Heart Beat: The problems besetting our health service, sadly are not new.
Any reasonable person might have expected that after a period of unprecedented affluence, the infrastructure and delivery of our health services at all levels, would leave us as a nation second to none in the delivery of health care. Instead, we have a shambles, with conflicting systems, public and private. We have problems in the delivery of primary care, of hospital care, both acute and long stay and in just about every part of our service.
I am intrigued in all of this that nobody appears to be responsible. It is usually the doctors, those "awful" consultants, or those "unreasonable" GPs who overcharge, that are seen as the culprits. Maybe they are to some degree, but long personal experience makes me very dubious about this proposition.
In fact, there is so much wrong that to enumerate the problems, let alone devise and propound solutions, is a most daunting task. Nonetheless, it is a labour that must be undertaken comprehensively and tirelessly. The Irish people deserve, like people throughout the world, that a complete and caring service be available to the highest standard.
This, of course, does depend on financial constraints as the money is clearly not unlimited, and nothing is more dispiriting - and to some inexplicable - than the fact that increasing the amounts of money invested seems to lead to no discernible improvement.
There is nothing new in these opening chapters and people have been saying things like these over many years, thankfully increasingly so in the recent past. The trouble is that there is a strong culture of denial at the highest levels that the problems are all that bad, and that those who protest loudest and most vehemently on behalf of the patients and the taxpayers are somehow cranks, motivated by anything other that patient welfare.
Such characterisations sadly have often been accepted by the people who are not hurting, those who are comfortably off with private insurance and the good life. Such complacency is perilous as the decay in what passes for our system, or rather systems, is pervasive and spreading. The days when misinformation, concealment of the true state of affairs, spin and blaming others have to come to an end and soon.
Propounding generalities is of little benefit. The subject is huge and complex but ultimately it boils down to one premise only: the right of a patient to see and be speedily treated by a doctor. This is the unrefutable bottom line. Everything else is ancillary and consequential. The political and administrative faculty should exist to facilitate and ensure the smooth, correct and efficient attainment of that goal.
Is this the case? Is it hell! Here lies the nub of the problem. Confusion, conflicting goals, obfuscation and protection of position are the order of the day, not the entrusted mission. Recourse is made to commissions, "expert" groups, sub-committees and various quangos, funded with scarce resources badly needed at the coal face.
It is interesting also to note that the presence of front line doctors in many of these commissions reporting to the heights is negligible or, indeed, non-existent. If you want to solve a problem use people who know little or nothing about it and minimize the involvement of those who do, especially those who have been critical and pointing to deficiencies and problems over many years.
Why is it that so many consider themselves to be experts on medical matters? In my own case having been involved in the profession for 49 years, medical and science student, intern, NCHD at all levels, here and in England and the US and consultant cardiothoracic surgeon, in the Mater, Our Lady's Hospital, Crumlin, and also a cofounder of the Blackrock Clinic, I do not consider myself an expert.
There are many aspects of my profession that are foreign to me and in which I entrust to my working, involved colleagues whose experience, caring and goodwill I have never found wanting; to the men and women who are available day and night, Christmas Day, New Year's, whenever; and yet whose views are seldom sought. I do not turn to those who pontificate without our hard-won medical knowledge and often bitter experience, nor to those whose involvement is academic and theoretical.
We are not a perfect profession. No profession is, but we are not responsible for the current plight of the Irish health service.
'It cannot be done without us and when reality dawns and the problems are identified and the dross removed then let's get started.
• Maurice Neligan is a recently retired cardiac surgeon who worked in the Mater Hospital, Dublin, the Children's Hospital in Crumlin and the Blackrock Clinic.