Britain's National Health Service is like the quintessential curate's egg - it is good in parts. At the level of primary care and community care it is superior to the structures and services available in the Republic. The concept of developed community care accessible at one location from integrated multidisciplinary teams is well established in Britain.
At a hospital and secondary-care level, however, the NHS is suffering at least as much as we are. Intensive care beds are woefully lacking, with the result that patients are often transported hundreds of miles from their local hospital to access a vacant bed. Levels of kidney dialysis and transplantation are much lower than in the Republic.
Private healthcare in Britain differs significantly from the Republic. There, private health insurance tends to be used for one-off procedures such as hip replacement. There is no strong tradition of looking after chronic disease in the private sector.
Here, there is mounting evidence that patients are accessing private medical care for their ongoing health needs in response to the failures of the public health system. General practitioners receive an increasing number of requests from patients with medical cards, but with no private health insurance, for referral to private hospitals and consultants.
Patients are opting for certainty; the certainty of seeing a consultant and not a junior doctor, but more than anything, the certainty of being seen quickly and treated efficiently.
Many commentators have pointed to the lessons we can learn from the Irish private health sector. There is no doubting the efficiency of an institution such as the Mater Private Hospital or the Blackrock Clinic. Beds are rarely empty, procedures are not cancelled, and the patient inevitably knows how long he will be in hospital for.
It is not surprising, then, to hear calls for the ways of the private sector to be imported into the public system. One plea is for the public hospital sector to be divided into regional acute care hospitals with enlarged casualty departments, and more local institutions which will concentrate on delivering the planned procedures and investigations generated by less urgent cases.
This would remove the current bottleneck whereby the swamping of accident and emergency departments continually interferes with elective work.
Some observers would even fund the health service by a State-run, not-for-profit insurance system. Dr John Crown, the outspoken Dublin oncologist, has called for such a system.
In his view, an insurance-funded system would hugely incentivise health-providers, because they would be rewarded for doing extra work. At present the system encourages rationing and quotas and a conservatism which, he believes, is at the root of some of the malaise reported by doctors and nurses.
Dr Crown has undoubtedly been influenced by his training in the US. The health system there is a reasonable model for secondary and tertiary care, but it is an unmitigated disaster where the community care of lower socio-economic groups is concerned.
The viewpoint of patients must be sought and listened to. Groups such as the Irish Patients' Association (IPA) have yet to be granted a first meeting with the Minister for Health. Patient empowerment requires that patients be allowed question services and make suggestions for change.
In July the Labour government in Britain presented its plan for a reform of the NHS. It has set ambitious plans for service delivery; by 2004 it aims to have a maximum three-month outpatient wait, and a maximum six-month wait for an operation. To achieve this, Mr Tony Blair pledged a 50 per cent increase in NHS spending over the next five years.
In Ireland the medium-term aim must be to roll back the cuts which crippled our system. In doing so, there is the opportunity to introduce genuine reform along with extra resources.
Once this is achieved, we can look to the longer-term goals of preventive medicine which offer a real opportunity to reverse the morbidity and mortality of chronic disease.
Series concluded