Madam, - A few issues come to mind following publication of the Government's proposals for health reform:
1. The proposed reduction in influence of local politicians is surely welcome to anyone genuinely interested in seeing health services improved. What it implies, however, is that our State's political structures have failed us.
Today's argument over failures in the health service could equally be applied tomorrow to issues of local planning or waste collection and the utter failure of local political structures to deal effectively with these.
A truly reforming government would look first to reform our mediocre political system before looking to restructure our public services. What chance that?
2. Where do these proposals fit in with the much-vaunted Health Strategy of 2001. Do they supersede, coincide with, parallel or ignore it? No one seems to be saying.
Can we expect another strategy launch in late 2006 if the polls don't look good?
3. The critical issue of funding services properly has once again been conveniently ignored. Some day very soon, clear political decisions will have to be made on the level of responsibility central government, local government and the individual have for financing health services. Only when these obligations are clear to all can long-term strategic planning really occur.
4. Nowhere, either in these proposed reforms, or in the 2001 Health Strategy, is the most fundamental of all issues - equity of service provision - broached, let alone dealt with. The barely concealed delight which some politicians take in bashing the consultant contract is a mere smokescreen covering a much wider issue. Even if all these proposals are magically implemented, it will still leave us with a two-tier service where private patients both expect and receive a superior service.
Surely the ultimate solution to both funding and equity within the service is to make all of patients "private" through a system of compulsory insurance and allow them to purchase, within limits, their health care requirements.
This would entail taking politicians, both local and national, out of the whole health care arena permanently and is unlikely to occur. For as the health services lurch from crisis to crisis, the political class feels it has a right to involve itself. The current state of the service might argue otherwise. - Yours, etc.,
Dr SHANE CORR, Carrickmacross, Co Monaghan.