Acceptable level of healthcare has already been decided

By Irish standards, and even by a few international ones, the Irish health service is a big beast.

It’s almost impossible to get noticeable improvement in such a large animal without some overall increase in funding. And I think we can take it that such investment is not going to be forthcoming.

We may bemoan this lack of funding, but it won’t make it any less real. This is not a government that has in any way signalled its intention to release the purse strings and employ the 800 consultants and several thousand nurses the system needs to be functional.

Indeed, for many (roughly one-third) there is no problem. The health service works pretty well for those with private health insurance, and that encompasses pretty much every politician and powerful person within the country. The fact that the public health service is poor for many others is not of major concern to most ‘comfortable’ people in Ireland.

Certainly, it is an irritant. Say you’re an ambitious public servant – working hard (by your terms) to get rid of other people within your Department who might have the ear of the boss. Are you entitled to another €50,000 a year? You might be – and more! Compared to lackadaisical attitude of some others, why the Hell not?

Fifty K is buttons in a system this big. It’s hardly traceable. If you were doing a good job, it’s great value, terrific value, amazing value. If you’re not doing a good job, it’s still unimportant, except in terms of the personal morality of taking money on false pretences. But it still won’t change the system very much.

And sadly, perhaps, were a Gandhi-like figure to come along and banish private health insurance from our shores, like St Patrick’s snakes, for many at the top their occasional healthcare would be done instead in London or Manchester. Their regular healthcare would still be done privately. And the difference would be negligible. It might even be better.

My point is that the powerful people in this society have already decided on an acceptable level of healthcare for the other two-thirds, and that is not going to change any time soon – no matter how much we indulge ourselves in virtue-signalling or hand-wringing.

The elites of the world have already figured out that while a sick child might draw on the heartstrings for a while, the problem will eventually resolve itself (the child will die or get better), and the public will move on to the next thing.

The mass school-shooting in Uvalde, Texas, recently has shown us that politicians and public officials are often completely useless, and without any real ability to make changes in society. They are often merely the well-paid mouthpieces of other more powerful forces.

Those forces are often purely commercial, and have no responsibility or feeling for the damage they might do tangentially. Does the BP executive go home to his or her child and mention how they are destroying the world but not to worry because Mummy/Daddy couldn’t do that much about it anyway – so we might as well take the money now? That’s the philosophy behind the new LIV Golf Tour – one that fails automatically when you ask the question of where is the Women’s LIV Golf Tour.

People tend to live in the here and now, and while there is no-one with real power driven to equalize the health system, it will not happen. One might even suggest that even that one person would be hampered and limited pretty quickly by other forces.

Ah, you say, but what about Sinn Féin? They are prima fascia an egalitarian party, working on socialist principles – surely when Mary Lou becomes Taoiseach, we will have equality and excellence in our health service?

We may. I cannot predict the future. But my caution would be that many well-meaning people have tried and failed to deliver health service goals and ambitions. And many have come up short. There comes a time when health is no longer paying off politically. People care about health when they, or a family member, is sick. People care about taxes all the time.

And Sinn Féin will have to do what the present government is failing to do which is to make the Irish health service at least a practical and desirable employer to Irish medical graduates.

At the moment, we are halfway through Sláintecare – a plan whose parameters have been changed so radically since it began that it now bears no relation to the original idea. The people in charge have left. The accountability is gone.

We also have had the government’s ‘Waiting List Action Plan’ this year. And the Health Service Executive’s Service Plan for 2022. These ‘plans’ are just words on pages that no-one is really serious about. What they really are is a list of justifications for non-action, or ‘what we’re doing with the limited money we have’.

Nothing will change in any major way until the government commits to funding the personnel needed to fill the gaps in the current system. And they show no signs of doing that any time soon.

But the real changes in healthcare will probably be forced on the powers that be by technology, pandemic threats and research. Amazing things are happening in the world of research – allowing for treatments – particularly preventative ones – which are currently the stuff of science-fiction novels, but are, in actuality, are only a few years away.

What’s wrong is the balance between the politics and the practical. We have no real say in our health service, or its priorities or how it works. As technology changes, we will face major challenges and threats to how the service is provided. We can be thrown a Zoom meeting instead of a GP service, and if we accept that, then perhaps, that becomes the norm. But then, telemedicine might just be the thing that makes general practice doable out-of-hours.

Either way, the importance of doctors reiterating the priorities of medicine is an important and vital part of the public debate. These words are never wasted in the on-going battle to provide a proper service to all. Doctors are not merely the guardians of our health, they are the guardians of proper standards in our health system. We need more and more doctors to speak out about the system’s failings to make government and the HSE accountable for the service they provide.

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