Sir, - I refer to Maev-Ann Wren's article of October 23rd in which she quotes from the address by the Health Minister, Mr Martin, at our recent annual conference, when he stated that "maintaining the status quo is not an option".
For the record, Mr Martin's predecessor, Mr Cowen, said at our 1999 conference: "I cannot support a solution based on more of the same."
Ms Wren can rest assured that consultants, just like patients on endless waiting lists, are most anxious to change the status quo. What consultant wants the status quo of spending a quarter-of-a-century on a 1:2 rota in obstetrics, surgery, anaesthesia, medicine or psychiatry? What consultant wants to maintain the status quo of between 11 and 21 days at work and on call round the clock without relief because locum cover cannot be provided for a colleague on annual leave? What consultant wants to maintain the status quo of facing an outpatient clinic of anything from 80 to 100 patients - all to be managed in a three-hour timeslot?
The people who bleat most about the status quo are the very ones who have given us our overstretched and under-funded hospital service with bed shortages, overcrowding, waiting lists and consultant shortages. What a pity that the verbiage is not matched with some action. Rest assured, consultants do not want "more of the same" or "the status quo".
I do not accept Ms Wren's explanation that public servants are not permitted to engage in public controversy. Any examination of the national or weekly newspapers or the weekly medical publications will show that the chief executives and other senior officers in health boards and voluntary hospitals are, quite appropriately, frequently quoted on health matters. Is it not surprising that these same people seem reluctant to put their names to criticisms of consultants' performance?
Could these timid, dedicated administrators, who outnumber doctors by two to one, not even give a hint on the record as to the particular hospital or even health board area where these scams are taking place? Is it not even more surprising that, in their capacity as the legally accountable officers, they have not taken steps to rein in the greedy consultants whose sole purpose in life is private practice? Is it not a fact that the volume of work, both public and private, of each and every consultant is on record in his employing hospital?
Ms Wren, as well as relying on anonymous sources, refers to the Report on the Commission on Health Funding which was published in October, 1989. While relying on a report from the last century the best she can do is to quote that "some consultants do not" give sufficient time to their public patients. May I suggest that "some consultants" can scarcely be construed as representing anything near a majority.
Ms Wren quotes from the ESRI report, published after her series of articles, which refers to private patients being accommodated in public beds. The Eligibility Regulations, 1991 and good medical practice dictate that a patient, irrespective of public or private status, be accommodated in the first available bed. The ESRI report fails to give equal emphasis to the fact that public patients are accommodated in private beds with equal frequency - and so they should be.
There are major structural problems with our hospital system:
1. The funding problem which Ms Wren covered, where I agree with her.
2. The exceptionally large number of acute hospitals and the ensuing cost of maintaining each of them as an acute facility, 24 hours-a-day, all year round. I do not think that Ms Wren placed sufficient emphasis on the consequences of this policy, which has been pursued by successive governments.
3. The extraordinary manpower policy which has been pursued in our health services for over two decades. Indeed, in a little over 10 years, the number employed in these services has increased from 59,000 to 80,000. The increase in nursing and medical staff during this period has been minimal.
4. Our community and stepdown facilities, which could be used to prevent people being admitted to hospital and to allow earlier discharge from acute hospitals, are abysmally insufficient. The equivalent of the Mater or St Vincent's hospitals, 450 beds, is constantly occupied by patients who should not be in hospital but who have nowhere else to go.
Finally, and I do mean finally, Ms Wren seems to be confused about the role of the Medical Manpower Forum. Its terms of reference are to map out the medical staffing policy for our hospitals and, having done that, to allow for the normal contract negotiations to take place at another level. To my certain recollection, this was agreed with a then secretary general of the Department of Health in the latter days of November, 1999. It was agreed that, following the planned publication of the report last December, six months' intense negotiations would take place to agree contractual matters.
The IHCA has had its Manpower Negotiation Committee on standby since February of this year. I have every confidence that the IHCA policy of a more flexible routine hospital working day with, at least, 1,000 extra consultants will be the formula on which negotiations to deliver a consultant-provided service will be based. - Yours, etc.,
Finbarr Fitzpatrick, Secretary General, Irish Hospital Consultants Association, Dundrumm, Dublin 14.