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New beginning needed in healthcare – Caoimhghín Ó Caoláin T.D

27 February, 2014 - by Caoimhghín Ó Caoláin TD



Caoimhghín Ó Caoláin T.D, Sinn Féin’s spokesperson on Health will address tonight’s public meeting on the future of our health services in the Granville Hotel Waterford.

Deputy Ó’ Caoláin will say that the Irish people have been failed by successive Health Ministers and needs fundamental reform.

The meeting, which will also be addressed by health service users, health service providers, interested citizens and public representatives, is organised by Sinn Féin Senator David Cullinane and will commence at 7.30pm.

Deputy Ó Caoláin said:

“This meeting comes at a very appropriate time because we are approaching a crossroads in the journey of public health policy in this country.

"The Fine Gael/Labour Government is committed in its Programme for Government to a system of Universal Health Insurance that would fundamentally alter the way healthcare is funded and provided in this State. It is clear that our health services are in deep crisis. Plans for their future must be fully and openly debated - not the subject of a dog-fight between rival Ministers in Government, as has been the cases with Ministers Reilly and Howlin.

"The current system is both inequitable and inefficient. Many people are paying on the double for health services through tax and PRSI and private health insurance. Many are paying through direct fees to GPs and hospitals because they do not qualify for the medical card. Many very ill people are losing or being denied a medical card. The public health system is carrying the subsidised private system on its back.

"We need a new beginning in healthcare. That is why we in Sinn Féin advocate a system based on fair and equitable and reformed taxation with care free at the point of delivery based on medical need alone. Such a system would be both truly equitable and more efficient. But it can only happen if people across this island demand healthcare as a right.

"I welcome the decision at last weekend's sitting of the Constitutional Convention by an overwhelming majority to endorse the proposal to amend the Constitution to entrench the right to healthcare (87%) and the rights of people with disabilities (90%).

"Healthcare as a right is the fundamental demand that we should be raising, both in the context of the Government’s promised public debate on its own proposals – which they cannot even agree on themselves – and in the context of our campaigning for health services in our regions."

The full text of Deputy Ó Caoláin’s speech follows:

I want to thank Senator David Cullinane and Waterford Sinn Féin and all involved in the organisation of this public meeting for the opportunity to speak here and to join you in discussing the needs and the future of our public health services.

It is very important to bring together health service users, health service providers, interested citizens and public representatives to address these crucial issues.
Because this is OUR health service.

It belongs to the people – not to the HSE or the Minister or the Department or the boards of hospitals.

The public health service is paid for by the taxpayer so the stakeholders are the people of Ireland. It is citizens, ultimately, who should decide the type of service we have and the proportion of national resources devoted to it.

“This meeting comes at a very appropriate time because we are approaching a crossroads in the journey of public health policy in this country.

The Fine Gael/Labour Government is committed in its Programme for Government to a system of Universal Health Insurance that would fundamentally alter the way healthcare is funded and provided in this State.

In that Programme for Government the Coalition promised to publish a White Paper on Universal Health Insurance early in its term of office. (A White Paper is a public Government document that sets out policy.) The Coalition’s term of office is now more than half over and we still do not have publication of the White Paper. But it is worse than that.

Not only is the White Paper not published – it is being torn to shreds before we even get the chance to see it.

The Minister for Health James Reilly and the Minister for Public Expenditure and Reform Brendan Howlin are at loggerheads in relation to the White Paper. We have two Ministers leaking and spinning against one another. It has become a war of leaks and spin.

We have the extraordinary sight of one Government Minister – Brendan Howlin - accusing another Minister – James Reilly - of putting forward a plan that would pose a risk to the State's financial stability.

The contents of the White Paper have now been extensively leaked to sections of the media while Oireachtas members and the people are left in the dark.

Let’s be very clear. Our health services are in deep crisis and plans for their future must be fully and openly debated - not the subject of a dog-fight between rival Ministers in Government.

This row certainly exposes the lack of clarity and lack of coherence in this Coalition’s approach to healthcare.

The Coalition’s concept of Universal Health Insurance is based on competing private-for-profit health insurance companies. We in Sinn Féin have criticised that approach as fundamentally flawed. We have a different vision which I will come to at the conclusion of my address.

The White Paper on Universal Health Insurance should be published immediately. I take this opportunity to call on the Minister for Health to publish it. Everyone can then judge for themselves and we can have a real debate focussed on the facts and on the needs of health service users.

And that is why we are here tonight - because we need to focus on the real needs of health service users and we need to base policy on those needs.

I know from long and bitter experience the negative outworking at local level of flawed Government policies.

The over-centralisation of hospital services is a prime example and throughout my time as a public representative since 1985 the people of my home county, Monaghan, have been fighting to retain services at what was once Monaghan General Hospital. That we still have any health services at all based on that hospital site is a tribute to the work of campaigners over all those years. If successive top bureaucrats and Health Ministers had their way there would be no health services at the Monaghan Hospital site today.

I have followed the similar efforts of people throughout the country to retain services in their regions. I have assisted many of them in my capacity as Sinn Féin Health spokesperson – in places such as Dundalk, Navan, Roscommon, Ennis and Nenagh. I have worked closely with Senator David Cullinane in the campaign to retain and enhance services in this region at Waterford Regional Hospital.

This and the last Government between them have produced a plethora of plans and strategies concerning our hospital network and the place of individual hospitals within that network. But since 2008 the biggest single factor determining the services available in hospitals has been the wrecking of the economy by the last Government, its imposition of harsh and counter-productive austerity measures and the continuation of those austerity measures by the present Government.

What has this meant in our public health services? It has meant cuts in staffing, cuts in services, cuts in funding and cuts in the levels of care available to those who need it.

By the end of 2014, under the HSE Service Plan published last month, almost €4 billion will have been taken out of our public health services since 2008. In terms of staff numbers, a further 2,600 whole time equivalents are to go in 2014, on top of the 12,500 that have gone since 2007.

The cuts being imposed in 2014 are unsustainable. The Director of the HSE admitted as much in a memo to the Cabinet on the HSE Service plan, a memo which was later suppressed and a sanitised version published by the Minister.

Last month also the Irish Emergency Medicine Trainees' Association stated that overcrowding in hospital emergency departments is ‘unequivocally dangerous for patients’.

An international study published this week in the Lancet journal, which analysed data across nine countries and 420,000 patients, has concluded that patients are more likely to die if nursing staffing levels are low.

The study, which included this State, found that for every patient added to a nurses workload the chance of dying within a month of surgery increases by a shocking 7%.

Professor Anne Scott one of the authors of the Lancet report has said that the “assumption that hospital staffing can be reduced to save money without adversely affecting patient outcomes may be misguided at best and fatal at worst”. Another of the report’s authors directly linked patient risk to staffing cuts arising from austerity measures.

Two weeks ago a seminar in Dublin by the Irish Nurses and Midwives Organisation also heard health professionals express concern for patient safety following last year’s Francis Report into the deaths of up to 500 patients at a hospital in Staffordshire in England.

There too, inadequate staffing levels, as well as a failure by hospital managers to listen to the concerns of frontline staff, were identified as key elements in the high number of deaths.

The INMO reported that it had recently completed a survey of 100 hospital wards in this state and that preliminary results gave rise to concern at staffing levels.

The survey is said to report that nurses in our hospitals look after six or more patients with some looking after double that at night.

Over 5,200 nursing nursing posts or 13.5% of the total (INMO figures) have been cut since 2010. These are in the main experienced, hardworking, qualified nurses who have been lost because of Government austerity policies.

How have these cuts been imposed on Waterford Regional Hospital?

Your Hospital has seen very significantly reduced capacity over the last seven years. Since 2007 funding and staffing levels have reduced significantly at the hospital.

In 2007 the WTE Staff level was 1,903. Today it stands at 1,597.

130 of these posts were in nursing, partly leading to the closure of two operating theatres at the hospital. Your Hospital has less funding, fewer beds and fewer staff which equates to longer waiting times.

Patients in eye care, ENT and Orthopaedics in particular are waiting longer than the 12 month target to be seen by a consultant as promised.

Funding for the Hospital was cut from €133 in 2013 to €130.4 for 2014, a cut of €2.6million.

Such cuts mean fewer services across the board in this region and countrywide. That is the bottom line.

I would take with a pinch of Government pledges about the improvements that will allegedly come through the reconfiguration of hospitals, hospital groups or by the renaming your hospital as a university hospital.

We need to be asking – will this mean more and better services at Waterford and will our hospital remain a service provider for this entire region?

Or will our Hospital become a peripheral outpost in its alignment with Cork University Hospital and University College Cork?

Government pledges are not worth the paper they are written on. What matters is the care provided to patients by dedicated staff in our hospitals and the support that those patients and staff receive from the health system overall.

I would advise you to guard jealously the services that you have and your role as a regional centre for the South-East. Be very wary of talk of reconfiguration and regrouping. We have been down that road in Monaghan and in other hospitals too many times and a bitter road it is.

Above all be vigilant. People in this City and in this region have marched to support their hospital services in the recent past. Such pro-activity by citizens is needed now more than ever.

We need a grassroots movement for an end to the health cuts and for a decent health service based on fairness and on the rights of all to the best possible healthcare that we, as a society, can provide.

We in Sinn Féin strongly advocate a universal healthcare system with equal access for all based on need and need alone. We want to see the two-tier public-private system abolished so that no sick person can be left behind.

The current system is both inequitable and inefficient. Many people are paying on the double for health services through tax and PRSI and private health insurance. Many are paying through direct fees to GPs and hospitals because they do not qualify for the medical card. Many very ill people are losing or being denied the medical card. The public health system is carrying the subsidised private system on its back.

We need a new beginning in healthcare. That is why we advocate a system based on fair and equitable and reformed taxation with care free at the point of delivery based on medical need alone.

Such a system would be both truly equitable and more efficient. But it can only happen if people across this island demand healthcare as a right.

I welcome the decision at last weekend's sitting of the Constitutional Convention by an overwhelming majority to endorse the proposal to amend the Constitution to entrench the right to healthcare (87%) and the rights of people with disabilities (90%).

Healthcare as a right is the fundamental demand that we should be raising, both in the context of the Government’s promised public debate on its own proposals – which they cannot even agree on themselves – and in the context of our campaigning for health services in our regions.

Once again, I commend you for your work and look forward to working with you in the future as we build a new and decent health service of which we and future generations can be truly proud.

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