A Balancing Act

April 19, 2008

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.

Health Service Exposed

September 25, 2007

I’ve long been a fan of Prof John Crown, Consultant Medical Oncologist, for the manner in which he speaks out to expose the faults in the Irish health system. John Crown does not mince his words – he says it as it is and in doing so has managed to rattle cages to shame the Department of Health into doing something about the disastrous health service in this country. He writes a regular column in the Sunday Independent which exposes the chinks and cracks in the system, and helps to paint a clearer picture of the problems involved. Last Sunday’s article was no exception where he likened the bureaucrats in the HSE (Health Service Executive) to the dinosaurs taking over in Jurassic Park, and named it ‘Burassic Park’.

In a week when the HSE announced a freeze on recruitment leading to health service cutbacks, they simultaneously announced a scheme of performance bonuses for senior HSE administrators. As John Crown so rightly pointed out, this clearly shows where the priorities of the HSE lie. This latest action by the HSE is a complete insult to those who are expected to continue to work in an already under-resourced and over-burdened health system. I personally feel very uncomfortable about the way in which our Minister for Health, Mary Harney, has reacted to the events that have happened at Barringtons Hospital recently concerning cancer care there. She is insisting that the Dept of Health has no authority over private hospitals and thus she says, it has no authority to take action to intervene. This does not bode well for the future of our health service which will have many more private hospitals coming on stream as the Minister insists on pressing ahead with the co-location debacle. Who will take responsibility when things go wrong in these private hospitals?

John Crown also clarified the problems involved in the stand-off that continues between the Dept of Health and the Irish Hospital Consultants Association (IHCA) over consultant contracts. To his credit, he actually criticised the consultants (his colleagues) for their increasingly unseemly row over private practice rights of their as yet, non-existent colleagues. He believes that the IHCA should concede the inevitable and accept that the new consultants will have to have new contracts which the Dept of Health will ultimately decide upon. He encouraged consultants instead to “channel their energies into the good fight, which is the fight for healthcare reform, universal health insurance and single-tier healthcare”. At last common sense has spoken!

Irish patients deserve equity of health care and a better healthcare service. We owe a great debt of gratitude to John Crown for the role that he plays as a doctor to advocate on behalf of all patients. He is a voice of reason in a world where common sense is sadly lacking. May he long continue to fight the good fight on our behalf.

(Co)-Location, (Co)-Location, (Co)-Location

May 14, 2007

I just don’t get it. As I understand this co-location policy, Fianna Fail wants to free-up more Public beds in Public hospitals for Public patients. They say that the quickest way to achieve this is by moving Private patients out of Public beds into co-located (cushy) Private hospitals on Public hospital sites. These Private hospitals are to be staffed by Consultants who agree to work in the Private system only. And in the long term, it’s hoped that Public hospital Consultants will agree to work only in the Public sector. In HSE speak, this policy will free-up approx 1,ooo Public beds for those patients without private health insurance. But let’s look at what else this policy will achieve.

Without doubt it’s going to cause an even wider divide between the Public and the Private systems. The Private health insurance market has gone mad and is set to get even worse with this government’s policies. Are the hospital Consultants happy with the HSE proposals? No. The HSE is interfering in doctor/patient relationships. Is it any wonder that the IHCA (Irish Hospital Consultants Association) is refusing to agree to new contracts. Private patients will always continue to need both elective and emergency care in Public hospitals as these are the centres of excellence for many complicated conditions. What is a Private consultant meant to do when his/her Private patient is re-admitted as an emergency to a Public hospital following surgery in the Private system. Are they expected to abandon their patients?
Could someone please explain to me why patients in Public hospitals are expected to put up with filthy, old-fashioned hospital conditions while Private patients are set to get all the nice new modern, clean facilities? And why is it that Public patients get lousy food when Private patients have á la carte menus? You’re either sick and in need of good hospital care or you’re not.

Surely it makes sense to concentrate resources on getting a decent Health Service that works for everyone. I say – one for all, and all for one! But it’s not about common sense is it?