The final general motions session has just ended, and with it comes a rather subdued end to what had the potential to be the most important AGM in years.
Perhaps it was the disastrous decision to separate doctors from journalists in two hotels. People talk about gathering at the bar after the meetings with an air of flippancy, but in fact the bar is where most of the work is done by journalists.
The day began with the unexpected news that the national consultants committee meeting would be closed not for 30 minutes, as was told to the media, but for more than two hours. If doctors have any hope of credibility when it comes to calling upon the HSE to be more transparent, closing doors to journalists (except in matters of the most obvious privacy) is unadvisable.
The messages consultants were giving before the meeting was closed were the kinds of message that must get to the public – specific cases of poorly resourced facilities, insidious loopholes in HSE policies and developments, a general sense of giving a damn.
The overall tone of the last day was a little hung over, not from alcohol but – it seemed – from the short-lived romance between doctors and Mary Harney, who only the day before had stood before them with nothing new to say, but she said it very authoritatively. There was long applause after her speech. For what?
The situation has not changed. While uncontroversial aspects of the consultant contract are being ironed out peacefully, the sides are as entrenched as ever on the big issues.
Well, maybe not, but how would we know, as the consultants meeting was closed?
The ads for new consultant posts are coming. Mary Harney doesn’t really back down from threats, unless she gets enough of what she wants. There’s the Medical Practitioners Act – which includes the end of self-regulation and risks forever deprofessionalising medicine – looming difficulties with the GP contract, co-location, primary care teams, flexibility, and so on and so on.
From where I’m standing, this is what the future looks like: ugly. Still, doctors in the IMO are committed to their patients and, importantly, the defence of moral and the ethical standards in medicine, even though all around them the market threatens to yank out all the dignity of being a doctor.
And I can imagine that it leaves a bitter taste in one’s mouth to believe that you are acting in the interest of others and then to see in headlines – following Harney’s speech – Minister losing patience with doctors. How, exactly, has she done her part to insure that negotiations reach a settlement that is best for patients, except to force a contract down the throat of the profession, a contract which could see many docs farmed out as cheap labour to enrich for-profit hospitals in a co-location scheme that has neither been planned nor has the inarguable support of the public?
The final general motions sessions should have been renamed The General Motions Session That Would Never End. No red light (a little bulb which signified the end of debate time) was ever so ignored. At times I felt as helpless as the red bulb, as doctors – who clearly had no read or thought of the motions in advance – fumbled around petty rewordings of the very obvious.
Dr Mick Molloy is an effective speaker. So is Mr Asam Ishtiaq. The rest could use some coaching.
It was mentioned by Dr Sean Tierney, the consultant chairman, that one of the reasons doctors get whipped around by the Minister in the news is that they don’t yet know what they know. Nevermind the lack of dialogue between doctors and health service managers. What about dialogue and agreement amongst doctors themselves?
Still, there’s something reassuring about the fact that many of the same motions the IMO passed three years ago, when I made my first trip to Killarney, are still being argued as though doctors made them up yesterday. Imagine how easy it would be to stop caring and just get rich.

The second day of the IMO AGM may have been dominated by Mary Harney, but she certainly didn’t seem to notice. To the Minister for Health, her session was probably just another filled time-slot — albeit a slightly more pressurised one, seeing as the two issues dominating the recent press — the new consultant posts looming and the nurses dispute — were on everyone’s lips as she arrived in Killarney.
Journalists, IMO staff, and doctors seemed to wait restlessly for Ms Harney’s arrival for most of the early afternoon, with rumours circulating constantly that she was just outside the hotel. (Which, by the way, is beautiful, and suspiciously similar to the usual spot, the Hotel Europe, just down the road).
As she arrived, and managed to escape the gaggle of journalists after promising an official press conference in half an hour’s time, things simmered down and people followed her meekly to the conference room housing her address. The Minister gave no sign she was aware that she was the main event of the day, and in fact seemed to be enjoying the fuss on her arrival.
Earlier, the IMO CEO George McNeice had given his address at the same podium, which went down a storm, and was followed by thunderous applause that rang with agreement.
“No-one can claim that our health service matches the standards we would expect of a mature developed economy,” said Mr McNeice. “Whatever its shortcomings, they cannot be laid at the door of doctors who daily struggle to overcome a system which has stagnated.”
Doctors then sat back and waited to hear what the Minister’s response would be – she had better not blame doctors for anything – but she didn’t. She spoke about change, adapting to new things and moving on from old ways – I wonder was this a mistake, with the election only months away, but I’m sure the opposition parties would agree with her theme.
Once her speech was over, the Minister smiled, said thank you, and sat down. Doctors and others who had been bad-mouthing her, her department and the entire PD party an hour earlier were smiling and generally looking satisfied. This led me to wonder what, exactly, does Deputy Harney possess that makes people suddenly like her in the space of half an hour? Some politicians are so charming that people can’t help liking them immediately, but Mary Harney is not exactly charming. Witnessing today’s frenzy, I realised that what she does is make people empathise with her job and what she is trying to do.
Her speeches generally follow a similar format: OK, she says, there are problems, but I am trying to fix them, and I am on your side. No one blames doctors. (And if we do, we don’t do it to their faces at their annual conference.) She then makes a few well placed quips and jokes (today it was one about her trepidation on learning she was invited to speak at the AGM on Friday the 13th, as well as jibes about Dr James Reilly, Fine Gael candidate for Dublin and sitting in the front row, arms crossed), praises the doctors, throws in a few personal references or two, and then it’s over. By which time, the very people who witness the disaster that is the health service first-hand are agreeing with her. Not all doctors were pleased with her of course – particularly after her comments on going ahead with advertising for new consultants next week – but the majority of the room certainly seemed to be, as the resounding applause, which matched that of the previous speaker, indicated. I’ve seen this happen at other medical conferences that the Minister spoke at, but today was the first time I saw such an interesting about-face. Maybe it was the sun.
The rest of the day passed quickly, with the general motions session in the afternoon as sparsely populated as always, yet the talk continued to be about Ms Harney. I sat near two elderly GPs in the motions session and listened to them discuss the Minister’s appearance. They proved what I had already suspected – this morning they were disappointed with her, but by late afternoon they liked her.
“She made a good case,” said one of the GPs. “And it was good of her to come down.”
“Things are in a bit of a mess, but it’s not her fault,” agreed the other, in what I thought was a good example of Irish logic.
Really, Mary Harney almost deserves to stay in the Department of Health just for her enviable powers of persuasion.
And now that she’s gone, we can all get back to criticising her in peace.

The Minister for Health, Ms Mary Harney, got a stirring introduction from new IMO president Dr Paula Gilvarry. It went: “I would like to introduce the Minister for Health, Mary Harney, on this beautiful day in Killarney.”
Dr Gilvarry was being true, I suppose, to that age-old credo of decorum: if you can’t say anything nice, say nothing at all.
If consultants hoped to hear a word of conciliation from the Minister, they got none whatsoever, which made the prolonged applause following the speech all the more curious.
Minister Harney spoke of teamwork and the public good, and perhaps it would have looked bad to be silent.
Still, this is the same stuff they’ve been hearing for years.
Ms Harney made it very clear: it’s not about inputs (staff and money), it’s about outputs (changing the way the medical profession works to maximize health investment).
She said Sweden does it.
She made it clear, as well, that the current investment in health is never going to increase (in terms of proportion of total Government spend) under her watch. One in four euro that the Government spends is spent on health. Now that teachers want more, and more has to be spent on infrastructure and other things, doctors are simply going to have to find innovative ways to get around underfunded, understaffed working conditions.

The passing of the chain of office from consultant Dr Christine O’Malley to public health doc Dr Paula Gilvarry was the feature event of the first day of the IMO AGM. The news, according to the outgoing president, was not good.
A crowd of about 30 people – the real IMO diehards who arrive on the Thursday – heard Dr O’Malley offer her perspective on what makes this year different from the previous: which was no difference at all, except that things were possibly worse.
The theme for this year’s IMO AGM is “Realism not rhetoric”. Nevermind that little witty slogans like “realism not rhetoric” are the very definition of rhetoric – the message got through: Doctors feel beat up this year more than ever. They feel outspun by Mary Harney, by the Department of Health, by the HSE. They feel like the media is against them. They feel like the public doesn’t understand.
Dr O’Malley seemed so fed up with all the forces working against doctors that she addressed her speech directly to patients, even though no patient was in attendance (people who are exclusively patients, rather than also doctors and journalists and a few PR types, I suppose).
She went so far as to apologise directly to them: “I would like to apologise to you, the patients of Ireland, that we did not speak out to contradict the HSE. You see, we thought we were on the same team. We thought we shared a vision for patients.”

That’s a nice bit of rhetoric, but I’m suspicious about the fact that any doctor, in 2006, felt like the HSE was on his or her side. My opinion is that doctors knew very well they were in for a battle, and have known since the honeymoon ended (the marriage of a consultant – Brendan Drumm – with health service management).
As the always outspoken Dr O’Malley (so outspoken that she has learned to speak twice as fast as anyone else in order to fit it all in) passed the chain of office to Dr Gilvarry, the dashed hope was palpable in the room – the feeling of banging your head against a wall for twelve months to no avail.
Dr O’Malley said it all in her speech: nobody seems to want to hear what is so self-evident to doctors – that the HSE is hell-bent on running medicine like a business, turning patients into clients, turning quality into targets, as well as building infrastructure on the cheap (nevermind that inequality will be institutionalized as a result).
The A&Es aren’t crowded anymore, except that they are. Cancelled elective procedures aren’t linked to A&E crowd ceiling, except that they are. Mental health tribunals are running smoothly, except that they aren’t. Consultants don’t want to work flexible schedules, except that they do, if they get paid for it. There are enough beds, except that there aren’t. Nurses are respected and are better off with benchmarking, except that they aren’t. The HSE does not employ creative accounting or spin, but they do.
Still, how in the world do you fight spin, except with relentless and daily honesty (as opposed to an annual outburst of honesty every April in Killarney)?
The IMO is always a little slow on the Thursday. There was a fascinating scientific session about HIQA, nursing homes, and care of the elderly in the afternoon (and I’m not even into that kind of stuff). Dr Cillian Twomey, Dr Martin Daly, Dr Brian Meade, Dr Shaun O’Keeffe, and some professor from England showed the following undeniably: doctors care about the health service, and they have solutions.
That doesn’t mean anyone’s going to listen.

The Irish Medical Organisation’s 2007 AGM kicks off in Killarney this afternoon (in a new hotel, as the Hotel Europe, where I personally have been twice now, is being renovated, unfortunately. This could have meant a new county and not just a new hotel, but tradition rules, obviously. It’s a pity it’s not in Galway, we could have saved money on bottled water.
This year may be quieter than previous years though, in the press at least. Today’s papers barely mention the conference. Usually they each have at least one story of pre-AGM soundbites from IMO doctors.
But it looks like nurses have stolen the doctors’ thunder, for now at least. Their work stoppages continue tomorrow, and unless the papers get bored of them (unlikely) the IMO will have to share space. The Irish Times today mentions the AGM briefly at the end of a story about the consultant contract negotiations; the Independent doesn’t mention it at all; and neither does the Examiner. All three are busy with the Teachers conferences and the nurses dispute.
At least Irish Medical Times covers every detail (or almost every detail), regardless of whatever else is going on.