Sir, - If consultants responded angrily to "An Unhealthy State" it is because they perceived that it had more to do with attacking them than addressing the problems of the health service.
If there is any doubt about this, readers should look at the allocation of space by Ms Wren in her justification published on Monday. She devotes most of it to renewing her attack on consultants rather than to addressing the root of the problem - the funding and structure of the health service.
The quality of "investigative journalism" which gives unquestioning credence to those who whisper in her ear without providing facts and figures is in serious doubt. The argument that public servants cannot engage in public debate does not wash. By imparting their views to her privately they are engaging in public debate, even if it is at second hand. They and the others who prefer not to articulate and support their views openly are subverting transparent and democratic mechanisms for achieving consensus. As such they deserve contempt. I thought we had left that stage of Irish history behind.
Other intellectually loose practices include the translation of the possible to the actual when, for example, she quotes the Government White Paper on private health insurance; or generalisation from the tiny minority who may neglect their public practice (which the IHCA does not deny or condone) to many, most or even all consultants.
Ms Wren quotes the 1989 Report of the Commission on Health Funding to support her contention that consultants' public commitment is not monitored. Let me quote from the common contract (1997):
"A consultant will supply to his/her employing authority such information on the discharge of his/her scheduled, fixed and flexible sessions as is necessary and reasonable to establish that he/she is fulfilling his/her contractual commitment. The employing authority is entitled to satisfy itself that the agreements referred to in paragraph 3 above are being fulfilled."
This document is readily available. Are your readers being treated to exquisitely selective quotation? When should facts intrude on conspiracy theory?
Another fine example of selective quotation is Ms Wren's reference to the postal survey of NCHDs about the sub-consultant post. "Eight-five per cent of respondents," quoth she, "expressed an interest" in the post. The very next sentence in the article reads: "However, about three-quarters of the respondents would prefer a consultant grade if given the choice." The conclusion is exactly the opposite of that which she wishes to convey to your readers. How can we take such writing seriously?
The IHCA is not and has no desire to be a trade union. We eschew the sanction of strike as it hurts patients more than anyone else.
When Ms Wren quotes me on the risk of exploitation of the proposed Category 3 consultants she is so anxious to score a point that she misses the serious point completely. While non-consultant hospital doctors may or may not be exploited, it is not consultants who are exploiting them but, as the NCHDs' recent industrial action has shown, the Department of Health and its agencies. The IHCA is concerned that potential exploitation is not deliberately built into the system by the creation of category 3 posts by diktat.
IHCA policy is to ensure that, where necessary, patients will be treated out-of-hours by fully trained consultants. Incidentally, this is very often the case at present - a verifiable fact.
Ms Wren is completely wrong when she asserts that the IHCA has rejected rostered shift working. We have clearly stated that where necessary we would be prepared to negotiate changes in the contract to enable this to happen. It was never intended that changes to the Common Contract should be negotiated at the Manpower Forum. Before the final report was agreed it was accepted that changes would be negotiated after the report was published.
What Ms Wren clearly fails to understand is that it is not necessary for all consultants to work shifts on site and that one of the issues to be investigated and agreed is what is required and when. Given the fractionated pattern of delivery of hospital services in Ireland it would be economically impossible to have all specialities rostered on site round the clock even if it were necessary. Her whole treatment of this issue and her repeated incorrect assertions clearly demonstrate the triumph of dogma over reasoned evaluation of the available facts.
She states that a global figure of £110 million was paid by the VHI to consultants last year. I can assert with complete authority that, as a matter of verifiable fact, this figure seriously overstates the amount actually paid out.
Is this series an exercise in serious investigative journalism or is it more to do with tailoring the "facts" to match the prejudice?
Does Ms Wren realise that if 1,000 extra consultants were introduced into the system tomorrow and all were rostered to work around the clock exclusively in the service of public patients, it would have little or no effect? Why? Because a commensurate increase in other staff as well as a root and branch upgrading and reform of all structures and work practices would be required before the much needed services of these consultants could be delivered effectively to the public. As it is, consultants cannot deliver the service they are capable of to patients because of a shortage of resources.
Sir, the Irish public wants this debate to move beyond rhetoric and dogma to the implementation of an efficient system. There is already a developed consensus between the IHCA and the Department of Health on this matter. Ms Wren's speculations serve only to obscure and obstruct. - Yours, etc.,
Dr Peter Kelly, Department of Pathology, Mater Hospital, Eccles Street, Dublin 7.