The latest 'Mickey Mouse money' offer, to coin a phrase, is for a 216,000 annual salary for those prepared to work only in the public sector on a 39-hour week including some nights, some weekends and the odd bank holiday.

The consultants, of course, have studied diligently from the Bertie Ahern Guide To Getting To The Heart Of The Matter and at this stage have offered so many objections to this new contract that it's hard to remember what it's all about . . .

insisting that when consultants are paid massive salaries from the public purse, they actually work within the public sector.

They maintain their opposition is focused on the potential for the contract to limit their powers of advocacy for patients and undermines their right to blow the whistle on poor practice within the health service. That case is made compellingly by individual doctors who have campaigned for patients' rights and reform of the health service but less so by the medical establishment.

Patients' rights are, of course, central. Mary Harney underlined her commitment to this in the new legislation governing the way doctors are regulated and dealt with when their fitness to practice is called into question. But ultimately patients' rights are being undermined every day as the current employment contracts cement our two-tier health system.

The overall budget for the HSE is now close on 14bn. It is true, as those working within the service argue, we are coming from a position of infrastructural deficit and we have to spend a fortune to catch up. But individual hospitals must work within their allocations, and if they need increases then they must argue their case.

For hospitals to mismanage their budgets and then hurt patients by implementing ill thoughtout cost-cutting measures is intolerable. But it is just as intolerable for hospitals to set a budget, overspend throughout the year and then expect a bail-out from the taxpayer to meet the shortfall.

Minister for finance Brian Cowen warned the Fianna Fail party at its think-in that the surfeit of funding we have enjoyed for the past decade will not be there this year as the tax take from the construction sector shrinks. This is the new reality for us all.