IRISH hospital consultants, the Health Service Executive and the Department of Health have been at loggerheads for so long that it's hard to remember a time when they weren't. Two years later we're still reading about consultant talks that keep starting and stopping, before starting again.

The consultants have been a thorn in Harney's side since she took office in 2004, but will she really manage to impose contracts on them before her time is up, or is this row set to rumble on for another dreary era?

WHY CAN'T THEY ALL GET ALONG?

Since 1981, the majority of consultants have been working under contracts (known as category II) that allow them to hold a full-time job in a public hospital, working 33 hours a week, while also treating private patients, often in a clinic on the public hospital site. This happy (for them) situation continued until 2003, when the Brennan report into financial management and controls in the health system was released.

In her report, Professor Niamh Brennan revealed that the consultants' contracts contained "shocking" weaknesses that allowed them to pocket an average of Euro152,000 a year for work on public patients while delegating the work to a junior. Brennan also found that consultants were earning an additional Euro127,000 for treating private patients.

Upon Harney's appointment as minister for health in 2004, she made it clear that reforming the consultants' contracts was going to be her top priority. But the Irish Hospital Consultants' Association (IHCA) and the Irish Medical Organisation (IMO) have remained firmly opposed to change.

Discussions have been underway since November 2005, but the talks have been characterised by chronic delays and breakdowns. Civilities finally ground to a halt this time last year when Harney announced outright that the HSE was going to scrap category II contracts. Since then, the IHCA and IMO have remained defiant and nothing has been achieved.

WHAT PRICE A NEW CONTRACT?

Harney started playing hardball last week when she announced that she wants to start recruiting 1,500 new consultants immediately to the health service and is planning to bring an outline timetable and timeframe for the plan to cabinet next Tuesday.

The minister initially plans to advertise internationally for two or three hundred consultants in a number of specialty areas and to offer a single basic contract with two manifestations.

The first type of contract would see the consultant employed exclusively in the public services. This means they would devote their time entirely to public patients and would be excluded from treating private patients. As a sweetener, however, they would be offered an annual salary of up to Euro240,000 with a possible 20% bonus. Not bad for a year's work.

The second contract would allow doctors to carry on seeing fee-paying patients in the public hospital or in co-located private hospitals on the campus. The sting in the tail is that there would be monitoring to ensure that public work is carried out and it is likely that their private practice could be curtailed somewhat. This is something the consultants are absolutely against.

Gerard Barry, CEO of the HSE Employers' Agency, said the current situation is "the equivalent in educational terms of a secondary school teacher who's paid by the state being able to leave the classroom during the day to go down the road and give private tuition in a private school, for which he'd also be paid."

In their defence, consultants say the government are reneging on a deal by threatening to abolish category II contracts and that the health service is in such a shambles that it is hardly in a position to start recruiting.

"There is absolutely no evidence of consultants failing to discharge their public commitments while they have private-practice commitments within the hospital or elsewhere, " maintained Fintan Hourihan, IMO's director of industrial relations.

WHY THE OBSESSION WITH 'UNCONDITIONAL?'

This unhappy row re-entered the public arena at the end of last month when independent chairman of the talks, barrister Mark Connaughton, sent a withering report to all parties describing his utter frustration at the lack of progress made in the past number of months.

The only surprise was that his resignation wasn't included at the end of it.

Connaughton reported, "Discussions never got off the ground because of the issue of private practice, " and advised that the only way talks could continue was if everyone could agree to "unconditional negotiations."

In other words, the abolition of Category II would have to be temporarily left aside by the HSE before they re-entered talks, while the doctors would have to get over the "breach of trust" they feel they have suffered at the hands of the HSE.

The IHCA promptly called an extraordinary general meeting in which they voted no confidence in the HSE, but decided to go back into talks once pre-conditions were removed.

"We want to explore what type of contracts, what range of contracts, what flexibility of contracts will provide the best care for the patients and people of this country, which we do not feel we are getting at this time, " said Mary McCaffrey, president of the IHCA.

The IMO concurred and eventually, just last Thursday, the HSE announced they would enter into talks unconditionally and for a defined period. Harney still intends to bring her proposals to cabinet however, and there's another problem.

No one has really defined what 'unconditional' means and everyone has their own definition of it. And so it has been predicted that everyone is likely to be subjected to preliminary talks before the actual talks can take place. Progress.

POLITICAL DIVISION?

It has become clear that Harney is determined to achieve one real success from her somewhat difficult stint as minister for health and that this is going to be the consultants' contract - an issue on which she knows has the support of the general public.

"I am not prepared to let fruitless discussions drag on without results, " she said, in response to the chairman's report, indicating that she would leave negotiations behind if she had to.

Unfortunately, Taoiseach Bertie Ahern didn't have quite the same view and his rebuke that "you never negotiate that way" was picked up nationally.

Labour health spokeswoman Liz McManus said she feels the government have handled the situation extremely badly. "This is a real opportunity to put private and public patients on an even footing but, regrettably, the government is choosing not to do that, " she said.

Fine Gael, however, have been largely supportive of Harney's policies, although Health spokesman Liam Twomey threw doubt on whether the minister is just making more empty threats. "The last time Harney threatened to impose contracts on the consultants, she didn't follow through, " he said.

Despite political opposition, Harney knows she could be on to a winner if this issue can be resolved on her terms.

WHERE TO FROM HERE?

The consultants say they will not bow under threats from the HSE to impose new contracts on them. Threats made by justice minister Michael McDowell to introduce legislation rather than have the government "mud-wrestled into submission, " have a hollow sound, given that such legislation would certainly be challenged in the High Court.

Everyone agrees that imposed contracts cannot be successful, nor will they be in the interest of the patients, who, after all, this issue is supposed to be about. Consultants may be losing the popularity contest, but with an average salary of Euro280,000 a year, they're not exactly crying into their chips.

Harney's ministerial egg-timer is running out, and if the issue cannot be resolved before then, when will it be? Two years since this row began, next to nothing has been achieved. It is debatable how much progress can be made in three short months.