A tale of two health systems

Revelations about the goings-on at Tallaght Hospital have once again laid bare the reality of Ireland’s two-tier health system, where lower earning members of the working class must take their chances in an underfunded, demoralised public system, while those with private insurance are fast-tracked, Francis Donohue reports.

It will be early May till the backlog of 58,000 x-rays that lay unchecked by a qualified radiologist, as well as thousands of GP referral letters lying unopened at Tallaght hospital, have been gone through. The failure to check these x-rays and letters in a timely fashion may already have cost one life.

The health authorities, headed by a jet-setting Minister Mary Harney, refuse to disclose how many of the X-rays and letters concern public patients and how many were private. This information remains undisclosed because more than likely the vast majority, if not all of them, were public.

Once again, as with cancer treatment scandals to failures in child care, we are faced with overwhelming evidence of a two tier health system where the only reliable way of being treated is by having private insurance.

Although these health debacles cost lives the sad fact is these scandals are not the result of problems in the department of health’s or HSE plans but merely the largely unavoidable working out of a strategy of dividing care between public and private.

The only logical explanations for the policies pursued by Harney, in her six years dismantling an already dysfunctional heath service from within, are a slavish adherence to the promotion of the interests of the private health care providers.

From the onset in 2004, even in a country supposedly awash with money, Harney refused to provide much needed new hospital beds. Instead she set about handing over state lands to private health consortiums, made up of our native developer elite backed by US health multinationals, to build so-called “co-located” fully private hospitals.

Profit rather than care would drive the health system according to the perverted logic of the PD/Fianna Fail government, that these co-located hospitals never materialised, and bed shortages continue, matters not.

Competition’ was the buzz word used to excuse our sick and elderly waiting days on trolleys in dilapidated hospitals. Rather than implement the type of health policies tried and tested across Europe Harney made it her business to jet around the world seeking to whip up business for private health multinationals.  Her former IBEC and FAS boss husband Brain Geoghegan more often than not in tow.

No doubt these for-profit medical businesses were assured of a steady flow of people escaping an undermined public health system. Those suffering for Harney’s failed ideological experiment were not her family and neighbours but the common people of Ireland – not her sort of people.

It was only possible for Harney to implement her plans because of clearly existing class divisions within what passes for our republic’s health system.

Irish hospitals consultants on average ‘earn’ nearly three times the wage of similarly qualified professionals operating within the British National Health Service. In 2008 a new public consultant’s contract was negotiated with the Irish Medical Organisation which guarantees a minimum wage of approximately €220,000 paid by the state.

This is only for public work and allows consultants to continue to spend around a third of their time earning more money through private consultancy. It is simply not sustainable that hospital consultants in the south are paid a minimum of €220,000 a year while across the border the same person would earn £75,000 (€82,600).

But these huge sums from the public purse are not enough for the southern consultant class. The most recent figures from the HSE indicate that the vast majority take more time with their private patients than their €220,000 contract allows. The result of breaking their legal pledge to the public health care system, at most a warning letter.

Unlike other countries which have developed a functioning free education system Irish doctors have continued to be in the main drawn from the narrow ranks of the middle class, many looking upon the treatment of others not as a vocation but a family business to support lifestyles well in excess of similar professionals in other European countries.

This professional class have zealously defended their earning power both now and in the past, such as when in alliance with the Catholic Church they defeated an attempt by Clann na Poblachta Health Minister Dr Noel Browne to introduce universal care for new born children and mothers in the 1950s.

Few break ranks amongst the medical elite but one, Dr Ciara Kelly writing about the Tallaght Hospital scandal recently wrote; “outside normal office hours our hospitals are staffed mostly by junior doctors in training — often poorly supervised and lacking in experience. There is a tacit availability of consultants, who can be called into work at night in emergency cases, but they are not on hand to routinely review patient care. The main reason they’re not there is an issue of cost. In our health service, it costs approximately €1 million to pay the annual salaries of four hospital consultants. With respect to the generally excellent job they do, that’s not great value. In the UK for example €1 million will pay for the services of approximately 12 hospital consultants.”

In other areas of health provision class divisions are also clear. In the last decade twenty children have died in the care of the HSE. It has emerged that reports into their deaths were to be allowed lie gathering dust rather than be made public. Would this be the case if these children from families based in Foxrock or Montenotte?

The number of children that were meant to be in the care of the HSE from ethnic minority backgrounds now missing is measured in the scores. It is time these issues were tackled — this process must start with an independent inquiry into the Tallaght Hospital debacle.

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