Sir, - Ray Kinsella (Opinion, November 28th) makes some insightful remarks. However, it is not correct for him to write that the medical profession has "failed to develop, articulate and push forward a clear vision" for delivery of health care in Ireland. Clearly he does not realise that doctors are in daily communication with hospital managements and health board managements making recommendations, outlining inadequacies and attempting to convey a vision for medicine in terms of improved levels of outcomes, cost effectiveness, risk management and performance. For many reasons the vision falls on "inaction"; the recommendations are not recognised in a practical sense and they get buried.
Many Irish doctors have worked abroad at senior level and appreciate more than many the inadequacies of the different health care delivery systems. Look at the mess the British NHS has got itself into - after 20 years of reform (report after report and reform after reform). Reports and reforms are necessary, but among other things an appropriate management structure is required that respects the high level of skill and dedication delivered by nurses, doctors and allied professionals.
The traditional corporate management structure embarked on by the NHS does not work in health care delivery. The model has been tried and failed. Health care mangement - there lies a major philosophical and practical challenge. Yours, etc., -
Dr G.T. Fahy, Flood Street Galway.