by Professor Trevor Duffy
by Professor Trevor Duffy
President of the IMO
26th April 2014.
Check Against Delivery
I’m deeply honoured and humbled to have been elected as President of the Irish Medical Organisation and let me start this evening by stressing my commitment to do everything in my power over the coming 12 months to promote the cause of this organisation and of all of our members and to continue the campaign for a just, equitable and progressive health care system - not just on behalf of our members but also on behalf of our patients.
I also want to acknowledge at the outset, the great work undertaken as President by my predecessor and good friend, Dr. Matthew Sadlier.
I would like to acknowledge the hard work, in new surroundings, of the IMO secretariat who have stopped at nothing to ensure this meeting has been a success.
And while I am on “thank-yous”, I want to acknowledge the support of my wife and children and, of course, my parents who have taught me the values intrinsic to the IMO – honesty, integrity and standing up for what you believe in.
I also want to thank the many journalists who have attended this weekend and who have been kept busy reporting on our deliberations…. your interest in our organisation is greatly appreciated.
I think this has been a very successful and important AGM, characterized by a renewed focus on core basics. To provide a sustainable health service requires sustainable working terms and conditions for doctors. That message has come across loud and clear form this AGM. I believe our new structures, rules and code of practice put is on a firm footing to act on the challenges ahead.
This AGM stands out in particular for marking the 30th Anniversary of the formation of the IMO back in 1984.
One of the themes that has come up in conversation over the past few days is how much – and - at the same time how little – has changed over those 30 years.
I had my own experience of that recently when I revisited the Hanley Report, which, in a sense, marked my entry into the world of medical politics.
The Hanley Report was published in 2003 as the outcome of a task force set up on medical staffing issues after a near NCHD strike in 2000. I was one of the members of the task force and had enjoyed participating in what was a very dynamic, engaging and objective exercise in reviewing manpower needs in hospitals across the country.
I looked at the published report a few days ago and was struck by a very young looking Micheal Martin – who was then Minister for Heath - and who wrote in the foreword to the document about how the European Working Time Directive (which was then about to come into force) would bring important changes to the working patterns of NCHDs.
How ironic than that we spent a lot of last year – a decade later - fighting for the terms of that Directive to be respected in this country and that we even had to resort to strike action to secure progress.
That experience speaks to me about how slowly some things progress – we’ve seen it also in relation to issues like contracts, manpower planning and other matters - and how important it is to have an organisation like the IMO to make sure that the pressure for change is maintained even as the individuals on the other side of the table – indeed on both sides of the table - move on.
Anniversaries are times for looking back but also for looking forward and this weekend I find myself wondering what the future holds for the Irish health services and what role will the IMO play in the years to come.
I think we all accept that change is one of the constants of medicine – not just here in Ireland but across the world.
That’s as true in areas of policy as it in the clinical areas. In my own area of rheumatology, for example, there have been enormous, very positive, changes in the way we can treat patients and the outcomes we can hope for even over the relatively brief time since I qualified.
So if change is inevitable, then surely a key challenge for the IMO will be how best to help manage - both for our members and for the wider population - the inevitable changes that will come in the years ahead.
For most of the three decades we’ve been in existence, our relationship with the HSE and its predecessors has been robust, but it is only more recently, I suggest, that it has become almost dysfunctional.
That need not be the case.
I am an optimist and as an optimist, I believe that we can work for and achieve a more co-operative relationship with the HSE. A relationship built on trust and mutual respect.
In that spirit, let me put on record my respect for many of the people who work in Hawkins House and Dr. Steevens’ Hospital; good, conscientious people who work hard and who often, ultimately, have very similar hopes and aspirations for the health services as we do ourselves.
Let me be clear however.
I would be very happy to play a part in renewing and refreshing the relationship between this organisation and the HSE and the Government….but it must be on a basis of mutual respect and honesty. Those qualities of respect and honesty must be seen in how the HSE and the Department deal with us – not just in how we deal with them.
In that context, I have to acknowledge the engagement between Minister Alex White TD and our GP colleagues today as particularly significant. I would like to commend GPs and others who made impassioned, honest arguments with dignity and respect.
The irony is that – as with most things in life – the outcomes are better when we work together.
That’s clear from recent history.
For example, all the problems which the IMO identified with the Consultants Contract back in 2008 have now come to pass.
The manpower crisis we warned of with the 2011 differentiated salary scale for new and established Consultants has now come to pass too.
We were right when we warned the HSE that if they didn’t tackle the NCHD crisis the situation would become critical and we would see an exodus of our brightest and best up and coming clinicians.
And, unfortunately, it is clear also in the manner in which the Government is conducting itself in respect of the new GP Contract which it is trying to impose at the moment….when every objection, however reasonable…….is seen as something to be overcome rather than informed advice on a potential problem that should be listened to.
No more than the HSE, doctors don’t have all the answers but we do have a particularly valuable experience and viewpoint because of our roles on the front lines and surely its not too much to ask that the HSE start to acknowledge that we are critical partners in the reform programme which we absolutely accept needs to happen.
I want to say a few words about the emerging debate on Universal Health Insurance which is obviously going to be a key issue for everyone involved in the health services over the coming months and which featured in a very useful session this afternoon.
I’ll start with a note of caution on this issue - which is the danger of confusing Universal Health CARE with Universal Health INSURANCE.
The cynic in me feels that the Government has already successfully blurred the difference between these two terms but I don’t believe that this will last long when people really begin to scrutinise what is being proposed.
The IMO has long supported Universal Health Care –in essence a policy, which ensures that all people are treated equally (regardless of means) when it comes to their health.
But Universal Health Insurance means nothing of the sort. In essence UHI is simply a funding mechanism for healthcare. It is not a commitment to the outcomes that will be delivered by the system in question.
I believe that the Government approach to this debate is too narrow. They are effectively inviting a debate only on the insurance model of finance. They are not debating other financing models and, more importantly, they are not debating the more substantial issue, which is what we want our health service to deliver.
We have set out our stall in this regard in very unambiguous terms and we have identified seven key principles that should underpin the health services.
1. A system based on universality and equity of access
2. A system that is based on solidarity and where finance is not a barrier to access
3. A system that provides transparency and choice
4. A system built around quality of care and value for money
5. A system in which clinicians have autonomy to diagnose and treat patients without interference from political or commercial interests
6. A system which values efficiency and affordability
7. And a system which is sustainable and which can adapt to the needs of an aging population and changing patient expectations.
We look forward to debating these issues vigorously over the months ahead.
A few moments ago I described myself as an optimist. I also believe I’m ambitious and I say that proudly.
Sometimes ambition is almost frowned upon in Ireland but I think it’s really important that all of us in the health services remain ambitious for what we can achieve for ourselves and for our patients. It is what drives many of us to seek further training overseas. Unfortunately on return home we typically find ourselves working without the basic resources required to do our job. The stories of surgeons waiting for 12 months or more to get theatre time are legion. I have my own small example of this.
After I finished my training in Vincent’s Hospital, I worked for four years in Geneva. I remember returning home to take up a position in Dublin and I travelled over a few weeks ahead with a car full of books and papers that I wanted to put into my new office.
Great plan, but when I arrived in Connolly Hospital they quickly informed me that there was no office.
Undeterred I wandered around the hospital until I came across an old, disused bathroom which had the critically important attributes of a door and a lock. I recruited some friends of my fathers and together we painted and organized the office and effectively requisitioned it. I remain there today.
But for all the shortcomings of the Irish health services, most of us do recognize that it can be a very rewarding place to work; that it is staffed by exceptional people, doing incredible work, under huge pressure. Most of all we recognise the privilege it is to care for patients in their time of need. We value the integrity of that relationship dearly and will defend it come what may.
So tonight let me finish by declaring my ambition for the Irish health services.
I’m not naïve and I fully understand the enormous challenges that lie ahead but somewhere in me I believe that we can make great strides forward.
And over the coming 12 months I hope to be able to contribute to that progress as President.
Than you all for giving me that opportunity.