Sir, – Your article on the crisis in the emergency department at University Hospital Limerick (UHL) quotes the Minister for Health as having said that the nurses and doctors need the support of hospital consultants and that the consultants need to have a greater presence in the emergency department (“Consultants need to be more visible in Limerick’s ED to tackle trolley crisis, Donnelly says”, News, April 5th).
This statement by the Minister paints a picture of consultants sitting in their smoking jackets at their club puffing on Cuban cigars and sipping a glass of port while chaos prevails at the emergency department. It is a portrayal that suits the Minister’s position but is far from the truth. A consultant friend tells me that he is currently expected to attend emergencies at night, and occasionally all night long, while he must also present himself for a full day’s work the next day.
Instead of publicly criticising his own employees, perhaps the Minister might look instead at the record of his predecessors. The current crisis at UHL represents a collective failure by many previous health ministers to negotiate suitable contracts for senior doctors to staff emergency departments on a 24/7 basis. It is hard to believe that such a contract wasn’t negotiated by health ministers 20 or 30 years ago when emergency departments first became swamped with work. – Yours, etc,
PAVEL MARIANSKI,
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Dungarvan,
Co Waterford.
Sir, – Interviewed in The Irish Times, Prof John Crown recently compared medical consultants with bar men. Those on the new public-only contract are analogous to staff paid a fixed hourly rate, while those with scope to treat patients privately were imagined in contrast to ones paid per drink served, in his analogy. The question arises as to which type would serve the most drinks (“I paid my dues in the public system”, Health, March 23rd). He described optimism about a new public-only contract as “panacea-thinking on steroids”. It’s hard to think of a more seasoned analyst of the realpolitik of Irish life and healthcare than the former senator and medical oncologist. If you were forced to try, though, a candidate might be Alan Dukes, a former party leader and government minister who held multiple portfolios from his mid-thirties. He recently (Letters, March 28th) described Sláintecare as “a utopian project” and expressed a lack of surprise at how some appointed to implement it have been “overwhelmed by the task”. Against such recent comments it is notable that Minister for Health Stephen Donnelly cites low “uptakes of the new consultant contract” and a “lack of weekend discharges” as factors underpinning chaos in Limerick hospital which he visited this week. It’s worth stating that the previous 2008 contract allowed weekend rostering, which I have myself have adhered to for about 10 years, as “structured on-site attendance”. Why a new one might be necessary to adequately staff weekend days is unclear, to me at least.
It appears difficult to reconcile these radically different views on, and expectations of, this new contract. Personal experience tells me that many colleagues are keen to sign it, though reasons proffered so far have not generally involved working much harder. Few people within the system expect it to increase productivity and, so far as I’ve heard, no one can explain how it might. The evidence of so many areas – from healthcare in terms of time taken to build hospitals or deal with waiting lists, in education, in transport or contrasting the Aer Lingus of my childhood with its current incarnation – is that, whatever wishful thinking might tempt us, privatised systems give better value and outcomes.
For all the verbal reference to evidence-based practice, it seems that in this area we are doomed to plough ever more money into a system with fewer incentives, and hope for a different result. – Yours, etc,
BRIAN O’BRIEN,
Kinsale,
Co Cork.