State-sanctioned corruption in Irish medicine

Dear Editor,
I have long been of the opinion that the fundamental basis of the majority of problems that beset the Irish health service is a consequence of political corruption, public ignorance and individual greed.
For these and other reasons, I moved to New Zealand five years ago with my family. I had the wonderful experience of working in a health service that is fair and efficient and actualises all of the political promises that are trumped out here at each election, but that are ultimately swallowed up and lost into committees, commissions, working groups and reports, leaving the status quo of a broken and corrupt health service perfectly intact.

Whilst in New Zealand from 2005 to 2009, I completed my General Practice Training Scheme, as I was unable to obtain a placement here at home. Since returning to Ireland in January 2009, my family and I were no longer merely to be witnesses to our corrupt health system, but were to become victims of it.
In December 2009, my wife and I purchased a property on the Main Street in Rush, Co Dublin with a view to opening a family practice. We had sold our home in New Zealand, paid off the mortgage and put the remainder into the purchase of the practice.
Original estimates for converting the property into a family practice came in at around €27,000. However, as we became aware of local authority obligations in terms of such things as fire regulations and wheelchair access, the costs soared to more than €70,000. Cap in hand, we returned to the bank and arranged for personal loans in order to complete the project.
It was our intention to open a modern family practice with nursing services, wheelchair access and appropriate toilet facilities. All of these proved quite expensive, but were undertaken in good faith, without ever realising that the HSE would not only deny patients the right to choose our practice, but do their utmost to shut us down.
And all this with a view to protecting the status quo of our broken health service and to ensuring that Minister Mary Harney’s mantra of competition and fairness remains, like most ministerial mantras, little more than hot air — smoke and mirrors, concealing the corrupt and incompetent mechanics of the HSE.
The most expensive aspect of our project was the installation of a wheelchair ramp and access. In an almost artistic display of Irish irony, the local authority insisted that our building be equipped with wheelchair access. (Of course, who would be fool enough or thoughtless enough to deny wheelchair patients access to a medical practice?) However, having installed the ramp and access, the HSE refuses us the right to treat wheelchair patients.
Ours is one of three practices in Rush and because the other two pre-date existing legislation, ours is the only one that is obliged to install wheelchair access and meet modern fire safety regulations. Yet because the HSE refuses us access to the GMS, we are not permitted to see wheelchair patients, as most, if not all, of these patients are medical card-holders.
Thus we find ourselves in the all-too-Irish position of being the only practice in the area with designated wheelchair access, and yet we are unable to treat wheelchair-bound patients. But the fun and games do not stop there.
Our practice is the only surgery in the area with a practice nurse, yet she cannot see medical card-holders as we have no access to the GMS. Our practice is also the only one in the locality to provide cervical smears on site, and whilst medical card-holders can avail of free smears, they must have their smears read by another doctor with access to the GMS.
Whilst our practice can provide free maternity care, medical card-holders must find another doctor when their pregnancy care is complete. And whilst we can provide free vaccines under the childhood immunisation scheme, once those vaccines are completed, medical card-holders must find another doctor for their children.
Every day, my practice receptionist must turn away patients who present with medical cards or medical-card applications. And should my patients lose their jobs and become eligible for a medical card (as is happening all too frequently), they can no longer be seen at our practice.
This medieval discrimination against my practice and my patients is conducted by the HSE with the sole intention of protecting the ‘lists’ of its GMS doctors. As one would expect, the HSE’s discrimination is in clear breach of the European Constitution (Competition Law Articles 101 and 102) and in breach of national competition policy.
Indeed, the State-funded Competition Authority acknowledges that these practices are in breech of national and international law. However, they inform me that:
“The HSE is not covered by competition law when it is purchasing the services of GPs. Thus, Articles 101 and 102 of European competition law, and the equivalent provisions of Irish competition law, do not apply to the HSE. The Competition Authority therefore has no legal power to change the HSE’s model for GMS contracts.”
This, of course, is a rather nice way of saying that the Competition Authority will regulate every-body other than the State itself. In Orwellian/Irish terms, ‘All animals are equal, but some are more equal than others.’
Ironically, all of this is little different to the policies of the now retired Financial Regulator whose lack of regulation is largely responsible for much of the economic mess we find ourselves in today.
In a recent study, Ireland was ranked 13th in Europe for the standard of its health service and, according to Fine Gael, 24th in terms of value for money. It is foolish and naïve to expect us to adhere or even aspire to European standards when we cannot even expect that they adhere to national or European law.
For the most part, I and my family are glad to be home, back amongst family and friends. Little has changed in our five years away. Brown envelopes have not gone away and are as endemic to Irish politics as they were in the Haughey years.
The envelopes and jingoism have evolved into political appointments, tribunals of inquiry, government contracts, working groups and expense accounts, whilst the immunity which the Catholic Church enjoyed and abused for many decades has been bequeathed to State-run institutions like the HSE, FÁS and the Financial Regulator, who seem to operate above the laws, which, as always, are only made for the little people.
Dr Marcus de Brun,
Rush, Co Dublin.