Take a mixture of half-truth and selective quotation, add opinions which have no factual underpinning, leaven with unsubstantiated assertions by anonymous individuals, and bake well in an oven of blind prejudice and what do you get? - Maev-Ann Wren's diatribe against consultants last week.
If this is investigative journalism, it is surprising that she was able to come to so many conclusions in the absence of verifiable facts. Investigative journalism is meant to uncover facts, not ignore them.
As chairman of the Irish Hospital Consultants' Association (IHCA) committees on the common contract and manpower, I have negotiated at length with officials of the Department of Health and other healthcare agencies and so am in a position to provide facts which disprove her assertions.
It is hard to know where to begin to unravel this tangle of, at best, half-truths. Before I get into the substance of the manpower issue I wish to correct some "misconceptions" which have been picked up by several of your correspondents.
Consultants have no control over their number. Any trainee journalist could easily verify this. Since its foundation, the IHCA has been calling for more consultants. We have been aware that, especially in situations where consultants work on one-in-one or one-in-two rotas, the public is not well served. We have consistently sought to increase numbers. How can consultants on such rotas possibly deliver a round-the-clock, hands-on service?
We do not control entry through the postgraduate examinations system. The purpose of this system is to protect the public by ensuring that properly-trained doctors are available to fill consultant posts.
Pass rates in these exams are not related to requirements for consultant posts and indeed, the output regularly exceeds the most generous projections of consultant requirements, a problem which we have sought to remedy.
The control of consultant numbers effectively lies with the Department of Health. Applications for new or replacement appointments cannot progress without funding which must be approved by the Department. This has proved to be the major bottleneck.
The contradictions in Ms Wren's series of articles are blatant. We cannot be conspiring to preserve a closed shop by limiting our numbers and at the same time, quoting Ms Wren, agreeing a "70 per cent increase in number".
We believe that a figure of 1,000 extra consultants is the least of what is required. We cannot, on the one hand, be objecting to the neoconsultants because they would grab private patients from under our noses, and simultaneously be seeking an extra 1,000 full appointments with the whole range of private practice options open to them - in competition with the established practitioners. She can't have it both ways.
The assertion that there is widespread neglect of contracted public duties by consultants in favour of private patients is without foundation. Say something like this often enough and people begin to believe it.
The only evidence adduced to support the statement is a quotation from a nameless official. I challenge this official to come forward, identify him or herself and provide the evidence to support it, naming the individuals involved. During the last contract negotiations, senior Department of Health officials repeatedly accepted that the vast majority of consultants comfortably fulfilled their contractual requirements. This is documented and verifiable. Managers in hospitals can monitor whether or not consultant services are being delivered according to contract and have a duty to do so.
The IHCA does not support or condone any breach of contract. There is no area of human activity without a small number of individuals who do not do what is expected of them. These exceptions do not prove rules.
In my experience, consultants are consistently frustrated in their attempts to deliver service to public patients by shortages of funding and staff, both of which regularly lead to cancellation of operating lists.
Once again, this is a fact which is easily verifiable. The consultants' frustration in these circumstances is shared by hospital managers and nurses.
NOW for manpower matters. The IHCA agrees with the Department of Health that some 1,000 or so extra consultants are needed to bring our healthcare service up to modern standards. We are deeply frustrated by the delay in publication of the report of the manpower forum and have lately met with the Department of Health to press it to get on with this task.
The IHCA has also recognised that in these times greater "flexibility" is required of consultants in the delivery of services to patients. This should ensure greater availability of consultants around the clock, but only if it is complemented by an increase in consultant numbers.
We are serious about this. So much so that, before entering talks with the Department of Health, we surveyed our membership on their willingness to consider renegotiation of the contract to permit routine availability of consultants outside conventional working hours. An overwhelming majority was in favour of providing this flexibility. An equal majority rejected the so-called Category 3 or sub-consultant post.
There are good reasons for this. The post as envisaged by the Department of Health is profoundly flawed and such appointees would be wide open to being exploited by hospital managers and other consultants. This would lead to discontent and strife.
Indeed, if consultants were the Machiavellian manipulators of the system that Ms Wren portrays us to be, we would have accepted these Category 3 consultants with open arms, as they would do all the difficult out-of-hours and weekend work!
Ms Wren is absolutely wrong when she says that the IHCA is not prepared to consider a "fundamental reform of their working practices". We have openly stated that where it is necessary for proper delivery of care, consultants would be prepared to be available on site out of hours, including the provision of some form of shift cover.
Prof Fitzgerald, oh Prof Fitzgerald, what can I say? The "many consultants who disagree with the IHCA" have remained resolutely silent while he persists as a lone voice in expressing his views. This invisible and shy army is truly without number.
His manpower model would have some currency in a large metropolitan hospital in New York or Boston, but has little functionality in a small hospital in Ireland. Remember that even our largest hospitals are relatively small by international standards.
Where I can agree with Prof Fitzgerald is about the need to rationalise the hospital structure in this State. The persistence of small units is an intrinsic part of the manpower problem.
It is extremely difficult to attract Irish graduates to train in these hospitals. This is not because of any deficiency in the quality of the consultants or their service, but because the numbers are insufficient to provide the breadth of training that is necessary. Furthermore, the rotas are so punitive that consultants have little time to train - and NCHDs to be trained - because both must concentrate on delivery of services.
The depth of distortion in Ms Wren's writings is such that I have little doubt if an individual were cited, instead of the collective of "consultants", many of the assertions would be open to action for defamation. The Irish Times should not allow its columns to be used for such a vitriolic attack, knowing that the targets have no legal remedy.
THE basic problem with the Irish healthcare system is underfunding. The powers that be openly accept this. Why otherwise would they be planning to increase capital and revenue spending? Why else are they currently deciding how to increase the number of hospital beds? Would they really be planning to spend more if they believed that the current budget was adequate?
The next major problem is the hospital infrastructure. We can only stand by in amazement at the misuse and sheer waste of resources and opportunities that lack of reform has caused.
Political courage is required. Properly informed, the public will support reform if it delivers better healthcare. It is not an issue of closing down hospitals but of streamlining how they are used.
Without the skill and dedication of consultants and other medical and paramedical staff in the public service, the situation today would be far worse. Ireland, despite the underfunding and the other shortcomings of its system, was respectably placed in the recent WHO league table of national healthcare systems. As such it falls just behind the vaunted NHS, well ahead of the USA and ahead of Germany and, interestingly, Sweden.
The latter is Ms Wren's favoured economic model. It is not clear why it should be so apart from the fact that it appears to her that it puts consultants in their place, at least in her order of things. She should remember that in Ireland we are in direct competition with North America, among other places, when it comes to recruiting new consultants.
The IHCA recognises the need for modernisation and has unequivocally expressed its willingness to participate in the process. Like any self-respecting representative organisation, it will negotiate the substantial changes required, but in private and with the relevant authorities. The outcome of this process will be in the public arena.
We have no intention of negotiating it in the columns of The Irish Times or being told what to do by a journalist with a one-woman mission. We will not be used as scapegoats for failings over which we have no control.
Peter Kelly works in the department of pathology at the Mater Misericordiae Hospital in Dublin.