Consultants and the health system


Sir, – When I was master and chief executive officer of the Coombe hospital, I had to contend with one group of HSE officials checking if the hospital was compliant with its public/private ratio (we were) and another group of HSE officials encouraging the hospital to attract more private patients so as to subsidise the annual revenue allocation by the HSE. Of course, whenever private income was increased, that sum was invariably deducted from the following year’s revenue allocation – and with a year-on-year reduction in allocation, there was constant pressure to increase private income.

In the context of the Dublin maternity hospitals, historically run on shoestring HSE budgets – delivering around 25,000 babies per year between them as well as providing highly specialised foetal medicine, paediatric and gynaecology services at regional and national levels – it is impossible to see how these hospitals could have continued to survive without private practice subsidies.

Abuse of the system by a small number of consultants is utterly inexcusable. Sanctimonious platitudes, however, about how public hospitals ought to work hold little weight in the context of the systemic dysfunction of our healthcare system – where the right hand of those holding the levers of power and the purse strings does not seem to know or care what the left hand is doing.

The solution? A one-tier system based on universal healthcare in which all patients are treated equally according to need and all healthcare workers are appropriately incentivised to work hard and do their very best within a framework of robust corporate and clinical governance. – Yours, etc,


Consultant Obstetrician

and Gynaecologist,

(Master 2006-2012,

Coombe Women

& Infants University


Dublin 8.

Sir, – A minority of consultants will game the system. That is human nature, and consultants are human like the rest of us. The real problem is the failure of HSE management to ensure that its employees work according to their contract. – Yours, etc,



Co Dublin.