Wednesday 26 October 2016

Ten years of failure is more than enough

The A&E crisis became a national emergency a decade ago. Nothing has changed

Published 25/09/2016 | 02:30

Illustration by Tom Halliday
Illustration by Tom Halliday

They've been buggering around with the A&E debacle since Mary Harney announced a "national emergency" in 2006. Ten whole years ago.

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Last week, the public health system began an inquiry into another death in regrettable circumstances.

There's no reason to believe that this latest tragedy will change anything. To too many, it's just another old woman dying on a trolley.

The A&E debacle continues alongside that other long-recognised national emergency, that of the thousands left homeless by a rampant property market - from which many of the well-off are growing richer.

Meanwhile, mainstream politics in Ireland continues to concern itself with such irrelevancies as who will succeed Enda, and just how large will Michael Noonan decide his "fiscal space" is this year.

Mary Harney was powerful enough in 2004 to decide which department she wanted to head. She chose Health, knowing it was difficult - and to her credit she didn't duck out of it when the going got tougher.

The A&E debacle was already a scandal. She seemed convinced her combination of "targets" and market forces would do the job. Those were the fashionable right-wing tools that could solve any problem.

Eighteen months later, in March 2006, things had deteriorated to the point where Harney declared the A&E scandal a "national emergency". It was time for urgent action.

"People who need to be admitted will have beds, not trolleys, and the basics for human dignity. This will be put in place in the coming months," she said. "Anything less than this is not acceptable".

Harney spent five more years as minister for health, wielding her targets-and-markets tools. To no one's surprise, the A&E debacle remained as bad as ever.

In the 2007 general election campaign, his first as FG leader, Enda Kenny promised: "I will end the scandal of patients on trolleys."

On taking office in 2011, he appointed a doctor, James Reilly, to the department. Reilly lasted less than three years and the A&E scandal continued.

In 2014, Kenny appointed another doctor - Leo Varadkar. When Varadkar was moved on less than two years later he was not heard to scream in protest at not being allowed stick with the job.

In July 2015, when he was a year in office, Varadkar visited the A&E at University Hospital Galway. The department was designed to handle 100 patients a day. The staff was struggling now to deal with 250 a day, and Varadkar said the A&E wasn't fit for the job.

Five months later, on December 2, 2015, Enda Kenny told the Dail: "The emergency department at University College Galway is not fit for purpose."

Last week, an inquiry began into the death 11 days ago of an 88-year old woman in that same A&E. She died, according to the Galway City Tribune, of "cardiac-related difficulties" after lying on a trolley for several hours amid the chaos of A&E.

You live a long life, through the uncertainties of majors wars and economic collapse; you work hard, pay your taxes, obey the rules. And the State you've helped to build can't give you the urgent treatment you need. It can't even provide you with a hospital bed on which to peacefully die.

The right-wing parties have for years appointed their top rank talent to the job of minister for health. Harney, Brian Cowen, Micheal Martin, Michael Noonan, Brendan Howlin - all alleged to be the best and the brightest. All have failed.

Currently, Simon Harris, the FG boy wonder, is impressing everyone with his ability to speak several sentences in a row without saying, "eh" or "um". This dynamo has the Health job now, and he, too, wields the same old tools beloved of the right-wing ideologues - targets and market forces.

You might imagine that 10 years was long enough. You might think by now the right would have learned that it's not too bright to keep doing the same thing, expecting a different outcome.

Fianna Fail, Fine Gael and Labour have genuinely given it their best shot.

Some claim that the right-wing ministers for health didn't care, or are at best indifferent to the misery over which they preside. I doubt that. Harney cared, she chose the job. Howlin, Varadkar and Martin cared, Enda Kenny cares.

The problem's not their personalities, it's their politics.

It's possible that when it's my turn to expire on a hospital trolley I'll be murmuring the words of Brendan Howlin, which I've quoted often enough to recite from memory. Having spent almost two years as minister for health, Howlin gave a thoughtful interview to Maev-Ann Wren, for her magisterial book on the health service, Unhealthy State: Anatomy of a Sick Society.

Howlin's politics may be regrettable but he's not a dope. He was reflecting on two years of his life spent working hard, only now seeing in perspective what he'd been doing.

The government, Howlin said, wanted about 30pc of the population to pay for private health insurance. And, he said, "in order for that to happen, they really required the public system to be inferior. Why else, if it was first rate, would people pay for a private system?"

The words of a former minister for health.

To promote and protect the business side of medicine, to attract investors eager for profits, you must ensure the public service isn't given the tools to do the job. You do this because you believe in the efficacy of the free market. You know, because it is part of the right-wing catechism, that a state system of healthcare would be chaotic.

And the right-wing parties, what we might call the Profits Before People parties, have held to this belief through the decades, amid the chaos that persists around them.

Mind you, memories fade, lessons are unlearned. In the years that followed, Howlin seemed comfortable enough performing the getting-the-job-done role of imposing austerity. Again, it was a must-be-done challenge, nose to the grindstone.

In 1936, the Irish Press did a fine job of campaigning journalism, exposing the extent of the slums in Dublin. Twenty years after the 1916 Rising, conditions for the Dublin working class were as bad as, and arguably worse than, they were under the British.

The State responded by building public housing estates; well-made constructions that housed generations.

Public housing continued through the decades, then died away as the market philosophy became more a right-wing religious creed than an economic tool.

Even now, with one national emergency piling on another, the right's religious creed insists there must be a market-based solution to every crisis. So, the State spends millions subsidising the private rental market, and more millions providing families with inadequate shelter in cramped hotel rooms.

Meanwhile, it seeks to "incentivise" the free market to attract investors who will go in search of profits and as a result generate a surge in building. All the while providing the land hoarders, the profiteers and the political strokers with their wasteful cut.

The "national emergency" in A&E has lasted 10 years, there's no reason it won't last another 10, and no reason the homelessness emergency won't last even longer.

The materials exist, there are building workers on the dole. Previous generations knew how you put these things together and build the goddamn homes that people need.

But, the State cannot build the houses; it cannot make the A&E functional. If the State ensured these things worked, why would people provide the housing and health investors with profits?

Sunday Independent

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