Sir, - As a GP, and as one of the small percentage of people to give the PDs my first-preference vote in the last election, I feel doubly entitled to criticise the party's proposals on hospital waiting lists.
I voted for the party because of a long-standing admiration for its leadership and because of its manifesto promise to undertake a comprehensive audit of all health spending in terms of both the efficiency and effectiveness of services provided.
The party has now been in Government for nearly four-and-a-half years and no such audit has been carried out. All we have seen are indiscriminate increases in funding given to the same failing health service. Not surprisingly, services seem to have improved minimally, if at all, and the gross inefficiencies and bureaucracy which bedevil hospitals and aspects of health board-led primary care remain rampant.
Little or no investment has been made in GP services and the two-tier system which Ms Harney bemoans has actually been augmented by Government policy through the reduction in medical card eligibility for people on marginal incomes, alongside their granting to well-off pensioners with no reference to income.
I assume the party hopes its waiting-list initiative will satisfy people when awkward questions are asked during the election campaign about the failure to improve the health service at a time of unprecedented wealth.
There are many flaws in their proposals, but let me outline just a few:
1. Most people take out health insurance to provide cover for their families for just such elective procedures as the PDs are intending to cover. If public patients are given guaranteed dates within an acceptable time, at a stroke you will have removed the great incentive for people to have private insurance. Many people will simply choose not to pay private insurance and switch to the public waiting list, and waiting lists will only increase over time.
2. Many of the diseases which need elective procedures don't just happen or worsen overnight. The procedure is often merely the end point when primary care is no longer able to provide care for the illness. Prevention through better education, support services such as physiotherapy, and improved primary care are the key to improving overall care. Accessibility to an elective procedure such as a hip replacement within a reasonable time is merely one part of the process and shouldn't be the primary focus of resources.
Logic would surely dictate that if consultants are to be paid extra to get patients off waiting lists, then people such as family doctors and physiotherapists who, through good management, prevent or delay other patients joining these lists should be similarly incentivised.
3. The current constraints in our hospital services are a shortage of consultants (pointed out for years by all the medical organisations); health spending which continues to lag behind the European average; a lack of beds both in the public and private sectors; and an acute shortage of trained nurses and other paramedical staff. This initiative would merely achieve some minimal increases in day-care surgery, mainly on fit young people where little extra resources are needed, and much wringing of hands by politicians when their constituents complain that granny was given the choice of going to Munich for her hip repair, or grand-dad continuing to wait for a bed in an Irish hospital.
The time for gimmicks and sticky-plaster solutions to our health service is long past. Patients and health service workers are sick of short-term measures which serve only to worsen problems in the longer term.
Michael McDowell's famous "radical or redundant" challenge to the PDs comes to mind now. If true leadership and vision existed within the party, it could easily take a radical approach to the health service. However, the populist, short-sighted nature of these proposals leads me to believe that redundancy is the more likely scenario. A pity. - Yours, etc.,
Dr Shane Corr, Carrickmacross, Co Monaghan.