RTÉ Investigates has found a failure by the HSE and hospital managements to properly implement the 2008 Hospital Consultants' Contract across acute public hospitals.

In one case a consultant observed for eight weeks was working less than 13 hours per week on average in the public system.

Just over 2,700 consultants work in 47 acute public hospitals across the country.

As well as being full-time HSE consultants, they are also, very unusually for a public system, permitted to do extra paid private work within public hospitals. On top of that, some consultants are also entitled to work in other private hospitals and clinics.

The 2008 contract provided significant pay increases to consultants in return for agreeing to limit their private practice. Under the deal, most consultants are contracted to work between 37 and 39 hours per week in the public system.

RTÉ Investigates research shows that failure to enforce the contract is resulting in 14 out of the 47 acute public hospitals exceeding the 20% limit at the expense of public patients. 

Salaries range from €113,000 to €229,000, which is before on-call and other allowances are added.

In the main, consultants and the hospital they work in are supposed to adhere to an 80% public patient and 20% private patient breakdown.

However, RTÉ Investigates research shows that failure to enforce the contract is resulting in 14 out of the 47 acute public hospitals exceeding the 20% limit at the expense of public patients. 

The figures nationally show the 80/20 ratio is being met, however, these figures mask the fact that the ratio target is only being met because some hospitals do exceptionally well when it comes to public patients and carry out very little private work. 

But, when it comes to regional hospitals it is a different story. A sizeable number of regional hospitals are significantly off target and this is having an impact on public patients.

Data obtained by RTÉ Investigates also found while some hospitals were compliant with the public-private mix, individual departments within these hospitals exceeded the 20% private ratio.

All in all, this meant in 2015, the number of private patients treated in these public hospitals in excess of the 20% private ratio was more than 19,500.

Last year, the excess number increased to almost 24,000, which is a total of more than 43,500 public patients on waiting lists that lost out to private patients in the two-year period.

Under Freedom of Information, for the first time RTÉ gained access to the HSE's information on consultants' contract types.

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Previously, the HSE routinely published data on compliance with private practice limits, however, when RTÉ Investigates sought the latest figures the HSE said it no longer kept national figures. It said in 2014 it stopped gathering the national information outright.

Until now there has been no information available about how many consultants work solely with public patients and how many there are on different contract types.

Under Freedom of Information, for the first time RTÉ gained access to the HSE's information on consultants' contract types.

At the time of its introduction the 2008 contract promised an increase in the number of consultants treating public patients only.

However, that has not turned out to be the case. RTÉ Investigates obtained data from the HSE that shows only 6% of all consultants treat public patients only - on a type A contract.

The HSE Information also shows that 66% of all consultants are on what is known as 'Type B' contracts. Under the contract, they were granted increases in salary for limiting the amount of private work they do. Crucially, the HSE expected this private work to be done in public hospitals or rooms close by.

RTÉ Investigates research also found that some of these HSE consultants are working in private hospitals away from the public hospitals they are contracted to, again at the expense of public patients.

In one case a consultant RTÉ Investigates observed for eight weeks was working less than 13 hours per week on average in the public system.

The programme found almost one in three of these consultants advertising their services in private facilities, either in consultant-owned private clinics on campus or other private hospitals many kilometres away.

Another group of consultants on more flexible contracts – Type B, C and Category 2 consultants - are permitted to work in private facilities on the strict basis they complete their contracted public hours over a minimum four days per week.

The programme found a number of these consultants doing a level of private work that meant that they were working significantly fewer hours at public hospitals than they were contracted to do, while still being paid a full-time salary for their public work.

Consultants give too much time to private patients

In one case, a consultant RTÉ Investigates observed for eight weeks was working less than 13 hours per week on average in the public system.

He was contracted to work 37 hours per week, but instead of working eight weeks, this consultant worked the equivalent of just three weeks.

Based on HSE salary scales, over the eight weeks it is estimated that this consultant was paid more than €14,000 for work he did not do.

The loss to the public hospital of absent consultants is not just financial.

It is also a loss in terms of patient care and hospital efficiency, when trainee doctors make important patient decisions. Unsupervised junior doctors seeing outpatients often leave patients on waiting lists even longer than is necessary.

RTÉ Investigates put its findings to Annette Schreiner, a former NHS Medical Director, and Sam Leinster, a former NHS Consultant Surgeon.

An orthopaedic consultant observed over an eight-week period worked an average 23.5 hours a week in the public system when he was contracted to work 39 hours per week.

During the same period, he worked an average 25 hours per week in a private hospital.

This means that instead of working eight weeks he is paid for at the public hospital, he worked the equivalent of just five weeks.

Another consultant observed for eight weeks, this time specialising in ear, nose and throat, worked an average 14 hours at the public hospital.

This resulted in a weekly loss of nearly 24-and-a-half hours to the public hospital system.

This means this consultant worked the equivalent of three of his eight weeks.

Once a month this consultant failed to attend his public outpatient clinic, when he was seeing private patients in a private hospital in a different city.

Based on HSE salary scales, over the eight-week period it is estimated this consultant was paid €14,921.56 for work he did not do.

RTÉ Investigates put its findings to the HSE. The National Director of Hospitals Liam Woods said that "many consultants work beyond their contracted hours".

He also said the contract makes "no provision for the monitoring of off-site private practice work" by consultants.

In a statement, the Irish Hospital Consultants Association (IHCA) said that it "can confidently state that the overwhelming majority of consultants are working well beyond their contracted hours in an effort to provide care for patients in an under resourced health care system.

"The IHCA President, Dr Thomas Ryan, said that each year hospital consultants throughout the country treat a quarter of a million more patients compared with a decade ago, despite the fact hospitals now have 12% fewer in-patient beds."