John Crown (Independent) | Oireachtas source

I welcome the Minister and Minister of State and their officials. I have a few quick questions. I am sorry I did not have an opportunity to submit questions. Would the Ministers and the head of the HSE acknowledge, in light of the recent coverage of concerns about obstetric services, that we had a big warning several years ago with the Galway tragedy ? If we just adopted a policy of aiming for an entirely consultant-provided obstetric service, with trainees there to be trained and not to provide services, many of the problems we encounter on an ongoing basis would no longer occur. This would save money. At the moment we are spending quite a bit of money on obstetric indemnification. The simplest way to reduce the indemnification cost associated with obstetrics is to reduce the risk, and the simplest way to reduce the risk is to increase to 100% the proportion of patient decisions made by fully trained obstetricians and not trainees. This is the standard that many of us who have dealt with the private sector are used to, and I believe it is the one that should be applied. Not only is it humane medicine and logical public policy, but it will also save money.

With respect to the ongoing crisis, I am very sympathetic to the fact that emergency departments sometimes get crowded in an unexpected way in response to flu, severe winters and different things that can happen, but we do not have all our ducks in a row on this yet. I have had occasion several times in the last few weeks to see patients of mine in the emergency department of St. Vincent's hospital, and it is as overcrowded as I have ever seen it. One patient of mine is an elderly gentleman who was admitted to St. Vincent's private hospital with a chest infection, who needed to be admitted not for cancer treatment but for antibiotic treatment. His very supportive family wishes to take him home, will pay most of the costs of his support at home and will pay for their own carers, but they are aware that they are entitled to a certain level of HSE support. During the last week, for some reason I could not quite understand, the planned discharge with HSE coverage suddenly evaporated. We were told that the HSE had decided, because he was so dependent, that he needed more care than it had originally budgeted for, which is reasonable. It then stated that it was not prepared to give that care, which we can discuss, but inexplicably it said that if he was transferred back to the public hospital he would be entitled to a higher level of HSE support than he would get coming from the private hospital. At a time when our emergency department should consider issuing stilts to people coming in so they can pick their way through the trolleys that are blocking most of the floor space because we cannot get people out of beds on the other side, it is illogical that this would occur. Clearly, this is no one's fault; this person is dealing with their budget and their rules. However, there is a complete lack of joined-up thinking on this. I thank Mr. O'Brien for taking my inquiry personally. I will make the details available to him on a personal basis afterwards.

With respect to the consultant hiring crisis, those of us who tried not to wallow in schadenfreude have to say, "I told you so." Over the years, multiple attempts were made to change the conditions of employment of consultants, and we saw what this resulted in - a decline in appointments. There is one quick, simple fix, which would go a long way towards reducing the burden. Why do we force healthy, fit, intellectually capable, highly skilled people who do not want to retire to retire at 65?

Can anyone explain that to me? We do not make our politicians retire. A few of us are in the process of trying to get a test case together for the courts on this, which will be heard by judges who do not have to retire at 65. The decision is being made by Ministers who do not have to retire at 65. When Bismarck, the Iron Chancellor, first introduced the concept of retirement at 65 as an optional life choice-----