“The one thing I want for the country I love is a health system that is accessible to every citizen regardless of their wealth.”
- Mary Harney, Minister for Health and Children, 29th September 2004.
It is no understatement to say that the health system in this state lurches from crisis to crisis like some uncontrollable monster that feeds mercilessly on the sick, the poor and on tax-payers money. It is nothing short of an abuse of human rights. It seems that a day does not go by without needing to add something new to the list of health-based crises in the state. Mary Harney’s statement from 2004, as quoted above, was an insult to the intelligence of those who knew better then, and remains an insult to those who have learned better since (aside from the fact it was a lie to begin with).
In 2008, we still do not have enough acute hospital beds; Amnesty International say that our suicide prevention and mental health funding and policies do not live up to international mental health standards; hospital budgets are being cut and GP training places reduced, despite the fact that this exacerbates risks to patients. The monster that is the HSE and the Department of Health authorizes and promotes policies that encourages the increase of Accident & Emergency Department waiting times, and forces hospital wards to close intermittently, and departments to close permanently, or in some cases, to never open in the first place.
Harney and the HSE monster are too busy worshipping Mammon to worry about providing the service that is so desperately needed by the people that fund it – the tax payer. Instead, alarmingly damaging plans for hospital co-location (despite opposition to the plans growing) are being railroaded through the Dáil and the tax-payer will be forced to watch private hospitals be ‘co-located’ on public hospital grounds.
Bad enough that the average person is forced to avail of under-resourced and over-stretched services in the public system. Now, under Minister for Health, Mary Harney’s plans, public patients will be able to watch those with the money, enter into an oasis of modern facilities and speedy provision of services situated within the grounds of a public facility suffering from lengthy waiting times, a plethora of hospital trolleys, and which gives the anxious patient a queasy feeling that their test results aren‘t accurate. They will also know that their taxes partly fund this. So, not only does this monster exist; it rubs our noses in the shambles of our current health system.
Since the last General Election, these crises have gotten worse and there is no sign things will change.
The Acute Bed Crisis
In January 2008, a HSE report Acute Hospital Bed Capacity Review said that the state would need an additional 20,000 acute beds by 2020 to meet with demand. In response to this, Prof. Brendan Drum had the gall to say that people must not be so dependent on acute hospitals and that “outdated practises” must be done away with, while claiming that more acute beds were not needed.
This report also stated that 180 additional beds would be required at Our Lady of Lourdes Hospital, Drogheda to compensate for cuts made during the 1980s. Due to the centralisation process currently being undertaken by the HSE, however, hospital services in Dundalk, Navan and Monaghan are now being transferred to the already over stretched Drogheda and Cavan hospitals. So, while the Government is dependent on co-location to deliver extra beds, it cannot reach any agreement as to exactly how many is needed. In fact, they do not appear to want to reach an agreement or even to discuss it. One could be forgiven for thinking that they are afraid of the truth.
Suicide Prevention Funding and Mental Health
Despite CSO statistics showing that over 400 people died through suicide in 2006 alone, the Government decided in January 2008 that it would not allocate the National Office for Suicide Prevention any extra money to combat this issue of major societal importance. The Office’s budget was frozen at the 2007 level, forcing many NGOs in the mental health sector to scale down their operations due to inadequate funding. The cut-backs came as no surprise to those who provide frontline services – funding of mental health services has actually decreased on an annual basis since 1997. During 2006, 7.1% of the health budget was spent on mental health in the South compared with 10% in the North.
Curiously, the ears of Celtic Tiger enthusiasts did not ring when Amnesty International and Schizophrenia Ireland raised the alarm on World Mental Health Day that comparisons could be made between Bulgarian and Irish attitudes to mental health problems. Bulgaria, after all is not well known for its progressive attitudes towards mental health. What is more, the largest mental health organisation in the state was forced to scale back its services drastically after levels of government funding were cut. The organisation is currently under incredible pressure, with only two workers to cover an area of Dublin with 1 million inhabitants.
Hospital Budget Cuts
In January, The Department of Health announced that 16 hospitals across the state would have its budgets cut by €10 million as a result of “inefficiency”. So, already over-stretched hospitals now have to struggle to reach unattainable standards under budgets that are even tighter than usual. According to Department logic, however, if a hospital cannot perform within its meagre budget, its budget is cut further. But don’t mention the fact that the reason the hospital under perform in the first place is because of a HSE embargo on recruiting staff.
Tallaght Hospital will be the worst affected, receiving a €2.1 million budget cut, while Our Lady of Lourdes, Drogheda and Our Lady’s in Navan will both have their budget cuts by €1million each. The only effect of cutbacks on this scale, of course, is the penalisation of patients who avail of the services and who are not fortunate enough to be able to ‘go private’. Indeed, those afflicted with a mental illness and cannot pay for private care, are now being put in prisons due to the lack of beds in psychiatric hospitals.
No Increase in GP Training Places
At the beginning of the year, the Irish College of General Practitioners revealed that there would be no increase in the number of GP training places for 2008. This is despite the fact that in 2005 FAS Market Research published a report stating that there would be a shortage of 1,000 GPs by 2015, a figure which essentially made a mockery of the Government’s primary care strategy.
Waiting Times in A&E Departments Get Longer
Overcrowding and waiting times in A&E Departments worsened throughout 2007 and have not yet improved. In response to this Minister for Health, Mary Harney declared that the situation in A&E units was a “national emergency” and set up a task-force to deal with the issue, which aimed for a maximum target of 12 hours waiting time. This has failed in its task and resulted in scathing criticism from the Irish Association of Emergency Medicine. Minister Harney has ignored numerous calls for her resignation after failing to change health policy to public provision based on need.
Hospital wards close as a result of HSE recruitment ban
A ward in Potiuncula Hospital, Galway was forced to close as a result of the strenuous effects of the HSE recruitment ban in December 2007. This was yet another indictment of Mary Harney who had previously pledged that cuts to the HSE and its recruitment freeze would not affect patient health care. As well as this the Orthopaedic Unit for the North-East region, serving four Counties, and located at Our Lady’s Hospital, Navan, also closed for most of December with staff shortages being cited as a reason.
Co-location schemes and a two-tier health system
Last December, members of the Dail discussed the Health (Miscellaneous Provisions) Bill 2007, which was designed to facilitate “co-location”. Co-location is a mechanism which is designed by Government to enable the establishment of private hospitals in the grounds of public hospitals. They have, without an ounce of shame, masked this as a way of freeing up extra public beds. In reality, when the policy is implemented it would reinforce the healthcare apartheid and two-tier nature of the current system. It will pave the way for complete privatisation of the health system.
Despite the Green Party’s previous commitment to opposing hospital co-location, it remains to be seen whether they will stick to this policy. Sinn Fein, Labour and Fine Gael have all come out quite strongly (and quite rightly) against the proposals.
Also relevant is the fact that the previous June (’07), Professor Brendan Drumm made a range of comments which corroborated the Sinn Fein and Labour view that plans for co-location needed to be scrapped immediately and urged the Green Party to reject any Programme for Government that contained co-location.
Yet it still remains in place.
However, while the government parties sing from the same hymn sheet about the €280m that the state will recoup from co-location, it emerged recently that the plans will actually cost the state €1.3b over the next seven years.
The Green Party Election Manifesto ’07 had committed to “scrap immediately the decision to subsidise the building or private hospitals on public land”. Drumm commented that he saw co-location as a “competitor” to the public system and that we should be “glad of competition”. This directly contradicted the previous claims of Bertie Ahern and Mary Harney that co-location would “free-up” 1,000 additional beds in public hospitals. It is unlikely that the people who remain languishing on trolleys in public hospitals will be “glad of competition”. More likely they will deem it to be, at best, an obscenity, and at worst an abuse of human rights.
Weak budget commitments in healthcare
Announcements made by the then Minister for Finance in his Budget address last December, relating to healthcare and medical cards, were beyond weak, to say the least. It failed to address the crisis in healthcare adequately and reneged completely on previous government commitments to extend eligibility for medical cards. The Irish Hospital Consultants Association also echoed the views of Sinn Fein by saying that the Budget commitments did nothing to address the need for 3,000 extra acute beds or adequately provide for the health needs of the population in the state.
However, Brian Cowen, the Minister for Finance at the time, did find it in his heart to leave tax breaks for developers of private for-profit hospitals. As a result taxpayer’s money will fund the co-location scheme and healthcare apartheid.
The biggest percentage increases in health spending in the budget are 146% for inquiries, legal fees and settlements and 42% to the State Claims Agency for payouts in cases of clinical negligence.
Motions of no confidence in Harney
A series of motions of no confidence in Mary Harney as Minister of State have been tabled. One was passed by a body established by the Government in the West of Ireland, which was designed to give local councillors a voice in HSE matters. The West Regional Health Forum passed the motion at its monthly meeting in January 2008. During the previous Dail, a motion of no confidence in Mary Harney was raised as an indictment of, not only her stewardship, but of Government health policy and management of the health services in general. The motion came after news emerged of a scandalous situation in the Midlands, where women were misdiagnosed after cancer screenings – due to fundamentally flawed policies and gross mismanagement of the health system. Unfortunately the motion was defeated.
Despite the increasing public dissatisfaction, when Brian Cowen became Taoiseach and reshuffled his cabinet, he neglected to move Harney. It has been abundantly clear for some time that she cannot do her job properly. Despite various political correspondents speculating that the Cowen government would be more efficient, health remains the one area that needs efficiency most. Yet it is one he has decided to leave in what are a decidedly unsafe pair of hands. The fact remains, however, nobody else wants the job.
Mismanagement of Cancer Services
During August 2007, the HSE told women receiving breast-cancer diagnoses and Portlaoise Hospital that there was “no need for concern” after a consultant radiologist and a review of practice was established. Previously a nursing director had alerted the HSE to high numbers of false diagnosis being given. A number of women were told that they had breast cancer when in fact, they didn’t. Eventually 3,000 mammograms were reviewed by the HSE. Nine women who were previously given the all-clear, were then told they actually did have cancer. During the following November it emerged at an Oireachtas Committee meeting that a further 97 women were being recalled after they were incorrectly given the all-clear, some of whom did have breast cancer. The 97 women in question had heard through the media and not the HSE that their ultrasounds were to be recalled. It also emerged that in 2005, a surgeon wrote a letter to the Minister for Health describing the cancer services provided in Portlaoise as a “shambles”. Furthermore, it emerged that hospital staff contacted the HSE in 2006 in order to express concerns regarding the age of the equipment being used in Oncology. Even the Assistant Director of the HSE’s National Hospital Office has said that the health service is “failing miserably” in its assessment times for breast cancer diagnosis.
A 41 year old Tipperary women, Rebecca O’Malley went public about her misdiagnosis in Limerick Regional Hospital. As a result of the misdiagnosis her treatment was delayed by 14 months. Another unidentified women was misdiagnosed in Barrington’s private hospital in Limerick and her treatment was delayed by 18 months. During October 2007, Ms. Susie Long (a public health patient) made the decision to highlight her plight against cancer and expose the healthcare apartheid that exists in this state. Susie Long’s diagnosis and subsequent treatment was delayed to such an extent by this apartheid that when she died from her illness even Bertie Ahern and Mary Harney admitted that the health system had “failed her”.
The cases of Rebecca O’Malley and Susie Long are symptomatic of the two-tier health system. Their cases have reiterated that the obstacle to access to the required care is the inequitable two-tier nature of the system.
In response to this Minister for Health, Mary Harney said that the crisis that now existed regarding cancer care services are as a result of “our failure to establish “centres of excellence” across the state:
‘It has happened because of our failure in the past to put in place centres of excellence, which could never have happened under the old health board regime.“
According to Harney, had we done this, treatment would be given speedily where necessary and scan results provided efficiently. Public protests at her decisions are met with indifference. Face-to-face confrontations lead her to blame someone else; using what is now known as the ‘it’s not me – it’s Drumm’ excuse.
It fails, however, to provide a reason why 6,000 Chest X-rays and 70 CT scans in the north east need to be reviewed. This was only discovered when four patients learned they had lung cancer after the locum consultant radiologist who originally viewed the scans and x-rays, failed to pick it up.
Deadlier forms of MRSA have continued to be found across the hospitals in the state. Even though single rooms and isolation units have been identified as a major need as far back as 2001 the Government has continued to remain inactive on this. It was revealed that Beaumont Hospital in Dublin was lacking in beds to such an extent that it was unable to provide isolation facilities for one third of patients with MRSA. Beaumont serves the entire North East region in many services, as well as being a national centre for renal dialysis and kidney transplant, and a national centre for neurosurgery. It will also become one of the hallowed “centres of excellence for cancer care“. Hospitals and medical facilities in the Netherlands have more single rooms and have made far greater advances in aiming to eradicate MRSA.
The first National Hygiene Service Quality Review by the Health Information and Quality Authority also said that the majority of public hospitals need to “dramatically improve their hygiene standards. The report said that the only seven out of 51 hospitals had good hygiene standards while none at all were deemed to be very good. Nine hospitals were rated as “poor”. It was also revealed in June that in May 2001 the infection control committees in two hospitals in Galway were expressing anger and dismay at the non-implementation of policies to combat MRSA.
During the month that the FF/PD/Green coalition was formed, news broke that despite the continuing escalation of problems with MRSA on the wards of hospitals throughout the state, the HSE had failed to spend almost a fifth of its capital budget (€97.7 million) for the year 2006. €97.7 million which could have gone some way to allocating funding for beds and isolation units which would go some way to relieving the overcrowding in hospitals.
Irish Government Make Moves to Close More A&E Units
Results of a Journal of Emergency Medicine survey revealed that there links between the distance traveled by ambulance to hospital emergency departments and the increased likelihood of death. Yet the Government have decided not to heed the warning signs from these compelling results and have continued with their plans to close A&E Units across the state and centralise all emergency care services.
Without a doubt, it is a depressing state of affairs. After all this I haven’t mentioned nursing home care, medical cards, PPARS, the consultants contracts, the ongoing nurses industrial action, lack of stroke units, the wrong kidney being taken from a child,…..the list it seems, is actually endless and so the crisis continues.
What Needs to be Done
If Brian Cowen had any backbone, the first thing he would have done on arrival to Roinn an Taoisigh was sack Harney on the grounds of incredible ineptitude.
In Cowen’s first speech as elected Taoiseach he said;
“In my first budget speech to this House I talked of economic activity as a servant of society. The statistics speak volumes for what we have achieved in the past 15 years. They might also get too much attention. Some might ask what year on year growth amounts to if it does not improve people‘s lives.”
He was quite right of course, but he, like his predecessor, doesn’t seem willing to give us the answers when it comes down to health system.
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