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Friday 19 September 2014

Only doctors can prescribe

Dr Maurice Gueret

Published 20/07/2003 | 00:11

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Unhealthy State - Anatomy of a Sick Society Maev-Ann Wren New Island Books, ?17.99 BEFORE a scalpel peels away the skin, the first task of any anatomist is to procure a good specimen to dismember. The ideal cadaver is intact, well-preserved and has all of the internal parts exactly where you expect them to be. Maev-Ann Wren's autopsy on Ireland's health service was no simple dissection.

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She must have found the experience more reminiscent of a forensic post-mortem. The festering wounds and disjointed pieces she uncovers all indicate the slow and painful death our public health service has undergone. Her dissection is exemplary. But when there is no shortage of suspects and willing accomplices, difficulties can arise when apportioning blame.

Those of us who prop up a decaying health service in our daily tribulations might resent an outsider who sees fit to examine, diagnose and prescribe some new medicine. Ms Wren is neither an under-valued nurse nor an over-worked doctor. She is an award-winning journalist with degrees in history and economics. The analysis that spawned her book began just three years ago with a series of challenging articles published in the Irish Times.

She hails from a family of doctors and, rather tellingly, grew up in a house where Michael Foot's biography of Aneurin Bevan, the founding father of British National Health Service, had pride of place on the bookshelf.

It is hardly surprising therefore that Unhealthy State is a book with a distinctly left-wing perspective. Both front and back covers boast citations from her fellow traveller Fintan O'Toole: "Essential reading for any concerned citizen."

Ms Wren's book is rich on historical detail and for this alone it is a tapestry worthy of admiration. She charts the reforming zeal of the visionary Dr James Deeny and the uncompromising Dr Noel Browne. There follows painful accounts of the battered careers of many health ministers who spent their time fire-fighting in Hawkins House when they might have been better employed talking to those who strike matches.

The author is fulsome in her praise and promotion of free medical care, public salaries, investment of further State resources and social solidarity. Her arguments about equity of access are well founded. The book's criticisms of hospital consultants and their representative bodies have been well aired.

When viewed with a cold historical eye, albeit a jaundiced one, many pillars of the Irish medical profession shine none too brightly in the genesis of our two-tier health service. Reformers have been few. Reactionary conformists have been many. But to cast the profession as the villain is myopic and dangerous.

The medical profession is no more or no less powerful than any other professional sector in Irish society. There is not one hospital consultant elected to the Dail. Indeed, I cannot recall when one of their number ever achieved ministerial office.

Their representative union, the oft-maligned IHCA, has had an often overlooked no-strike policy since its formation. Sure, every basket has its rotten eggs. But those who neglect their public work for private benefit remain few.

No government has ever tried to enlist their expertise in overhauling what is patently an unfair system. A them-and-us mentality has pervaded the Department for Health for years and few ministers have been brave enough to desert their civil service trench and cross over to "enemy" lines.

Ms Wren's attentions are less rigorous when it comes to the many failings of State-sponsored healthcare, a service where huge increases in funding, albeit short-term, have been frittered away on propping up back-room jobs and bloating State salaries. Its greatest dereliction of duty - an age-old inability to vaccinate Irish children to anything even approaching international standards - doesn't merit a mention.

Proponents of fiscal and structural reform are attacked as being "motivated by their rearguard defence of lower taxes". There is little mention of the talent that is stifled by an inward-looking public health service, where innovation is actively discouraged and motivation is frowned upon as a dirty word.

Too late for inclusion in her tome was the news from the South Eastern Health Board that an obstetrics and gynaecology unit which has been granted an extra consultant, was ordered to maintain its workload as before, and not to engage in any extra clinical activity. Is it any wonder that senior doctors increasingly seek refuge in a private system that rewards initiative and encourages hard work? One early chapter is titled "The Unleashing of Private Medicine" as if is was some sort of wild dog that any civilised society would have shot and buried long ago.

There is scant recognition of the fact that this "growth industry" is attracting more and more "concerned citizens", that it delivers a high-quality service (albeit a limited one) and attracts a paltry level of customer complaints compared with a much better funded public health service.

Our failure to develop an equitable health service rests heavily on many shoulders. Ms Wren has a vision that many of us would like to share. But it is a journey that would be easier if ideological baggage was shed early on and scapegoats were asked to do some of the driving.

Dr Maurice Gueret is editor of the Irish Medical Directory

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