15th March 2002
There were two letters in the Irish Times recently which made me wonder why any of us bother negotiating with the Department of Health. The first letter was from the Department of Finance and is as follows:
"Department of Finance,
January 7th, 2002
Dear Michael,
May I take the opportunity to make a number of points regarding the issue of medical manpower.
Clearly, the matter is central to the future delivery of the high quality health service to which we all aspire.
Nevertheless, while the studies done to date point in the direction of a consultant provided, rather than a consultant led, public hospital service, the Government have not endorsed this pending their further consideration of the matter in the light of the outcome of the substantive work now commencing.
Given the significance of what is involved, not least in terms of its potential financial implications, it is essential that the steering group does not approach its work on the basis that a consultant provided approach is the sole option - which, clearly, it is not.
Obviously while this does not rule out the adoption of a consultant provided approach, neither does it make its adoption indispensable.
Yours sincerely,
David Doyle,
Second Secretary General."
The reply from the Department of Health:
"Department of Health and Children,
24 January, 2002
Dear David,
We would view as very undesirable any question of effectively rewriting the Forum and Hanly Reports. The core issues are well rehearsed in a series of reports.
Every analysis to date comes back to the same key point: service provision in the Irish hospital system is over-dependent on doctors who, while still in training, are required to provide 24-hour, seven-day medical care.
While this care is formally under the supervision of individual consultants, their presence on site is in the main limited to 33 hours per week provided between 9 a.m.-5 p.m. Monday-Friday.
Patients therefore have limited access to appropriate levels of senior clinical decision making, with inherent implications for safety of diagnosis and treatment on the one hand and efficiency and cost-effectiveness on the other.
The task force will no doubt examine alternative approaches but it must do so in the context of patient safety and quality of treatment.
Yours sincerely,
Michael Kelly,
Secretary General."
Frequently I have asked in the Seanad if the Minister for Finance rather than the Minister for Health would come into the House to discuss the health service but even I did not think the situation was as fraught as this. How can any of us believe in any negotiations when, from these letters, it is perfectly plain that the Department of Health has no scope to make any promises at all, once money is involved and there is little to do with the health service which does not involve money.
For a considerable number of years I have been deluded enough to think that we had decided on a consultant provided service in this country. Many others did, too. I was on the last Comhairle na nOspideal and that Body had the same idea. Why on earth were we appointing all these extra consultants if it was to have a consultant provided rather than Consultant led service? Why was the Medical Council going on about training by consultants of non-consultant hospital doctors?
And now this letter from the Department of Finance saying no decision has been made. Charlie McCreevy made a pronouncement during Cheltenham this week, but not from Cheltenham I believe, that extra funding for the health service was not available unless taxes went up, and I gather that it is not his intention to increase taxes.
Charlie was lucky he was at Cheltenham. That same week saw, after weeks of warning, the nurses from A and E departments out on the streets with frustration at the appalling conditions their patients endure and the stress under which they work. Their work to rule meant that elective surgery patients had to have their operations cancelled. Now these patients were not all waiting for cosmetic surgery, many will have been waiting for operations for cancer, vascular operations and so on. The delay in treatment will matter to their outcome. These same people have paid taxes for decades so, in fact, they paid up for their treatment in advance and now when they need it they are denied it.
What on earth was the point of all the work that went into the production of the Health Strategy by the Department of Health? If we don't know what will happen tomorrow how on earth can we believe anything about ten years down the line? Why is the Manpower Task Force continuing?
At the end of 1999 the Minister for Health and Children, Micheál Martin, requested the urgent appointment of 27 temporary consultants to A & E departments. There were not, of course, 27 Irish trainees in this specialty abroad who have wanted to return to our dysfunctional A & E service on a temporary basis, so what this really meant was we were to bring in 27 non EU well trained doctors to shore up the system and give the Minister a bit of respite from the justified complaints about the A and E service. Sense prevailed and ten proper posts are now filled but it was interesting to see short termism at work as usual.
The unfortunate conclusion one would have to draw from this sort of action is that in his heart the Minister for Health knows that the Minister for Finance has no intention of paying up. Well, he was told so at the Government Cabinet meeting at Ballymacscanlon some months later.
A recent OECD survey showed us that we were well down the league in spending on health, although I do realise that comparisons in spending can be misleading. The French system is good but the French pay up for it in a separate area of tax so that they can see where their money is going. The person who said recently that in the health service we have been reviewed to death, was right. We should realise now we are doomed to continue in the same chaotic fashion.
Senator Mary Henry, MD
