The HSE – a state of permanent crisis


Sir, – It is with interest that I read in your Letters section about the location of a major trauma centre at the Mater hospital (“Trauma centre decision a risk to patients”, May 5th). This in itself is a great step forward in the care of the patient suffering from severe trauma.

As a surgeon, I have spent a career in the care of these patients, and agree with the group of neurosurgeons who feel that a complete team approach to these patients will ultimately provide better outcomes. The whole trauma team and ancillary services need to be located in a single location, with immediate access to the emergency department where the patient is located. The transfer of these patients to another hospital may not provide optimal ongoing care due to delays, stabilisation, and future specialised management. It is unfortunate that what looks like a turf war has also broken out among the specialists of both hospitals, which of course is of absolutely no benefit to the patient.

I cannot help wondering if Ireland has a major problem with construction of advanced hospitals. The National Children’s Hospital is being constructed at astronomical cost, probably one of the most expensive in the world per head of population. Then there are all the arguments over the National Maternity Hospital (“Fresh thinking on National Maternity Hospital impasse vital”, Opinion & Analysis, May 5th), concerning its possible inability to provide full women’s health services because of religious affiliation, and now this discussion over an advanced trauma unit and its location.

All of this reminds me of a three-legged donkey competing in the Grand National. Why can’t Ireland get these things right the first time? – Yours, etc,


(Retired Consultant





Sir, – What sickness leads to the National Maternity Hospital embarrassment, the Dublin major trauma centre battle and the National Children’s Hospital fiasco?

Is there no cure? – Yours, etc,


Gaoth Dobhair,

Co Dhún na nGall.

Sir, – Our lives are more deeply interconnected and interdependent than we might care to admit. In this odd era of mask-wearing and elbow-bumping, never before has the relationship between the well-being of the individual and of broader society been rendered so explicit: “We are all in this together” goes the slogan. All of us have fundamentally altered our lives in unpleasant ways, to protect not just ourselves and our loved ones, but society as a whole, especially our most vulnerable.

This ethical shift is novel and profound, and we must apply it to the other great problems we face. In particular, consider our health system.

Ireland has one of the most inequitable health systems in the developed world. Too often it reflects a conception of healthcare as a privilege to be bestowed, rather than a human right of all people. Our public hospital waiting lists are longer than ever (for those who cannot afford to pay to expedite the process). Allied healthcare professionals in our communities are stretched to breaking point. We remain the only country in western Europe without universal access to primary care.

Surely, four years after the Sláintecare report, it is time to change these things. Ireland deserves a universal healthcare system, where all people are guaranteed healthcare that is timely, excellent and delivered on the basis of clinical need and not ability to pay.

It is striking that all Covid-related healthcare – from GP phone consultations to hospital care to getting a Covid test – has remained free for patients throughout the pandemic. In a setting where early identification of cases is paramount, the logic for removing barriers to care is self-evident. However, though less obvious, the same principles apply to healthcare generally. In a system heavily dependent on ability to pay, in which people who cannot do so face barriers to accessing care, getting sicker in the meantime, society as a whole ultimately suffers.

We are indeed all in this together. In this shared weakness lies a great strength. We all suffer from a fragmented and under-resourced public healthcare system. In a universal health system, in which healthcare is upheld as a human right of all people, we all stand to benefit. – Yours, etc,



Dublin 1.