Try not to get sick...

How Ireland Cares: the case for health care reform.

A. Dale Tussing and Maev-Ann Wren. New Island, Dublin. 2006, pp 434. Price E30

This review was submitted to the Editor of the IMJ (Irish Medical Journal) on 26 March 2007.

This report by two highly qualified observers of our health care system was sponsored by the Irish Council of Trade Unions in preparation for its intended Social Partners negotiations with the Government in the spring of 2006. ICTU represents the IMO, the INO, SIPTU and IMPACT. The two authors were instructed to research the current health care system in Ireland and to make recommendations based on a critical review of current services and about the authors’ views of the system which would best suit Ireland.

How Ireland Cares is just one of several similar reports which have been commissioned and published in this country on health care reform in recent years. The authors underline the many problems which are contributing to the unsatisfactory state of the service and, perhaps most importantly, they include a number of recommendations for reform.

As in similar previous reports, the authors differ with recent Ministers for Health on many issues. These include the iniquity of the current health service, the need for reform of the current consultants’ contract, the privatisation policies and the lack of an orderly and coherent healthcare system. They are highly critical of the intention to build new private hospitals financed by private and institutional investors who will receive generous tax breaks and their criticism in this regard has to be seen against the background of similar views expressed by all the opposition parties in the Dáil and by many other commentators, particularly among health professionals. The minister’s policies will inevitably lead to a shift to an American two-tier system or lack of system of health care, its excessive cost and the gross iniquities which exist in that country; nor do they share a better health record in terms of health and life expectancy.  The authors refer to a fair one-tier system which would be compatible with the systems in the European Union and particularly with our northern brethren and our neighbouring island

Most worrying is the Minister’s decision to allow investors, including doctors, to invest in private hospitals and to benefit financially by their investment. This is surely a serious threat to the integrity of our profession and to the strict standards which are inherent among doctors who have a serious commitment to integrity in dealing with their patients.

The authors support the Hanly recommendations that hospitals should be organised into regional groups with a common board of management for each hospital group. They refer to other compelling needs such as an increase in the number of consultants. In Ireland the number of consultants falls far short of that in other European countries. We need a higher ratio of consultants to resident doctors and we need substantially more Irish medical students to fill places in general practice and in our hospitals.

Another day at the emergency department

This important commentary by two experts with a distinguished research background in health affairs is a sequel to Ms. Wren’s Unhealthy State published in 2003 and to the many other reports and commentaries which have been published in Ireland since the beginning of the new millennium. The intention of the ICTU initiative in commissioning How Ireland Cares was ostensibly to bring pressure on Government as part of the Social Partnership discussions to dispense with the inequities in the Irish care system.

Regrettably the report did not fulfill its objective. The question of the health service was not raised during the negotiations with government. Apart from the financial settlement which was agreed, no mention was made of the inequities in our health service. On contacting the ICTU representative after the negotiations were completed I was informed that the issue would be raised later in the autumn  but I am not aware that ICTU has done anything over and above sponsoring the Tussing/Wren report to influence government and the health authorities about the future of healthcare in Ireland.