Madam, - The Minister for Health, Mary Harney, has stated that she will impose a public-only consultant contract if a "deal" is not done on the existing consultant contract. This raises some interesting questions regarding current health policy.
If this revised consultant contract is central to "reform" of the hospital system, why did her civil servants fail to produce the promised position paper, or sample contract, at our recent negotiations?
After all, the revised consultant contract has long been touted as the answer to all the problems of our hospitals. If only life were so simple! The daily routine of caring for patients in our current public hospital environment is so stressful that, in my opinion, consultants would clamour for a new contract if they thought a piece of paper would solve the problems. I suggest that there is no such piece of paper.
The truth of the matter is that our hospitals are overcrowded with sick patients because one third of acute hospitals were closed in the 1980s and 1990s, and we do not have enough public hospital wards to treat our growing population.
Patients who are ill with heart attacks, strokes, pneumonia, appendicitis and accidents need urgent care by doctors and nurses. In Ireland, that urgent hospital care is available only in a public hospital and accounts for 75 per cent of our work.
Private hospitals do not offer this service, as it is too expensive to maintain so many staff on standby.
Whether you have a medical card or VHI Plan E or both, the only place to go is your public hospital. Yes, you may be treated on a trolley in A&E, or a bed in a corridor, because the wards are already full. That's the equivalent of a hotel offering a camp bed in the foyer because all their rooms are full. The current arrangement is stressful for patients and hospital staff alike, but it is remarkably equitable. No one is turned away, but no one is guaranteed a bed in a ward, not for cash or insurance or because your consultant wishes it.
Our hospital problems will not be solved until the embargo on recruitment in the health service is lifted, allowing us to innovate and to open up new services and new wards.
Another interesting question arises. If, in future, all consultants hold public-only contracts, who does the Minister intend to be responsible for the care of patients in the proposed 1,000 new private beds? Bear in mind that the Minister has also stated that, in future, private patients (who make up 50 per cent of the population) will not be allowed use public hospital facilities.
This is despite the fact that everyone in Ireland has a statutory entitlement to public hospital care and that Irish private hospitals have no track record in urgent care.
I suggest that we are starting to see the contradictory nature of current health policy, divorced from the realities of daily life in the health service. - Yours, etc,
Dr CHRISTINE O'MALLEY, Consultant Geriatrician, Nenagh General hospital; Vice-President, Irish Medical Organisation, Nenagh.