Sir, - The consultant obstetricians/gynaecologists who defend their position in our health service (October 11th) ignore the structural anomalies so ably described by Maev-Ann Wren (An Unhealthy State, October 2nd-6th).
Consultants in public posts are contracted to provide 33 hours' service each week. In practice they have complete discretion as to how to divide their time between public and private activities. Since private activities can be very lucrative and public activities are paid for regardless of time input, this constitutes a conflict of interest.
Because of this total discretion of time input on the part of publicly employed consultants, training and supervision of NCHDs in our teaching hospitals can be neglected, particularly in specialities where there is a high demand for private practice. Again I stress that this is a structural problem - it depends on decisions made by individual consultants. Other countries provide well-defined training and mentoring programmes, much in demand by Irish NCHDs, who are voting with their feet to take up such positions abroad. What a shame courses and posts of equal calibre aren't available here to keep this talented generation within our own health service.
Hospital consultants have consistently resisted the appointment of "public only" consultant posts which would help to improve access and reduce waitinglists. One reason surely be the defence of their own private interests which strongly conflict with public interest.
When are our politicians going to give us an imaginative lead in looking for a truly comprehensive, free health service worthy of a modern, developed European economy? There are many working examples to study among our EU partners. When are we, Irish citizens, going to look for a more equitable, integrated service than our present system of "private affluence and public squalor"? - Yours, etc.,
Ann Bridges, Brookville Park, Dublin 5.