Heart Beat: In my thesaurus there are three definitions of the word kaleidoscopic, two of which appear relevant to our health service today.
Changeable: shifting, varied, mobile, fluid, uncertain, volatile, unpredictable, unstable, fluctuating, indefinite, unsteady, protean, mutable, impermanent, inconstant.
Complicated: complex, confused, confusing, disordered, puzzling, unclear, baffling, bewildering, chaotic, muddled, intricate, jumbled, convoluted, disorganised, disarranged.
The compilers sound as if they were very familiar with our service. I might, along with others attempting to shore up the coalface before they can actually work properly, have suggested further terms not eminently suitable for a family newspaper.
Goodbye Mr Hanly. Goodbye Prof Brennan. Goodbye Mr/Ms Prospectus (whoever you are). Thank you all for your work but there is an election coming and we can't afford you. Sadly, organisation and efficiency and accountability have no place now, and therefore the Minister of the Kaleidoscope had to (regretfully) dispense with your services. The fact that there was much merit in what you all said is unfortunately irrelevant.
The fact is that if you want to reform something, you must first know what that something is. I challenge anybody to describe the Irish health service.
It is no longer possible to live in a fuzzy comfort zone of delusion. Everything will be all right on the night. Just give us a little time for the reforms to work. Sorry about the last statement, I forgot we had just abolished the reforms.
I have only been minister for four months (the Government has been there for seven years).
The smoking ban will kick in, and people won't get sick and die any more.
We might get a week or two of good weather during the summer and then the number of people on trolleys might reduce. (It would be churlish of me to point out that the beneficial effects of such good weather are often cancelled by hospital authorities closing beds and whole units in order to stay within budget.)
I am not even yet mentioning the sheer bungling incompetence that has landed us in the very jaws of a consultants' strike. Mind you, varying the point of bungling has brought us close to the same result with nurses, non-consultant hospital doctors (NCHDs), public health doctors and general practitioners.
I can state categorically that none of these groups want confrontation, let alone industrial action. Nobody asked the Government to unilaterally breach the consultants' contract by introducing so-called enterprise liability. The consequences are, however, very real. Doctors who have worked all their lives to the best of their ability to provide a service, in often very sub-standard conditions, face the possibility of losing their homes, possessions and provision for old age; a nightmare scenario.
For any who doubt this, an ongoing case against a consultant, by the North Western Health Board, seeking to recover €4,000,000 in an obstetrical case, points this up graphically. This, pressing as it is, is not the only cause of consultant anger.
There are many other issues, of pay and conditions and breach of contract, and there above all is intense anger about the failure of Government to provide the facilities to allow them get on with their jobs.
I was a founding member of the Irish Hospital Consultants' Association (IHCA), and for us the notion of withdrawal of service was anathema. It is now a measure of desperation for my colleagues and, however reluctantly, I would stand with them. I pray as does every right thinking person that wiser councils will prevail, and that accommodation can be reached.
In talking of the problems of the consultants, I do not mean to trivialise the concerns of other branches of the health service. Rather it is symptomatic of the malaise of the whole that such dissatisfaction becomes inevitable and widespread.
There are many questions to be addressed. Is our service to be public, private or mixed? If the latter, in what proportions?
What services are to be provided and where? Training of doctors and nurses must be addressed, and questions of supply covered.
Is the development of the private sector to proceed unabated and uncontrolled, and how will it relate to the public system? This is an essential question. VHI, BUPA, Vivas etc. cannot out of their funds sustain this rash of development, without vastly increasing their subscription level. This may well be a self-defeating exercise, as the number of subscribers able to meet the increases may drop.
Therefore one must conclude that for such developments to succeed, a massive transfer of State funds will be required. This leaves the prospect that our major hospitals, that train all our doctors and nurses, will be further deprived of funds. Indeed it raises the possibility that such hospitals will only be for emergencies and centres for the care of the more costly procedures and the care of the chronically ill.
This is no solution; it will only accentuate our current difficulties. I return these problems to the Minister of the Kaleidoscope for speedy solution. In the meantime I note that the fight against the demon tobacco goes on apace.
We cannot recruit or pay intensive care nurses, but we can find the money for agents provocateurs to entrap small shop holders into selling them 10 fags. God help us all.
Maurice Neligan is a cardiac surgeon.