Have you ever wondered why the retirement in so many countries across the Western world is set at 65? It seems an arbitrary age, particularly in the 21st-century, when most 65-year-olds are as fit and feisty as a 40-year-old would have been, half a century ago.

It all goes back to Otto von Bismarck, who first proposed the idea in Prussia, in 1881. But at that stage, apart from the fact that many people would have been lucky to reach the age of 65, those who did so had a tendency to shuffle off their mortal coil within a few years. Nowadays, people are routinely living three decades past retirement.

There is a growing chorus in many countries calling for that age of retirement to be scrapped, and on Saturday's Marian Finucane Show, one of Ireland’s most respected medical consultants joined that chorus.

Michael O’Keeffe is professor of Ophthalmology at UCD and is attached to several hospitals, including the Rotunda and Holles Street. And he told Marian Finucane on Saturday he believes that doctors get better as they get older.

"I'm better at what I do now than I was fifteen, twenty years ago."

Prof. Michael O’Keeffe

In Ireland, consultants in the public health system face mandatory retirement after a certain number of years' service, or upon reaching the age of 65. And Michael O’Keeffe thinks that policy to change now.

A long-time critic of the health service, Prof O'Keeffe is maintaining an extensive private practice, as he moves away from working in public hospitals. Indeed, he says, he had intended to stay longer as a locum in Temple Street children's hospital, because his replacement hasn't arrived yet, but he's found it too tough to go on in what he describes as chaotic conditions.

Given that he's an ophthalmologist and that he's reached an age that the Health Service Executive believes he should be retiring at, Marian wondered what condition Prof O'Keeffe's own eyes are in.

He told her he's managed to get this far without glasses because, although he was born with one eye slightly short-sighted, his brain adapted to it and now his left eye is good at reading and his right eye is good at distance and, concerned parents everywhere will be relieved to hear, he can operate very well.

"I give out about the health service a lot… but one of the jewels in the crown has been the neonatal unit in Holles Street."

Prof O'Keeffe has been working in the neonatal unit in the National Maternity Hospital in Holles Street for more than 30 years and he believes it's one of the best units he's ever worked in because they have a can-do attitude and the nurses there were trained before the box-ticking and the form-filling came in and before what he calls the "touchy-feely stuff" came in.

With his extensive experience of Holles St, Prof O'Keeffe believes he can see both sides of the current National Maternity Hospital relocation controversy.

So, exactly what does he think should happen to alleviate the well-publicised concerns over ownership?

National Maternity Hospital

According to Prof O’Keeffe, the board of St Vincent's University Hospital, who own the site where the new hospital is to be co-located, needs to come out and say that the maternity hospital would be truly independent – despite the Catholic Church's view on a variety of medical procedures – and that there would be no interference with medical decisions made. Such a statement would, he believes, diffuse the situation.

Saint Vincent’s Hospital

"The nuns were in the Mater Private, the Mater Public, they were in Temple St and they ran a really good show."

During his time working in the health system, Prof O'Keeffe experienced how the religious orders ran hospitals and he told Marian that they did an excellent job. The proof, he says, is what happened when they stopped running our medical facilities: dirty, dysfunctional hospitals, with nobody in charge.

"The nuns have been a force for good, in my opinion."

Marian wondered who was going to do neonatal eye surgery, now that Prof O'Keeffe is retiring, but he told her that although he is stepping back from his work in the public system, he's staying on in the Rotunda and Holles St because, he says, these hospitals are so well run that he likes going there. They represent, he believes, the best parts of the public health system.

'Why is that?' Marian wondered. Because "there's someone in charge," is Prof O'Keeffe's response. "There's a nurse with common sense who has been trained in the old style." Too much time these days is taken up with bureaucracy, and so much of it is designed to protect health workers from being sued, but it doesn't even do that, in his opinion.

"We're covering our flanks at every level and a lot of it is a waste of time."

Government

How do we resolve the issues within our health system? You've got to start with the organisation first, Prof O'Keeffe believes. The system is unwieldy and a lot of it is unnecessary for a country of fewer than five million people.

"We need a Minister for Health who's in charge, who can make a decision."

It's up to the minister to decide policy, according to Prof O'Keeffe, but too often successive ministers have allowed the HSE do that, when the lead should come from the department. Then in the hospital system, he says, the attitude is can't-do, as opposed to can-do. "You start off, the phones aren't answered… patients don't know when they get their appointments… they're being cancelled on admission… there are rolling closures… the trolley system is out of hand, we've even given up getting mad about it." It's quite a list and few would argue with it. But how do you fix it? Prof O'Keeffe believes that management structures in hospitals need to be changed.

"In 30 years of practice, I never had a manager in a hospital come to me on the ground floor and say, how are you getting on."

There doesn't appear to be accountability at management level, Prof O'Keeffe says, and now it's running into the nurses' level. Nurses, who he says are poorly paid and badly treated, are now trained to box-tick and form-fill, instead of putting the patient first, as used to be the case. Our health system needs major surgery, according to Prof O'Keeffe, but what are the odds of that actually happening? We need more equipment, more beds, more – and better-paid – nurses. Doctors need to work better and we need the resources we have to start working better. And Prof O'Keeffe doesn't believe that the HSE is the body to administer those resources. He thinks the executive should be abolished and a streamlined department of Health should do the job instead. We need, he believes, a CEO and a few people who take charge.

"Michael O'Leary is the sort of person we need… a guru to come in and shake it up and say we're not taking anymore nonsense."

Prof O'Keeffe is leaving the public health system, but will remain working in private practice.

You can listen back to the entire interview here.