Sir, – In his comments on a letter I wrote about unifying health systems north and south of the Irish Border (April 8th), Jim O'Sullivan seems to have entirely missed the point of the data I cited, and to confuse causes with outcomes (Letters, April 9th). The observation that life expectancy in the Republic is longer than in the north has to be considered by those advocating extrapolation of a system analogous to the NHS across the island, such as Sláintecare. The time difference is not trivial ("Life expectancy for children born in NI 1.6 years shorter than in the South", News, November 28th, 2019). The fact that it is longer again in Macau, Hong Kong or Japan, as Mr O'Sullivan states, is of little relevance as the genetic, cultural, nutritional and other differences between our population and these others makes comparison largely uninterpretable.
But across the island of Ireland there are no real differences in our biology, diet or climate to account for such discrepancies. “Lifestyle” may cause variations in health outcomes between parts of Asia and Europe, but it can hardly account for differences between the North and the Republic of Ireland of this magnitude. And if it did, unification would clearly be even more challenging, as such radically different ways of life would somehow have to be reconciled. For what it’s worth, I should point out too that only one of the “three countries” he cites as having a long life expectancy is actually a country. That, Japan, operates a system of mandatory health insurance for workers.
With regard to the astonishing difference in Covid related deaths – that for the UK being 80 per cent higher than the Republic of Ireland – Mr O’Sullivan sees the slow intervention of the UK government as “the likely sole cause” – but also mentions the effective nationalisation here of private hospitals. The latter was of course possible precisely because of our two-tier system. For all of its logical shortcomings, our status quo has the potential to generate surplus capacity very quickly, and in a way useable, during a crisis therefore.
His suggestion that we "ask a mother with a few children who can see a doctor free up north" which system she would prefer interestingly echoes the views of Kenneth Harper whose correspondence began the discussion (Letters, 6April 6th). Mr Harper was alarmed because those in the North believed medical care was better in the republic than he himself did, making the type of assumption Mr O'Sullivan does.
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General practitioners in the UK frequently have long waiting lists though and, more broadly, my point is that it is always tempting to believe that some other location has idyllic healthcare, getting it just right. Nowhere really does, however, and it is inherently a matter of priorities and constant trade-offs. And no matter what we do in terms of strategies, the options for Ireland are likely to be between the systems of the north or the south, or some hybrid. Nothing we do in healthcare provision is likely to give our population much in common with Macao or Hong Kong. – Yours, etc,
BRIAN O’BRIEN,
Kinsale,
Co Cork.
Sir, – The regular refrain mythologising the UK’s healthcare system has once again been cited as a argument against the reunification of Ireland on the spurious assumption that the NHS provides a better health system than that to be found in Ireland. On the contrary, a global study carried out in early 2017 by the Lancet, rated 192 countries in terms of their quality and access to healthcare. The UK‘s health system was ranked in 30th place. Ireland, by contrast, came in at a respectable 13th place.
If we are going to have a discussion on unity, it needs to be based on facts, not biased and historic perceptions.
The NHS was once one of the best health services in the world; that it no longer is can be attributed to successive UK governments. It nonetheless retains some extraordinarily valuable facets which we here in Ireland could well adopt. Similarly, based on the Lancet’s assessment, the HSE, for all its flaws and for all we complain about it, is clearly doing something right. Perhaps any debate might look at potential synergies deriving from the best of both systems rather than engaging in oneupmanship for political advantage? – Yours, etc,
RAY LEONARD,
Blessington,
Co Wicklow.