Sir, - Like many previous contributors I deplore the frequently facile attempts to incriminate consultants as the major cause of the inadequacies of our current health service. It should be remembered that consultants do not manage the service and they are as frustrated as patients and other hospital staff when recommendations to improve patient care, based on clinical experience, are ignored. to vilify consultants as a group merely allows those really responsible for the deficiencies of our health service to escape censure.
Similarly, to identify private practice as a major issue seems to miss the point. The extent to which private practice exists is largely an indictment of the non-availability of facilities to allow access to an appropriate public service. Certainly it would be desirable to have "public only" consultants as suggested by Ann Bridges (October 13th). She is, however, incorrect in claiming that the reason for their absence is consultant opposition. I was personally refused conversion to "public only" status in the previous consultant contract by the Department of Health, and no such category even exists in the present contract, except where such a status has been carried forward.
It is true that changes are needed in the health service, but those empowered to achieve them need to be aware that such changes must recognise staff as well as patients. Failure to do this could result merely in a further flight of trained staff, due to loss of job satisfaction, as has already occurred in nursing. - Yours, etc.,
John N. Lavan, MD, FRCPI, Consultant Physician in Geriatric Medicine, Killiney,Co Dublin.