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New Government’s Health Policy: Same Ol’, Same Ol’?

By Jim O'Sullivan

Eighteen months of evasion, dithering and bizarre explanations for
decisions taken have seriously dinted the Minister’s “caring” image.



Before the last election most believed that in the prospective Health Minister James Reilly we might at last get a person to head up a caring service who actually cared.

A big cuddly brother figure whose first desire each morning is to give a comforting hug to any fellow citizen with so much as a headache.

A crusader who would cut a swath through red tape, ineptitude and ideologically created reticence to ensure that all those who ailed would be swept up into an egalitarian Nirvana to be treated efficiently, competently and equally.

The profit seekers, like the temple money lenders, would be banished, packed off into anonymity with their benefactor, the Hammer of the North West, Harney. We would have a health service with a single question constantly reverberating within it; how best to treat the sick? But alas, things are beginning to take on an all too familiar look.  

Worrying cracks appeared last year. First, commitments freely entered into turned out to be balls of smoke---nothing more than election ploys. Then rumours started which focused on the wealth accumulation appetite of the new Minister---wealth which most certainly was not garnered wiping the troubled brows of suffering old ladies in the small hours. Our Minister, it appeared, had a deep desire for the good things in life and the fear arose that he would, like his predecessor; walk over a suffering old lady if she was lying on the pavement to get his mitts on even more dough. We sucked in hard, held our breath, and hoped for the best---we are after all the children of a long suffering people, hoping for the best is our comfort blanket of choice.

But a fear that the Minister was not an enthusiast when it came to taxation raised serious questions about his commitment to public services---a fear that has been exacerbated recently by news that he has two advisors being paid through a British based company so as to avoid paying tax here. After all, a prerequisite for providing a first rate health service for all is adequate funding from tax take. Is it possible that a person can be committed to the one and not the other?

And answers to simple questions were so bizarre that they delivered what surely is the coup de grâce to our hopes that we had at last a champion of fair play readying plans to deliver the health service that we all want and need---equal access and equal treatment.

In the Seanad a Marc MacSharry proposal to extend to Irish cancer patients access to all medications approved by the European Medicines Agency (EMA) was rubbished by Minister Reilly via a statement read into the record by Labour Junior Minister Kathleen Lynch. It was claimed that the EMA was incapable of approving medicines in “the best interests of patients” Had this well respected European body lower standards than applied here? It was a very odd statement---and particularly as the MacSharry initiative had the full backing of expert in this field John Crown. MacSharry ripped up the statement---frustration with what he thought was political game playing combined with the powerlessness of opposition get the better of his emotions---a slip from grace that is easily forgiven in the circumstances. The rest of us sucked in again.

 Fast on the heels of this episode came another statement that sucking in deeply would not suffice to block out what was fast materialising into unavoidable reality---the new Minister was not a bearded Mother Teresa after all and patient care might not be his burning motivator. Another North West Senator Brian Domhnaill sought an explanation as to why a bus that was being subsidised to the paltry tune of €100,000 a year to carry patients from Donegal to Dublin to access treatment had been scuppered. The opening sentence of the reply, read by Brian Hayes, (a most irritating blatherer), is worth repeating verbatim;

“I wish to make it clear on behalf of the Minister for Health that the HSE has no statutory responsibility to provide transport or support for patients to attend its facilities or clinics.”

The reply immediately conjures up images of a medical team, suited and booted, looking out the window of a pristine treatment facility with a sign over the door, “We will treat you---if you can get to us”. Kind of like what you might see outside a private facility, “We will treat you---if you can afford us”--- a case of one barrier to access being replaced by another.

But is it really credible that a Minister for Health might consider it unnecessary to ensure that transport to access treatment is made available to any patient that might have difficulty organising their own---for whatever reason?

Thankfully the Act that gave birth to the HSE is very specific on what its “statutory responsibilities” are, and that is to treat those in need of treatment. It would surely be bizarre beyond belief if a patient who had not the wherewithal to get from their home to the place of treatment was just left to suffer while the Minister pleaded he had no “statutory responsibility” to intervene.

The 2004 Health Act states;

 “7.—(1) The object of the Executive is to use the resources available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.”

 And if that is not clear enough here is what the Health Department’s own Mission Statement states;

“To improve the health and well-being of people in Ireland in a manner that promotes better health for everyone, fair access, responsive and appropriate care delivery, and high performance”.

So there can be little doubt that the “statutory responsibility” of the Minister and his department is to “...improve, promote and protect the health and welfare of the public” and provide “fair access, responsive and appropriate care delivery.” That cannot be fulfilled if he fails to ensure that those in need of treatment can actually reach the place where that is to be administered. The Bart Simpsonesque replies, while baffling, would indicate that the Minister is not that terribly concerned should a patient not have the means to reach a treatment facility---but as a medical man he must be aware of the various studies and viewpoints that regard transport as an integral part of the treatment process.

One such report, “Transportation Barriers and Health Access” (Morgan Shook, Professors Jennifer Dill and Ethan Seltzer) found that “transportation is inextricably linked with how patients access health services and these percentages suggest that transportation problems affect a large proportion of patients” The report goes on, “The findings clearly document the need for assistance for patients obtaining needed health care services, especially in the classes of patients that are more apt to encounter persistent problems with transportation”    

Nearer to home, Prof Niall O’Higgins, author of a major report on cancer services, has also stated that transport was a crucial part of healthcare delivery and this was overwhelmingly the case where services were “centralised."

 Prof O’Higgins stated that, “You cannot just pretend that transport and infrastructure is no longer a concern” and went on to state that “a transport system built into the strategy” is the ideal.

But then again there is hardly any need to bring this stuff to the attention of the  Minister because he knows full well that ensuring patients can access treatment is crucial and in many cases one without the other is useless. In 2010 while attacking Mary Harney on the issue of transport provided for patients to access treatment he stated in the Dail, "Clearly there is a need to provide transport for patients...”  By the way, Harney never evoked the “no statutory responsibility” excuse.

When all of this is added to the recent news that the same Mary Harney is gathering up Board positions with companies in the healthcare business like a squirrel preparing for an ice age, we can assume that profit making is not going to be exorcised from healthcare anytime soon.

So the old advice remains the same as it has been for a few years now---if you can at all avoid it, don’t get sick---and certainly not on this guy’s watch.