Letters

Public-only consultant contracts

How will contractual change improve services or care?

Mon Dec 26 2022 - 00:12

Sir, – When I travel by bus or train I pay a fare while many other passengers, such as those at the extremes of age, can do so for free. It would clearly be possible to fund all of our travel out of the public coffers. I don’t think, though, that anyone would expect such an alteration in the funding model to make the bus go faster or otherwise improve the logistics of travelling. It would simply mean that we had a single-tier public transport system.

In describing a similar change to the resourcing of our healthcare, Domhnall McGlacken-Byrne appears to anticipate that it will alter the process in ways that are hard to envisage. Currently he says if “you don’t have private health insurance . . . you may wait years for treatment” which is “unfair” (“Public-only consultant contracts a step closer to universal healthcare”, Opinion & Analysis, December 17th).

It will indeed be more fair to place everyone in the same uninsured category, but that seems to be a category unable to meet existing demand.

Making the system equal is one thing, but one might ask will it be equally good or equally bad?

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To return to the analogy with transport, I’d imagine that there are bus drivers around the country who drive taxis, or hackneys, sometimes while off duty. Presumably their employer could offer to pay them a generous premium to desist from such private enterprise, and to rest instead. It would be very hard to see why that might be done, or what benefit might accrue from it. Nonetheless, clauses preventing private sector work seem to be common in medical consultants’ contracts for no apparent reason. Their presence in the existing contract made a degree of sense when written in 2008, as co-located private hospitals were envisaged by the then-minister, and the arrangement would have limited doctors to conducting their private work in them. Given that no such hospitals were ever built though, it makes little or no sense to limit doctors from treating patients anywhere in their free time. And given the numbers on our waiting lists it seems a bizarre objective.

Writing as a doctor with several decades of experience, I would emphasise that it’s heartening to see the idealism and enthusiasm that this young doctor expresses. But nonetheless the changes that might offer the type of service he hopes to see – within which surgeons get enough theatre access, GPs collaborate meaningfully and no child has to wait for care – don’t require a new contract. They require new infrastructure. On which subject, it’s instructive to consider that plans to build Tallaght hospital and the Blackrock Clinic were announced roughly contemporaneously. However, the former took over 15 years to build while the latter opened in much less than five. The children’s hospital project would suggest we haven’t improved much in our capacity to undertake such large-scale public ventures.

I’m genuinely at a loss as to why anyone might expect this type of contractual change to improve services or care. It seems comparable to taking our aviation sector and reverting it to the Aer Lingus of my youth, when Dublin to London was reputedly the most expensive route in the world and incentives to improve it were nonexistent. The idea that the contract might boost recruitment and retention of highly trained doctors is likewise unjustifiable. It does not appear to have been developed as an answer to their concerns, and seems less popular than the current one which so many find unattractive. – Yours, etc,

BRIAN O’BRIEN,

Kinsale,

Co Cork.