Heart Beat: I listened with interest to our new Minister of Health on RTÉ Radio 1. She said she was committed to ending the situation whereby patients spent a long time on trolleys in A&E departments in our hospitals prior to admission, and she referred to waiting times of 12 to 14 hours. She said unfortunately that was the situation today. It is even worse than that Minister. Patients have spent days on trolleys in very adverse circumstances, writes Dr Maurice Neligan
Angels and Ministers of grace defend us!
Be thou a spirit of health or goblin damn'd? - Hamlet
I welcome your commitment and also your statement that in approaching your new portfolio you will not be driven by any fixed ideology and will seek practical means to ensure that everyone gets the service they require. As you know, there are no quick and easy answers here and facile solutions such as the National Treatment Purchase Fund only camouflage the underlying decay.
Similarly, the unchecked and unregulated development of private hospitals shielded by tax breaks will not solve our problems either. Private hospitals are for profit, somebody's profit. That is not necessarily a bad thing as it leads to tight control and efficiency - features clearly missing in our current public service.
Equally clearly, however, the private system does not welcome the long stay and chronic cases, the problems of substance abuse and dependency, stroke and rehabilitation, and long-term medical illness. Rather it picks the more lucrative surgical options with good results and a quick turnover. Unless something can be done about consultant insurance and litigation reform, the private sector will soon be unable to provide an obstetric service. It does not provide an A&E service nor can it do so in the foreseeable future unless the European Working Time Directive (EWTD) is amended.
The drive to privatisation has problems and is developing into a significant political battleground in Britain, where it is supported by the Tories and opposed by the government, and similarly in Australia, where Premier John Howard is in favour of the "public-private mix", and the opposition is vehemently opposed to the break up of the present state system.
I have nothing against private medicine, but if it is there it should be all embracing. Make everybody a private patient through universal insurance, either by personal payment on the part of those who can afford it, and premiums paid by the State for those who cannot. Bring the principles of business management and sound economics into our hospitals and gradually move away from State and political control of the health system. It sounds simple but clearly it is not.
I wish you well Minister, it was a brave decision. You certainly talk the talk and I hope there are enough open-minded people out there to enable you to walk the walk.
I would suggest to you as a retired consultant with no axe to grind, that you forget all the drivel about a consultant-provided service. This exists nowhere in the world nor will it ever. Claptrap like 24/7 means nothing and ignores the fundamental fact that hospitals also sleep at night and that health personnel in all grades need their weekends and a life outside. Emergency services and facilities for even the most complex interventions out of hours if necessary must be available, but common sense and the consideration of limitless expense must be borne in mind.
All consultants in Ireland and similarly developed countries trained up through broadly similar systems and the young doctors of today are doing the same. Just because some people with no hospital experience think that 24/7 consultant-provided will solve everything, let me state categorically it will not. There are always exceptions and A&E services and intensive care are two that spring to mind.
The common contract for consultants is held by many to be a problem. Just why this is so I am not sure. It will be difficult to renegotiate in good faith as it has already been breached unilaterally by your Department in the introduction of enterprise liability.
The experience of consultants in dealing with the Department Of Health and the Health Service Employers Agency has been largely negative. Changing the contract will not solve the real cause of the problems in our hospitals.
There are not enough beds in our system, either acute or step down. Until such time as this is addressed, all else fails. Capacity is the major consideration in an expanding and ageing population and until that is provided, access, let alone equity, will always be a problem.
The EWTD for junior doctors cannot be implemented commensurate with patient safety. The hospitals and doctors say this. Your Department apparently sees no problem. We should be back in Europe asking for health to be excluded from the directive, as is law enforcement and security. Don't tell me that you, as Minister, can work all the hours God sends, 70 to 80 hours a week, and that a junior doctor can work only 58 hours. Heaven forbid Minister, you might make a mistake!
Lastly I hope you will be left alone to draw your own conclusions and formulate your plans. The Taoiseach in a recent article in the Irish Medical Times demands contract accountability. We demand Government accountability. In the terms of the old joke where the patient in the dentist's chair grabs the dentist by a tender part of the anatomy: "Let's not hurt each other."
Dr Maurice Neligan is a cardiac surgeon