If the Government has its way, bureaucrats will rule doctors and patients will be treated as statistical objects instead of people, according to Dr Mary McCaffrey, who speaks for consultants
A fraud of great proportions is about to be visited upon the Irish people.
Today, when you go to see your doctor, you know that he or she is answerable to you. Your doctor is professionally and ethically obliged to put you first and to do whatever is necessary to provide for your medical wellbeing. The Government intends to change that. It wants to bring in a new regime in which the doctor is answerable to the State, not to the patient.
Take, for example, a doctor confronted with the following dilemma:there are three cases to handle which are important but not critically urgent. There is another similar case which is life-threateningly urgent but which will take more time to resolve.
Today, the doctor knows what to do. The doctor applies independent clinical judgment and handles the most serious but complicated case, delaying three others. The Government plans to put in place a structure in which a doctor would be penalised for doing this. In much the same way as a fitter in a car factory is rewarded for the number of engines fitted, the Government plans to drive doctors on the basis of quantity of patients.
Bureaucrats with no medical qualifications will look at targets, not individual people. Patients will become objects.
At present the consultant is directly answerable to his or her patient and has the straightforward obligation to do whatever is necessary for the good of that patient.
The Government/HSE wishes to change this fundamentally so that the doctor will be answerable to the Minister, through the nightmarish bureaucracy that is Ireland's health system. Politics should not be given primacy over patients' wellbeing.
Doctors are, of course, accountable at present, not only to their patients but also to their employers, to the Medical Council and to the courts.
That is what the talks about the new contract for hospital consultants have been about from the outset. That is why they have dragged on for months without progress. Were the discussions simply about remuneration, they would have been solved long ago. Indeed the Government raised the issue of salary only last week, a year and a half after the negotiations began.
At a practical level, many useful things have been agreed. The Government/HSE and hospital consultants have agreed to more flexible ways of delivering services to patients and have also agreed that the number of hours in the public contract be increased from its present 33 hours per week. Both sides have agreed that there will be consultants delivering public services who will be entitled to conduct private practice.
If this policy is pushed forward, then Ireland will have a two-tier health system in which the private system is hermetically sealed from the public. Private patients will go to private hospitals to have private care from a doctor who is answerable to them. Public patients will go to public hospitals to have medical services delivered by people who are answerable to bureaucrats. Highly skilled doctors with specialist expertise in the private hospitals will not be readily available to public patients. Then we truly will have a two-tier system with no crossover of skills.
It is not easy to see why the Minister for Health and the HSE are driving the Irish health system in this direction. Either they do not see what they are doing or else there is some ideological determination to establish two very different and segregated Irish health regimes.
The hospital consultants have entered discussions in good faith. They have been met with levels of arrogance on the side of the State that almost beggar belief. Whereas consultants have repeatedly sought practical discussions on how to make the health system serve patients more effectively, the Minister for Health has spent the past 14 months issuing threats. She appears to be unaware that the HSE has turned up at meetings unprepared and has repeatedly cancelled or delayed meetings because of its inability to produce documentation on time.
Consultants and many others in the health services welcomed the setting up of the HSE. It has been a disappointment.
Instead of ridding us of bureaucracy, it has mushroomed beyond proportion. It is a monolith, fed increasingly large amounts of taxpayers' money, presiding over the chaos that is Ireland's health system. Now it wants to interfere in that most precious relationship in medicine over the centuries, that between patient and doctor.
The HSE should instead do the job it is paid to do. That is to administer health services. If it did this, and worked towards a health service that respects the patient/doctor relationship, there could be a new contract for consultants very quickly.
Dr Mary McCaffrey is consultant obstetrician gynaecologist at Tralee General Hospital and president of the Irish Hospital Consultants Association