Sir, - In your news reports on the Estimates and in the related article by Mark Brennock (Irish Times, November 16th) comment is made on Mr McCreevy's views on health spending and the state of the health service.
No one can take issue with his analysis that without reform it is very likely that additional spending on health will be wasted. His observation that, with the "youngest population in Europe we should be fitter and less sick", is worth closer scrutiny.
What was wrong with the reported 920,000 patients (25 per cent of the population) who required hospital treatment this year? Mr Martin's statement also reported with "obvious satisfaction" that an extra 52,000 patients had been treated by hospitals this year, suggesting that the object of the exercise is to increase such hospital productivity. Surely the direct opposite should be the primary objective of any new health strategy.
The numbers game was further highlighted by the acknowledgement that there are 88,000 people working in the health services, with an additional 2,500 to be employed next year. The general public might well surmise that simply increasing the number of staff, beds and patients will solve the problems.
Unfortunately there are no numbers to measure the promises and commitment of the Minister for Health to reforms, presumably because, as Minister McCreevy says, "there are many vested interests in the health area which have terrible clout and have used it on many occasions". Again Mr McCreevy is correct. If he had expanded on this statement in his own inimitable style he would have added that the primary vested interest is the political system at national, regional and local levels.
The other two major vested interests are the patients and the doctors. The latter two have largely been ignored in the formulation of the new health strategy, though significant window-dressing exercises were conducted throughout the country. The patients continue to complain and have become more vocal and demanding in seeking equity and access to quality healthcare. Their doctors welcome this development and recognise that patients are likely to be more successful than the profession in this endeavour.
However, one last effort by a member of the profession is worth a throw! The same news reports state that acute hospitals will receive only one-third of the service development funds allocated to the Department of Health (€94 million) and yet the entire political debate on the health service has been focused on the acute hospitals and the waiting lists.
In that context I offer some numbers that I suggest speak for themselves. Approximately 55 per cent of the public hospital waiting list, according to recent figures from the Department of Health, relate to patients waiting for treatment in five speciality aras. These are ear, nose and throat surgery, eye surgery, plastic surgery, orthopaedics and urology. The total number of consultant posts in the country as of January 1st, 2001, according to Comhairle na nOspideal, was 1,560. There are 161 consultants (10 per cent) in the above specialities. More than half of these are based in Dublin. Some regions have no consultants in more than one of these specialities. Dublin has 36 per cent of the population and 48 per cent of the consultant establishment is based there.
It was reported in June 2001 that the CEO of the Eastern Regional Health Authority (ERHA) stated that over 40 per cent of non-emergency beds in the Eastern region are used by patients from outside the region. This fact was represented in the press as county hospitals "dumping" on Dublin. Any citizen can get sick away from home or be involved in an accident. They must depend on the acute hospitals. As can be gleaned from the figures above, medical care is frequently conducted and delivered without the necessary expertise and support on site.
This unacceptable situation has been allowed to continue by Government. Consistent and definitive advice from the profession about structural deficits, quality assurance and safety issues and resource utilisation and distribution has been barely tolerated and frequently ignored.
The above shortcomings can only be addressed by reform. The numbers are important and the Minister might well reflect that the consultant establishment accounts for only 1.8 per cent of the workforce. - Yours, etc.,
F. Lennon, Consultant Surgeon, Ardee Street, Collon, Co Louth.