Irish Medical News


A letter to Dr Reilly


A root and branch reform of the health service is required by the next Health Minister



Dear James,

You have a tough job ahead. There are three main elements which require to be addressed in order to achieve a healthcare system in this country which we can stand over. These are meaningful reform of the public healthcare administration, ensuring that cost-effective treatments are available equally to every citizen in a timely manner, and finally to address the obscenity that is specialist pay, as the current situation besmirches our profession, corrupts physicians, and demoralises the faith and confidence of all patients in the system of care.


Take out Kafka

In the post-industrial era, where information technology allows for the reliable automation of so many administrative tasks to a far greater and more reliable extent than ever before, the arcane reliance of the Irish Civil Service on administrative procedures, straight out of the 1970s and earlier is quaint, crippling, and exceptionally wasteful. It is demoralising to both the civil servants who have to drive these systems, and especially so to the taxpayer and to patients.

A large proportion of the civil service engaged in these activities requires to be stripped out, along with their associated costs, leaving only those essential and necessary to a lean and efficient process. There are many well motivated individuals trapped within the HSE, spending their lives in vacuous and ultimately futile positions, and in addition to the demoralisation they experience in the course of their “work”, they are absorbing resources directly at the expense of poor public patients, languishing on waiting lists.

Do an immediate “An Bord Snip” on all evidently redundant posts. Genuinely open up all middle management and senior management positions to full-on competition from within the broader economy. Upgrade the expected level of qualification for all budget holding managers. No individual should find themselves the CEO of any hospital, institution or office with a budget of €10 million or more without holding an MBA or equivalent, and preference should be given to those with an established and accounted level of achievement within either the public or private sector over those who do not. Collectively, their mission should be to ensure delivery of medical treatment to all patients presenting to public facilities.


Free for all

All treatments scientifically proven to be cost-effective should be available to all citizens of this State. There are several ways to achieve this objective, it is the principle which is most important. It matters less which system is used than the manner in which the system is implemented. In Ireland, we have become so acculturated to the mire of public mismanagement that private healthcare has acquired a glamour which is bordering on the frankly evil. There are other jurisdictions where the public system is actually held by citizens to be largely and significantly better. Go Dutch, Australian, English or Scandinavian, but put a stop to the present vile situation where we have public patients dying of indifference and incompetence, and private patients being farmed and over treated by rapacious “for profit” private healthcare businesses.


Closer to home

Finally, and closer to our professional home, there is a pressing need to immediately address the kleptocratic process of specialist pay. It represents the successive failure of largely Fianna Fáil administrations in buying industrial peace and IR flexibility during the last 30-40 years. It is to healthcare what Anglo Irish is to the banking sector. It is corruptive to the specialists and deeply repugnant to public patients, other healthcare professionals, and is often alarming to right-minded and thinking private patients.

In an economy such as ours, it is profoundly wrong, immoral and perverse that any individual should stand to profit from the misery and suffering of their fellow citizens to the extent that the specialist establishment does. It is my considered opinion that a majority of our specialist colleagues, who are serious, hard-working and right-minded individuals, would not disagree with your taking immediate and purposeful action on this issue, correcting the present situation over a three year term which will see specialist income benched at €100,000 per annum for a 45 hour week.

Any who do take issue may move to the US, or any other jurisdiction prepared to tolerate the moral turpitude inherent in an orthopaedic consultant trousering €500,000 per annum, while entertaining their public patients on a six month waiting list for basic and essential treatments. Ministers Martin and Harney had the advantage of fiscal flexibility, and wasted it entirely. They failed in the face of entrenched vested interests, and lack of absolute focus on what patients require. Martin huffed, puffed, and postured, Harney tinkered at the edges. You have the advantage of the clear thinking resolve and imperative which can emerge from catharsis and a clear mandate for root and branch reform. As an experienced general practitioner, you have an intimate professional knowledge of how our system cheats, injures, denigrates, and misleads public patients.

Irrespective of any of our individual political or professional allegiances, and indeed our own position on the spectrum of left or right, you will enjoy the support and ambition of all right minded healthcare professionals for you to succeed.

Good luck with it.



0 #4 Michael McConville 2011-03-17 14:28
We have become obsessed with pay in this country and it’s vacuous comparisons to other jurisdictions, apples and pears and all of them green. Productivity is what must be measured, if you do 500K worth of work, thats what you should receive. What is worse 200k per annum for a 24hr contracted GP or 20k per week for a second rate footballer ?
+1 #3 Pablo 2011-03-08 12:43
Surely if consultants pay is decreased to 100k, they will do more private practice.
+1 #2 Conor 2011-03-07 22:59
Dr O’Shea, you re leaving yourself wide open on this one – have you read the 2008 consultant contract salary terms? Are you aware the HSE now applies an additional 10% reduction in salary for “returning” consultants – few of whom will expect hope to be paid one third of your notional “$550k Orthopod”.

Of course the older generation working under a much sweeter deal are still out there -and, just as in society at large – the revenue is entitled to tax payments from these high earners – and this is we assume privately earned income not taxpayer HSE salary. Now if you had argued that consultants are neglecting public duties – well, make that argument. But your position as stated is flimsy and damages your presumption to contribute to the discussion of future directions for our health service.
+5 #1 Patrick Forde 2011-03-06 22:17
An interesting article, Dr. Shea, presumably you will also be restricting your income to less than 100,000 euro? According to information available on the HSE website you received a total of 201,222.50 euro in payments from the HSE in 2009.

Given your self righteous tone I presume this was the total income of your practice for that year, that you do not see any private patients and that you will be sitting down with your colleagues and staff to reduce costs drastically given the circumstances our nation finds itself in?


Patrick Forde

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