Sir, - In your recent excellent series "States of Health", there were two constants in your comparisons of our ailing public health services with those of countries with similar levels of wealth and development. Firstly, lack of investment; and secondly, failure to train and retain in the service adequate numbers of vital first-line health professionals.
The number of permanent doctors currently working in the Irish health service is approximately 4,000. Relative to population, we have only a third of the number of permanent doctors in countries such as the US, Canada and France, half the EU average, and two-thirds that in the United Kingdom. It is interesting that the United Kingdom is seeking to increase immediately its numbers of permanent doctors to the EU average.
In view of the above, I read with anticipation the Government's new 10-year strategy to improve our health services. However, the document failed to indicate how many hospital consultants would be required. And in relation to the development of primary care services it significantly underestimates the need for additional general practitioners at 500 over the next 10 years. It is obvious to those of us working in the health service with an interest in education and manpower issues that the additional number of permanent doctors required over the next 10 years will be more than 2,000. This figure would not even achieve the current EU average relative to population.
The intake of medical students in this State is 610 annually. The Government will fund and allow only 330 Irish citizens to take up these places through the CAO each year. The number of students who listed medicine as their first preference in the CAO last year was over 1,200. Twenty-five years ago there were over 400 medical school places available to Irish citizens each year. Almost half of all places in medical school are now reserved for students from non-EU countries including North America (where the need for additional doctors is not as great), to generate additional fee income for the universities.
The approximately 300 Irish doctors graduating from our medical schools each year do not meet our current replacement needs. This is due to a variety of factors including career changes, failure to train and retain doctors in our healthcare system, and part-time working.
The number of medical school entrants in 2002 necessary to meet the replacement needs at the end of the health strategy programme will be over 450. These entrants will not be ready to take up full-time employment in the Irish Health Service, following undergraduate education and postgraduate training, for at least 12 years. If the Government's health strategy is to be more than a paper exercise, it is essential that the number of places available to Irish citizens in 2002 be increased by at least 50 per cent.
Failure by the Ministers for Health and for Education to show leadership on this issue would seriously undermine my confidence that there could be any serious intent to deliver on their proposed strategy. - Yours, etc.,
Dr Martin White, Nobber, Co Meath.