Google+ Followers

Saturday, May 16, 2015

Politics of health a sick state of affairs

LEO Varadkar is ashamed, and well he might be. On Thursday, following the publication of a report into the deaths of five babies at Portlaoise hospital, the health minister proclaimed himself ashamed of the treatment of patients there.

“I am ashamed at the manner in which patients were treated without respect, care and compassion when they most needed it, by members of my own profession and other professions,” he told an Oireachtas committee.

Reaction elsewhere has followed a trend. In the Dáil, there have been expressions of anger at a State that treats its citizens in this manner. The media has been beside itself with outrage as well. There is plenty of blame to go around. There were, and possibly still are, specific problems in Portlaoise, but there is a much bigger picture that few want to talk about. Any proper analysis of why scandals keep emerging from within our health system has to accept that society at large has major questions to answer. In particular, why is politics allowed to dictate the provision of healthcare in this country in a manner that is detrimental to the nation’s health?

For more than 40 years, there have been attempts to rationalise the number of hospitals. This is a matter of nothing more than common sense. Fewer hospitals mean more resources concentrated in fewer locations, and greater throughput of cases. This enhances experience, and cultivates expertise. This is the case in maternity, emergency departments (EDs), cancer care, or whatever. All of which leads to better health and lower mortality rates.

That’s the theory. And, every so often, reports are compiled by people who work in this area, telling governments what needs to be done for the sake of the nation’s health. One such report said that there were too many small hospitals in the State — 51 at the time — and a lack of co-ordination between them.

It recommended the establishment of four regional hospitals, supported by 12 general hospitals, with the remaining hospitals downgraded to health centres and community facilities. That report, chaired by a Prof Patrick Fitzgerald, was published in 1968. As health policy analyst, Sara Burke, wrote of it: “The report generated considerable opposition from communities where hospitals were to be downgraded, and from the management of voluntary hsopitals who rejected losing autonomy. The 1970 Health Act did not adopt Fitzgerald’s recommendations and the proposed reconfiguration of hospitals never happened.”

That report was the first of many, which all broadly said the same thing. Yet, precious little has changed. Earlier this week, the Irish Association of Emergency Medicine reported that the State has far too many ED facilities. The report stated that political considerations on whether to maintain services “seemed to take precedence over all other matters, particularly patient safety concerns”.

The IAEM’s Fergal Hickey told RTÉ Radio that the system needed to be reconfigured. “Our difficulty is that we have 29 emergency departments in the country, which we simply cannot sustain. And there’s no point in us continuing to claim that we have this service, when the reality is different,” he said.
When Dr Hickey advises his patients on their health, they listen. When he advises society on its health, it turns a deaf ear. And don’t expect politicians to listen to a doctor in a year of election. People die all the time, but elections only come around once every four or five years.

The Hiqa report into the Portlaoise maternity deaths provided another searing example of the politics of health in this country. Hiqa’s draft report stated that, in 2012, the hospital was due to have its 24-hour facility downgraded. There was holy war. Local TD Charlie Flanagan sat in on an Oireachtas health committee meeting and made the case for retention. The then health minister, James Reilly, said it was not government policy to downgrade Portlaoise.

At the time, the Government was reeling from the defection of Roscommon TD, Denis Naughton, who had resigned because he said he couldn’t stand over the decision to downgrade the local ED. Naughton’s decision made him a local hero. He will waltz in at the next election.

His constituency and former party colleague Frank Feighan will struggle. Feighan accepted his Government’s decision. One might well ask which of them did more for the health of the people of Roscommon.

When politics clashes with health, all actions are informed by perceptions rather than reality. Everybody wants a building on their doorsteps that advertises itself as a hospital. Everybody wants that building to preferably operate on a 24-hour basis. It doesn’t matter if people who know about these things tell you that your health, and that of your children, or your parents, or your community, is better-served by having a proper hospital a further distance away. All that matters is perception. And perception, like promises, is the staple of politics.

The politics of health is a major reason why we continue to have scandals, deaths, and poorer public health than should be the case. All decisions on health, at local level, come down to a simple attitude: “What we have, we hold”.

There is a shining example of a better way. Cancer care has been greatly improved since it was reconfigured into centres of excellence a few years ago. That took an outsider — returned emigrant Prof Tom Keane — to implement. He came up against fierce opposition, but the government of the day knew that if he walked it would reflect appallingly on the administration. So they reluctantly let him at it, and rates of recovery and mortality have improved hugely as a result. The instinct to hold on for dear life to the local, less efficient facility has extenuating circumstances. There is lingering distrust of central government. There is deep-seated worry that the promise of better care further away will simply turn out to be inferior care further away. The removal of something that has “always” been there will inevitably generate short-term fear. And transport for areas that are particularly isolated is often ignored.

Then there’s the politics. The multi-seat system greatly heightens competition and rivalry. If one politician is willing to tell it like it is for the common good, there will always be another who sees irrational fear as an opportunity. It can’t all be blamed on the politicians. Certainly, precious few of them display any leadership in health, but it takes two to tango, and voters reaffirm them in their perception that pandering to fear will always trump leading from the front. In the meantime, people die; public health remains inferior; scandals await. That’s the Irish way of doing things. So when tragedies occur, and families express their grief and rage, a little reflection from society wouldn’t go astray. There is plenty of blame to go around.

Michael Clifford

Tuesday, May 12, 2015

Top 10% own over half of Irish wealth

More than half of the country’s net household wealth rests in the hands of just 10% of the population, while people in less well-off sectors of society owe more than they own.

                                                                  Fr Sean Healey

CSO research shows the top 10% of the country’s richest households own 53.8% of net wealth — defined as real and financial assets minus debt.
The top 5% of households can lay claim to almost 38% of net wealth while 15% of the wealth lies in the pockets of the richest 1%
At the opposite end of the scale, the data paints a darker picture as the poorest 20% of households owe more than they own.
The figures illustrate the two-tier society that has developed across the country, partly as a result of government policy, according to Fr Sean Healy of Social Justice Ireland.

“These figures emphasise that it was profoundly wrong of the Government to prioritise the better-off in society in the last four budgets,” said Fr Healy. “As resources become available in Budget 2016 and beyond, priority should be given to those hit hardest during the recession — Ireland’s poorest.”
With some of the country’s richest individuals experiencing large-scale losses in the past seven or so years, the level of inequality has not risen to a major degree. However, low- and middle-income families have been badly affected.

“Some people on exorbitantly high incomes have lost out despite recent budgets favouring them and, consequently, inequality has not risen dramatically,” said Fr Healy.
“However, those already struggling to survive have been stretched even further. This was not an accident, this was the result of Government decisions.”

With the Government flagging an equal split of additional funding between spending increases and tax cuts when it announced the budget in October, a much fairer manner of distributing the benefits of recovery would be to put twice the amount into restoration of services, Fr Healy said.
Recent research by the Central Bank points to a higher level of wealth inequality in Ireland than the eurozone average. However, it is less than that in the US.

Research indicates that countries with higher economic inequality suffer from greater unemployment, social instability, and reduced investment, although other academics dispute these effects.
Although open to a degree of statistical error due to the challenges in accessing relevant data, the Irish wealth gap appears to have widened over time, according to Tom Healy, a director of the Nevin Economic Research Institute.

Since the 1980s, a range of factors, including taxation policy, changing demographics, and house price fluctuations may have driven the changes.
Research carried out by Brian Nolan of the ESRI in 1987 showed that the top 10% of the population then owned 42% of net household wealth as opposed to 53% in current times. The top 1% then owned 10% of net wealth.

Mr Healy said wealth distribution has not tended to feature in public discourse here to the same degree as in some other European countries.
“While comprehensive data are hard to come by, Thomas Piketty in his book, Capital in the Twenty-First Century, managed to track the main trends and composition of wealth in a number of large countries such as Britain, France, and Germany,” Mr Healy said.

“Here in Ireland, discussion of wealth has been an under-researched and under-reported area until comparatively recent times.”

Mr Piketty’s best-selling book put the distribution of income and wealth back in the public consciousness last year.
Peter O Dwyer

Photo Minute: It really is a beautiful world out there

Sunday, May 10, 2015

Let Us Be Clear Here…..

The Pantomime of greed: the O' Donnel's

The Irish Independent, that lover of the establishment at any cost, today lauds and gives free expression without reproach to the O’ Donnel’s, whose only claim to wealth, fame and fortune, lays in the money they borrowed and the lies that they told to get it and try to hold on to. Let us be clear here: this family are not victims of the ‘norm’ when it comes to the banks and the banks for their part are as guilty for giving it to them. In recent days as the directors of the banks kneel on feigned expressions of remorse, the one word that they have commonly used to explain their actions is ‘stupidity’. Of course the word they left out with it as it’s partner was greed, the pure naked stuff and so it goes…… Ultimately it is what the whole mess of the Celtic myth was about from both sides of the counter in the bankers office. 

Denis The Menace

Be that as it may these problems were of a private nature in the commerce of free people and it’s natural aftermath was that the bondholders of these private banks would go down with the ship. Instead, and as always before, the citizens en-masse of this small country were landed the bill. A bill so large that it will never be paid. That is not democracy at work but corruption.

We are still in the top five of the highest debtor nations in the world and only dropped down from number one because of simple accounting: reducing the debt owed to one by handing it  to another at a reduced interest rate. Just to keep afloat week on week, we still borrow billions from Peter to pay Paul and both are laughing all the way to their banks. Clever accounting is as about as much you can say about it all, but just as the Celtic tiger was no more than a giant pyramid scheme, the optics what is left is exactly the same. Sooner or later this house of cards will fall.
                                               Smiling Bertie

The root cause of it all is parish pump politics that builds the nest for corruption to thrive. You get elected there and it is very hard to crowbar you out of just one hiding place in Government. Think Michael Lowry, Flynn, Cowen and Ahern here, and Denis O Brien, where just one small bribe bought it all. The institution of corruption itself is what glues it together. There is but a thin veneer of democracy left here now and certainly not what they fought for in 1916 and 1922, or enjoyed by the rest of democracies everywhere else today. We are at a crossroads and the nature of what politics is and it’s relationship with the money men that run this country from within and abroad. The only way forward is transparency and accountability to stop the rot enshrined in corrupt laws meant to hide and evade justice. It's as good as it ever got here.

                                               Anyone for tea Haughey

The reality is we are treated everyday to some trial or other of a banker, politician, counsellor, civil servant, or indeed a more recognised crook such as a bank robber with just a gun, to fill the courts and entertain us. None are ever found guilty except the guy with the gun. If anyone is still laughing then I am not one of them. The legal system that defends them is more corrupt than those they are defending. This is a what the court of last resort is really about. Is there hope? Of course there is but it can only start with reform from the rotten ground up and should have started yesterday. 

We can always be accused of being naive at some point in our lives, of being conned, or of being guilty of tribalism and the embracing of unforgiving beliefs of a religious ethos. Age tends to mellow these things as we look through the window of a melancholy day when the  rains on the window pane slows us down long enough to think. In the end it is rather anti-climatic for it’s clarity is so clear  that it can almost be depressing just before it’s liberation. Common sense it seems is just not so common after all.

 The lies and the liars that tell them

All life looks towards it’s family and young as the future. As a social species we cannot survive alone for we are tethered by this socialism to help others as it ultimately helps ourselves whether we are aware of it or not. Dammit, it feels good too!! When the deluded insulate themselves by money and power, these things are very fragile and toxic in themselves, but there toxicity can burn all round them and consume others that had felt safe before. This is the perfect storm and the one that is raging across Ireland today. To help survive, you look for someone to help if you can't find a tree in a storm.

When I look at a candidate between storms, beyond the smiles and a nice suit, I start with the ‘whats in it for me’ and the ‘whats in it for them’ question. There is always a caveat for someone. And yes, I need someone that is there not just for me but the country as a whole. My intuition and instinct tell me to vote for Sinn Fein. They are here now after the civil war in the north and the civil ignorance in the south that pretended that no war existed. They have embraced the peace process warmly on both sides of the divide since, but the poisonous arrows of the establishment have and are still trying to bring them down.
 Gerry Adams and leader of Sinn Fein

It cannot be said that Sinn Fein is there for the money men, for the obscene pensions, for the benefits of power itself. Their ethos, right or wrongly, misplaced or otherwise, has been to help the lot of others and advancement of a more equal society. It is the totality of their actions going forward that does not fail to impress and the polls reflect that as much. The alternative and more truthful social media is keeping the engines fired up in that march for real change.

That has kept the Irish Independent and the other political parties in the permanency of a siege mentality. The electorate has just one more chance in the next general election to seed for change and give chance for something better and more permanent to grow for future generations, for the one's now are bereft of that one thing that drive us all forward: hope.

Barry Clifford