Irish healthcare




Irish healthcare

The last week has been a difficult one for the Government. There have been no winners since the Supreme Court decision on rape, only victims.  While the debate goes on, talks have been ongoing on seeking a solution to other concerns - Social Partnership.     
Social Partnership is one of the success stories. For the social partners to sit around a table and thrash out a deal is a common sense approach to ensuring stability in all strata of life in the human spectrum. Apart from the wildcat actions of a few stray egos, Social Partnership has been a resounding success. It did not prevent legitimate claims being presented and, occasionally, picket-speak. Under Social Partnership the partners burned the midnight oil to ensure some form of stability for the next few years. All participants benefit from the end result and all participants should be equally proud of the roles they played.

‘How Ireland cares’
One of the unexpected by-products of these talks is a new book by A Dale Tussing and Maev-Ann Wren called ‘How Ireland Cares – The Case For Health Care Reform’. The limitations of this column will never do the book justice. Suffice to say that for everyone who works in healthcare and all who have any interest in the sector, this book is a must-read. Both authors have published previously on health issues. They were commissioned to write the book by the Irish Congress of Trade Unions, as an aid for the Social Partnership negotiations, which were scheduled to start in November 2005. Social Partnership has always been about more than mere tax reduction and take-home pay. Issues in the book formed part of the arsenal of discussions this time around. Social Partnership was and is always concerned with the bigger picture of life and how we live it. The book examines healthcare in all its facets, from the health of the nation to financing the health system, the A&E crisis, private hospitals and an agenda for reform. It is as thorough as it is exciting. It is full of facts and statistics and augmented with most interesting appendices. It examines the cost to the Exchequer of tax incentives for private hospitals. It proves that the rich get richer and the poor get an even worse service. It explodes the myth of private hospitals as a value for money exercise for the state. Investors get the cream. Using an example of a €100 million construction cost for a private hospital that qualifies for tax relief, the authors show that the Government could borrow money more cheaply on the money markets than by granting tax relief to an investor who pays 42% tax and has substantial rental earnings. Such relief would cost the Government almost €40 million. The writers present a table that shows the Government would be better off investing directly in the project. When the tax breaks are finished the owners can sell the hospital property, as apartments or whatever!
And the Government is seeking private (for profit) hospitals to set up on public hospital campuses. This is similar to the West Link Toll Road fiasco. The way the Government is managing major projects makes it even more imperative that all projects are ‘value-proofed’ before contracts are signed. There is no point in engaging in ‘I told you so’ exercises through the Dáil Public Accounts Committee because that only examines issues once the cheque has been signed. It is preventative measures that are needed not doctorates in hindsight.

Medical cards
There has been a great rí rá agus ruaille buaille over medical cards. Many column inches have been devoted alongside broadcast minutes to the great medical card give-away – something akin to ‘one for everyone in the audience’! This book brings us back to reality and lays bare the ‘advertising signs that con you into thinking you are the one…’.  It has the figures and the statistics. In 1996 medical cards (means tested) were issued to 1,252,384 people out of a population of 3,626,100. This equals 34.5%. In 2005, 1,150,551 people had cards out of a population of 4,130,700 – that is 27.9%. The 2005 figure included those who were means tested (1,037,712 – 25.1% of the population) and those who qualified because they were over 70 (112,839 – 2.7% of the population).              
In order to reach 1996 figures on a pro-rata basis in 2005, medical cards would need to be issued to another 387,380 people. With all the fuss, hassle, embarrassment and shame some people are forced to endure when applying for medical cards, one would think that the Department of Health, through the long arm of the Health Service Executive, would be better placed to employ a team of people to go around knocking on doors in an effort to sign people up on medical cards. The Health Squad!  

The health strategy 2001
Too often we are all accused of being cynical when it comes to Government promises. One has only to examine the spending promised in the National Development Plan for the BMW Region to understand that so-called cynicism is in fact reality. The underspend in the region for the duration of the plan is €3.6 billion. The figure is even too large to comprehend. It sounds better to say the underspend is €10 million a day for every day of the year. It looks better in figure form - €10,000,000.
Another reason, rather than an excuse, for being cynical (or realistic) is an examination of the Health Strategy of 2001. Promoted with the greatest of fanfare for the common man (and woman) it was announced that a ten-year plan would be introduced to solve the healthcare crisis. 
Suffice to say that the plan is like the proverbial ashtray on a Honda – brilliant but useless. It was a useless strategy for one simple reason – the Government never implemented it. Along with the ‘value proofing’ required before any finance is committed to a major project, there is also a need for a bulls**t detector before any major strategy is let loose upon the general public.

This great book, ‘How Ireland Cares’, offers more than a critique of the health system, it also offers recommendations from the authors, one of which is the abandoning of plans by government to ‘permit and encourage private hospitals to be constructed on the grounds of private hospitals’. The two-tier consultant system (public and private patients) could be avoided by the adoption of a ‘part salary and part fee per item of service’.
All this and there are so many issues still untouched in this column – Irish health spending has remained below the EU per capita average in 2004 and 2005; mental health resources are over-stretched and best developed in areas of greatest affluence, rather than areas of greatest need; Irish adult life expectancy is among the lowest in Europe; Ireland’s incidence of breast cancer is among the lowest in Europe, yet the death rate in 2001 from breast cancer was the highest in Europe (15 countries).  And I have not mentioned A&E!
Book details: ‘How Ireland Cares’ by A Dale Tussing and Maev-Ann Wren.  Published by New Island, available nationwide, €29.95.