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Caoimhghin O‘Caolain’s Response.
The text of Deputy Caoimhghín Ó Caoláin's contribution to the conference follows:
I commend the Adelaide Hospital Society and the Department of Public Health and Primary
Care, TCD for their initiative in organising this conference.
The key phrase in the
title of this Conference and in its Objectives is ‘Universal Healthcare’. The achievement
of Universal Healthcare in Ireland should be our common purpose. Of course the current
Government and some others would argue that a Universal Healthcare system already
exists here. In doing so they are, in our view, defending an indefensible system.
We know too well that the essential features of the healthcare system in this State
remain as they were before the advent of the so-called Celtic Tiger. This is not
to in any way belittle the major advances in medical science, the improvements in
the delivery of care on many fronts or, above all, the dedication of people working
in the health services. Nor is it to under-estimate the huge sums of public money
spent on the health system.
But the reality remains that the system in this State
continues to fail people because it is a grossly inequitable two-tier, public-private
system. The standard of care is generally high but access to care is not based on
need alone. Ability to pay is still a key determining factor in access to care both
in terms of timely access and, in many cases, quality of care.
In June 2007 one of
our hosts - the Adelaide Hospital Society – together with the Jesuit Centre for Faith
and Justice - joined forces to warn against the trend in healthcare policy that private
hospital co-location represented. They said it “sends out a powerful message about
Government backing and support for the existing two-tier hospital system” and that
it “represents a significant threat to the fundamental values of care and justice,
which require that health provision is seen first and foremost as an essential service,
which should be available on the basis of need”.
Much of the co-location scheme now
seems to have run into the sand - at what cost in terms of waste of money and effort
we do not yet know. But this we do know. A Government which sponsors such a scheme
can never be relied upon to deal with the underlying inequalities which contribute
significantly to ill-health in our society. In this country the smaller your income
and the greater the social and economic disadvantages you suffer the more likely
you are to die from cancer. The Public Health Alliance of Ireland points out that
death rates for cancers are 100% higher among the lowest paid and most disadvantaged
of our people.
I will come to our different perspectives on the issue of healthcare
funding in a moment, but I think it is important firstly to acknowledge that Sinn
Féin and the Adelaide Hospital Society share the same objective in terms of universal
access based on need alone. And we recognise that there has to be root and branch
reform and that reform must be based on values. As the Society states: “Clarity about
the values which determine health policy and which influence the implementation of
health policy is crucial.” Values identified by the Society are justice, caring and
patient and public participation in healthcare. We certainly endorse those values.
Such values definitely influence the work of people throughout our health services
but they do not determine and influence policy as decided at Government and HSE level.
That policy is influenced by political expediency, short-termism, playing to privileged
vested interests, a privatisation mentality, bureaucracy, careerism, a drive to centralisation
and book-keeping. The result is an unholy mess both in terms of policy and delivery.
The 2001 Government Health Strategy Quality and Fairness: A Health System for You
was deeply flawed, but at least it had some coherence; it is now in tatters.
A perfect
example of the valueless direction of the Government in health policy and delivery
is the decision to undermine the General Medical Services Scheme by introducing prescription
charges for medical card holders. I take this opportunity to call on the Minister
for Health & Children not to proceed with the legislation to introduce such charges,
which will hit the most vulnerable in our society.
Such a measure, along with the
other cutbacks we have seen, serve only to deepen health inequalities and health
inequalities kill. The late Susie Long, a cancer patient, was brave enough to highlight
her own case nationally, not for personal redress but to expose the injustice of
the system. As a public patient she had to wait seven months for vital cancer tests.
As a private patient she would have got those tests in time – possibly in time to
save her life. Before she died she summed up the position simply and clearly when
she said:
“I believe that people should be seen on the basis of how ill they are,
of their symptoms, not on how much money they have.”
We need a universal healthcare
system based on that fundamental principle of justice and equality as outlined by
Susie Long.
Achieving such a system in Ireland is one of the key objectives of Sinn
Féin and our vision is set out in our policy document Healthcare in an Ireland of
Equals. Our core policy proposals on Healthcare are:
• A new universal public health
system for Ireland that provides care to all free at the point of delivery, on the
basis of need alone, and funded from general, fair and progressive taxation.
• Fundamental
re-orientation of the health system to adopt a central focus on prevention, health
promotion and primary care (including mental health care), and on ultimately eliminating
the underlying social and structural causes of ill-health and premature death, such
as poverty and inequality.
• Immediate establishment of a Health Funding Commission
to report within a reasonable timeframe on the projected costs of the transition
to an all-Ireland system of universal provision, taking into account all
spending
on health services under the current systems, including state funding and spending
on private insurance, and to make recommendations on how the state can best harness
these resources in the interests of more equitable and efficient delivery.
We seek
to reverse the privatisation of the health services and phase out the role of the
private for-profit sector in the provision of essential care. We see a new system
on the island as a whole being under the aegis of an All-Ireland Strategic Health
Executive with overall responsibility for ensuring national level co-ordination of
the delivery of public health services.
You can see right away that Sinn Féin favours
a public healthcare system funded from general taxation. This would clearly be a
very different means of funding and management from the current two-tier public-private
system and from the health insurance model favoured in the Adelaide Hospital Society
Policy Paper Universal Health Insurance: The
Way Forward for Irish Healthcare.
The
key questions are: ‘Which system would have the fairest and most effective outcome?’
and ‘Which system would be most sustainable?’
The challenge has been made infinitely
more difficult by the economic recession. The tragedy is that fundamental reform
and the transition to a truly equitable system were not undertaken when Government
revenue was reaching record levels year after year. By the same token equity and
efficiency are more vital now than ever.
We believe that there is no more important
area of State spending than healthcare. We believe we should aim for the best and
most accessible and equitable healthcare and that that requires ring-fenced funding
from general taxation and provision by a fully public system. Policy in such a system
would be democratically accountable at national level and based on a network of community
health partnerships at local level.
We would establish a Health Funding Commission
to help plan the transition to such a system. Its first task would be to provide
a full account of all spending on healthcare in this State, both public and private.
In our party’s 2010 Pre-Budget Submission The Road to Recovery we identified just
some of the savings that could be made in our public health system by reversing privatisation.
Ending the co-location scheme would save €400 million over seven years; phasing out
all subsidies of private practice in public hospitals would save €100 million; introducing
measures to reduce the cost of medicines, including the establishment of of state
wholesale distribution of drugs and use of generics would save €200 million; a cap
of €150,000 on salaries of hospital consultants would save €210 million. These are
just some of the hugely wasteful costs associated with a two-tier system.
Of course
a fully public system would have to be delivered in the context of fundamental tax
reform that would ensure that the wealthy pay their fair share. And the development
of a renewed public health system would also go hand in hand with a programme of
economic recovery, involving a real strategy to retain and create jobs.
We would
have a number of concerns about a funding system based on health insurance. The example
of The Netherlands is often cited and on the surface it is attractive. However serious
issues have been raised about the role of the insurance companies. In such a system
the danger is that the interests of insurance companies and their share-holders may
become a more important consideration than public health policy. An insurance-based
system here, while genuinely proposed as a solution based on sound values, could
be seized on for the purposes of profit with the public interest taking second place
yet again. I would not trust any conservative political party in Government with
such a system.
As I said at the outset, the initiative of this Conference is most
welcome.
The aim of Universal Healthcare is shared.
But the debate needs to be widened
to include other models of healthcare funding and delivery, including that which
I have outlined.
The Irish people need and deserve a better health system, based
on our shared values of justice and fairness. I believe such a system can be delivered
if we harness the talents of our people, both inside and outside the health system,
and if we use the resources of the nation for the public good.