Sir, - In her opening contribution to the studio discussion that concluded the recent RTÉ Radio 1 series "The Truth About The Health Service", Maev-Ann Wren described as "institutionalised apartheid" the current arrangements by which hospital consultants are paid for treating public and private patients.
The sole aim of this, to my ear, was to seek to blame hospital consultants for the failures of our health service.
The current system was designed by bureaucrats and institutionalised by our elected politicians using the 1991 Health Amendment Regulations, over the heads of hospital consultants.
Ms Wren has expounded on many occasions her view that consultants discriminate against public patients because of these differing payment mechanisms. Two recent independent reports rubbish this proposition.
The Acute Hospital Bed Capacity Report, published by the Department of Health and Children, estimated that an additional 160 beds could be made available to public patients if the strict 80:20 ratio of public to private beds was maintained. In the context of 11,800 beds that amounts to a 1.3 per cent improvement. That hardly amounts to apartheid.
It must be noted that the estimate of 160 extra beds is based on the premise that there are public patients waiting for the beds that are currently being used for private patients. This cannot be taken as a given. There is not a public waiting list for every specialty in every hospital.
The Deloitte and Touche report, "Audit of the Irish Health System for Value for Money", commissioned and published by the Department of Health and Children, devoted only seven out of a total 266 pages plus a further volume of appendices to the public-private mix. This report "identified no systematic evidence to support any widespread abuse of public sector responsibilities by consultants".
The report also found that, based on 1999 data, the evidence indicated "prima facie that the private workload in public hospitals is being contained closely in line with the level of beds designated to this area".
Taking this objective evidence the impartial observer must conclude that consultants are delivering the service for which they are contracted and are not disadvantaging public patients.
Since its inception, the Irish Hospital Consultants Association has been tirelessly argued for more consultants, more nurses, more technical support staff, more acute public hospital beds, more appropriate rehabilitation beds. The issue now facing the nation is how and how much we are going to pay for our health service. The forthcoming election provides us with an ideal opportunity to move the debate forward.
Should we have:
1. A centrally funded system for those least able to afford healthcare?
2. A centrally funded system for everybody?
3. An insurance-based system for everybody, with the State paying the subscriptions of those who can least afford it?
The public and politicians need to be clear about their vision of the future of the health services. Using the Boston versus Berlin aphorism, we know that there are some politicians who do not want to make additional investment while others accept the need.
These are fundamental issues that should be debated openly rather than being relegated to a side issue in the rush to blame one group of dedicated health sector employees for the faults of the current system.
For the record, the Irish Hospital Consultants Association has no preference about which system of funding is adopted.
We do however, care passionately about the amount of that funding, so we can be sure that every patient, public or private, can enjoy a medically appropriate standard of care. - Yours, etc.,
DONAL DUFFY,
Assistant Secretary General,
Irish Hospital
Consultants Association,
Dundrum Office Park,
Dublin 14.