Outsider's close-up look at a health service under growing pressure

Over the past few weeks, I have been talking to people involved at every stage and level in the health service for a documentary…

Over the past few weeks, I have been talking to people involved at every stage and level in the health service for a documentary series I'm planning with RT╔.

I freely admit to being a blow-in. Having worked in Britain as the BBC's health correspondent for many years, I thought I'd heard all the horror stories there were to hear.

And frankly it is hard to beat stories about mass-murdering GPs; nurses who, despite being convicted of raping patients, are allowed to continue practising; and wards that are so dirty people are advised to bring their own J-cloths with them.

But even before I had a chance to find out for myself, friends, family members and new acquaintances were describing the public healthcare system in Ireland as "Third World".

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The stories I have heard first-hand involve hospital consultants whose public clinics are so overstretched they spend less than five minutes examining their patients. I've heard of a woman who, after giving birth by caesarean section, was left on a trolley in a corridor for several hours.

Then there is the young child having to wait nearly 10 months for a test to see whether he has a potentially fatal heart problem.

There are stories of homeless people, injured and possibly the worse for drink, being left on thin mats in a bare room by a major Dublin hospital, on the basis that there are more important people to be seen. And, of course, there are the endless waits in casualty.

At the top of the political agenda is the waiting list. There are 26,000 people waiting for operations. This, it has to be said, represents an improvement on last year, although many have been waiting for more than a year for treatment.

But the problem with hospital waiting lists is that they are a crude and simplistic measure of performance. They don't include the time people have had to wait to get on to the waiting list. Nor do they include waiting for other things such as MRI scans, access to stroke rehabilitation, or places on drug detoxification schemes.

And what about people suffering from severe mental health problems - how long do they have to wait for a secure bed?

The new proposal by the Progressive Democrats - of putting many millions of euros into a special fund and treating anyone waiting more than three months as if they were a private patient paying for rapid treatment - could make a sizeable dent on the existing 26,000.

But, as experience in the UK shows, waiting lists are not solid edifices - they're in constant flux. People move off and on to them all the time. So clearing one set of people may simply allow another 26,000 to replace them.

And the scheme could also place senior surgeons in a position of some ethical difficulty. At present they are paid a salary by the State for their public work, and by the VHI or BUPA for each patient they see privately. If they were unscrupulous, they could take advantage of a system which allows them to boost their private income by slowing down their public work rate.

But what the plan has done is to draw a line in the sand. From now on three months is the benchmark for what can be considered an acceptable waiting time. Something not always achieved by the private sector, I understand.

While waiting lists occupy a lot of headline space, concern about accident and emergency (A&E) units is rising. One in five of the population visited an A&E department last year. Many are deeply unhappy with the service they received. In some areas the wait has become almost farcical. At one south Dublin hospital last month, the assembled sick and injured clapped and cheered every time another patient was called to see the doctor.

One woman who took her elderly mother to a casualty unit was told by a foreign-born doctor that the delay was nothing compared to his third- world country. But while getting treatment seems to the biggest worry for most people, this appears to me to be only half the story. What about the quality of care people receive?

It's clear from many surveys that people revere doctors and nurses. But how can the public judge whether those in charge of their health are truly excellent or simply mediocre? Coming from Britain, I have found it impossible to know where to go to get good advice about which GP I should sign my family up to.

The Irish College of GPs has looked into providing a specialist register, but so far the proposal has been blocked by concerns that it could give one doctor a commercial advantage over another.

And then there is the issue of variations in treatment. There are some 150 hospitals in the Republic. Many are based in medium-sized towns. But I've been told by a number of doctors that, unlike their patients, if they had a heart attack today, they'd head for the nearest city, where the kit and experience of the medical team is better.

During my investigations for the radio series, many people have commented on the uniqueness of the Irish health system. With its mixture of State, private, voluntary organisation and church funding, it is indeed unlike other systems in Europe.

But, as in every other country, it does have vested interests. A recent opinion poll found that nearly a quarter of those asked blamed the deficiencies of the system on different occupational groups in the health service. However, successive ministers for health seem unable to deal with these groups.

The recent extension of the General Medical Scheme to cover everyone over 70 - no matter their income - may be a case in point. While doctors are paid just over £100 a year for each ordinary GMS patient, they now get £300 a year for everyone over 70.

While this could reflect the fact that older people get sick more often, many of those elderly sick were already GMS patients. One doctor I spoke to thought it was more likely that it came about because many GPs along the south Dublin coastline - known in some medical circles as the Gold Coast - were worried that their incomes were about to fall and successfully lobbied for a higher fee.

Despite the events of September 11th, and the uncertain economic future, all the politicians seem to have now accepted that a modern European state should provide a certain level of healthcare. And while each of the parties draws the line in a slightly different place, all accept that the current situation needs more investment and reform. The Government will shortly publish its National Strategy which, it is said, will propose radical reform. It will certainly provide a sound basis for the debate

Of course, any system of healthcare really only picks up the pieces after the damage has been done. And Ireland's health statistics are pretty poor. There is an epidemic of death here from tobacco, alcohol abuse and poor diet. Heart disease and cancer are massive killers.

Reforming the way the system works won't stop that (the bigger reform is of people's own lifestyles - more exercise, fresh vegetables, no fags and less booze), but sorting out the system is a start.

Richard Hannaford's radio series The Truth About the Health System will begin on January 10th on RT╔ Radio One