Madam, - Minister for Health Mary Harney writes that the new consultants' contract will ensure that there "will be one A&E [ sic] service for all, and no private fees will be earned for any patient in an A&E" (Opinion & Analysis, November 21st). The Minister knows (or should know) very well that Ireland already has one emergency medicine service for all and that every patient attending an Irish emergency department in a public hospital is treated as a public patient, on the basis of clinical need. For her to imply otherwise is misleading.
Ms Harney decries the "very high level of private admissions at public hospitals". Given that the bulk of admissions to our public hospitals are unplanned emergencies and that between 40 and 50 per cent of the population have private health insurance, the public-private mix largely reflects the insurance status of those arriving at hospital, rather than the unspecified "certain events and practices" to which she alludes.
The Minister claims that "the existence of privately managed hospitals does not undermine the commitment to equity for public patients". But her plan to co-locate private hospitals on public hospital sites will do just that. Patients requiring emergency admission will attend the public emergency department and, as they are being wheeled to the ward, will turn right to the brand-new private hospital if insured and left to the run-down public hospital if not. Funds which could have been used to enhance public hospital infrastructure will instead have been used to further line the pockets of private developers.
There will be one hospital for the rich and another for the poor, where the length of wait for admission from the emergency department will likely be determined more by insurance status than, as is currently the case, by clinical need. We appear to be sleepwalking towards this copper-fastening of inequity, perhaps robbed of our critical faculties by the constant barrage of bad news health stories.
Ms Harney seems determined to continue to farm out profitable aspects of public health care to the private sector. Waiting-lists, dialysis and infusion therapy are already firmly on that agenda. This approach, with patients being tossed back and forth between the public and private sectors at various points in their healthcare journey, can only lead to further fragmentation of the system at a time when it is clear to those of us on the ground that safe and effective clinical care demands a more streamlined and integrated approach. - Yours, etc,
GARETH QUIN, Consultant in Emergency Medicine, Mid-Western Regional Hospital, Limerick.
Madam, - On reading the article attributed to the Minister for Health in Tuesday's edition, it struck me that it's no wonder things are in the current hapless state.
Ms Harney states that "out-of-hours GP services exist now", as if this were something new and, moreover, something she apparently can take credit for.
I have been a GP in Sligo for the past 23 years and, along with my colleagues, have been providing an out-of-hours service for all that time, as have my colleagues all around the country for very many years. To imply that this is a new development, as she does, is an insult to past and present GPs who often worked a lifetime on call every night or every second night and received precious little recognition or thanks for it - except, that is, from patients.
The other thing that stands out is the Minister's patent lack of understanding as to why 50 per cent of the population chooses to take out private medical insurance while she does her best to trumpet the public hospital service to which, she rightly points out, all citizens have access.
It is exactly because people know that private health insurance buys them access to healthcare based not on medical need, but on the ability to fork out money, that half of us choose to purchase it, including many who can ill afford it. Access to the public hospital service is, by and large, based on need - not much consolation if you have hip arthritis, chronic angina, or especially if you are simply waiting for an outpatient appointment for perhaps a non-urgent, but nevertheless disabling, problem.
Here's something for the Minister to ruminate on: During my time in Sligo (since 1984) the number of consultants in the local general hospital has multiplied three or four times (as was badly needed, I'm sure all agree). In the same period the number of GPs in the area has changed very little, if at all. This is in spite of population increases, people living longer and becoming more knowledgable, and the enormous influx of immigrants with their own beliefs and language difficulties (all of which result in a greater number of more complex consultations).
Without addressing this crisis in general practice, progress will be limited, as is proving to be the case.
To take the pressure off secondary care, sort out primary care - the only branch of our health service that does not operate in a two-tier fashion, and also, incidentally, the part of our healthcare system that consistently has greatest public satisfaction ratings. - Yours, etc,
RODDY QUINN GP, Ransboro, Sligo.