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Ferris highly critical of Consultants role in Health care crisis

2 March, 2004

Speaking in the course of the debate on Health Care Delivery during Private Members Business this evening Sinn Féin's Martin Ferris strongly criticised the role of Consultants saying that they cannot be "allowed to promote their interests at the expense of public patients." He was also critical of the centralization that exists within the health system and the concentration of specialist services in certain hospitals.

Full text of speech follows:

One of the most striking features of our hospital system at the present time, is the level at which consultants are using the facilities paid for by the taxpayer, to give preference their own private patients. I can't imagine that this would be acceptable in any other branch of the public services. Would an Iarnroid Eireann driver, for example, be allowed to run excursions at times not covered by the official timetable. Or worse, would he be allowed to do so at the same time as official passengers were waiting for the train? I doubt it.

A recent report by the Health Boards revealed that in some instances over half of all those being cared for were receiving private treatment. At Saint Nessan's Regional Orthopaedic Hospital in Limerick, 68% of day care patients were private while at Saint John's, 57% of elective admissions were private.

Those statistics make a mockery of the guidelines that stipulate that there should be a ratio of 80% public to 20% private. The Department is said to be concerned over this and to be reviewing how best to deal with the problem. Surely it ought not be difficult to ensure that the consultants are held to the terms of their contracts in the same manner as any other public employee and that they ensure that public patients attending public facilities receive the treatment to which they are entitled.

Of course I am aware that the majority of private patients only find themselves in the position which they do because of the inadequacies of the health service. Most private patients are people who have been forced to opt for private care due to waiting lists and other shortcomings in the public system. However, the real issue is that consultants contracted to the Health Boards are abusing that position in order to boost their own practises. As I have said, I doubt that this would be tolerated in any other branch of the public services and it ought not be tolerated in the health service.

I suspect that one of the reasons that the level of private practise is tolerated concerns the power of the consultants. They, in common with any other professional body, are of course entitled to represent their members and to fight their corner. However, they can not be allowed to promote those interests at the expense of a public service to which they are primarily contracted.

Many people will recall that it was vested interests in the medical profession who more than anyone else obstructed the constitution of the public health system when it was first proposed in the 1940s. It was they more so than the Bishops who sabotaged Doctor Noel Browne's scheme, and they had to be faced down by the Fianna Fáil Government in which Doctor Jim Ryan as Minister for Health introduced the beginnings of a modern health service.

It is also clear from the crisis facing the Health Boards that there is a marked centralisation within the system. This is obvious when one looks a the way in which specialist services are being concentrated in certain hospitals with the result that regional hospitals, such as my own local one at Tralee, are in danger of being downgraded.

Over the past year or so I have raised several examples where Tralee is being denied the necessary resources to either maintain existing services or to provide those which it has been promised. It seems as though there is a constant battle to be waged to ensure that existing services are maintained. The level of uncertainty that this creates is unsettling for both the Staff and the people who are relying on the service provided. In fairness, most of the concerns raised result in a positive outcome but Hospitals ought not to have to operate in such an atmosphere of constant uncertainty over resources.

The consequences of centralising specialist services, especially in areas like oncology and radiology is that extremely ill people will have to travel long distances to receive the care which they require. Such facilities are overly concentrated in the main population centres. We have already seen the tragic consequences of this in several parts of the country.

Unfortunately there has to be the suspicion that when reports such as that of the National Task Force on Medical Staffing recommend that services are centralised, that this will not be to the overall benefit of existing services. I have no doubt but that the authors of the report were sincere in hoping that the changes will lead to an improvement in the level of provision. There is the danger, however, that a Government seeking to save money will simply use reports like this as an excuse to make cuts.

Another issue of concern to people is the lack of democratic control over the Health Boards. I do not believe that this is enhanced by removing local elected representatives from the Boards. While the system as it operated was far from perfect there did at least exist the mechanism whereby local people felt that they had some input through people they had elected, on the manner in which the various Boards operated.

In the absence of local democratic accountability, the danger is that Health Boards will come increasingly under the control of the Department and that the purpose of having them in the first place will be lost. It is vital that a mechanism exists with the capacity to scrutinise Departmental directives and provide a coherent opinion independent of the Minister.

If the Health Boards are solely made up of Ministerial appointees, that capacity will be removed. In conclusion I ask the House to support this motion as I believe that it accurately reflects the current crisis in the health service, and the view held by most people in this state that it is the most serious issue of public concern.

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