From a patient perspective, the level and quality of care available in hospitals have dropped significantly. Every patient is entitled to the best diagnosis, treatment and care which the health service can provide. Sadly, what they receive from the public hospital system falls well short of this and is too often marked by inequality.
The national health service in Britain sets out principles in its patients' charter, which are worth enumerating in the context of hospital service delivery here. Services should be:
Equitable: treatment should be based on clinical need, irrespective of income, gender, race, religious affiliation, sexual orientation or place of residence.
Accessible: all hospital medical services must be equally accessible to both public and private patients.
Effective: each patient is entitled to the best possible result from treatment.
Efficient: hospital services must be organised in a way that delivers the best value for money.
Responsive: services should meet the needs and entitlements of patients and should respond to their concerns and suggestions.
Dignified: hospital services must be provided with courtesy, ensuring confidentiality and respect for beliefs of the individual.
Clearly, the public secondary care system in the Republic falls well short of adequately delivering on most of these principles. While the manpower report concentrates on issues of medical staffing, it acknowledges the important role of teamwork. Medical care was historically organised on a hierarchical basis, with a single consultant firmly at the top. What is needed for the future is a team-based approach, with consultants working as teams within each specialty and with decision-making shared with nursing and paramedical staff to a greater degree than heretofore.
The much-delayed and as yet unpublished report was held up mainly by the unwillingness of medical representative organisations to concede the establishment of a new "sub-consultant" grade to be filled by doctors who had completed their training. Instead, what has emerged is a consensus on increasing full consultant numbers but with the important proviso that "a significantly greater degree of flexibility should be introduced into the routine working day".
In other words, consultant numbers will be increased by between 600 and 1,000 but only if the new appointees work a shift system. At present continuity of patient care can be a problem because a consultant may not be present outside normal working hours.
So, if you present in the future to an accident and emergency department at 10 p.m. with chest pain, you will be assessed by a consultant rather than a doctor in training.
Decisions will be made more quickly and effectively, provided that the consultant is supplied with a full X-ray and laboratory service to match his new hours of availability. And provided that the current bed shortage is dealt with also.
We have already had a 30 per cent increase in hospital consultant numbers over the past seven years without achieving much in the way of improvement in outof-hours hospital services. If a consistent, high-quality, equitable and patient-centred service is to emerge, then nothing less than a complete restructuring of our hospital system will be needed.