HEART BEAT: In writing this column over the past few weeks, I had moved away from the problems of today and was reminiscing about the passage through medical school, which subsequently landed me where I am now, writes Maurice Neligan.
This autobiographical journey may take a long time and is certain to be interrupted as now by detours in response to events in the medical world and elsewhere. The reason for this week's diversion is a front page headline in the Irish Medical Times of January 23rd this year. "Harney launches fresh attack on doctors," it declaims.
On reading, however, the little part of the Tánaiste, Ms Harney's speech reported, and allowing for the fact that it may be somewhat out of context; there is much good sense in what she is reported as saying.
She called upon politicians, bureaucrats and "vested interests in the medical profession" to step aside and let the people with the expertise and experience get on with reorganising the health service. I quote again from the article, "there is too much bureaucracy in healthcare, far too many administrators and politicians and maybe too few professionals. I think the health service should be run by those who have knowledge, experience and expertise".
At last somebody is talking sense. I would not disagree with any of the above and I do really appreciate the difficulties ahead. I feel similarly that for the reformation or indeed new beginning that is required, much reconsideration of currently held opinions will be necessary. If this can be entered into willingly by all concerned, there may be a glimmer of light ahead.
The worthy people who have advised on the Hanly and Brennan reports are not by any stretch of the imagination medical experts. They do, however, have experience and skills which, married to those possessed by the experienced health professionals, may signal the way forward. This must be in partnership and not in confrontation. Between the aspiration and accomplishment of whatever goals are agreed, there is a lot of heartache and hard work.
What is attempted will be judged by achievement. Does the patient gain by such changes? Are those delivering the service content? Are the tax payers and Government reasonably happy that value for money is being provided? We have arrived at a situation whereby we have a hybrid system. It was not really planned that way; it developed over the years in response to many different problems. It saw the change from a largely voluntary service (often provided by religious orders) to a situation where the State is in control.
Demands, reasonable or not, are incessant and indeed pressure groups and vested interests often rule the roost to the detriment of the weaker groups of society. Certain specialities in medicine are exciting, challenging and dare I say even glamorous. Some are difficult with major problems and scant rewards.
We must develop a system whereby the patient gets to see the doctor promptly and affordably and can then be treated. Money should not be the key to unlock the door to treatment. This is fundamental; everybody should have the right to access the best treatment that can be provided.
Should this system be private or public? Here we have a truth to be grasped that will be unpalatable to some. The fact is that the private hospitals are more efficient and tightly run than the public sector. Please don't tell me that this is not so. I have a long experience of working in both sectors and the public sector badly needs the business planning and best utilisation of manpower that is the norm in the private sector.
That said, we are not comparing like with like and the public sector has to carry burdens the private sector is careful to avoid. Rehabilitation, chronic long-stay illness, alcoholism, mental handicap, psychiatric illness and many others are not attractive in a private sector.
The public sector also provides the training for our nurses and doctors and paramedicals of all kind, many of whom are headhunted into the private sector which has not contributed to the costs of their development. Most obviously too the private hospitals do not run large-scale accident and emergency or trauma units.
The development of more private hospitals usually will do nothing to improve this situation, particularly as there is as yet no body charged with overseeing standards in such institutions. Also the problems facing the principal providers of health insurance in the State will simply be compounded by such a rash of development and may well be unsustainable in the long term.
It must be conceded that without private hospitals the situation in the public sector would be catastrophic. Not alone do 40-45 per cent of the population carry private health insurance, but the State through the National Treatment Purchase Fund chooses to use these hospitals to alleviate the problems of the public sector.
So what do we do? Let us look at the possibility of everybody being a private patient. Those who can afford it pay their own insurance, those who cannot are paid for by the State. Let us also look at modifications of this like the Health Saving Accounts that President Bush signed into law in the US last year. This is where the doctors who know what has to be done interface with those whose different expertise may point the way. More to come, I suspect for a long to come.
mneligan@irish-times.ie
Maurice Neligan recently retired as a leading cardiac surgeon.