on the following basis: i) half the balance 16 from 1 st January 2009 ii) the remaining balance from 1st June 2009. These rates will attract a 2.5% Towards 2016 general round increase from the 1st of March 2008 and a further 2.5% 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: 54
  • 55. Structured on-site attendance at weekends and on public holidays will be subject to the following premium payments: i) Time + 1/2 on Saturdays ii) Double time on Sundays and Public Holidays g) Continuing Medical Education The CME allowance will be increased to €3,000 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 (C.P.I.). 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 the 1st June 2008. The payments for more onerous rosters will increase by 5% from the same date. j) C Factor (Call-Out) Payments The Consultant will be eligible for payment on a per call-out basis 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 The term „half the balance‟ refers to the difference between the 14 th September 16 2007 rate and the fully implemented salary scale. 55
  • 56. 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. Revised structures and rates for C Factor payments from the 1st June 2008 are as follows: First 31-120 121 Call-Outs 30 Call- Call-Outs or More Per Call-Out (Hourly Outs €100 €150 €200 rate or part thereof): If Call-Out Occurs After Midnight €125 €187.50 €250 (hourly rate or part thereof): Annual limit €30,000 With the exception of the payments referred to at sub-paragraphs g) and h) above the foregoing rates will be increased in line with general round increases under National Pay Agreements. 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. 56
  • 57. 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 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. 57
  • 58. 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 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 6 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 4 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; 58
  • 59. 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 A list of Mediators/Adjudicators have been agreed between the parties as suitable nominees for appointment in any individual case17. 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. f) Review The parties agree that the Grievance and Disputes procedure shall be reviewed within 2 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. These are available from the HSE Employers Agency 17 at 63-64, Adelaide Road, Dublin 2, tel: 01 6626966. web: www.hseea.ie 59
  • 60. c) Should you occupy a designated position of employment18 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. 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 month s 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 2 5(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 9 months before or after the date of your appointment or ii. an Application Statement issued by the Collector-General not more than 9 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 http://www.sipo.gov.ie/ . 18 Applicable to those employees in public service whose remuneration is not less than the lowest remuneration for a Deputy Secretary in the Civil Service, i.e. €168,992 as at 14th September 2007. 60
  • 61. 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 the University of Dublin, Trinity College and 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 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): XXXXXXXXXXXX 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. 61
  • 62. v. I have read this document and I hereby accept the post of XXXXXX in accordance with the terms and conditions specified and I undertake to commence duty on 1st January 2009: Name (Block Capitals): XXXXXXXXXXXXX Signature of Consultant: ______________________________ Date: ______________________________ Employer (Block Capitals): XXXXXXXXXXXXXXXXXX Signature on behalf of Employer: Date: Employer (Block Capitals): XXXXXXXXXXXXXXXXX Signature on behalf of Employer: Date: 62
  • 63. Section B – Appendices Appendix I – HSE Letter of Approval 63
  • 64. 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 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. 64
  • 65. 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 time scale 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 management19. Appeals must be made in writing setting out the grounds for appeal within 14 working days of the Consultant being notified of the decision. Stage 2 Written Warning 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 time scale for improvement. The Consultant will also be advised that failure to improve within the agreed time scale 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. 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 19Appeals will be to the Assistant National Director, NHO / National Director PCCC / CEO of the HSE-funded Agency, as appropriate. 65
  • 66. 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. 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: 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) 20. Note: The above list is not exhaustive. 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: This would only arise where a complaint has been upheld following an investigation 20 under the Trust in Care policy 66
  • 67. 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 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 t o 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. 67
  • 68. 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 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. 68
  • 69. 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 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. 69
  • 70. 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 wi thout inordinate delay; The investigation will be carried out in strict accordance with 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, e.g. o Details of alleged misconduct. o Witness statements (if any). o Minutes of any interviews held with witnesses. o 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. 70
  • 71. • 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. 71
  • 72. 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 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: o Corporate level: As part of the overall Service Plan of the organisation. Set at high level. Progressed and reported on quarterly. o 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, 72
  • 73. o Quantifies the total resources available to the Directorate for the forthcoming year / month o Specifies services to be delivered through these resources in quantity and qualitative terms by the Directorate on an annual / monthly basis o 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 o 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 attached. 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: o Directorate o S peci alt y o Consultant Sample outline of a performance report is attached. 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. 73
  • 74. Clinical Directorate Plan Consultant Assignment Schedule: Month: Clinical Directorate Work Schedule – Location and Activity Medical Ward Quality Education CME / Absen O Rounds / Theatre & Risk Training Statutory CPD Service P Inpatient / Day On- (incl. ce / and (protected Commitment D Theatre call Audit) Research Commitment leave care time) Day of Am month 1st Pm Am 2nd Pm Am 3rd Pm Am 4th Pm Am 5th Pm Am 6th Pm Am 7th Pm Am 8th Pm Am 9th Pm Am 10th Pm Am 11th P m Am Etc. Pm 74
  • 75. Consultant Work Schedule – Month Medical Ward Quality Education CME / Absen O Rounds / Theatre & Risk Training Statutory CPD Service P Inpatient / Day On- (incl. ce / and (protected Commitment D Theatre call Audit) Research Commitment leave care time) Day of month Am 1st Pm Am 2nd Pm Am 3rd Pm Am 4th Pm Am 5th Pm Am 6th Pm Am 7th Pm Am 8th Pm Am 9th Pm Am 10th Pm A m 11th Pm Am Etc. Pm 75
  • 76. Performance Report – at Directorate, specialty / sub-specialty and Consultant level Planned vs. Actual (month) Planned Actual Areas of Focus Public Private Total Public Private Total In-Patient Measures Day Patient Measures Out-Patient Measures Ed Measures Other Measures Quality Performance Indicators Corporate Management Operational ........ . ........ . Clinical (including outcomes) 76
  • 77. 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 in the eligible Consultant grouping b) All applicants are interviewed c) Interview panel to comprise: i) Chair ii) 2 x management / board representatives iii) 2 x 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. 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. 77
  • 78. 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. 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. 78
  • 79. 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 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. 79
  • 80. 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 extend beyond consul tation, 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.” 80
  • 81. 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. 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 81
  • 82. 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) / 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. 82
  • 83. Appendix VII – Correspondence between the parties The following correspondence is incorporated into this contract as noted in the preamble: “Irish Hospital Consultants Association & Irish Medical Organisation 25 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 16 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 83
  • 84. 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 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% 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 1 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. 84
  • 85. 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”. Practice Plans/Service Plans Consistent with Mark Connaughton‟s letter dated 2 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” 85
  • 86. Appendix VIII – Special leave provisions for Consultants in non- HSE employment These provisions are in addition to those set out in Section 18 (i). 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 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). 86
  • 87. Appendix IX – Committees to advise HSE on Consultant Applications Health Service Executive Consultant Applications Advisory Committee 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 and 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) 2 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. Modus It is envisaged that the CAAC will meet every 2 months, or more often as Operandi 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 87
  • 88. 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 & 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. (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 The CAAC will be supported by the officials of the Consultant Support Appointments Unit (CAU). Term The CAAC will be appointed for an initial period of one year. 88
  • 89. Type C Consultant Posts Establishment process 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. 2. Establishment process 2.1 Application process Applications for Consultant posts are generated through the pertinent hospital / network / PCCC agency / area in the prescribed format. o The applicant organisation is required to specify its proposed post type (A, B or C) in its related submission. o 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; 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. 89
  • 90. 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: o Chairperson; o HSE Corporate; o DoHC; o Public voluntary agencies; o Members of the public; o 1 representative of the Irish Hospital Consultants Association; o 1 representative of the Irish Medical Organisation. 90
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