This is a tale of two consultants. The one I got to see and the one someone very dear to me did not...

WHAT would you say was a ‘Mickey Mouse’ salary? Maybe €15,000 a year working a zero-hours contract in a supermarket, or that of a young teacher or junior nurse doing the same work as an older colleague but for a lot less money?

Well, you’re way off the mark. When Mary Harney, who was minister for health at the time, attempted to recruit hospital consultants from overseas back in 2007, the salaries on offer were up to €205,000 a year – and that, according to a former president of the Irish Hospital Consultants’ Association, Dr Josh Keaveney, was ‘Mickey Mouse’.

Speaking at the time, he pointed out that his counterparts in the United States were earning up to $500,000, or €368,000 at the exchange rate of the day, and his organisation, and the Irish Medical Organisation, contacted similar representative bodies abroad warning members not to apply for the posts.

To anyone else, those would be vast sums of money and it is easy to be outraged by them – until, of course, you personally need the expertise of a consultant, at which time you wouldn’t begrudge him or her a cent.

Illness

Certainly, when I was admitted to hospital almost three years ago with a mystery illness, a consultant physician and a consultant surgeon were exceptionally thorough in getting to the bottom of it.

It turned out I had a massive septic infection that was the result of previous emergency surgery in Spain.

The mesh patch inserted to fix a strangulated umbilical hernia pierced my bowel, which then leaked for eight months until I doubled over in agony.

The physician later told me he was very surprised I didn’t die, and I owe him and all his colleagues a huge amount of gratitude for getting me through.

I was in hospital for 17 days, but I was lucky. My parents enrolled us all in the VHI as children, and I’ve kept up the payments ever since.

As a consequence, I was able to go to Blackrock Clinic, where the care was exemplary, and later to St Vincent’s Private for an operation to reverse the damage done in Spain.

My bills for that year totalled in the region of €55,000, but I didn’t pay a cent, except for one consultant fee of €100.

I have absolutely no idea how I would have done in the public system, which I have needed only once in my life.

Sixteen years ago, I developed an abscess on my cheek that caused it to droop rather alarmingly, leading to the suspicion I had Bell’s palsy. On that occa- sion, there was no private bed available, and when one eventually was freed up, I elected to stay in the public ward anyway because I was having so much fun in the ward with mostly older men who all acted like naughty schoolboys.

Would I do so now? Probably not, because as we learned this week from the RTÉ Investigates programme, there are consultants who are taking money from the State to deal with public patients but not working the hours for which they are contracted.

One was observed by RTÉ working less than 13 hours a week of the 37 he was supposed to put in, with a consequent overpayment of €14,000.

Another worked an average of only 14 hours a week in the public service, and missed one clinic a month because he was seeing patients in a private hospital in another city. The overpayment for work not done in that case was an estimated €15,000.

Criticism

According to the investigation, only 6% of consultants treat public patients only.

The others are supposed to treat no more than 20% private patients and commit to 80% public, but failure to enforce this ratio means that 14 of the country’s 47 acute hospitals fall short.

Minister for Health Simon Harris was trenchant in his criticism after the programme, and said the behaviour of the consultants involved was ‘immoral, brazen and unfair’, and he called for a more robust monitoring system.

Well, sorry, but Mr Harris is the minister and it’s up to him to enforce this. In fact, he could have started by immediately suspending the two consultants in question, or even firing them altogether.

That’s what would happen in the real world if you or I took a salary for work we hadn’t carried out. The problem is that ever since Mary Harney attempted and failed to rein in the consultants, every minister seems terrified of them. They are as protectionist a group as you will find in Irish life, policing their own patch at the expense of patients who need their services, as I learned a couple of years ago.

Someone very dear to me failed to get the care she needed in the public system, and she died. Perhaps she would have done so anyway, but it is hard to shake the ‘if only’ thoughts when you’re staring at the ceiling in the dead of night still trying to rationalise what happened, and why.

The fact of the matter is that we simply don’t have enough consultants. In 2015, there were no applications at all for one in four advertised posts, and just one application for a further quarter of them. That’s why the obvious solution would seem to be a simple one, namely to invest in training more doctors to the level required for consultancy, and maybe target them at an earlier stage of their careers.

Talent

Is there an argument, for instance, that says specialisation should be actively encouraged, so that a student doctor who wants to be a cancer consultant could skip modules on other disciplines such as obstetrics or general paediatrics?

One of the problems is that we are dealing with a small pool of talent. Ireland has fewer doctors per 100,000 population, at just 2.789, than any country in Western Europe. Norway has 4.42, and Greece, despite its economic woes, has a whopping 6.255.

If we were to introduce more consultants into the mix, it is possible, though not inevitable, that salaries would drop. By comparison with what the overwhelming majority of people earn, though, they still would be more than generous.

As it happens, the level of pay is not my biggest concern here, but more the fact that we have not come to grips in any meaningful way with the two-tier system. Indeed, all the evidence says the gap is widening between the public and private medical sectors.

My VHI costs roughly €2,500 a year and, given what I know about the public system, it is the last thing I would give up. Honestly, I’d rather miss a mortgage payment than miss a month of the insurance premium.

The medical issues I had before I turned 50 were very minor, but those since have been more serious. I’m now at the stage of life where I need the safety net of goldplated care.

I genuinely wish the health service promised the same outcomes for all, but when you have consultants playing hooky to line their pockets with cash from private patients, there is no guarantee of that at all.

And that really is sick.