Less Can Be More

November 27, 2009

I attended the sixth and final debate of the Pfizer Health Debates Series in association with the Irish Times. The series, which included six debates across Ireland in 2009, offered attendees an opportunity to hear important health issues being discussed in an open forum by leading commentators.The debates also provided an opportunity for audience engagement and open discussion.

The motion for the final debate was “This house believes that reduced health spending should not lead to poorer healthcare“. It transpired that the wording of the motion was somewhat misleading as both sides seemed to be in agreement that it isn’t about spending more money; it isn’t about cutbacks; it’s about spending more wisely. The motion was carried by a large majority.

These public debates have provided an opportunity for those attending to articulate perspectives and concerns through a question and answer session following each debate. They have been successful in raising awareness of the many wrongs in the Irish health system while also acknowledging the many good parts. At a time when the health service is facing cutbacks of over €1 billion, the positive message to take away from this debate is that money is not the sole factor in health. Better organisation will lead to better outcomes. Increased spending on healthcare does not necessarily lead to better results. Less can be more.


Health Access

March 26, 2009

Do you agree that all patients should be entitled to equal access to healthcare whatever their lifestyle choices? This was the motion put forward for last night’s Health Debate, the first of six debates to be held across Ireland in the 2009 Pfizer Health Debates series in association with The Irish Times. These debates on healthcare are open to the general public, free of charge, through advance registration and provide a forum for those attending to articulate perspectives and concerns. I couldn’t resist the temptation.

Last night’s debate was chaired by Irish Times columnist, Fintan O’Toole. Well-known economist, Jim Power argued against the motion along with Prof Charles Normand, professor of health policy and management at Trinity College, Dublin. They went head to head with Labour’s health spokeswoman, Jan O’Sullivan and Dr Donal O’Shea, consultant endocrinologist who spoke in favour of the motion. Before the debate commenced, the chairman asked the audience for a show of hands on the motion. Interestingly, there was fairly equal distribution of those ‘in favour’, those ‘against’ and the ‘don’t knows’.

Did you know that obesity accounts for 40% of all cancers? Add smoking to the equation and it becomes a 70% causal factor. Last night’s debate raised many philosophical as well as practical arguments. Should people who adopt risky lifestyle behaviours like smoking or abusing alcohol, be given the same access to healthcare as people who adopt healthy lifestyles? Is equity of healthcare, a fundamental right for everyone? Should people be judged by their lifestyle choices? How do we define which patients are worthy of treatment? Should our limited resources be put into educating people to change their behaviour? Who decides on these huge moral issues?

diet-shakeThe debate was opened to questions from the floor giving the audience an opportunity for engagement before the final show of hands was taken. The motion was overwhelmingly carried in favour of equal access to healthcare for all patients regardless of lifestyle choice.

I voted against the motion and for good reason. I happen to believe that hard decisions need to be taken to stop the drain put on hospital resources through risky lifestyle behaviours. Look at the problems in A&E with the drunks and drug addicts. Are you happy that they get the same priority of treatment as the genuinely sick and the elderly? Instead of waiting to treat the problems caused by unhealthy lifestyle choices, healthcare resources could be allocated to educating people to take responsibility for their lives. I also believe that people with serious illness are being denying optimum treatment by our failure to prioritise treatment on the basis of genuine need. The poor survival rate in this country for cystic fibrosis sufferers, is the direct result of a system that refuses to make decisions. The cervical screening programme is another example of the failure to prioritise. It was rolled out last year, 21 years after the government first agreed on the need for such a programme. It’s time people woke-up to the fact that patient’s lives are being lost through lack of government leadership. Our health service is rudderless and it remains to be seen if Captain Harney and her First Mate Drumm, will stay with the sinking ship.

The next debate in the series takes place in Cork in UCC, on 29/04/09 and will discuss the hot topic of co-located hospitals. This issue has already generated much discussion nationally so it should be a lively debate.


The Road to Recovery?

May 31, 2008

This evening a debate is due to take place in Seanad Éireann to discuss the future of the HSE. Last week, the Labour Party announced a set of proposals to reform the HSE. It has now put forward a motion to the Seanad seeking it’s support in facilitating reform of how healthcare is delivered in Ireland.

Senator Alex White leader of the Labour group in the Seanad writes “The motion is not a personal attack on the Minister, the Government or anyone else, nor is it a retreading of old arguments; it is comprised of a positive set of proposals regarding how the HSE can be reformed.”

The wording of the motion and the Labour Party’s six step recovery plan can be found here.

You can learn more about the Labour’s plans for reforming the HSE by clicking here.

Having listened to RTE’s recent Prime Time investigation into the HSE where our health service was described as a poorly integrated, fragmented, poorly structured, inadequately resourced, appallingly planned service, I think the HSE would do well to take heed of some positive suggestions.

I welcome any debate which facilitates the best way forward for our health service. Otherwise the road ahead looks depressingly bleak.


Be Angry

April 9, 2008

When I first saw the list of speakers lined-up to participate in the Health Debate, I couldn’t believe my luck. This was a prime opportunity to hear our Minister for Health endeavour to defend her tactics to privatise healthcare in this country at the cost of the public health service. As it turned out, she left in a bit of a hurry but I did, at least succeed in getting to have my say.

I arrived early in the front square of Trinity College Dublin (TCD) just as the State car drew up at the entrance to the Exam Hall. Mary Harney stepped out of the car wearing what can only be described as, velour pyjamas and with her entourage in tow, she proceeded up the length of the exam hall with me in hot pursuit. Her pyjamas proved to be an excellent decoy as nobody took a blind bit of notice of her and she was quickly escorted to a side room to await the arrival of the real stars of the night. The debate was ably chaired by Conor Gannon of TCD VdeP Society, who did a fine job introducing each of the speakers and keeping order throughout the debate. The motion put forward was: “This House believes that the Irish Health System Fails the Disadvantaged”. I’m delighted to be able to report the motion received unanimous support from the audience and Mary Harney and her band of loyal followers suffered a resounding defeat. Unfortunately, she didn’t stick around for long enough to hear the disquiet that flowed from those on the panel in support of the motion, and from the audience. She made a hasty retreat shortly after delivering her own contribution to the debate. We were told that she had been “called away by Cabinet business”. Yeah, right!

The debate was opened by Prof. Orla Hardiman who gave an impassioned speech about the faults within the health service. She urged the audience to “be angry, be very angry”. She is firmly in favour of an equitable healthcare system for all and her address received rapturous support. Mary Harney then got to her feet and declared that it is her intention to provide a health service based on medical need (as opposed to ability to pay) and insisted that huge progress has been made. We got reams of statistics about how the health service is helping us to live longer but in reality, it was a lacklustre performance. She was constantly interrupted by a heckler in the audience who persisted in shouting her down despite repeated requests to desist. While this heckler was clearly out of order, his intervention proved to be the only challenge to Mary Harney last night as she departed before any one else got the opportunity. Fergus O’Ferrall, speaking in favour of the motion, informed us that 90% of the €16 billion spent annually on the health service comes directly from our taxes. The other 10% of funding comes from the private health insurance market. He accused the HSE of mismanagement through under-provision and rationing of services. The next speaker, Dr. Sean Barrett who opposed the motion, almost won approval when he declared that this health service not only fails the disadvantaged, “it fails everyone”. However, he then proceeded to place the blame on productivity being too low, the fact that private medicine is practised in public hospitals, the high ratio of staff to number of beds, and a greedy medical profession. He made no mention of the Dept of Health or the HSE. Mary Harney scuttled out of the room at this point while she still had someone on side. Throughout the evening, those in support of the motion gave credit to the late Susie Long for using her own plight to highlight the failures within the service. The opposition put forward two further speakers, an ex-TCD student and member of the young Progressive Democrat party (Mary Harney is a PD ) and also a manager from the HSE who were both, it has to be said, less than convincing. We also heard from two further speakers in support of the motion. Audrey Deane, representing the St.Vincent de Paul Society, told the room that HSE managers are turning to the SVdeP to access help for those failed by the system. How bizarre is that? The final speaker in support of the motion was Prof John Crown who denounced the waiting lists caused by underfunding in the health service. He joked that if we had such a thing as an abortion clinic in this country, he was sure the waiting list would be 10 months. “That’s if you go privately, going publicly would take longer!” EU figures for waiting times, show Ireland coming 2nd last on the list. He accused the HSE of employing too many spin doctors, referring to the place as ‘Burassic Park’. John Crown wants to see the Bismarck model of healthcare implemented (a one tier, not-for-profit health service) or else he warned “we’re heading for a ‘Paris Hilton’ style of health care”.

The debate was then opened to the floor and speaker after speaker outlined their experience of the deficiencies within the service. I waited until the end of the night before taking to the floor and then, I let rip. I surprised myself by the depth of passion which flowed as I spoke about the chaos in the public health service, the squalor of the conditions endured by sick people and the scourge of MRSA in our hospitals. I outlined the madness of the recent HSE cutbacks, the continuing problems in A&E despite claims to the contrary and warned of the consequences to follow if Mary Harney’s continues to privatise healthcare in this country. I also spoke out in defence of those who have private health insurance. We tend to be blamed for contributing to the a 2-tier health system when in fact we feel forced to seek insurance as we know we cannot rely on the health service in times of need. I concluded by commending the hard work of those healthcare workers who strive to provide excellent care in difficult conditions and reminded the audience that we need to protect the good aspects of our health service from further government interference.

Following the resignation of our Taoiseach, Bertie Ahern, last week Mary Harney announced that she had no intention of running away from her post as Minister for Health. In response, I’d like to say to Mary “be afraid, be very afraid. Time and patience is fast running out.

UPDATE: I forgot to thank Grannymar for her support in helping me to highlight this debate. The chairman of the debate was delighted to have a full house for this annual event and was impressed to hear that the blogging community had given support.


You wanted more

April 5, 2008

Here is another opportunity to join the Health Debate.

Motion:This House Believes That The

Irish Health System Fails The Disadvantaged”

Tuesday 8th April 2008, Exam Hall, TCD @ 6pm

Speakers include:

Mary Harney (Minister for Health & Children)

Dr Sean Barrett (Lecturer in Economics, TCD)

Frank Mills (HSE)

Prof John Crown (Consultant Medical Oncologist, St Vincent’s Hospital)

Audrey Deane ( St Vincent de Paul Society)

Fergus O’Farrall (Adelaide Society)

Prof Orla Hardiman (Consultant Neurologist, Beaumont Hospital)

It’s a fantastic line-up of speakers. I intend to be there too!


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