6 July 2000 Edition
Not very healthy at all
The announcement by Six-County Minister for Health Bairbre de Brún this week, of ``severe pressure'' on the health services, was accompanied by similar soundings in the 26 Counties. MICHAEL PIERSE reports on the crisis in health, north and south.
This week, the 26-County Minister for Health admitted to a shortfall in the hiring and retention of non-consultant hospital doctors (NCHD). Of the 3,000 NCHD posts in the 26-Counties, last week there were 110 vacancies in health board hospitals. Since this includes anaesthetists, the shortfall is likely to cause the postponement of surgery especially, while affecting the availability of other medical facilities also. Although the Department of Health claims that ``it has been traditional in previous years for posts to be filled right up to the deadline'', the reality of staff shortages generally within the health services cannot be passed off as a ``tradition''.
``The legacy of Tory cut-backs and centralisation of health care under British rule'' has, Sinn Féin Assembly Member Francie Molloy believes, caused the serious difficulties now faced in health care in the Six Counties.
``In rural hospitals in particular, we have been losing services for a long time,'' Molloy explains. ``The British government followed a policy of letting service levels drop in the hospitals, then winding them down and closing them with the excuse that centralised services would be a better option.
``The result of this has been that hospitals in Banbridge and Dungannon have been wound down and amalgamated into one hospital in Craigavon. This means a jump from one hour waiting spans in emergency situations to a six hour wait.'' Molloy gives the example of his own infant grand-daughter, who had been suffering from severe diahhorea. Even though she was living 250 yards from Craigavon hospital, she had to be taken to Belfast for proper medical treatment.
Though Craigavon has taken on the responsibilities of two other hospitals, there is still a lack of services there as compared to the hospitals in Belfast. Evidently, there is also a sectarian agenda at work. The so-called `Golden Fix' means that there are five hospitals in the Belfast Greater Metropolitan area, with only one in Derry and one in Craigavon - most hospitals are noticeably situated in unionist areas, east of the Bann. ``Sinn Féin's policy is to stabilise, rebalance and rebuild,'' Molloy says. ``Besides the sectarian agenda, there is also the serious problem of medical care being run increasingly like a business. Care for patients is being centred around budgetary considerations, rather than an ethos of compassion and traditional medical care.''
In the 26-Counties, the same problem of a badly underfunded health care system has caused a deterioration in the service being provided for patients as well as a lowering in the morale of hospital workers.
``Our health service has been short-changed over many years,'' says Maeve Healy, Chairperson of Drogheda Senior Citizens and local Sinn Féin member. Six months ago, a long-serving hospital consultant in Drogheda was suspended for allegedly keeping patients in hospital too long. The unprecedented step caused a major contorversy in the town at the time, with a protest march of 1,000 people and a petition with 10,000 signatures calling for the medic's reinstatement.
Colman Muldoon, a chest specialist, was suspended with pay from his post amid management claims that he had created ``chaos'' and jeopardised the welfare of patients. They did not claim that Muldoon harmed his patients but that he kept them in hospital for too long, thereby denying treatment to other patients and potential patients. He has yet to be reinstated.
Muldoon had been in dispute with the Lourdes Hospital management for some years over the length of hospital stays versus the financial problems and cutbacks faced by the hospital. He claims he was harassed and bullied by management and that he had his responsibilities gradually downgraded.
Muldoon claimed at the time of his suspension that 61 of the hospital's 360 beds were closed and that up to six patients frequently slept overnight on trollies. He says he made a formal complaint to management a year ago after an elderly patient of his had died while awaiting an appointment.
The hospital has been penalised for excessive length of stay by Department of Health fines totalling £1.2 million in the past six years.
``The Lourdes Hospital has been the victim of government cuts, nurse shortages and junior doctors grossly overstretched - often working over 70 hours continuously. Services have deteriorated as a result,'' says Maeve Healy. As chairperson of the Drogheda Citizens' Group, she has been campaigning for older people to be kept in for longer stays. The Health Board has overseen a shortage of community care, respite facilities and home care workers.
Maeve is angry at the government cutbacks that have followed through from the 1980s. ``For over ten years we were told to `tighten our belts'. Services were cut, ordinary people died on waiting lists while we are now learning that vast amounts of money were going astray.
``All that seems to matter to the health board is cutting back on expenditure. All you hear is `the budget, the budget'. Everyone on the staff is under pressure. You'd think they were running a factory, not a hospital,'' she says.
For Francie Molloy, the situation on both sides of the border will require an all-Ireland, integrated approach. ``Health care cannot as an issue or as a service be separated along sectarian lines, or by an artificial border.
``It is nonsensical that someone in Donegal should have to go to Dublin for treatment, when the same services could be provided in Derry. Medical services generally, and most especially ambulance services, must be provided on an all-Ireland basis. You cannot play politics with the health service.
``Sinn Féin will be taking a long-term approach to radically restructuring the health services north and south. The minister will need a complete review of acute hospital services and their location. We will be concentrating on more services in the community. There is also a need for more preventative facilities - to treat medical problems before they arise and lessen the burden on existing services.''
While Six-County Health Minister Bairbre de Brún has received an extra £7million this week, which will mostly be used to tackle waiting lists, she slammed the lack of funding in health care and said ``there is no doubt that local services will continue to face severe pressure''.
Problems which arise from the lack of funding are accompanied by other more complex difficulties, such as the male-dominated medical establishment's exclusion of the interests of predominantly female nurses and the sectarian divisions in the spreading-out of medical facilities.
De Brún's brief may turn-out to be the most difficult of the Executive positions. With all the good will in the world, it will still be up to the British government to finally fork out the necessary finances, mones they have denied and cut back over the years. In the 26-Counties, meanwhile, services are unlikely to get much better if the current Fianna Fáil policies of under-resourcing and fining hospitals that care for their patients remains in place.
Equality in health care abandoned
The right to affordable and quality health care has been the promise of many Dublin governments. Yes, we all know that this has never been delivered, but this week the current Fianna Fáil/Progressive Democrats coalition took a major step backwards from even this unfulfilled commitment.
A new Health Insurance Amendment Bill is laying the ground work for the privatisation of the Voluntary Health Insurance (VHI) agency. The VHI has become the health insurer to over 1.3 million Irish people. Originally set up as a way of covering health costs for the self employed and farmers who were not covered by the public health system, the VHI has transformed itself into a substantial part of the 26 Counties' inequitable two-tier health care sector.
VHI subscribers use the agency as a means to bypass a poor quality and underfunded public health care service. VHI membership can cut down waiting list times and give patients smaller ward sizes as well as letting patients pick their own hospital consultants and at times a hospital of choice. The VHI has even opened its own exclusive private hospitals to cash in on the demand from the higher income earners for hotel-like accommodation and fast track medical treatment.
Up until now, VHI subscribers all paid what was termed a community rating where everyone, regardless of their age, paid the same VHI subscription for a particular level of service. Under the new Health Insurance Bill published this week, over 35s who join the VHI will be charged a higher rating than those who joined earlier.
This could perhaps be justified on the basis that those with longer VHI membership have made a longer term investment in providing for their health care. However, thousands of people spend their early adult years in education or working in temporary, part-time and contract posts where there is simply not enough disposable income to buy private healthcare.
The new act also allows for charging on an age related basis for outpatients and GP services. Given that older people are more likely to need these services, there is every reason to believe they could be penalised under the terms of the new act.
The 1994 Health Insurance Act that the new bill is amending guaranteed ``in the interests of the common good, for the regulation of the business of private health insurance''.
Now, with the VHI set to be privatised, the real meaning of the new act is to deregulate and abandon the interests of the common good. Most people who are VHI members have joined because of the poorly funded service in the public health care system. This new bill is going to cause more inequality in the health service.
The government should be moving towards delivering a quality health care service for all not a just one for those on high incomes.