A STATE OF EMERGENCY

General consensus on our health service is that it is a system in crisis and spiralling out of control. Author Marie O’Connor exposes the sordid reality behind a hospital service that she says favours professional self–interest over patient care. Niamh MacSweeney reports.

Billions are poured into the health system every year, yet people wait for medical attention on trolleys in A&E. Some develop serious complications while waiting; others die. So why is the system failing people in such inhumane ways and what if anything can be done to change a service that is being driven by vested self-interests?

These are just some of the questions Marie O’Connor investigates in her compelling and damming book, Emergency: Irish Hospitals in Chaos. An author and journalist working in health for many years, O’Connor is a longstanding health activist, who felt compelled to reveal the real truth behind the system.

Centralisation And Privatisation

In this complex and multi-layered book, O’Connor analyses the twin pillars of Government ‘reform’, centralisation and privatisation, arguing that the closure of smaller hospitals will lead to needless deaths. She also maintains that it is vested interests that are driving our hospitals, reducing significantly the ability to provide proper care, because the private is bleeding the public, with doctors paid twice as much to treat the same patients.

O’Connor begins by examining areas that she considers particularly dysfunctional, such as cancelled operations of which there are approximately 22,000 at the end of each year, long waiting times to see a specialist and hospital acquired infections.

In a chapter entitled the ‘Killing Wards’ O’Connor highlights the huge problem that hospitals have with MRSA and she argues that we are not giving enough resources to combat infections which are very serious and potentially lethal.

We spend €40 billion a year on the health services, which may seem like an ample amount to ensure the smooth running of the system, however O’Connor argues that while it may appear that we are spending a huge amount, the fact is that even that level of funding is not enough to remedy the historic levels of under funding. “We striped out 29% of beds when Rory O’Halloran was Minister of Health and the system has never recovered from that so we limp along from year to year with a system that is far more inequitable now than it should be,” O’Connor explains. This drop in equity she says makes the services less fair than it used to be and that “people are being served death sentences because they don’t have the money for private healthcare.”

Private v Public

O’Connor believes that the only conclusion you can draw from the situation is that the system is driven largely by the needs of the profession and not by the needs of patients, which she says is clearly visible when you consider the governments constant drive towards centralising the service.

She also reiterates that massive growth in bureaucracy is choking the system and the decision to nationalise the administration will in the end turn out to be an expensive mistake. “If you take one period from 1980 to 1993 the numbers employed in administration rose by 32% while the numbers of medical staff actually fell. Now it’s far worse again. It’s well known that jobs were replicated when the Health Service Executive (HSE) was created but the services haven’t got any better,” she says.

Accountability and transparency is the cornerstone of any service, but O’Connor is adamant that if the service is to be held to account patients should have the right to complain to an external agency. “If you read the 2004 Health Act you will see that we now have a health act that protects hospitals and medics up to the hilt. Patients have no right to question or query or complain about any aspect of their treatment and the only avenue open to them under the health act is the Medical Council and they don’t have a terrific track record when it comes to investigating patient complaints.”

Rising Premiums

O’Connor suggests that we are moving towards a US style health care system with the government adopting a policy that looks to the private sector to “shore up the craters in the public system.” She warns that even for those of us who can afford private healthcare, premiums are set to rise and we will see an explosion in private for profit healthcare. “At the moment premiums are relatively affordable but if you take the US system you see that the average private health insurance cover for a family of four is the same as the family mortgage so there you have 46 million Americans walking around without health insurance because medical insurance is galloping due to the system they have created and we can see that happening here,” the author says.

Resolving The Conflict

According to O’Connor the problems in the health service may never be resolved, but she does suggest that the system could recover over time if more resources were available and if the money was spent wisely. “We have got to put more resources into the system. If we want to sort out MRSA seriously we have got to have isolation rooms because its simply not enough to go on about hand washing,” comments O’Connor. She points to money being squandered and says the employment of massive numbers of external consultants at enormous expense is an obvious place to start cutting back on.

Allocating Funding

O’Connor attributes ideology as the main reason why insufficient funds are being allocated to the service. “There is a commitment to private for profit healthcare and positive discrimination and a reluctance to fund the public system,” she says. Essentially O’Connor agrees that we need more beds liberated back in the public system, and we need to democrasise the services and de-layer the bureaucracy within the system. “I think we should go back to the regional administration of the health services and I’m in favour of the 50/50 non-professional split on the various medical boards so that people are appointed in a more democratic manner. I also see a huge need for patients to be able to query their treatment by going to an independent agency. We need a health ombudsman but obviously we need to reform those sections of the 2004 Health Act that
make it impossible for people to query their care. Finally I think we need to reverse the policies of centralisation and privatisation that are being pursued at the moment,” O’Connor concludes.

ABOUT THE AUTHOR