Physician, heal thyself

The American circus impresario PT Barnum used to say, ‘there’s one born every minute’. He was referring to thicks, gobshites, gullible nincompoops, the kind of fools who were easily parted from their money. And he was right. That’s how he made his millions.

A century later, his successors are hard at work in Ireland. They’ve been making millions out of gullible fools. But this time, we’re the ones easily parted from our money. And in what might easily be described as circuses too.

Three groups seem to epitomise it. There’s the legal profession, some of whom are literally to make millions out of the tribunals. There’s the construction industry, about whom I need say little more. You know what I mean. And there’s the medical profession, and the consultants in particular.

I am sure it cannot be so, but many people have a strong impression that these service industries regard us as a well from which they can draw what water they need. If we take the health area, what will come to be called the Brennan report details a system that has left the rails.

That report makes it clear that nobody in that system has any incentive to manage costs effectively. And if we look at the consultants, they have a common contract that is especially favourable to them. It was, by the way, agreed by the former Minister for Health, Michael Woods.

The cushy terms of the contract are only part of the problem, though. More fundamental is the sense that the consultant is the top of the pyramid, the person from whom the system derives legitimacy, the fulcrum of health service in Ireland.

This idea that there’s a top echelon, an elite, a hierarchy is outmoded and anti-democratic. It is a vestige of a time when the Catholic Church dominated Irish life, and permeated the professions like a dull grey mist. The medical profession was, indeed still is in many ways, infiltrated by conservative Catholics, often Knights of Columbanus.

This hierarchism is intrinsic to their world view. Doctor knows best. Be quiet, take your medicine. Behave yourself. Know and respect your betters. It was particularly interesting to see them being taken on by Professor Niamh Brennan. A woman, for God’s sake!

They’re not alone, of course. Consultancy is not confined to the medical world. Indeed, the last decade in Ireland has been the era of the consultant. There are whole firms of them specialising in everything managerial, from human resources through strategic planning, systems management and evaluations.

Not much has moved in this country since the late 1980s without its attached consultant and lengthy report. Since 1997 they have become even more central, more embedded in the flesh and bones of our way of doing business. Those are the Celtic Tiger years, and a lot of money was sloshing about in the trough, and the consultants got their snouts in there like everyone else.

And we all pay.

Oh yes we do. I don’t know how their costs are calculated. I have met one fellow – he once worked in public service – and his charge for a day’s work is €1,500 (“with all preparation and attendances,” he added). If it isn’t done that way, it’s tied into the cost of the project as a percentage. Either way, it’s a lotta money. And it is so ingrained as to have been instrumental in the teachers’ dispute last year. A lot of ASTI members found they were slipping way behind their golf club friends in the earning stakes. They heard what consultants of various kinds were earning and got very angry indeed.

Their response was to look for more for themselves. Ours should be to sort out the mess and get value for our money. Because most of what’s spent is ours.

Just how the course of history, and consequent cost, can be misshaped by consultancy culture is revealed by the visit of a man who might one day become another foreign Irish hero.

He’s another academic, Professor Manuel Melis Maynar, president of the Madrid metro. He came here to tell everyone how Madrid was able to build a metro very quickly and for a fraction of what our projected costs would be. And by the way, it’s really good. I’ve been there and I’ve used it. We need it. And soon.

The bell seems to have rung, because the Railway Procurement Agency dropped its estimate for a Dublin metro by a full €1.3 billion, which caused a lot of people to scratch their heads. And no wonder.

Their story is that the original estimate was for a top-of-the-line two-tunnel metro. Crucially, though, it was based on Irish cost factors. And, like consultancy, Irish cost factors are based on the premise that every dog in the street gets a bone, and everyone in the line gets a cut.
Percentage, percentage, percentage.

Like the barristers in the tribunals and the medical consultants and the property dealers and…you get the picture.

They look at us all and say ‘there’s one born every minute’, and we, like saps, pay over the money to go see the circus. Jaysus, nine times out of ten we thank them as well. Who are the clowns?

Perhaps they’re right.

Well, roll on the reform of the health system. About time too. And roll on the cheap metro. And if it has to be built by Spaniards, so be it. It’ll work and it’ll be set up on time, and it’ll be built to budget. Unlike what will happen if we are left to our own devices…

There’s been enough consulting. It’s time for a bit of action.

¡Arriba!