Deal being touted as 'the panacea for health system'

THE INTRODUCTION of the new consultant contracts will have little impact without "root and branch reform" of the health service, a senior hospital consultant has warned, writes Kathy Sheridan.

Prof Michael O'Keefe, consultant ophthalmologist at the Mater hospital, said the contract was "being touted as the panacea for the health system, as a big, big breakthrough in health reform", but there was nothing to suggest this would be the case.

"What you hear is a load of management-speak and guff about world-class centres and nothing working. The system is . . . dysfunctional.

"It needs root and branch reform at a ground floor, practical level. A factory will go broke if the conveyor belt isn't working and meanwhile, on the top floor, grandiose plans are being created but without any productivity".

One of the planks of the proposed new system was the private hospitals, he said, "yet this new document is completely silent on that. So when they come on stream in three years time, these contracts will have to be renegotiated; that's what it states in the appendix.

"This will involve huge issues. No one knows what's going to go on in them, what the facilities will be, how many beds, what kind of on-call cover there will be - I'm not sure if they [HSE] even know themselves," Prof O'Keefe said.

"We do know that those hospitals will be all private patients but what happens for example if there is a call in the night from the co-located hospital? Doctors on the new A-type contract can't answer it because their contract specifies no private practice.

"The A-type contract will be attractive to psychiatrists, geriatricians and anybody with a limited private practice or who is near retirement and wants the additional money reflected in the pension terms. What will happen effectively is that between the three contract types, there will be an apartheid approach."

He accepted that there was currently "an abuse of the system, certainly. Some doctors are doing up to 40 per cent and more of private work in public hospitals and it's fair to want to stamp that out.

His own solution, he says, would be "to bring in a common waiting list, so if you want to be seen in a public hospital, you have to wait like a public patient. That's how you stamp it out".

But there was nothing in this document to increase capacity, he said, adding, "the assumption is that this will take all private beds out of public hospitals but there are still going to be private beds in Beaumont hospital.

"And at the root of it all, people have to realise that there is no proper running of these hospitals, no proper management of the kind who will get out of the office and actually get involved in patient care . . . "

"Then those patients end up on the National Treatment Purchase Fund [NTPF] and on the surface that seems great. But a lot of those patients should have gone into the public system. What happens instead is that a patient waiting three months for a cataract operation goes on the NTPF list and ends up with people like me in the Mater Private where I get paid €900 a shot and can do eight to nine a day.

"Over 50 per cent of cataracts in the Eye and Ear hospital are being done on Saturdays on the NTPF list - in an eye hospital. Hip replacements from Tullamore are being done by public consultants on a private basis in the Hermitage [a private hospital]."

The bottom line, he said, was that there was nothing in the contract to improve conditions for patients.

"Go to AE and you'll probably get better conditions in the earthquake area of Burma," he said.