Madam, - In The Irish Times debate on health, the contribution of James Sheehan stands out (Opinion, June 10th). He is accurate in his advocacy of universal insurance, competition and accountability across the board as the simplest reform that would eliminate discrimination and increase efficiency.
It might also help to address the supply-side problem which is the true cause of the queues. Dr Gerard Bury (same date) asserts that private health care undermines the public sector and claims that "but for its role, Ireland's health care structures might be a great deal better". An opinion certainly, but in my view, unlikely to be accurate.
Patients waiting in A&E and on waiting lists need more beds in acute hospitals to address their immediate needs, more step-down nursing-home places to allow appropriate use of the current bed complement and someone to pay for all this. Once the doctors are appropriately trained generalists or specialists and once the institutions are formally accredited, the site of the medical work is the least germane issue.
Who owns or operates the institution is not important. Private practice off-site has been a release valve in medicine for consultants denied the facilities to work full-time in major hospitals. Closure of beds, operating theatres and some imaging and laboratory services have the effect of wasting doctors' time, increasing the cost base of every procedure, and reducing morale.
Irish hospital consultants are well paid overall. Their clinical standards are excellent where I work in Beaumont and Blanchardstown and in the audit data I have seen published from hospitals across the country. That is not surprising, because Irish doctors are a top-slice academic cohort of the school-leavers of the country and are highly marketable overseas in the best centres in the international medical world.
What consultants should be paid, and how, is a matter of opinion. We claim we are a very valuable resource for the community and earn our corn. Others clearly think otherwise. Consultant salaries are not a serious funding issue for the Government.
The pace of change in medicine is frantic and accelerating. The US spends $27 billion on research yearly, more than the rest of the world combined, with consequences that have wider effects on patient care. What medicine can do for patients is yearly being transformed, but it is not cheap. The drugs industry also spends millions of dollars on trials trying to validate its drugs and other therapeutic interventions.
Patients demand the best for themselves and doctors are ethically bound to do the best they can for each individual. The cost inexorably rises. Bioscience is big business. Medicine is the end target audience for much of its innovation.
There is therefore no easy, equitable answer to the provision of an up-to-date health service. Has every citizen a "right" to every therapy possible for every ailment? No country in the world has the answer because the ground continually shifts.
One thing is certain: if you demoralise the providers, the quality and volume of service will fall. Health and medicine are complex subjects which require more than a brief letter to address. My considered contribution will be published in a book in the autumn. - Yours, etc.,
Dr BILL TORMEY, (Hospital consultant), Glasnevin Avenue, Dublin 11.