Madam, - I am tired of hearing of "vested interests" in the health service, with the implication that having a "vested interest" is a sin akin to that of Cain. For if we have no vested interest, why should we come to work, when work is so difficult and resources so constrained? Why should we put up with the barriers to our working life now placed by the Health Service Executive and the Minister for Health and Children? One wonders why we don't simply walk away. Do not the chief executive of the HSE, and his Minister, have a vested interest in the health service also? If not, why are they in post?
The description of more than 20 administrators joining Prof Drumm in his address to the members of the Oireachtas last week was galling, when one takes into account the explosive enlargement of that group while the HSE refuses any further expansion in health service staff numbers, or even in locum replacement for maternity leave or long-term illness.
What was I doing on that same Friday morning? I was grovelling in apology. I was explaining to a bereaved daughter, and to her widower father, how the mother of the family had died as a result of a lack of understanding on my trainee's part. The death may have been inevitable, but it was guaranteed by the inability of a trainee to understand that elderly people "hide" their illness well.
Would it have helped if the patient had been seen by a consultant in emergency medicine? Possibly. But is it likely that I can see 150 new patients, spread over 24 hours, every single day, all year long? No, it is not.
In 1988, I became only the fifth consultant in my specialty to be appointed in Ireland, the first in what is now the busiest hospital in the land. The following year, I sought to expand to a second consultant, in order to improve training and patient care. It took until 1999 - yes, 10 years - to get a second consultant in post. We then tried to expand to a group of four, given the development of the specialty internationally.
It took until 2001 to get a third and we still await a fourth, despite repeated formal applications. In March 2006, the Minister for Health and Children declared an emergency in this area and a task force was set up to report urgently on the matter within three months. They signed off their report in November 2006, but it was not actually published until mid-2007. Even now, over 18 months after the Minister's declaration, the HSE has not formally responded to the advice of the task force.
Why not? In any normal year, there would be over 100 consultants appointed to the health service, many being replacements for those retiring. How many have there been in 2007? Virtually none. The HSE might suggest that this is because the new consultant contract has not been agreed. But, as a member of the negotiation team, I can safely say that this resembles no other negotiation I have ever been involved in.
Negotiation assumes a two-way process, with give and take on either side. In this case, there has been no move from a stated position by the HSE. The medical organisations have moved closer to the HSE position, but have enormous difficulty with certain aspects of the proffered contract, as they fear inordinate interference in the doctor-patient relationship, which every consultant values and which each patient appears to demand.
Yes, I have a vested interest. My vested interest is that I have devoted the past 35 years of my working life to the Irish health system, whether here, or during six years training abroad. I earnestly desire to see the Irish health service provide a first-class service to the Irish people. I do not want to support a sinecure for administrative personnel, or a cosy nest for those few doctors who feather their own nests (I accept that there are some self-interested people in every walk of life).
I am not alone - there are many more doctors in the Irish health service who truly want to work for their patients. But we need the patients to indicate unequivocally to our pay masters what precisely they want from health care delivery. This is not a manufacturing industry, with profit as its main aim.
There are many views on the ideal way to fund health service delivery. I am not recommending one above another. But I am aware that the profit-based system of the US is one which leaves very many patients with no primary care, no preventive medicine and no access to high-tech medical advances. Those patients see the emergency department as their only access to any form of health care. Isn't it sad that they have no advocates with vested interests to look after their needs?
Once again, I apologise for the failure adequately to diagnose an elderly woman who died after seeking help in my emergency department. Ultimately, such apologies are my personal responsibility, not that of a nameless Health Service Executive. But wouldn't it be nice if the service was such that apologies were unnecessary? - Yours, etc,
Dr PATRICK K PLUNKETT, Consultant in Emergency Medicine, St James' Hospital, Dubin 8.