Putting the patient first

FOUR WEEKS ago, Minister for Health Mary Harney declared that agreement had been reached with hospital consultants on a contract that would provide significant improvements in public patient care. Last weekend, the Irish Hospital Consultants' Association (IHCA) said it would not recommend the terms of a new contract to its members until the end of next month.

What is going on? And why have the needs of those at the heart of this exercise - sick patients - been put on hold once again? It has taken nearly five years of intermittent negotiations to bring us to this point. In that time, the dysfunctional nature of many of our hospitals has become obvious. With no agreement on a new contract, natural wastage reduced an already inadequate number of consultants. Last year, in a show of political determination, 68 new consultant posts were advertised - and then frozen - pending negotiations with the IHCA and the Irish Medical Organisation (IMO). Those jobs remain unfilled and unfortunate patients are suffering and dying.

The IHCA has blamed the Health Service Executive for the current delay, talking about "a lost sense of urgency". It complained a HSE contract document did not reflect the terms of agreement reached last January on issues like rest days, pension entitlements and continuing medical education. The HSE has denied any lack of commitment to complete the deal. But a shortage of funding and a dispute over salary scales for academic consultants have created obvious difficulties.

We have been here before and it is soul-destroying. Both sides have a moral obligation to resolve these issues and facilitate recruitment of some of the 2,000 additional consultants that have been long-promised by Government.

Because of a lack of trust between consultants and the HSE, perhaps the only way to surmount these new difficulties would be through the recall of independent talks chairman Mark Connaughton for a set number of days. Matters already agreed could formally be set down in contract form and outstanding issues addressed as a matter of urgency. It is vital that, at a time when private medicine is receiving extensive Government supports, momentum for change within the public health sector is not lost.

Our two-tier system has been in crisis for years. And the situation is getting worse. Ireland was at the bottom of the EU league in 2007, in terms of waiting time for services, according to the Euro Health Consumer Index. More than 140,000 public patients are now on waiting lists to see a consultant. But negotiations on a new contract for these well-paid medical specialists drag on and on. The Government resolved to avoid direct responsibility for inadequate services by establishing the HSE as an independent agency. And Ministers now complain about a lack of accountability and defective healthcare. It is a shameful exercise. In spite of that, the HSE executive and hospital consultants have duties and responsibilities.

The care of patients must come first.

© 2008 The Irish Times

This article appears in the print edition of the Irish Times