Pure motives but no mandate: how lobbyists monopolise health debate

ELLEN COGAVIN was a Fine Gael candidate in the Dunshaughlin area for Meath County Council in last June’s local elections. She is a senior nurse in a nearby hospital and health was probably one of the issues she campaigned on.

She polled 916 votes, just under half a quota in that electoral area.

She wasn’t elected but it was a good run. Contesting an election, even unsuccessfully is always to be admired. It is to be respected that somebody would put themselves in front of their peers seeking to make a contribution to public life.

However, since the local elections, Ms Cogavin has managed to find a much more effective way to exercise political influence. In a new unelected role she has generated acres of media coverage for her views in a manner which even the most impressive contributions to Meath County Council could never have achieved for her.

About two weeks ago, Ellen Cogavin emerged as the spokeswoman for a new health lobby group, Patients Together.

Patients Together apparently emerged spontaneously to campaign against delays at accident and emergency units at our hospitals. The group claims to have 100 members. About 20 people attended its inaugural meeting in Dublin Mansion house three weeks ago (not counting the Labour Lord Mayor and a Labour TD who squeezed into the photograph). The “members” present for the first meeting were nearly outnumbered by the journalists who showed up, cameras in tow, to get the footage of what would inevitably be an emotionally charged gathering. It was a dramatic event. The group demanded a meeting with Tánaiste Mary Harney threatening that if they didn’t get it they would stage large rallies in protest. Some 200 people turned up for the most recent march they organised last Saturday week.

In many ways the media hype generated about this lobby group illustrates how distorted and dysfunctional the debate around health issues has become in this country.

There will always be reams of newsprint available for stories criticising governments in particular or the political system in general. Negative news is always more dramatic. The entire debate is always wrapped in emotion.

In the last few weeks neither Liz McManus TD, health spokeswoman for the Labour Party, nor Liam Twomey TD for Fine Gael got much of a look in during the extensive coverage given to the accident and emergency situation. However a dozen different packages on the television news in the last fortnight have featured Patients Together. Even last Friday the story that the group held their meeting with the Tánaiste and predictably came away disappointed, was the top item for much of the late afternoon and early evening news bulletins.

Now that the contact details for this group and its spokespersons are lodged safely in the filofaxes of the top journalists in the area, we can expect they will be called on to “balance” any Government utterance or initiatives on A&E.

A precursor of the Patients Together group was the Irish Patients Association.

This group hit our media screens and newsroom faxes a few years ago. A comment from the chairman of the Irish Patients Association is now a near-must in every package or article on the health services. Yet nobody knows how he became chairman of this group or how many people he is chairman of or who appointed him spokesperson for the country’s patients. How is an association of Irish patients constituted? Do they hold ward meetings? Do you have to be a current user of inpatient or outpatient facilities in order to be a member? Does your membership lapse when you return to full health?

As it happens, their chairman is a particularly articulate, informed and, I sense, committed spokesperson. But he was elected by no one (not even by patients) and he is accountable for nothing.

I know that even entering upon this line of argument I run the risk of raising the ire of all who are convinced that our health services are in a deep crisis. They are not. We have a very advanced, modern and dramatically improving health service. There are enduring shortfalls, especially when measured against rising expectations in health care and advances in medicine. Some of these shortfalls, like those at A&E, are highly visible. Others, like shortage of therapies in the special needs area, are less apparent. All shortfalls are unacceptable. However, the story needs to be balanced. The advances in our cancer treatment facilities and in tackling heart disease have been quite stunning in recent years. When these advances are occasionally reflected in data or reports, they usually get one day of coverage. Gradual, although significant, improvements are less dramatic and therefore less newsworthy.

These improvements in our health services are too aggregate, too complex or too macro to fit into dramatic packages or soundbites.

I am not saying that there is not deep and justified public annoyance at the problems in the health services. One would be heartless not to be moved by the personal stories of those who have experienced A&E delays. My point is that Mansion House press conferences by self-appointed lobby groups are not the only place where emotional accounts of the traumatic delays have been heard.

MOST TDs hear similar personal accounts face-to-face at their clinics in their constituencies every weekend. That’s one of the pluses of the clientelism of our politics. The public anger at the problems was reflected in the elections in June. Before and since the elections it has been reflected in the internal forums of the political parties - all of them. It has been reflected too in parliamentary debate where it has been addressed comprehensively and largely constructively in the Dáil and Seanad. These debates, at most, get five minutes in the midnight hour programming which now passes for parliamentary coverage.

The extent of public anger, and the need to address the A&E problems, has got through the political system. Of course the problem isn’t solved yet, because there are no quick-fix solutions. A range of medium-term proposals to address the problem are in hand and the details are likely to be rolled out in the coming week.

It doesn’t advance our understanding of the problems much by the fact that most of the coverage of the issue takes the form of patient stories pitched against demands for political action. Little of the coverage focuses on questions of bad management in individual hospitals or on the reality of additional costs. Practically none of the coverage deals with restrictive practices by medics, paramedical staff and even nursing staff. Yet all these may be contributory factors. Privately, politicians who have specialised in the health area talk about how problems in accident and emergency rooms are exacerbated by individual examples of bad management. They wonder how some hospitals have got their acts together whereas others, notwithstanding the provision of additional resources, have not. However, any public effort by politicians to explain or contextualise the problems in this way would by shouted down by taunts about buck-passing.

There are various disability and carer organisations which provide services to, and advocacy for, those with specific needs. These make an important contribution to our health services and to the health debate and I distinguish them from the type of media-generated lobby groups I am focusing on here.

Many commentators in the health area were quick to deride the role which local public representatives had under the former health board structure.

Ironically, many of the same commentators are happy now to have health policy debate distorted by the noisy clamour of well-motivated but unrepresentative self-appointed groups such as Patients Together. I don’t doubt their motives - it’s their lack of mandate that I question.