Ireland: “Two-tier health service can be deadly”

Socialist MP condemns Prime Minister over health crisis

In the following two speeches by Joe Higgins, Socialist Party (CWI) TD [MP], lambasted the Irish Taoiseach (prime minister), Bertie Ahern and his right wing coalition government for starving the health service of funding and creating ‘two-tier’ health that results in unnecessary deaths.

“Two-tier health service can be deadly”

Dáil Éireann, Leaders’ Questions, 31st January 2007

Joe Higgins (The Socialist party):

I wish to remind the Taoiseach that this debate is not about newspaper headlines. It is about public patients suffering acutely on hospital waiting lists and in our hospitals because of a simple failure by his Government. He has gone all over the place with figures so I will keep the focus of my question narrow. Later tonight an excellent motion on cancer care tabled by the Independent Deputies and me will allow a much wider discussion on this and wider aspects of the health service. It is very simple to see why planned surgeries in St. James’s Hospital have been cancelled over the past week because the Taoiseach, the Tánaiste [Deputy Prime Minister], Deputy McDowell, and the Minister for Health and Children, Deputy Harney, individually and jointly have blatantly and cynically failed to meet the commitment the Taoiseach made five years ago to restore 3,000 extra beds to the public hospital system.

Finian McGrath (Independent):

That is the story. That is the real world.

J. Higgins:

These are the 3,000 beds that the Government parties ripped out ruthlessly in the 1980s when they aimed at the old, the sick and the handicapped. If the Government rips out thousands of beds, naturally it will have an acute difficulty. If in the meantime the population increases by three quarters of a million people it will have a full-blown crisis. That is as simple as A,B,C.

The Government deliberately obfuscates the problem because instead of providing those beds in a straightforward way, by extending the capacity of existing hospitals which have plenty of land for such development, and maybe building some new hospitals where they are required, it delays. It then gives its political friends, beef barons, speculators and developers, lots of tax breaks and public land to make a killing on people’s health. In the meantime public patients are suffering grievously because of this agenda.

When will the full complement of the 3,000 beds be provided? Does the Taoiseach have an accurate figure for the extra beds needed by virtue of the increase in population by three-quarters of a million people? When will they be provided? Then we will have no more of this.

The Taoiseach:

In answer to the Deputy’s last question the Health Service Executive and some statisticians are examining bed capacity for the country. I do not know the figure. We must wait for that. To date we have provided approximately 1,500 beds and there are approximately 1,000 in the co-location initiative, which invites private investment and is designed to free up 1,000 beds in public hospitals for public patients. I know the Deputy does not approve of that initiative but it will add to overall capacity. I have already given the figures for this year and next year. That is the status of the bed numbers.

I have not quoted the wrong figures. For the winter months so far the reduction in accident and emergency units, which were a significant problem needing to be tackled, was as follows – October, -34%, November, -32%, December, -53% and January, -57%. Those are the real figures. The hospitals have worked extremely hard with the Health Service Executive and the accident and emergency unit initiative to provide services more efficiently not just by moving patients around. This was achieved by providing out-of-hours services, the winter initiative, the rapid access clinics where the services have commenced and to which people have been referred from accident and emergency departments and are receiving efficient services and use of the National Treatment Purchase Fund. These initiatives were designed to help people. There are pressures at certain times of the year in hospitals. At other times, when there is less pressure they can take more people off the waiting lists for elective surgery. It is not always so easy to do this. While there are some staff difficulties they are not too great, as I understand it, from the Health Service Executive.

J. Higgins:

The reality is that the Government stands over a two-tier health system which it sponsors and nurtures. That is having a grievous impact on the plight of public patients including those who are very ill. For the most part private hospitals do not cater for the very ill. They cherrypick the profitable procedures and the very sick and those requiring high maintenance are directed back into the public health system. In recent weeks, everyone became familiar with the gut-wrenching case of a Kilkenny mother who was obliged to wait eight months for her colon to be examined. That delay will cost the woman in question her life. This is the reality faced by people who are not wealthy and who are dependent on a proper public health system.

Did it ever occur to the Taoiseach that there is a good reason that the section of consultants who want to operate in the private health system cannot take the Minister for Health and Children seriously when she lectures them on the need for a public-only contract? Such lectures on her part ring hollow because she is doing everything in her power to shift an increasing level of resources into the private hospitals where these consultants wish to operate at the same time as having contracts to work in public hospitals. The metaphor of the fox lecturing the members of the pack for casting their eyes over the henhouse comes to mind, particularly in light of the fact that the Minister has already directed the fattest chickens in that direction. Now she is telling consultants that they cannot move in this direction because she wants them to remain in the public sector. It is important to note – this is sometimes overlooked – that doctors are committed to public-only health care.

The problem does not relate to the quality of health care or the dedication of those who work in the service, but to access and capacity. The Taoiseach did not indicate the date on which the full complement of 3,000 beds will be provided and I want him to do so. Is it not pathetic, when it is clear that the population is burgeoning, that the HSE [Health Service Executive] is only now discussing carrying out of a survey? Have the HSE and the Government been asleep for the past several years? When will that survey take place and when will an accurate number of additional beds required by our increasing population be provided?

The Taoiseach:

I stated earlier that the overall survey relating to a population of 4.25 million and rising is under way. The HSE [Health Service Executive] will present its report on the survey when it is completed. I also indicated that 1,500 have already been provided and that approximately 350 private beds and 446 public beds will be provided this year. Arrangements have been made to provide approximately 400 additional beds next year. I also referred earlier to the 5,000 private beds in public hospitals.

This matter is not as simple as the Deputy thinks. The length of stay by patients in all our hospitals has been dramatically reduced. In the past, people were obliged to remain in hospital for between 14 to 16 days in respect of quite minor procedures. An enormous level of day surgeries are being carried out at present and the figures have risen by hundreds of thousands. The old system – even that which obtained five years ago – does not necessarily apply. That point has been made by medical and nursing organisations. It is because of the efficiency and skill of the members of these organisations that the number of day patients being treated has increased while the length of stay has decreased.

Dr. Cowley (Independent):

Why then did the Taoiseach state that an additional 3,000 beds are needed?

The Taoiseach:

I am aware the Deputy is an expert on medicine. We can discuss the matter later. Day and inpatients are being dealt with in much shorter periods. The relevant staff have, therefore, maximised the return from our acute hospitals.

Deputy Joe Higgins is correct that because of the standard of services on offer in our public hospitals, the huge numbers of staff that have been committed and the deployment of modern equipment, people who are seriously ill are far better off in public hospitals than they would be in their private counterparts. Deputy Joe Higgins is correct that the standards on offer in and the capacity of our public hospitals are of a level of which we should all be proud. We should continue to put resources—–

J. Higgins:

I did not say that.

The Taoiseach:

That is what I heard the Deputy saying. He stated that, because of the standards on offer and the resources available, one would be far better off in a public acute hospital than in a private hospital and he is correct in that regard.

J. Higgins:

The Taoiseach is rewriting the script.

Pat Rabbitte (The Labour Party):

Is that why the Government is intent on building more private hospitals?


The Taoiseach:

That is not to take from the fact that hundreds of thousands of people opt to pay health insurance to various companies so that they can access private care. There is nothing wrong with that.

Some 1.3 million people have medical cards and 60,000 people have doctor-only cards. I congratulate the parties opposite for at last seeing the wisdom behind our decision to introduce doctor-only cards. The Opposition berated me last year and stated that such cards are worse than useless.

Emmett Stagg (The Labour Party):

The Government did not issue any of them.

The Taoiseach:

We issued 60,000. I would have issued one to the Deputy if he had been under the limit.

E. Stagg:

A total of 200,000 were supposed to be issued. There is a shortfall of 140,000.

The Taoiseach:

I will ask the Minister to increase the limit in order to take account of that fact. This development has been of major assistance to the service.


Dáil Éireann, Private Members’ Business, 31st January 2007

Joe Higgins (The Socialist Party):

I move:

That Dáil Éireann [Irish Parliament] conscious of the fact that 20,000 new cases of cancer are diagnosed in the State each year with 7,500 dying from the disease:–

– calls on the Minister for Health and Children to make a clear and comprehensive statement on current services for cancer patients in this State and to clarify in detail the position on the implementation of the national plan for radiation oncology;

– notes with alarm the recently highlighted situation of a Kilkenny mother, "Rosie", with an aggressive cancer of the colon, who, being a public patient, had to wait eight months for a colonoscopy with the most serious and tragic consequences for her health and life;

– condemns the fact that after ten years in power the Fianna Fáil-Progressive Democrats Government has failed to put in place a comprehensive national cervical cancer screening programme, 11 years after this was announced, while the waiting time for test results can be six months;

– further condemns the fact that a comprehensive national breast screening programme is not yet in place;

calls for:

– vigorous programmes for cancer prevention including education of children in schools from a young age;

– urgency and added resources to put in place a comprehensive programme for the earliest possible detection, and the best possible treatment of cancer;

– the immediate extension of cervical and breast screening to all areas of the country;

– appropriate national screening programmes for other cancers such as colorectal and prostate cancer;

– the provision of 3,000 acute hospital beds that are urgently needed to ensure cancer sufferers are not prevented from immediate admission to hospital when necessary;

– the scrapping of the Government bias toward privatisation of health care through fostering tax incentivised private hospitals in the grounds of public hospitals;

– regional radiotherapy centres providing access for cancer patients throughout the island of Ireland and to meet the concerns of communities in the north west and south east at the failure to provide radiation therapy for public patients;

– a review of the decision to close St. Luke’s Hospital in Dublin in view of the testimony of former and current patients about its contribution to cancer care; and

– a fully resourced public health service with immediate access to services by all, based on medical needs.

Ba mhaith liom mo chuid ama a roinnt leis na Teachtaí Catherine Murphy, James Breen, Finian McGrath, Connolly, Sargent, Boyle and Ó Caoláin.

I commend the Independent Members of the Technical Group [of MPs in the Dáil] on putting forward this important and comprehensive motion on an issue that affects a broad cohort of people in the State. The motion points to the serious deficiencies in cancer services before constructively pointing to what must be done to redress them.

I commend the Kilkenny mother, who went by the name of ‘Rosie’, who explained to the nation some weeks ago how a two-tier health service can be literally deadly for human beings. The eight months she waited for a colonoscopy can make the difference between a much longer span of life or a much shortened one. It is absolutely inexcusable that in this State, probably the richest country in the European Union, patients depending exclusively on the public health service can find themselves in such a situation. It should never happen again.

Cancer is a terrible tragedy. Each year, 20,000 families learn that a loved one has developed the disease. Some 7,500 people die from the disease every year, ranging from the elderly to the very young. It is inexcusable, therefore, that significant preventative measures are not in place. The comprehensive cervical cancer screening programme that was promised 11 years ago, for example, is still not in place. International experience shows that such a screening programme is hugely successful in detecting the early signs of a cancer that is usually curable. Moreover, I am aware of a constituent who, having taken a test had to wait six months for the result. This is also inexcusable.

This motion does not cast any reflection on the medical staff in the health services. Between June and November last, I watched my brother Liam Higgins, at 61 years of age, progress from a healthy looking man to a shadow, when cancer of the oesophagus claimed his life. This is an experience endured by many thousands of families each year. The care my brother received from doctors, nurses, district nurses, hospice nurses and medical staff was exceptional. What we call for in this motion is a commitment to provide the resources necessary to ensure care is available whenever it is needed and, second, that nobody should have to wait one day longer than necessary to avail of that care.

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