Medical Matters: 1916 leaders would be aghast at two-tier healthcare

"Let us revive the best of the promise of 1916, so that those coming generations might experience freedom in the full sense of the term – freedom from poverty, freedom from violence and insecurity, and freedom from fear." President Michael D Higgins, Easter Monday, 2016

It has been a splendid 1916 commemoration. Mature, reflective, generous and inclusive. A fitting reminder of the rebels’ vision of equal rights and equal opportunities for all of the Republic’s citizens.

I have been thinking about the Proclamation from the perspective of the health of the nation. What would the 1916 signatories make of our health system 100 years on? I suspect they would be disappointed to hear a widespread lament at the lack of vision for the health service.

I have no doubt they would be taken aback at the continued existence of our two-tier health system. And perplexed by our failure, despite an annual spend of some €13.2 billion on health, to have found a way to ensure that healthcare is available free at the point of delivery to every citizen, based on medical need and not on ability to pay.

While proud of our democracy, the signatories may well have had a wry smile at the outcome of the most recent general election. The rising up of rural Ireland, in response to years of infrastructural neglect, could be interpreted as a failure by the Republic to follow through on the Proclamation’s resolve “to pursue the happiness and prosperity of the whole nation and of all its parts”.

No doctor, no village

They would have noted the success of TDs such as Dr

Michael Harty

in Clare, who built a broad political campaign on the rallying cry of “No doctor, no village”.

At the same time they would probably shake their heads at how the Irish health system has such an urban focus and wonder how – despite their ideals and our continuing rhetoric – the Irish health system is overly hospital-centric.

The 1916 leaders would be puzzled as to why the primary care sector has never been properly developed in the Republic. They would be saddened at the sight of under-pressure GPs referring greater numbers of children under six to hospital emergency departments as a tsunami of increased attendances follows universal free entitlement for this age group.

As visionaries I suspect they would see that, without a proper primary care infrastructure in place, increasing the number of people entitled to free care would simply collapse an already creaking service.

In responding to the State’s continued failure to establish a fair and functioning health service, I would like to think they would support calls for the depoliticisation of health. They would surely see the wisdom of establishing a national health forum charged with formulating the principles upon which to base a new national health service.

Party politics

And distaste for their colonial masters would not blind them to the success of cross-party support having allowed Aneurin Bevan introduce the

NHS

in Britain after the second World War. Having replicated that success, they would surely have the vision to then keep party politics out of health.

Recognising that even the best health systems need renewal, the leaders’ ears would be open to suggestions such as those recently put forward by the Place-Based Health Commission in Britain. Acknowledging that increased health service funding cannot be sustained, they would refocus on delivering health locally.

This would be achieved by moving from a system based on institutions towards prevention and the embedding of health as a social movement; and a shift from service silos to system outcomes by creating a new health system from the inside out.

Our 1916 leaders would recognise that such change will take 15 years in order to overcome the short-term operational pressures that will threaten to derail transformation. But as visionaries they would be sustained by the prospect of the birth of a better health system.

mhouston@irishtimes.com @muirishouston