Dr Domhnall McGlacken-Byrne: Health scandals will endure until we clarify what exactly needs to change

Health reform is difficult. No country on earth has achieved it without certain key ingredients, like genuine engagement with the healthcare workforce; serious investment of resources; and bold political leadership, right from the very top. 

There’s always a scandal.

In recent weeks, we have read grim reports of children receiving unsafe psychiatric care in Kerry, and of warning signs ignored.

Before Christmas, it was surgical waiting lists, and a tearful mother on RTÉ, describing the physical pain experienced by her child, as he waited year after year for his scoliosis surgery.

Two years ago, it was a photograph of a 90-year-old woman on the front page of a newspaper, propped up on the edge of a trolley, in a glaringly bright hospital corridor, clearly in pain. 

I still remember seeing that image as I bought my coffee in the hospital shop one morning. It stopped me in my tracks. 

After a 48-hour wait, it transpired the woman — her name was Ann — had a fractured vertebra.

The scandal changes; the pattern remains the same. Revelations emerge; outrage ensues; commitments are made. 

A working group. Root-and-branch review. Recommendations implemented without delay.

Each time, we share that sense of outrage — even if it’s not our mother on the trolley. 

What's your view on this issue?

You can tell us here

We share the conviction that no parent should have to go on television to beg for healthcare for her child — even if it’s not our child.

Ultimately, we recognise that in a decent society, there are certain things all people should have: Food, a place to call home, an education, and healthcare.

These things are called human rights, and they are a reflection of the inherent value of each of us. 

Fundamentally, we are outraged by the trolleys and the waiting lists and the reports from Kerry because we know that if a right is granted to some of us, but not to others, then it is not a right at all, but something else.

Healthcare is not a human right in Ireland. It never has been.

Nearly one in five Irish citizens are on a public hospital waiting list. Our primary care sector is at breaking point, as hundreds of GPs are set to retire without replacement in the coming years. 

Our community health services are overwhelmed, particularly in areas like paediatric disability and, as we’ve seen, mental health. 

Our healthcare workforce is running on empty.

Inequality is baked into this system. After decades of under-investment, we remain the only country in Western Europe without universal access to primary care. 

In many areas of community care, the choice in real terms is go private or to get nothing at all. 

And our public and private hospital sectors remain intermingled in a way that is complex, deeply unfair, and simply not seen elsewhere.

It does not have to be like this.

In the aftermath of the Second World War, global bodies like the World Health Organization emerged, advocating a rights-based approach to health. 

Our European neighbours constructed universal health systems on the premise that all citizens are entitled to safe, timely, high-quality care, no matter their background or means. We did not. 

Britain established the National Health Service. We did not.

Instead, for decades we outsourced the provision of basic economic rights such as healthcare to the church — to the realm of charity. 

This is the complex legacy we inherit. I believe it no longer reflects who we are as a society.

Though it has not been perfect, our national Covid-19 response has been characterised by cohesion, collective regard, and an awareness that, when it matters, we are all in this together.

Similarly, even though the status quo treats some of us better than others, we must realise that the current system ultimately sells all of us short.

Staff are fed up. Politicians live in dread of the next scandal. Those without the means for private health insurance face disparities in access that are clearly unfair. 

And those with private cover end up paying for the same thing twice — their insurance premium and a tax bill. 

The current system sells all of us a bad deal.

I spend more time than I’d care to admit thinking and reading about health systems. Health reform is difficult. No country on earth has achieved it without certain key ingredients, like genuine engagement with the healthcare workforce; serious investment of resources; and bold political leadership, right from the very top. 

From the start, Sláintecare has lacked all of these things. 

However, it could prove to be the best chance of reforming our system for a generation to come.

Families in Kerry bearing the consequences of chronic underinvestment in mental health services deserve answers. 

But the question we must ask ourselves is personal: Do we believe that healthcare is a right? If we do — and I believe we do — that carries implications for action, because we ultimately choose our political leaders, and we set their priorities.

The only way our health system will ever change — the only way we will ever break free of this perpetual cycle of scandal — is when enough of us demand it. We all stand to benefit from universal healthcare. The real scandal is that it has taken so long to happen.

Domhnall McGlacken-Byrne is a doctor and is currently undertaking a Master’s in Public Health in Harvard University. He is also the co-founder of Doctors For Universal Healthcare