Madam, - I am a consultant and I acknowledge that there is a need for changes in the consultant contract, so my comments are not intended as an argument against such change.
However, I am concerned that in much of the public discussion regarding change in the contract and working conditions of hospital consultants it seems to go almost unchallenged that the appointment of 1,500 or 1,600 additional consultant specialists would be a great thing for the health of the country provided that the new contract is implemented.
I recognise that there is a need to increase the number of specialists in certain areas. However, I am not at all sure that wholesale expansion of the number of hospital-based specialists is the best way to ensure equitable healthcare for all.
We specialists are useful to have when we are needed but in truth we are simply not that important in determining how long people live and how much they enjoy their lives. Would the public money for staff and infrastructure not be better spent on measures to develop public health and primary care services?
The right of access to first-class preventive and primary care services in the community, regardless of income, is the best way to deliver decent services for all at a cost that society can reasonably afford. A society and a health service that place too much emphasis on the role of hospital-based specialists will never deliver the best value for money in terms of health outcomes regardless of how much the specialists are regulated and controlled.
This story of confrontation between the Minister and the consultants representatives is high drama and of great human interest but it tends to fuel the myth that hospital specialists are the central element in providing a decent healthcare system.
I suggest that in the great scheme of things hospital specialists are simply not that important. It would be wonderful if we could have just as much energy and passion engaged on the larger questions of what we mean by health and how best to achieve it for all. - Yours, etc,
MARTIN CORMICAN,
Tonroe,
Oranmore,
Co Galway.
Madam, - Finbarr Fitzpatrick's IHCA is like a large truck that chooses to travel at 10mph on a three-lane motorway, ignoring everybody's requests to speed up or turn off. Mr Fitzpatrick then has the audacity and self-indulgent impertinence to throw insults and criticisms at everyone else (February 2nd).
Consultants deserve high rewards for their skills and experience. Perhaps they do not deserve the extraordinarily favourable contracts that some of them enjoy; however, they have these contracts now so I would have no interest in denying them their good luck.
But the IHCA and IMO should have absolutely no role in dictating the conditions of any new HSE employees, consultants or otherwise. Nor should they have any role, other than advisory, in the HSE or general management.
The IHCA should have enough dignity and respect for others to abandon selfish and brutish trade union tactics reminiscent of the 1970s and desist from wilful obstruction or sabotage of management's efforts at reform. - Yours, etc,
Dr FRANK DEVITT,
Griffith Avenue,
Dublin 9.
Madam, - Please! Enough self-serving letters from hospital consultants. Anyone who has ever been advised that "Mr X can't see you as a public patient but if you go private he will see you straight away" knows the truth.
What we need are more public-only consultants. As another letter writer said, it is time to back Mary Harney in sorting out the vested interests. - Yours, etc,
STEPHEN GLEESON,
Brehonfield,
Dublin 16.