Sir, - Not only does Fintan O'Toole (Opinion, September 4th) place responsibility for all the shortcomings of our public hospital system - inadequate consultant numbers and long waiting lists - on consultants; he goes further and lays the blame for the lack of medical and scientific research on their doorstep as well.
Mr O'Toole offers an opinion while taking, it would seem, great care to avoid being confused by the facts. Your readers, before reaching a conclusion on Mr O'Toole's claims, should take note of the following facts.
The number of consultants appointed to public hospitals is controlled by the Department of Health and Children. Unless that Department expresses its willingness to fund a post, an application cannot be made to Comhairle na nOspideal to have the parameters of the post defined, qualifications specified, advertisements placed, etc.
Notwithstanding this stranglehold on appointments by the Department, the number of consultants in our public hospitals has increased from 1,064 in 1989 to 1,341 (establishment) in 1998.
The IHCA, since its foundation in 1989, and every college, faculty and institute representing consultants that I am aware of, has consistently called for the creation of extra posts in virtually all specialities in every public hospital. Notwithstanding these repeated calls the ratio of consultants to population in Ireland is among the lowest of the OECD countries.
While Fintan O'Toole may not be interested, your readers may wish to note that the ratio of beds to population, the average length of stay and the number of admissions per thousand population in Ireland are all among the lowest of the OECD countries.
The Tierney Report on Manpower, published five years ago, has been allowed to gather dust on a shelf in the Department of Health.
The vast majority of patients admitted to our public hospitals are emergencies. In excess of 90 per cent, on average, of the 500,000-plus admissions each year are, quite naturally, given preference over elective admissions. The result is 34,000 people awaiting such procedures as cardiac by-passes, hip operations and various ophthalmic, ENT and gynaecological procedures. The provision of resources is a matter for the Department of Health and its various agencies. Please, Fintan O'Toole, do not blame consultants for the inadequate resourcing of our health services.
At this very moment the IHCA is seeking an urgent meeting with the Minister for Health and Children, Brian Cowen, because of our concern at the growing number of patients on our waiting lists, while at the same time approximately 1,500 beds are either closed or inappropriately occupied by longstay patients who need nursing care rather than medical care in step down facilities.
I am not aware of any consultant who continues to be dependent on the skills and diagnostic information that he learned 20 or 30 years ago as claimed in Fintan O'Toole's article. I contend that, more so than any other professional group, hospital consultants are extremely conscious of the necessity of continuing medical education. The medicine practised by me and my colleagues today is very different to that practised when we were appointed in 1978.
Notwithstanding the fact that the vast majority of consultant posts in Ireland are service orientated, our extraordinary track record in medical publications and research has been recognised repeatedly by reputable medical publications in the UK and North America.
Incidentally, I agree with Fintan O'Toole's contention that medical research is grossly under-funded in this State. But do not blame hospital consultants for the shortage. - Yours, etc., DR D F Lillis,
President, Irish Hospital Consultants Association, Heritage House, Dundrum Office Park, Dublin 14.