Mick Clifford: Hospital fix requires political bravery
For some reason, an annual horror show of hospital overcrowding, which was flagged well in advance this year, was not the subject of forward planing, or at least not enough to alleviate needless suffering
An ambulance outside the Emergency Department of the Mater Hospital in Dublin. For some reason, an annual horror show of hospital overcrowding, which was flagged well in advance this year, was not the subject of forward planning, or at least not enough to alleviate needless suffering.
What a country. This week it was announced that the national purse was €5bn in the black for 2022. The rest of Europe is looking into the eye of a recession, but we’re doing not so bad at all. “The risks are to the downside but in the round, the overall forecast for Ireland is that we will grow next year,” minister for finance Michael McGrath said on Wednesday. “The Irish economy is in a good position to weather the storm.” We are officially world beaters in economic activity. Take a bow, Ireland.
The national coffers are not an outlier of such rude health. In November, the jobless rate was 4.4%, a level that is regarded as practically full employment and the lowest rate in twenty years. There is work for everybody and people are arriving on our shores to grab a piece of the action. Net migration into the country in April 2022 was 88,800, which would have included a relatively small number of refugees from the Ukrainian war. Overall though, the figures illustrate how the curse of immigration has been completely turned around. The country is economically and socially flying. According to the Central Statistics Office just over half of those in the 25 to 64 years-of-age category have a third level education, a greater proportion than in any other country in the 27 member EU.
A lot of people, and not just a cossetted elite, have plenty of money. Last May savings in banks and credit unions hit €144bn. The median net wealth value of Irish households was €193,100 that same month, according to the CSO. On the social side the referenda during the last decade illustrate how progressive society has become and the welcome for refugees fleeing the Ukrainian war demonstrated that we haven’t lost our sense of community. It’s no wonder that last year Ireland was officially the thirteeth happiest country in the world, according to the UN’s world happiness index. Finland was number one, followed by Denmark and Iceland but none of them are really much craic. We are officially well off, very happy, open minded and great fun. Poor, underdeveloped, repressed Ireland is with Dev in the grave.
What a country. This week, right across the state, sick people were treated as if they were living in an impoverished outpost in the developing world.
Trolleys and chairs in emergency departments substituted for hospital beds. Some among these people were undoubtedly in the late stages of life, others in serious pain and here they were at the mercy of a state that for some reason can’t cope.
Patricia McCarthy went into the Emergency Department in Cork University Hospital last Sunday as “ a bright 70-year-old, but I’m coming out an old woman,” she said. She spent 57 hours sitting in a chair using her coat as a pillow before eventually getting a bed.
“I didn’t sleep for four nights,” she said. “I still haven’t slept. If I was an animal, I’d have a tag and I’d be treated better. I saw a mother lying on the floor in pain, without a blanket, without a pillow, crying, waiting for meds to kick in. On the floor. By my feet.”
If money alone could solve this problem, the billions are at hand. But during the week the Irish Times reported that the secretary general of the Department of Health Robert Watt noted last September that he could see “no prospective improvement” in waiting lists despite the injection of “significant money”. This was a reference to a €350m action plan to reduce waiting lists announced earlier in the year.
There are other issues. Despite high education levels and attractive aspects to living here, we have a chronic shortage of staff, both in the community and in hospitals. According to the Irish Hospital Consultants Association, there were 40% fewer consultants at work in this country than the EU average per population.
In 1980, when the country was economically banjaxed and coughing out huge numbers of its youth for lack of work, there were 17,665 in patient beds in hospitals, according to the Irish Medical Times. Today, with a population increase of over 1m, and in an infinitely wealthier country, there are 11,892. Go figure, as our American friends would say.
How do these two Irelands exist, the bright, shining example of private wealth and a health service that in some areas has all the appearance of public squalor?
One major factor is the two-tiered system, in which those who have benefited most from the elevation of the state’s fortunes are occupying the upper tier. Around 45% of the population is covered by health insurance. Is there really a major thirst for change among this cohort for whom the system, to the greatest extent, is working?
When Fine Gael and Labour came to government in 2011 there was a commitment to end the two-tiered system. The Slaintecare report published in 2017 was the ultimate outcome. Its progress has been uneven and way behind schedule. Implementing the plan fully and swiftly would inevitably mean disruption of some sort for the cohort who are insured. Is any government prepared for that kind of flak from the section of society that is most plugged into the political system? Is that why implementation has been so slow?
Investment is obviously a major issue, but Robert Watt is not alone in believing that without serious reform the money will continue en route to a black hole.
And reform will also mean disruption, this time for many who work within the system. Is any government prepared for that kind of flak?
One of the elements feeding into the current crisis is that hospitals operate on a Monday-to-Friday basis as if the health of the nation is a weekday business. It is difficult to see how that is sustainable in a modern, progressive society. Yet, no government has had the courage to push change in this regard. Is a simply a case that they have repeatedly decided it wasn’t worth the political cost that would inevitably accrue?
The country has been transformed over the last thirty years or so, elevated to the front rank of developed and wealthy nations. During that time some elements of the health service have kept pace, particularly in areas like cancer care. But there remains huge problems with the big picture stuff that has defeated successive ministers who have come into office full of plans and energy. Ultimately, they have all been defeated. Political leadership in this respect has been sadly lacking, but it will take more than politicians leading from the front to effect the kind of change that is required. Until such time, we may well continue to live in two Irelands in this respect.
