Last week, Sinn Féin’s health spokesman David Cullinane published his alternative health budget. Cullinane is a serious operator, aware of the danger of over-promising, careful to cost proposals, certain to be a minister if Sinn Féin leads the next Government. He’s a politician too, though, so he couldn’t resist the big promise: an Irish National Health Service.
But why on earth would we want an Irish NHS? Are things not bad enough in the health service already?
“An Irish NHS” is an oft-repeated pledge from Sinn Féin, frequently name-checked by Mary Lou McDonald. It’s also widely touted as one of the benefits of united Ireland: no more HSE failures – in the new, united Ireland, we’d have our own NHS. It’s been a familiar refrain for many years; in his Leargas podcast a couple of years ago, Gerry Adams intoned: “We need an Irish National Health Service... This isn’t pie in the sky – this is a realisable objective, an achievable objective. It just needs political will. That means we need a new government in Dublin and we need to manage our own affairs across this island.”
Adams, it will be recalled, avoided the NHS altogether, and indeed the HSE, and went to a clinic in New York, funded by a wealthy Irish-American friend, when he had to undergo treatment 10 years ago. “It’s a private decision by me. That’s my business. And those who attack me on that are engaging absolutely in hypocrisy and opportunism,” he said at the time.
Well, fair enough. But it hardly bespeaks a commitment to public healthcare. Anyway, his private arrangements have done nothing to dampen the enthusiasm for an Irish NHS in Sinn Féin – or anywhere else. It is a ubiquitous refrain, and you’ll hear a lot more of it as the next election nears.
Health outcomes in the South are better, access to treatment is better, life expectancy is higher. The Republic’s health service is already miles better than the North’s NHS
But as Cullinane well knows, this is sloganeering, not policymaking.
“We’re not looking at any other country as a model,” he told me this week. “What we’re calling for is the principle of universal healthcare. That’s what we mean by an Irish NHS.”
Falling to bits
Just as well. Because as Cullinane’s party colleagues in Northern Ireland could easily tell him, the NHS is falling to bits.
According to a study by the Department of Health, obtained under the Freedom of Information Act by Freya McClements for The Irish Times, hospital waiting lists in the North are twice as long as in the Republic.
Health outcomes in the South are better, access to treatment is better, life expectancy is higher. The Republic’s health service is already miles better than the North’s NHS.
And better than the rest of the NHS, too, which has endured more than a decade of underfunding. It is a staple of political debate in the UK to regard the NHS as “broken”; public satisfaction with the service is at the lowest level since measurements began 40 years ago.
A report by think-tank the King’s Fund last summer compared the performance of the NHS with the service provided in comparable rich countries and recorded a gloomy diagnosis. It found that long delays in seeing a GP, getting into an emergency department and getting the surgery patients need are the norm. All, it found, were consequences of the NHS funding failing to keep up with demand for the past decade. The result is that people in the UK die sooner than they need to, especially from big killers such as cancer and heart disease.
So much for the NHS. As Cullinane says, though, it’s less the actual NHS (despite the rhetoric) than the idea of universal healthcare that Sinn Féin is seeking to emulate and implement. But all parties agree on the goal of a health service that provides universal access, based on need and not ability to pay, free at the point of access. That’s what gave us the Sláintecare plan – agreed upon and supported by all the parties.
For the foreseeable future, as Gerry Adams would no doubt agree, there will be a role for private healthcare alongside the public system
On certain pillars of Sláintecare – significantly expanded spending, reducing charges, expanding primary care – the current Government and the last one have made some progress. But are we really that much closer to its essential idea of a single-tier public health service? Almost half of the population still has private health insurance, because they know it can secure them speedier access to the care they need in many cases.
Taking the final decisive Sláintecare step and totally separating the private system from the public system is a step that any government will be reluctant to take. That includes, I suspect, a government in which David Cullinane is the minister for health. The way to eliminate private healthcare, if that is your goal, is to make the public system much better. As Cullinane may find out (and I suspect already knows), that is an awful lot easier said than done. For the foreseeable future, as Gerry Adams would no doubt agree, there will be a role for private healthcare alongside the public system.
Where does that leave dreams of an Irish NHS? The words of the west Cork blacksmith, as recounted by Breandán Ó hEithir in his Begrudgers’ Guide to Irish Politics, spring to mind. A hundred years ago, as Irish independence dawned, the local parish priest was exulting to the blacksmith on the bright new future for all. The blacksmith was not convinced; it might be fine news for some people, he said, but he made his living from the gentry, and now they’ll surely leave the country. Worry not, advised the parish priest. In the brave new Ireland, he said, “we’re going to have our own gentry now.”
“Our own gentry!” the blacksmith muttered as the priest departed. “We will in our arse have our own gentry.”