John Crown (Independent) | Oireachtas source

I welcome my fellow professional colleagues here today. Their illustrative, illuminating, educational, informative and humane presentations have gone to the heart of some of the most difficult interactions that doctors have with patients and their families. It is not all that long ago that I used to find myself occasionally having this conversation with relatives. It is one of the most difficult areas.

I would like to pay particular tribute to Professor Hickey who has been an extraordinarily wonderful role model for young Irish doctors in terms of his devotion to this cause over the years and for keeping it on the agenda where it should be.

The problems of transplantation are contributed to partly by the organ crisis. I am delighted that so many of our colleagues have correctly and forthrightly pointed out that one of the major problems is also resourcing. There is no doubt that this is a microcosm of the health service in general and its problems. Unfortunately, we have a system which is under-resourced, grotesquely understaffed and mismanaged by people who should not be managing it. The people who should be managing the service are being relegated to the status of clinical technicians by a group of people who should not be making the relevant decisions. The system is not underfunded, but it is severely malfunded and requires reform. Professor Hickey's apocalyptic scenario involving the rationing of dialysis should not be dismissed as a Cormac McCarthy-like future fiction. The inexplicably widely-loved NHS in the United Kingdom was doing this until comparatively recently. Certainly, in my professional memory, middle-aged patients were systematically denied dialysis in certain regions as it was felt the system could not support them.

I am 100% in favour of Professor Hickey's suggestion that we should have a solitary national transplant centre. While much of my criticism is aimed at bureaucracy, there is a certain amount to be laid at the door of doctors and medical-school politics. Norway has a slightly larger population than Ireland and has four medical schools. There is only one medical school in Oslo, while Dublin, with a smaller population, has six medical schools. We have one medical school per 750,000 inhabitants, whereas the European average is one per 1.5 million. The average in the United States of America is one school per 1.2 million people. One cannot have rational structures when one disperses one's resources across an irrational number of centres, which are kept alive for the benefit of powerful medical-political and academic forces with a vested interest in maintaining them. It is an issue we must discuss, albeit in another forum.

Professor Hickey, Dr. Conlon and Dr. Plant are perhaps best placed to assist me on the following. As a general rule of thumb, the number of specialists per capitain Ireland is approximately 80% of the number in the UK, while the UK has approximately one third of the number which is the norm in continental Europe. In turn, the number in continental Europe is substantially lower than in North America. Do the three witnesses know roughly what our figures are and how we compare? I suspect that by European standards we are grotesquely under-provided not only with transplant surgeons but with nephrologists, if only somewhat under-provided by UK standards. Is that a fair characterisation?