The Power and the Glory

Good news is a rare commodity these days. Your good news generally tends to be somebody else’s bad news – in the karmic balance of Covid-19, writes Terence Cosgrave.

You get a raise in your wages  – somebody else has to pay. Covid is a danger to older people, but flu seems to have disappeared. There are more doctors on TV than ever, but bizarrely people still keep getting sick.

But the news that the Irish Medical Organisation has secured agreement with the Department of Health and the Health Service Executive to create 84 new Public Health Consultant posts is good news for just about everybody – not least the IMO itself.

Under the proposed agreement, 34 of these posts will be filled in the coming 12 months, a further 30 will be filled between June 2022 and June 2023, and the final 20 posts will be filled between June 2023 and December 2023.

The argument over Public Health Consultants has been going on now for two decades and the government finally had to do something about public health – in the middle of a pandemic.

Dr Anne Dee, IMO

It was an open goal in many ways – Ireland is the only country in the developed world that has no consultants in public health – and that was beginning to look bad, which of course, is the prime reason for Irish government action and inaction, as we have all come to know.

(This theory fails to account for the appointment of Stephen Donnelly as Minister for Health but that was part of a coalition agreement between the government parties – which in its Father Ted equivalent is known as an ‘ecumenical’ question.)

Naturally, even though it made us look bad among our friends in the EU and elsewhere, we did not achieve consultants in public health by the benevolence and far-seeing wisdom of our elected representatives. No.

It was the threat of a strike by public health doctors that brought this issue to the table. A deferred strike. But a strike, nonetheless. And to have a strike by public health doctors in the middle of a pandemic was just too embarrassing. Even for Irish politicians.

So after 20 or so years of arguing the point, we finally have Public Health Consultants, the country feels that little bit safer, and the IMO have a big win to take to the bank, just in time for their annual general Killarney meeting.

The fact that the IMO would have – in all likelihood – been sporting and playing in the lakes of beautiful Killarney were it not for the pandemic is an anachronism. The fact that they have been going to specifically Killarney every year is a tradition that has passed its sell-by date. Why not Athlone? Or Dublin? Or anywhere more central and less connected to an inglorious past?

One thing we can say with a bit of certainty is that there will be big changes following the pandemic in work practices, economies, lifestyles and social discourse. And people are just not going to put up with the same excuses and obfuscation that was a staple of pre-pandemic life.

The government might have been willing to lock everyone up if it made them look good, but the story was going to get out fast and reaction was also going to be quick. The nightly humming and hawing of low-level politicians on TV current affairs shows is beginning to become even more meaningless as the public itself finds our more information online. In real time.

And that is, in turn, preventing much mendacity and dissembling from gaining ground. There is still a lot of disinformation that needs to be combatted, however, and Public Health Consultants will have a key role to play in that.

Dr Anne Dee – the incoming chair of the Public Health Committee rightly called the deal a ‘landmark agreement’ which she said had the potential to transform public health in this country. She said it would support the efforts to recruit the next generation of public health doctors who ‘will be relieved to see that Ireland will now respect their skillsets in the same manner as other specialties and as other countries do’.

That is much to be desired. But this deal also exposes the fact that our actions, our work, our behaviour is now monitored like never before. Tradition needs to be justified for it to continue. The public are simply not willing to let go on some issues, and they will keep up a level of social media activity to keep their issue before the public.

Which means that the argument itself now has some power – perhaps enough to get some things done. It gets harder and harder to hide away in government buildings with the public suspecting you know nothing about your brief – now you’re expected to go on television and prove it. Many do.

And mere power – or the expression of it – will not get you past public opinion – as the teachers found out when they thought about striking to move up the vaccination list. Their plan ended in failure when it was realised that the public would not back them on that one. No one backs a horse running the same race as yourself.

So, a great victory for the IMO and Irish health in general. But now that the public is engaged, there is the opportunity to do so much more. To open up a real debate on healthcare in Ireland, and what it’s going to cost. We will see this weekend how well prepared the IMO is for such a task.

There was a time when they were the only reformers in the system capable of making change. But increasingly it is ideas which are changing Ireland, not ideology. The IMO must show that they have not alone the power, but the glory of having the best ideas to improve and develop Irish healthcare. Let’s see if they can take it from here.

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