Sinn Féin - On Your Side

Health Bill props up two-class, two-tier health system -- Ó Caoláin

24 January, 2007


Sinn Féin's Dáil leader and Health spokesperson Caoimhghín Ó Caoláin TD has characterised the Government's Health Bill, debated today in Leinster House, as 'too little, too late'. He accused the Government of having 'failed, and failed miserably' on health policy and being wedded to a 'two-class, two-tier health service that is inefficient because it is inequitable'.

The Cavan-Monaghan TD said: "The Fianna Fáil/PD partnership has had nearly a decade to get health policy right and they have failed and failed miserably. At the root of all this is the Government's refusal to take a rights-based approach to healthcare. We have got a two-class, two-tier health service that is inefficient because it is inequitable.

"This Bill is too little, too late. The Government set a target date of 2003 for the establishment of the Social Services Inspectorate on a statutory basis. This was to be in tandem with the establishment of the Health Information and Quality Authority. It took until 2005 for the Minister for Health and Children to establish an interim Health Information and Quality Authority. The Bill to establish the fully fledged Authority and to put the Social Services Inspectorate on a statutory footing is only coming before us now, in 2007.

"Reading this Bill many people will be astonished at the lack of proper regulation up to now. Even registration of centres providing care was not properly established. And we know very well also that existing regulations were not enforced. Had they been enforced, inadequate as they were, they would have prevented much distress, illness and death, especially for older people in nursing homes.

"Sinn Féin would go above and beyond the measures in this Bill and would:

· Enshrine the right to health and the right to healthcare in a future all-Ireland Charter of Rights and a future United Irish Constitution, and seek in the meantime to amend the current 1937 Irish Constitution to include these rights.

· Establish a Health Ombudsman to provide an administrative remedy short of the courts.

· Introduce equality-proofing and human rights-proofing to all health policy, law and practice.

· Pursue economic and social programmes to ensure social and economic equality which will have a positive impact on health outcomes."

CRÍOCH

Full speech follows, check against delivery

"As the Government brings this Health Bill before the Dáil, its health policy and its management of our health services is being exposed yet again as a shambles. The number of patients on trolleys and chairs in Accident and Emergency units has reached 339 on one day already in 2007. When the Task Force report on A&E was published last week the Health Service Executive claimed a major improvement in A&E but then they admitted they only begin counting the waiting time for a patient in A&E from when a consultant decides to admit them as in-patients. No account is taken of the time - often many hours - spent waiting to be seen by a consultant. The Government's cancer strategy is in disarray as exposed in the HSE report leaked last week. The Fianna Fáil/PD obsession with public-private partnerships means that delivery of vital radiotherapy services is being delayed. The talks on a new consultants' contract are deadlocked. And this is only January.

The Fianna Fáil/PD partnership has had nearly a decade to get health policy right and they have failed and failed miserably.

At the root of all this is the Government's refusal to take a rights-based approach to healthcare. This Bill fails to vindicate healthcare rights. It is too little, too late. The Bill has been long promised and is long overdue. The Government's Health Strategy 'Quality and Fairness -- A Health System for You', Action 63, set a target date of 2003 for the establishment of the Social Services Inspectorate on a statutory basis. This was to be in tandem with the establishment of the Health Information and Quality Authority. It took until 2005 for the Minister for Health and Children to establish an interim Health Information and Quality Authority. The Bill to establish the fully fledged Authority and to put the Social Services Inspectorate on a statutory footing is only coming before us now, in 2007.

This legislation should not be enacted at all without another piece of equally long promised and long overdue parallel legislation. This is the promised Bill to provide "clear statutory provisions on entitlement to health and personal social services". This was the commitment given in the Health Strategy and the target date for publication of the Bill was 2002. We still do not have that legislation. It is easy to see why. Such a Bill would raise many embarrassing questions for this Government about our grossly inequitable two-tier, public-private healthcare system. If you set out in law the entitlement of people resident in Ireland to healthcare you must deal with the issue of healthcare rights. And that is something this Government cannot face. It refused to enact rights-based disability legislation and it is refusing to enact rights-based healthcare legislation.

The interim Health Information and Quality Authority published its first newsletter in December 2005 and stated its purpose. It said it will "assure the delivery of world class health and personal social services". That is a very tall order indeed. To thousands of people who experience our health system today it will seem like a sick joke.

A "world class health service" has been the repeated promise of this Government. But what have we got instead? We have got a two-class, two-tier health service that is inefficient because it is inequitable. I have already cited the Health Strategy, which, of course, has been effectively abandoned by this Government. In 2001 it stated that greater equity for public hospital patients would be achieved through a revised contract for consultants. The target date was the end of 2002. Here we are in 2007 and the talks on the contract have barely got past the starting post. To their shame, that section of consultants which runs the Irish Hospital Consultants Association is holding out in defence of the indefensible -- the so-called Category Two contract which allows consultants who are paid generously from public funds to provide care to public patients in public hospitals, to also carry out private work for personal profit in private hospitals and clinics. And to their shame this Government and the HSE are preparing to make further concessions by allowing consultants working in public hospitals to spend more time treating private patients in those hospitals.

All of this comes as the Minister for Health and Children continues to pursue her scandalous scheme to privatise hospital services by providing land at public hospital sites to developers of private hospitals. This is on top of the massive tax breaks the developers will receive. The government has no mandate for this privatisation plan and it should abandon it now.

The Health Information and Quality Authority is tasked in this Bill with setting standards on safety and quality in relation to services provided by by the Health Service Executive and to monitor compliance with those standards. Will it apply different standards to the public and private systems? The reality today is that different standards do apply and this Government and all its predecessors have perpetuated such a manifestly unjust system. How will this Authority work if the two-tier system is maintained?

Anyone who doubts the injustice of the system and the fact that injustice in healthcare delivery costs lives should read the letter from the cancer patient in Kilkenny sent to RTÉ's Liveline on 9th January and widely publicised. This cancer patient has been told by her doctors that she has only a few short years to live. Her life could have been saved if she had had access to a colonoscopy. She visited her GP in the summer of 2005 and was referred for the procedure. But she did not get that vital diagnostic procedure until 28 Feburary 2006. It was found that she had bowel cancer and the cancer had spread to other organs.

On her 12th session of chemotherapy, the Kilkenny cancer patient spoke to the partner of another patient. She told her that her partner's GP had requested a colonoscopy and he was put on a waiting list. She then phoned the hospital and told them she had private health insurance and he got that colonoscopy within three days. The cancer had not spread and his life was saved. The Kilkenny patient stated:

"I then came home, flicked on the tv and got into bed. The first ad on the tv was from the government telling people that bowel cancer can kill, but not if caught in time. If Bertie Ahern or Mary Harney or Michael McDowell were within reach I would have killed them."

And she concludes her letter:

"Despite one and a half incomes we couldn't afford VHI or BUPA. But if if we could we wouldn't have gotten it because we believed (and still do) that all people should get good care despite their incomes. We thought jumping queues was wrong."

I make no apology for placing that eloquent indictment of Government health policy on the Dáil record.

Now the question I have is what will the Health Information and Quality Authority do for a patient like that? The flaw in the system that is literally killing this woman is inequity of access. Apart from her experience in the Mater Hospital which she found filthy and squalid, she does not complain of the treatment she received from the health services when she finally got treatment. But the system failed at its most vital point, the point where it should have provided early, life-saving diagnosis. And this woman's experience is replicated by thousands up and down the country. Because the Health Information and Quality Authority is not going to be based firmly on legislation enshrining the right to equal access for all patients, it will have no remit to examine why this woman did not get immediate access to the early diagnosis that probably would have saved her life. We are not even clear if and how it will be able to examine individual cases.

The comprehensive report 'How Ireland Cares' sponsored by the Irish Congress of Trade Unions makes recommendations about the remit of the Health Information and Quality Authority but those recommendations are not met by this Bill. The ICTU-sponsored report calls for the Authority to have the power to inspect all hospitals, primary care providers, long-stay care providers and all other healthcare facilities. This Bill provides for the Inspector of Social Services to inspect designated centres but these are confined to residential services and nursing homes and they exclude virtually all other healthcare facilities. The exact role of the HIQA with regard to hospitals and primary care providers and the range of other services is far from clear in this Bill.

Of course the stricter regime for nursing homes and other residential settings is welcome and vital as the Leas Cross scandal all too tragically demonstrated. Reading this Bill many people will be astonished at the lack of proper regulation up to now. Even registration of centres providing care was not properly established. And we know very well also that existing regulations were not enforced. Had they been enforced, inadequate as they were, they would have prevented much distress, illness and death, especially for older people in nursing homes.

This Bill can be no substitute for comprehensive rights-based healthcare legislation. We in Sinn Féin base our approach to health on the principle that everyone has the right to timely and appropriate high quality healthcare that is available in sufficient quantity and accessible to all without discrimination. To that end we would go above and beyond the measures in this Bill and would:

Enshrine the right to health and the right to healthcare in a future all-Ireland Charter of Rights and a future United Irish Constitution, and seek in the meantime to amend the current 1937 Irish Constitution to include these rights.

• Enshrine the right to healthcare in legislation, and make this a fully enforceable right in Irish Courts.

• Establish a Health Ombudsman to provide an administrative remedy short of the courts, in the interests of speedier and less expensive resolution of disputes and redress regarding violations of the right to healthcare.

• Introduce equality-proofing and human rights-proofing to all health policy, law and practice, and introduce public health-proofing of other areas of law and policy.

• Pursue economic and social programmes to ensure social and economic equality which will have a positive impact on health outcomes."

CRÍOCH

Connect with Sinn Féin