In January 2005, Michael X, a courier driver, went to see his GP complaining of recurrent diarrhoea and passing some blood. Following an examination, his GP sent a letter to arrange for an appointment with a gastro-enterologist for specialist assessment. His appointment arrived in the post - he could see the consultant in July, six months later.He duly attended in July and was told by the specialist he needed urgent hospital investigation. He was given a date for admission three weeks later but a week before this date, his admission was cancelled as there was a bed shortage at the hospital. He was subsequently given a new appointment for late October. However, only two days before this booked admission date, he was again phoned and his appointment cancelled; the reason this time was an outbreak of 'vomiting bug' at the hospital. The secretary who phoned him apologised for the delay.

He was given a new appointment and finally, 11 months after he first sought advice, he had his 20 minute bowel test. Unfortunately, he was diagnosed with cancer of the bowel. (The very thing his GP said he needed to go to hospital to be tested for). He was operated on two days later and made a good recovery. However his diagnosis was complicated by the fact that the cancer had spread beyond the wall of his gut. He remained optimistic but just before Christmas 2006 he became quite ill and had to give up work. He died last month.

It has since emerged that if 'Michael X' had had private insurance he could have seen the consultant within a few weeks of his GP visit in January of 2005. In all probability his cancer would have been caught in time and he would still be alive. It is worth mentioning that he is sadly missed by his wife, three children, and all his friends.

So What Do We Do?

With a general election looming in the Republic, a key issue is likely to be the ongoing problems in the health service. Long waiting lists, a shortage of beds and the persistant threat of catching the MRSA bug, have all contributed to a widespread sense that something is not right. Add to this, the scandals around the Leas Cross nursing home and the Neary case in Drogheda - two widely different cases which nonetheless underline the poor treatment that can sometimes be meted out to vulnerable patients. The key question is what is to be done and where lies the solution?

One powerful lobby group, aided and abetted by the PD Health Minister, Mary Harney, has been ably promoting the 'private health care' model. Their vision is similar to what's available in the USA, where the quality of health and medical care received is tied closely to the reality of 'what can you pay for'. In other words if you can't afford care, it's 'tough luck'.

As the 'Michael X' case shows we are already someway down the road to having this US health care model. Right now "in the Republic" there are two health services in operation. One, provided by the health insurance system (VHI, Quinn-BUPA and Vivas), guarantees immediate and top level care. The second, paid for through our taxes, is also top notch - the problem is accessing it. Long waiting lists, under- funded staffing levels and reduced resources insure long and sometimes tragic delays for patients.

Two Tiers

This Republic's two-tier heath system is established government policy, allowing some people to buy their way to the top of the treatment queue. It's a disgrace but it is by no means the end of the story. What is now becoming increasingly obvious is that there is also a government policy to under-fund the public health care system so as to build demand for 'private' health care. Sounds cynical? Look around and see what's happening. (Eighteen months to get your dodgy knee seen by a specialist in a public clinic. Not happy? The same doctor can see you privately next week!)

Another example of this policy has come to light in the Cork area in the neo-natal care unit. The unit has become the focus of a HSE reorganisation plan which, on face value, looks great: the unit is to be doubled in size to 50 beds, and moved to a new modern location. But there's one problem. Although the unit is doubling in size the staffing levels are not - they're being left as they were! So the nursing staff already completely over-stretched in what is an intensive hands-on job, are now being asked to accept intolerable and potentially dangerous conditions in the name of a 'business plan'.

This is just the tip of the iceberg. Across the health service problems abound to do with understaffing, contracting out of work, casualisation and poor pay. Workers are fighting back, particularly in areas that directly concern their own particular sections, but the overall problems facing health workers, as well as the massive problem of access, is not. Health care should be a right, after all, not something to be costed and delivered according to your income.

How can we fight back? The fundamental issue is that the forthcoming general election will have no impact. The present government and the 'government-in-waiting' all accept the basic two-tier system we now have. Whereas what we need is to get rid of this!

An important first step that could be made is to work towards the coming together of a network of health workers who can link workers struggling in the service across a wide number of areas, sections and issues. Such a network is desperately needed in terms of extending solidarity between workers. But it could also play a big role in laying the basis for the promotion of a model for health care that is a real alternative to the present mess.

Kevin Doyle

This article is from Workers Solidarity No96, March April 2007

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