Maurice Neligan - getting to the heart of things

  • Niall Hunter, Editor

Maurice Neligan is not exactly a paid-up member of the Mary Harney fan club.  Her basic problem, he believes, is that she does not talk to the people who matter.

And he feels a fellow consultant, Prof Brendan Drumm may have developed the Stockholm Syndrome, whereby you begin to identify with your "captors".

“I would say Mary Harney has failed. You will always find a few people who will think what she is saying is right; you will always find a few who are promoted within the system or who will become directors of this, that and the other and they ‘buy into the programme', but the vast bulk of the medical profession wouldn’t be of the same mind.”

The well-known retired heart surgeon and media commentator on health and other matters is reluctant to credit her for even attempting to go where her predecesors had not dared to go in trying to reform the unreformable.

“She was equipped with what she felt to be certainties. One was the new consultant contract, and anybody who knew a blind bit about the hospitals would know that consultants were not the problem.”

Maurice Neligan, in an extensive interview with irishhealth.com, says despite the much-vaunted reforms we are told are taking place in the hospital system, the facilities that were supposed to accompany the changes have not materialised. “And they’re certainly not going to materialise now because there’s no money.”

On the Harney approach
Referring to the Irish-born British businessman who tried, on TV, to fix the NHS, he believes the Minister should have adapted a “Gerry Robinson” approach.

“He sat down with everybody in a hospital and asked the staff what do we need to do to get things right. That is what needed to be done. But when you go in with a series of diktats and try to bully the doctors, nurses, paramedics etc you are going to get nowhere. If she had appealed cooperatively she might have got a hell of a lot more done.”

He does not agree with what might be Mary Harney’s riposte to this, that there are so many vested interests and such an “us versus them” mentality in the Irish system that the Robinson approach might have been impossible.

“No, I don’t think so. Admittedly, there might have been an us versus them attitude to a certain extent but it was not that bad in the past. I think that particular problem has been exacerbated since Mary Harney and the HSE came along. I feel we are going backwards.”

He does agree, however, that the state of industrial relations in the health service is “appalling”.

“I don’t think it is really capable of a solution at present. 

“Bertie Ahern gave job guarantees when the HSE was set up so the economies of scale necessary could not be achieved. Despite the fact that there are many good people working within it, the HSE is a failed entity.”

Maurice Neligan believes Mary Harney has been pushing degrees of privatisation in the health services that have been “terribly harmful.”

“She contracted cytology out of the country, so a lot of the expertise will be gone. Farcically, they are now trying to re-contract some of it back to Ireland.”

Maurice Neligan will not even give Mary Harney, despite her stalwart college debating days, any credit as regards her debating and communication skills, believed by many to be her strong point.

“No, she won’t go on any TV or radio programme where she is up against someone who knows what they are talking about. She won’t go into a debate unless she has 10 advisers sitting outside.

“Leaving the party politics out of it, I would certainly welcome a new health minister. One who would engage and listen. There will be a change of Government eventually but I don’t have any party preferences as regards Minister.”

On co-location
“It’s extraordinarily socially divisive. It’s a case of drive through the gates and are you in the rich or the poor hospital?”

But was the object - providing more public beds, through decanting private beds from the public hospitals into new private units - not basically sound?

“In that case, why not just build more public beds? They may say the co-location way is cheaper, but I really don’t think cost should be the overriding factor in medicine all the time. The main thing should be treating patients properly.

“It’s all about bean-counting nowadays. How can you countenance sending a 70-year-old person back to a house where they are living on their own, where there is no structure in the community to look after them and where the primary care teams are not there?

“There are around 800-900 delayed discharge patients in the acute hospital system at the moment who have nowhere else to go. I think that’s a total indictment of the system.”

On constant cutbacks
Maurice Neligan, as a heart surgeon at the Mater and Crumlin Hospitals for many years, has seen pretty much the same problems recur in the hospital service no matter who is in charge. However, he thinks things have taken a turn for the worse in recent years.

“The surgeon is told you cannot admit your patients as there are no beds. So the consultant cannot work as he has no beds and they go onto a waiting list. The consultant is being expensively paid under a new contract do to a certain number of hours but he can’t do them because the beds aren’t there. The patients go on a list and now we have the State buying them off the list through a treatment fund and sending them to a private hospital, or worse, the same hospital.

“So the doctor may end up in a private hospital operating on the same patient for an extra fee on top of his public salary. You couldn’t make this sort of thing up.”

He agrees the NTPF as a concept for a year or two was fine while the public system was being fixed. “It should never have been allowed to become part of the system. It was only ever intended as a finger in the dyke.”

On Brendan Drumm
“I really don’t understand why Brendan Drumm can say we have too many beds. What gives him the right to say that? We are way down at the bottom in international comparisons as regards bed numbers.

“I know Brendan Drumm. I served on Comhairle na nOspideal with him and we both worked in Crumlin Hospital. But you could say it’s almost like the Stockholm Syndrome, where you begin to identify with your captors.

“I honestly cannot believe that he believes what he is saying himself, particularly about things like the primary care teams.

"So we are told it’s going to be great tomorrow but then tomorrow stretches out longer and longer – 1,900 beds are not available, hospital infection is a problem, emergency department trolley counts are still high.”

On cancer services
“It was an outrageous decision to close down the service in Sligo. Tom Keane should have a little think for himself. There are far more considerations than the purely medical. I don’t see what difference it would have  between having eight or nine centres nationally. There is a social aspect as well and I don’t see how they can have a satellite in Donegal linked to Galway and have nothing for Sligo. The journey from Sligo to Galway is a hard one for cancer patients.

On public versus private medicine
Maurice Neligan believes that Mary Harney has made us move towards the inequitable US-type of health system that Barack Obama is now trying to dismantle.

He admits he is not against private medicine as a concept. He was one of the founders of the Blackrock Clinic back in the mid-1980s.

“What I am saying is that people are now being driven into private medicine and private medicine cherrypicks. They don’t want the complicated long-stay patients.”

But is that not an advantage in that it will take the pressure from more routine cases off public hospitals?

“It may take off some of the routine work, but then, how do you train the doctors, nurses and other staff? Surgeons aren’t born knowing it all. In the big teaching hospitals, part of their remit is that they have to teach and train.”

Maurice Neligan agrees, however, that having such a large cohort of private care in Ireland is part of the problem in the system at present as regards equity and capacity.

“We do have a system that is inequitable; there is no question about that. I think we need universal health insurance and it needn’t be a case of public versus private. The money should follow the patient.

“Fine Gael’s is the Dutch model and it is a good one but it is certainly not the only one. People who can insure themselves should be able to insure themselves and the State would insure people who cannot. You then tender for the work.

“In any case, I believe there is a level of hypocrisy in the whole public versus private debate. Technically, everyone, even those with the highest level of health insurance, is entitled to free hospital care (minus a daily bed charge for non-medical card patients). But all the figures about the level of private practice are relative and there are confounding factors. For some things, you would probably be better off going into a public hospital. As there is no 24-hour a day A&E service in the private sector many patients with insurance end up in the public hospital.

“And it has been shown recently that public hospitals have difficulty collecting private fees from patients. If someone with a high level of insurance is admitted to a public hospital with a heart attack and are put in a public bed, do you charge them? It can be a bit of a nightmare finding out who is a private patient. and who is not.”

On heart transplants
Maurice Neligan carried out Ireland’s first heart transplant back in 1984. “The first transplant recipient died quite early on but there are around 15 to 20 heart transplant patients still alive who would have had the operation 15 years ago or more. It’s totally donor-dependent; some years they can do 10; in other years it might be only three, but the numbers have picked up again recently.”

“Heart transplants pretty much burst on the scene in 1967 when Christiaan Barnard carried out the first one in South Africa. However, they disappeared very quickly because the immunosuppression issue could not be overcome. Then later with the use of cyclosporie came a second wave and that is where it is today.

“With the first transplant in Ireland, we really did it off our own bat. We did not get any help from the Department of Health or anything like that. In fact, not long after we did the first transplants the Mater stopped the programme during the cutbacks in the late 1980s.

“We got around that by doing transplants in the recently-opened Blackrock Clinic. Then we sent the message out through the media that the only way you could have a heart transplant in Ireland was if you were a private patient. The then Minister, Rory O’Hanlon, didn’t fancy that and rang the Mater and said put the programme back. Rory was a reasonable guy so it got back on track.

“But of course, this has been the recurring story of our lives in the Irish health service. Constant rationing of resources. And I think it’s getting worse.”

On the Blackrock Clinic
“The Blackrock Clinic was set up in 1984. There had been a lot of criticism about treating private patients in public hospitals. So we said, OK, we now have a solution. So with the heart operations we got the private patients out of the public hospital but the end result was that the Mater cut back the amount of open heart surgery we could do, so in fact nothing improved for public patients.”

On consultant pay

Maurice Neligan doesn’t hold with the argument that Irish consultants are well paid compared to their counterparts elsewhere.
 
“That’s nonsense. Some of the German consultants make three times what we would make. I would have a problem with a system whereby everybody is paid the same no matter what they do. There are elements of medicine that are more time-consuming and stressful than others.”

On making thing simpler
He believes we need to make things simpler in the health system. “Our population is only four million. We have endless working groups and reports but nobody sitting down and actually working hard and talking to everybody else.”

But wasn’t the small population argument used as a justification for closing down smaller hospital services, especially cancer services?

“Yes you can use that argument and that was the original Hanly plan and many people said fine, but then you come along and you start shutting services down and moving them in the north-east and then the Government turns around and says there is no money for a new regional hospital.”

“What they have done is reconfiguration, which in their language means close down, but they haven’t provided the alternative. They haven’t done enough on ambulances, paramedics, primary care teams etc, They have reconfigured into Cavan and Drogheda, both of which as a result have an increasing number of trolley patients in the emergency department.”

“They started to shut services at the smaller hospitals and provided nothing to replace them. The proof of that is the scandalous carry-on in the north-east where first Monaghan, now Louth and Navan are shutting services but essentially nothing in terms of resources is going into Cavan and Drogheda.

“Brendan Drumm makes numerous statements about the number of primary care teams that are being put in place. But the primary care network that’s needed is not there.”

What about the argument that you need to reconfigure services for safety reasons?

“Well, if you’re talking about safety, take infection for a start. If you are running hospitals that are 100% full all the time after other services have moved there your MRSA risks are enormous. All eight hospitals in the cancer strategy have waiting lists and trolley waits and that is going to get worse.”

On writing
"The Irish Times column can be a challenge. The health field is so big that in any given week there could be a million things you want to write about so it’s hard to choose.

"I do get a huge response to it, sometimes from former patients. I also got a sizeable correspondence from some members of the clergy and religious orders on how they felt they hadn’t been fairly treated following the Ryan report, which they felt had cast a blight on all of them. While not justifying for a minute the horrific things that happened, I think that’s probably true.

"Two subjects that caused a particular row were the Irish language (the level of spending on which I criticised) and climate change.  I’m a tremendous climate change sceptic. I feel we have been here before. Yes, there are lots of things we should be doing, for example on fossil fuel use, but as for culling the number of cows and that sort of thing I think it goes too far. It doesn’t matter what we do on this little island, the power stations in China will undo it all.

"Apart from the column. I read an awful lot and play golf. I have a very strong interest in wildlife and country life, and I have a place in Kerry where I spend a lot of time when I can."

See also 'Mary Harney - still hopping through Angola.'


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