Sir, - The series An Unhealthy State rightly highlighted problems in the Irish hospital service. Four years ago, as president of the Irish Medical Organisation, I unsuccessfully sought to persuade the then Minister for Health, Brian Cowen, of the need to commission a strategic plan for the hospital service.
The issues to be addressed by such a plan are complex. At the macro level a balance must be struck between affordability, accessibility and quality of service. At the micro level there are problems with management, service delivery, quality assurance, staffing and education/training.
Far from being an obstacle to improving services, most professionals devote their lives to serving people. The articles did not emphasise enough that he who pays the piper calls the tune. Since I became a consultant (at the now defunct North Infirmary) in 1985, my career and my ability to function have been profoundly impaired by financial cutbacks, inadequate buildings, lack of support staff, lack of investment in equipment and failure of management response to repeated requests for more consultants in my own discipline.
All of this results from topdown control held, in the final analysis, by the Department of Finance. It was the Government, and not obstructive doctors, which axed hospitals in the late 1980s. Money is the real power.
Why is there not a strategic plan for the future development of such an expensive and complex service as the acute general hospitals? What is the objection to transparency and accountability? Political "strokes" are no substitute for progressive planning. Unfortunately, one of the facts of life for health service managers and staff is the necessity to have a local "heavyweight" politician (preferably as Minister for Health) backing major capital developments. The public deserves better.
The purpose of a strategic plan is to raise the issues of quality, equity, accessibility, costs and accountability for public debate. There is an job to be done educating the public, politicians and professionals. The Department of Health badly needs beefing up if such a plan is to be developed and implemented. Doctors and other healthcare professionals may be important stakeholders, but through and after any reform they will still have to actually care for patients, provided burnout, low morale and better opportunities elsewhere haven't prompted them to early retirement. - Yours, etc.,
Neil J. Brennan, FRCPI, Mercy Hospital, Cork.