Sir, - The report by Padraig O'Morain "When patients compete for a bed" (The Irish Times, March 10th) should be mandatory reading for all mandarins and politicians. It gives some hope that good sense rather than a series of annoying polemics might come from your pages. He succinctly summarises the true problem for all patients: "Without the extra beds, the high sounding policies of the parties will be no more than tricks with smoke and mirrors. . .the sick will continue to have to fight each other for scarce beds."At present all public and private hospital beds are full and there are people waiting to fill them whenever someone dies or is discharged. While there is never maximum efficiency in bed use within any hospital system where professional judgements have to be made, providing extra beds and nursing staff must be the priority. If the whole population were instantly insured to-morrow morning, not one extra patient would see the inside of a ward but the cost of current provision would increase by about 15 per cent to service the new paper trail. I have personally explained these basics to Ruairi Quinn.The core activity within hospital medicine is to allow patients be treated by doctors, nurses, physiotherapists, occupational therapists, etc. Patients rarely attend hospitals to consult administrators! Politicians should reform the Oireachtas committee on health and question the doctors and nurses in each institution in rotation to understand the detail and reform the health service. It would help if the Minister for Health and Children would ensure that subtle threats to doctors would no longer emanate from hospital, health board or department officials when the medics act as patient's advocates and make a public statement that is true but awkward for the institution. Issues of service delays, waiting lists, rationing and private and public practice could then be thrashed out in public, preferably live on television. Interesting subjects - such as surgeons who cannot operate because there are no anaesthetists or nurses or because theatres are closed or surgeons with no public out-patients' slot - could be teased out.The tribunals have shown the necessity for medical accountability. The doctors' responsibility is real. This Minister seems to have a principle of letting the facts and the experts speak for themselves. He should abolish some of the new administrator tiers such as the ERHA and get nearer the action at less cost. Preservation of morale in the health services is crucial to clinical efficiency. Just look at the mess in the NHS. - Yours, etc.,Dr Bill Tormey, Glasnevin Avenue, Dublin 11.