Issue 3-2023-200dpi

20 December 2001 Edition

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THE HEALTH CRISIS: A republican response

While 26-County Minister for Health, Micheál Martin, is at pains to assure people that his government has the health crisis in hand, most people who have had dealings with the state's healthcare system, in recent times, will beg to differ. Sinn Féin offers an alternative view, in an edited text of the party's 2002 health strategy, set out below.

What has Micheál Martin been doing since June 1997, a period in which record tax revenues were generated, a period that offered an unprecedented opportunity to provide a first-world health service for Ireland in the 21st century?

Free Healthcare for all

Our health service is in crisis. It's time for change. Twenty-eight thousand people are on hospital waiting lists and many thousands more are waiting for an appointment with a specialist just to get on the list. How long you wait for treatment depends on your ability to pay. It's not right. It's not fair.

In the public system, services are being run down. Maternity wards and operating theatres are being closed through lack of resources and staff. People attending Accident and Emergency Departments have to queue hours for treatment.

Healthcare workers are victims too in this system. This is especially true of nurses and junior doctors, who have to work long hours in wholly inadequate conditions.

The reasons for the poor state of the health service are:

Lack of long term planning over the last 20 years
Bad management and organisation of services
Inequality within the system
Under-funding and cutbacks

Níltear tar éis tabhairt faoi fáthanna eile droch-shláinte, ar nós ioncam íseal agus gnéithe timpeallachta - caighdeán uisce agus aer, sábháltacht bia, bainistíocht dramhaíl agus córas taisteal.

Sinn Féin will build a programme of healthcare that no previous government has done.

We will address the inequalities that lie at the heart of the system. Sinn Féin is also concerned that the 66,000 people working in the sector are treated fairly and that the new health service is something they can be proud of.

Above all, the scandal of the two-tier system must be ended and access must be based on patient need. The best way to achieve this is through a new all-Ireland health service, with equal access for all, built side-by-side with a visionary programme for preventative health care.

Change will only come when the political will is there to make it happen. Sinn Féin will make it happen. Join us in the fight for a fair and equal health service.

Sinn Féin ten-point plan of action

create a new all-Ireland health system, free at the point of delivery and funded by general taxation
increase healthcare funding to the EU average of eight per cent of GDP, plus additional funding to help redress years of underfunding & cutbacks
harness all of the health resources, facilities and skills on the island into a dynamic, island-wide healthcare system
set up a single waiting list
increase the number of health workers, with special location allowances
end the public subsidising of private hospitals
a properly funded anti-poverty strategy, to eradicate poverty and deprivation in Ireland and to be carried out within a specified timeframe
the health proofing of all public policies
long term planning and funding for hospital services
ensure local communities are directly involved in developing health policy and strategy

End Waiting Lists

Increasingly, in the 26-County state, access to quality healthcare is dependent on ability to pay and not on need. Public patients wait years for treatment that is available to private patients within weeks. The result is that more and more people are turning to private health care, as they are afraid to depend on public health care, while others are abandoned on waiting lists.

58% of people rely on the public system for health care, including 18% who are not eligible for a medical card but cannot afford insurance cover. There are currently almost 28,000 people awaiting hospital treatment in the state. More than 10,000 adult public patients and over 2,000 children have been on hospital waiting lists for 12 months or more.

These figures don't tell you the full story, as you have to be waiting three months before going on the waiting list. The waiting list problem is a complex one. It's solution lies in increased funding and radical health reform. Sinn Féin believes that there should be a single waiting list that ensures universal access to acute services on the basis of need. This process should be fair and transparent and under the control of an independent body.

Free GP service demanded

Sinn Féin wants to see the current two-tier system dismantled and the medical card system abolished and replaced with free GP services for all. There also must be a greater integration of health services including GP, acute hospital and community care. Given the current shortage of staff, throughout the service, initiatives are required to fill present vacancies, especially those of junior doctors and nurses - with special location allowances for the greater Dublin area. More consultants are required, especially in Accident and Emergency. We want to end the present system of long working hours for junior doctors and to see the recommendations of the Commission on Nursing implemented. The number of beds, particularly in the Dublin area, needs to be increased and badly needed acute services need to be freed up, through the provision of additional resources to geriatric and community care services. Sinn Féin supports initiatives under the National Development Plan to upgrade and refurbish community health centres. We want to see more public health nurses employed and carers in the home supported.

Two-tier health system must go

The 26 Counties spends less of its income on health than almost any other state in the EU. Spending is currently at 5.1% of GDP - approximately 80% of the EU average. The result is that the state has the fewest hospital beds per person in the EU, those citizens who reach the age of 65 have the lowest remaining life expectancy in the EU and 43% of those on waiting lists have been waiting for more than a year.

Three quarters of health funding currently comes from the exchequer - mainly general taxation - while private insurance contributes 9%. We now have the situation whereby taxpayers are spending £130 million annually to subsidise the hospital stays of private patients. The inequality in the system is obvious. While an increase in funding by itself will not end the crisis in healthcare, there is an urgent need for spending on healthcare to be prioritised. Healthcare funding should be brought into line with the EU average of 8% of GDP, with a sustained period of additional funding to help redress years of underfunding and cutbacks in the public health service.

Poverty = ill-health

Speaking at our party Árd Fheis, the Sinn Féin Minister for Health in the Six Counties, Bairbre de Brún, said:

"The causes of ill-health are as marked today as they were at the turn of the twentieth century; poverty, poor housing and other social and environmental factors still determine our health status." In Ireland today, one quarter of children and one fifth of adults live in households existing on less than half the average income.

Part of the solution, in addressing ill-health, is the eradication of poverty, an end to sub-standard housing, improvements in air quality, education, awareness-raising programmes and changes in lifestyle. Sinn Féin supports the development of a comprehensive all-Ireland strategy to eradicate poverty and deprivation in Ireland. This must be properly resourced and carried out within a specified time-frame. Reform of the taxation and social welfare system must all be part of the process to redress health inequalities. We want to see the implementation of policies that actively deal with social, economic and environmental inequalities. We want a fair tax system that will see the wealth in our society shared equally.

The poor relation

After more than four and-a-half years in power, the government has finally launched a long-term health strategy. We offer them our congratulations and ask them a simple question: what have you been doing since June 1997, a period in which record tax revenues were generated, a period that offered an unprecedented opportunity to provide a first-world health service for Ireland in the 21st century?

The launch of a new health strategy, coupled with constant reminders that spending on health has increased by more than 100%, will be cold comfort to people, relying, as they are, on a health service that has yet to recover from the so-called 'Dirty Dozen' cuts of the 1980s.

A health service that remains under-staffed, under resourced and very much a poor relation to the health services of most European states.

An Phoblacht
44 Parnell Sq.
Dublin 1