A Balancing Act

I listened with interest to Prof John Crown on the Late Late show last night as he outlined the failings within our health service. John Crown is a leading consultant oncologist working in the front line of the Irish health service and he doesn’t mince his words. He believes that the consultant’s contract as currently presented by the HSE, is a fiasco. He described it as an apartheid contract for an apartheid system of healthcare. Today, I heard that the Irish Hospital Consultant’s Association (IHCA) has accepted the HSE’s proposals and will be recommending the contract to it’s members in a ballot later this month. Meanwhile, the Irish Medical Organisation (IMO) is still refusing to come on board and has today requested third party mediation to resolve the problems. On one side, we have a government that insists on perpetuating a 2-tier system of healthcare despite the consensus of opinion which believes that a single tier health service is the way forward. On the other side, we have doctors who don’t like being put under the thumb by administrators who will decide their working hours. This contract has already been four years under discussion and I have to agree with Prof Crown, it has the potential to be a fiasco.

We have a health service in Ireland that offers a high standard of care but the care is not optimal. According to John Crown, this is due to ‘mal’ funding rather than underfunding. When the allocation of money from the HSE runs out, services are cutback at the expense of patient care. Treating patients costs money but It costs the system nothing to have patients on waiting lists. We have a health service run by civil servants instead of having a medical leadership structure in place. The policy of co-located hospitals as proposed by the Progressive Democrat (PD) health policy, is set to cause an even wider divide between the public and private systems. Each system will be differently funded, further adding to the complications. The concept of co-location ultimately means that services are duplicated in the one location. This is neither efficient nor cost effective . The co-located private hospitals already in existence, tend to be small and have sub-optimal expertise in place. As a holder of private health insurance, I can personally testify to this having once faced the decision of having to choose between standard of accommodation and standard of medical care. I was very unwell in A&E at the time and required admission for investigation. As I was known to be infected with MRSA , I required isolation facilities in order to be admitted to the hospital. There were single rooms available in the co-located private hospital but the physician under whose care I was to be admitted, worked only in the public hospital where no isolation facilities were available at that time. This dilemma typifies all that is wrong with the plans for co-location and the divisive nature of the consultant’s contract. I had no problem choosing medical expertise over comfort but I should never have had to make that choice. Why does healthcare have to so divisive? If you’re sick and in need of hospitalization, the type of care you receive shouldn’t be dictated by your ability to pay.

John Crown is in no doubt that the way forward for our health service is a single-tier, not for profit system of healthcare based on a universal system of social insurance. He makes no apology for speaking out about the deficiencies within our health service. As long as there continues to be vested interests and a burgeoning bureaucracy in control of our health service, the system is doomed to fail. The future of the consultant’s contract remains in the balance.

10 Responses to A Balancing Act

  1. Grannymar says:

    Long live John Crown!

  2. Too many cooks involved …. and the biggest cooks or should I say crooks? are the politicians.

    We have administrators and medical practitioners at loggerheads with politicians having their say also.

    Trying to dilute contracts or change work conditions will lead to bad feeling and lead to a system where those who work in the system will feel they are being done bad by and will turn whatever goodwill that they have into apathy.

    I honestly can’t see any resolution in the short term.

  3. Steph says:

    Thanks GM. Yep, we could do with a few more like him who are prepared to stick their necks out and say it as it is!

    Paddy – John Crown quoted that there’s been a 10,000% increase in Grade 8 administrators working in the health service since the formation of the HSE. That’s says it all as far as I’m concerned!

    At the moment I’m clinging to the hope that Cowen will be brave enough to shunt Harney off the stage and bring in someone with fresh ideas and a willingness to backtrack on the ridiculous 2-tier healthcare system. I’m not holding my breath though.

  4. Ian says:


    The single tier NHS in Britain did not come in without a battle, but was carried through by a government with a mandate and desire for far reaching reform. Neither of Ireland’s main political parties show the slightest inclination that they would be prepared for such a battle. We simply do not have politicians of the calibre of those who created the welfare state across the water, nor the political consensus that allowed the system to develop.

  5. Steph says:

    Ian – Are you trying to depress me even further about the health service? 😉

    I would tend to agree that’s the case as long as Fianna Fáil remain in power. They’ve shown no political will power to reform the health service and are using Harney as their scape goat. Fine Gael and Labour are not in favour of the 2-tier system but they’ve no hope of doing anything about it.

    For the moment, I’ve reserving judgement on Cowen until he’s completed his cabinet re-shuffle in May. That’s when I’ll probably despair!

  6. I reckon ….. that the PD’s will pull out of government under the new guy …. last ditch effort to save the party and all that.

    Mary Harney, being the tough nut that she is, will be reluctant to leave her Ministry. She may even do a deal with Cowen ….. leave me be and I’ll join FF.

    Anything is possible ….. and I reckon Mary’s time in politics is drawing to a close. So what does she care if she goes out in a blaze of contoversy!

    Cowen’s tenure could bring some interesting changes.

    As an aside …. if Mary is taken out of Health …. who would you like to see in there? Who do you think could do most good and least damage?

  7. Steph says:

    Cheers! Paddy

    Harney is well past her sell-by date. She’s had her opportunity and she knows it. Her contribution to the Health Debate in TCD sounded less than convincing – there was no evidence of the grand promises to reform the health service, as seen at the time of the last election. Now that the PD’s have a new leader, anything is possible with Mary.

    If I had a choice, I’d like to see Dermot Ahern as Minister for Health. He has the clout and more importantly, an ability to negotiate without causing alienation like Harney.

    However, it suits Cowen to continue to use Harney to take the flak as she has nothing to lose at this stage. I suspect Cowen is likely to back Harney and instead, recommend changes at HSE level. John Crown praised Brendan Drumm as an excellent leader but commented that he’s not being allowed to lead. To date, he’s simply been used as a puppet to manage the PD health policy. This situation has to change. We need a medical leadership structure in place where patient care is seen to come first.

    Our health service is being bled to death with administration costs – Cowen knows the figures and knows that changes have to be made if he’s to save face in office. Let’s hope he makes the right decisions for the right reasons!

  8. laura says:

    whoever is minister for health should do this one thing first watch via a camera for one week admissions via A&E 24/7 and follow a person through the system

  9. Steph says:

    Brilliant thinking! Laura

    A live video cam linking a busy A&E Dept to the Dáil chamber, would help focus priorities fairly quickly.

    If they won’t listen, then we’ll make ’em watch! 😀

  10. aeb says:

    Let’s campaign for a universal health insurance scheme in Ireland that delivers to those in need rather than ability to pay…and is funded through every citizen paying according to their income….with the government (i.e. us) subsiding those whose income is low….this would do away with the public /private split, the duplciation and the inequity that exists today…..other things need to be discussed and addressed though as well …for example…the fact that consultants and GP’s don’t get along and have a healthy or unhealthy disrespect for each other…and this gets in the way of patient care so much of the time… GP’s and consultants are really individual business’ that sell their labour just like the rest of us … they want the best possible contract and deal for their labour and they don’t want to be accountable for what they do…they monitor themselves …most hospitals have evolved from the religious orders…they are private corporations with their own boards of management and CEO…the HSE has very little influence or power over them…so don’t kid yourself…..we get the government and ministers we elect.

    * Final sentence removed by blog owner as it was considered offensive.

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