The Socialist (December 07) - Unions must organise people power campaign to End Health Crisis!

Breast cancer scandal, dirty hospitals, privatisation…
Unions must organise people power campaign to End Health Crisis!

Stephen Boyd

The breast cancer diagnoses scandal and the report on hospital cleanliness have further exposed the depth and seriousness of the problems in the health service.

Mary Harney, Minister for Health, stated in an article in The Irish Times 20 November 2007: “Our pledge to patients should be threefold: You will be safe; you will get the best quality care for the best possible outcome; and you will be seen and treated on the basis of medical need… Breastcheck is now starting the national roll-out. Our survival rates for breast cancer care are fast improving”.

The facts expose Mary Harney’s “pledge” and statements as false and another example of this government trying to con people with political spin. Ireland has the highest mortality rate for breast cancer in the Western world. Breastcheck doesn’t exist in 11 of the 26 counties. There is still no national screening programme for cervical cancer eight years after the government pledged it would be introduced. And the government and the HSE has admitted that cancer treatment services around the country, for which they are responsible for providing “the best quality care for the best possible outcome” have been under-resourced and so inadequate that patients have died due to their neglect.

After ten years in power and with more money at their disposal than any other Irish government, the major problems that exist in the health service should have been resolved. Mary Harney and the government cannot be trusted. In the same article, the Minister for Health claims that the government does not prioritise private healthcare over public. Once again the reality shatters this claim as completely false.

The government’s record speaks for itself. Their answer to the lack of hospital beds has been to support the building of private hospitals on public land. This co-location policy will cost the taxpayer €1.2 billion and will not provide the 15,000 beds needed. Their answer to cutting the hospital waiting lists wasn’t to invest more money and resources in the public health system – no they have paid the private health sector to treat 70,000 public patients under the National Treatment Purchase Fund. And there are still up to 240 people on trolleys in A&E on a daily basis.

None of the state's 51 public hospitals received a top score in the national review of hospital hygiene carried out by the Health Information and Quality Authority. Hospital hygiene is of course crucial and is underlined by the increase in deaths from MRSA. What hasn’t been highlighted enough is the cause of the decline in standards. A major contributing factor has been the outsourcing of cleaning to private companies like Maybin Support Services, who have replaced permanent health service cleaners.

These private companies pay low wages, provide minimum training, and aim to get the job done as quickly and as cheaply as possible in order to maximise their profits. Once again, the government has put penny pinching and the profits of the private sector before the need for clean hospitals. An OECD report, Health at a Glance 2007, states that based on figures for 2005, Ireland has only 2.8 acute hospital beds per 1,000 population compared with an OECD average of 3.9.

The report goes on to say that in 1990 the number of hospital beds was 3.2 per 1,000 – so under this government the number of hospital beds has fallen! The government’s ideological commitment to private healthcare is inflicting enormous suffering on tens of thousands and is costing the lives of many that cannot access quality care and treatment.

There is enormous anger in society over the health crisis. Thousands have been protesting in places like Ennis, Sligo, Letterkenny and Monaghan. The trade unions and in particular the health unions representing the 120,000 health workers who deal with the problems in the health service on an hourly basis must take action.

A trade union and health worker led campaign could mobilise hundreds of thousands of people onto the streets in protest at the health crisis. A movement of this scale could force the government to abandon its support for private healthcare and force them to invest and make the changes needed to create a free public national health service open to all regardless of income.

Breast cancer
For financial reasons people got second-rate care

Kevin McLoughlin

The debacle at the Midlands Regional Hospital in Portlaoise has brought confidence in cancer services for women to a new low. People are justifiably angry at this unbelievable failure of care.

Undoubtedly more women will die due to the chaos of mis-management and policies that deny patients their rights to high quality care. More than 3,000 breast scans taken at the hospital are being reviewed. In the review so far it has transpired that up to 20 women who had been given the all clear, have in fact got cancer. The figure may increase.

The HSE have gone out of their way to avoid any real responsibility and have in fact used the crisis to justify their plans to close important local cancer services. Portlaoise Hospital was designated to provide the quality cancer care since 2000. Officials at the HSE were aware that questions had been raised about the quality of services in Portlaoise since 2005. Why wasn’t there an investigation then? Why was there only one consultant radiologist at the hospital? Why was equipment used in mammographies out of date?

The publication by the HSE of a list of twenty hospitals where women could avail of “best possible practice” cancer care is necessary but doesn’t answer the key question - why did the cancer services for women operated by the HSE in many centres around the country not already offer “best possible practice”?

Mary Harney says that these centres did not treat enough patients to justify the number of specialists necessary for best practice in cases of symptomatic cancer referrals. She then says that there needs to be a switch to bigger centres of excellence. This is a disgrace. In other words, for financial reasons people got second-rate care. It's a fraud, some hospitals that promised proper care for cancer in fact couldn’t deliver. It’s like using the lives of women as a mechanism to achieve the policy of centres of excellence. The death rate of women here due to breast cancer is 15% greater than in Britain and by international standards their performance is poor.

The HSE must take emergency measures to ensure that there are no backlogs or delays in screenings and assessments of women because they have suspended cancer services in a number of areas and that all cancer care be immediately upgraded.

Centres of excellence or local services
It’s a phoney choice

Kevin McLoughlin

Everybody should have access to centres of excellence that provide the best possible care for cancer and indeed other ailments. But the choice this government and the HSE is trying to enforce on people – that you can have centres of excellence or second-rate local services – is a phoney choice and should be rejected out of hand.

Medical arguments for the need for the centralisation of cancer services should be accepted by all. But the approach of the government and the HSE to centralisation is in the short to medium term actually likely to make accessing cancer services more difficult as they close many local services.

Their approach is also saturated with a commercial ethos that puts balancing books ahead of the health of patients. The HSE say they are basing their plan for eight centres of excellence for cancer on a report done in 2000. Yet that report from Dr O’Higgins stated that there should in fact be thirteen centres of excellence. Undoubtedly financial factors are an important part of this change – the HSE are not willing to invest in people’s health. It is also clear that in their version of centralisation, little weight is given to the real logistic difficulties and serious costs involved for many people in traveling the long distances envisaged for care.

In their plans for four centres of excellence in Dublin, they propose that some different tumors would be treated in different hospitals, which will mean that no hospital will offer truly comprehensive cancer care.

This could be linked to commercial considerations as it could make it easier to maximise profitability for private cancer specialists. Centralisation of cancer services will not solve all problems. You can have better quality services but unless you get rid of the discrimination against public patients in the health system, it won’t make a huge difference to many people.

Before any decision is taken to close local cancer services, at minimum, the alternative services at a centre of excellence should up and running and proven to be adequate and accessible to the whole communities in the catchment area.

The problem is the government and the HSE’s approach to centralisation and cancer care and the best way to force them to act with urgency and to put the needs of cancer patients first, is to mobilise a united national movement involving communities and health workers.

Private healthcare
The government's "answer" to a health crisis they created

Michael Murphy

The government is using the crisis in the health service they created to step up their agenda for a two tier health system.

The inequality of this system was illustrated by the tragic death of Susie Long from cancer in October. If Susie had private health insurance, she would have been diagnosed quicker and been able to avail of treatment that in all likelihood have meant she would be alive today.

The Hanly Report is the government’s grand plan for the health service. If implemented, this plan will result in the closure or severe winding down of hospital facilities throughout the state. This will include up to two thirds of hospital casualty units and leave many parts of the country without a hospital and thousands of people with no access to a local service.

This plan is an attempt to centralise many hospital services under the guise of providing a better service for patients – but in reality will pave the way for outsourcing and privatisation of services. Incredibly, while the government thinks this is the best way to deal with public patients, Bertie Ahern and Mary Harney are opening small private unregulated hospitals, in some cases close to where they are shutting public facilities.

Hospital co-location is also part of this plan where private hospitals are built on public land while the private investors get massive tax breaks in return. This will cost the state over €500 million.

On top of this the income lost to public hospitals from the transfer of private patients will be €700 million, which makes a minimum cost to taxpayers of €1.2 billion. This is nearly 50% of the total cost of building these hospitals from the taxpayer but the hospitals will be wholly owned by private companies!

Harney claims 1,000 public beds will be freed up by putting private beds into the co-located hospitals, but these new beds won’t give the full range of services. According to a recent book Emergency: Irish hospitals in Chaos, by Marie O’Connor, “the number of extra beds the plan is supposed to free up is completely inaccurate. By my calculations there will only be just over two hundred extra beds and this will come at a cost of over €300 million to the taxpayer”.

Research carried out in the US shows that for-profit hospitals provide lower quality care and have a higher mortality than not-for-profit hospitals because private hospitals do not provide the full integrated health care that public hospitals provide. These new private hospitals will cherry pick the less expensive procedures leaving the complex cases and the chronically ill to the public hospitals – because you can’t make a profit from the chronically ill.

Hanly, co-location and the cut backs are just the start. Mary Harney and the government are planning to strip our public health services bare, transferring as much of it as they can into the hands of private health companies.

Health Crisis
We need more health protests not less!

Michael Murphy

"The irony here is that the system that operates in Portlaoise is one that we've inherited and have tried to change against major resistance from the public and many other interests . . . the system in Portlaoise is totally unfair to the women who have used it… but it's been defended by marches on the street, by local people and indeed by practitioners." - Professor Brendan Drumm, Chief executive of the HSE speaking to RTÉ's This Week programme.

Despite the fact that there hasn’t been a protest on cancer services since 1999 in Portlaoise, that didn’t stop Professor Drumm blaming protestors for the situation in Portlaoise.

Drumm's comments came days after 7,000 people took to the streets in Castlebar over the withdrawal of cancer services from Mayo General Hospital. Thirteen regional centres have been told to discontinue breast cancer services immediately and others including Mayo General Hospital has been told to do so on a phased basis.

In September, 5,000 people took to the streets of Ennis, Co. Clare as part of their campaign to fight the loss of 24-hour A&E services at Ennis hospital and cutbacks in breast cancer facilities.

These protests and the one in Letterkenny earlier in the year are very significant – however they need to be extended and stepped up. It is crucial that the health unions take a leading role to up the pressure on this government.

Health Crisis
Action needed to defend Tallaght Hospital

Gearóid McLoughlin

Anger, discontent and loathing were the general feelings at a meeting organised by the Socialist Party about the current state of Tallaght Hospital.

Around 70 people attended to discuss the future of the hospital and the need for a campaign to oppose the government’s attacks on the hospital. Now, after the false promises of the elections are over, and people are coming to terms with the lies of Fianna Fail TDs, a sense of real anger has filled the community and was reflected at the meeting. One speaker declared: “We must fight this, we are the tax payers and we have been abused. They’re looking after their pockets not the people.”

The government plan to close the Children’s Hospital and the cancer services in the coming years. Such a move will amount to a major downgrading of the hospital. In the context of the building of a co-located private hospital, which will leech off the public sector, this represents a real threat to the future of the hospital. It comes just after the hospital was given a clean bill of health regarding hygiene from the Health Information and Quality Authority. The power of active communities and trade unions is the only thing that stands in the way of Harney’s dream of a completely privatised health service run in the interests of profit, not people.

A large scale campaign is necessary to save the hospital. The people of Tallaght need to get organised and send a clear message to Mary Harney and the other crooks in the government and the HSE. We will be working to build such a campaign in the coming weeks. If you would like to help, contact Cllr. Mick Murphy on (01) 4934696.