JOHN BEN HARPUR,
Madam, - When will the Government seriously review the rationale for maintaining so many health boards in a state with such a small population? It was singularly ironic that on the day The Irish Times published an obituary of Ivan Illyich (December 14th), the paper contained so many reports on the policies and activities of the North Eastern Health Board.
The Government could learn a lot form Illyich's work demonstrating that institutions, while operating initially with the best of intentions, frequently end up working against the best interests of those they were designed to serve.
One has to ask: how did it come about that the medical staff in the individual health boards number in the hundreds while the administrative staff number in the tens of thousands? There are CEOs, assistant CEOs, deputy CEOs, programme managers, assistant programme managers, directors of this that and the other, officers for freedom of information, governance, media affairs - and let's not forget the legal advisors.
Now throw in God knows how many administrative staff grades (make them up as you go along - this is a game for every taxpayer),lashings of secretaries and secretarial assistants, and you have one massive administrative behemoth.
All this management structure and Ireland is still well below the EU ratio for medical specialists per head of the patient population.
On the face of it, it seems that someone has lost the script along the way, and the new business of the health boards is not patient care but "administration care".
The emphasis seems to have shifted from making sure that there is a medical service available for the population, to making sure that as many administrative positions as possible can be created.
How on Earth can it be in a country as wealthy as Ireland that basic services cannot be provided in rural hospitals? Perhaps a few return tickets to Cuba might clarify the thinking of the administrators on this matter. However, let us also acknowledge that litigation mania in the country is compromising the level of health care available is non-primary hospitals.
What do you do if a patient needs an emergency operation? Do it, or ring your solicitor? What I would like to see is the Minister for Health having the temerity to perform a root and branch reform of health board structures.
Behead this inefficient, self-absorbed organisational hydra, and replace it with a workable Northern European model. Such actions may mean shedding administrative staff, but the Government has already sent 1,800 Aer Lingus workers out the door without too much breast-beating.
Time to board up the Health Boards and start providing tangible, patient-focused medicine. - Yours, etc.,
JOHN BEN HARPUR, Roristown, Trim, Co Meath.