Sir, – The broad point made by Fintan O’Toole regarding the long-term economic trajectories of Ireland and the UK, and their implications for unionism, are interesting (“Liz Truss’s hollowing out of Britishness surely alarms unionists”, Opinion & Analysis, October 8th). However, regarding the challenges in healthcare and for their National Health Service, I suspect he is missing the real issue. This is the fact that what the NHS set out to do, and once did well, has almost ceased to be possible. It is important, not least because Ireland seems inclined to attempt to do the same.
Since the foundation of the NHS, medical inflation has run at an average of 3.6 per cent and in more recent years the rate is higher. Economic growth, conversely, has been closer to 2 per cent, with current times tending toward recession. Over the 75-odd years involved, such an apparently small difference amounts to a vastly greater proportional requirement in resourcing for healthcare.
There are, of course, topics upon which one expects political disagreement. That conservatives might want lower taxes and less expenditure is as predictable as that left-leaning parties will want the opposite. No one, though, realistically promotes illness, or suggests the prevention of medical care. Reality may generate such difficulties but they are scarcely ever intended. This is relevant to Fintan O’Toole’s point that while the NHS “was vastly better than Ireland’s dire two-tier system … the Conservatives are destroying that too”. He supports this by citing recent data on NHS waiting lists.
It is fairly obvious that the Conservatives, however ill-conceived their tax cuts, or even Brexit might have been, do not wish to generate enormous waiting lists. Covid and its disruptive effects on schedules, along with an ageing population, have driven them to record breaking levels.
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Meanwhile, the very concept of a “two-tier” health system seems archaic and undemocratic. But it isn’t, when looked at empirically and objectively, demonstrably worse than the NHS. In the UK, the difference in life expectancy between the richest and poorest men is over nine years. The equivalent figure for Ireland is about five years, as Fintan O’Toole has previously noted (“Ireland’s well-off live five years longer than its poor”, November 23rd, 2019). Overall Irish life expectancy is slightly longer, perhaps most significantly.
The NHS was able, in its early decades, to meet the modest healthcare demands of a younger population than that for which it now caters. Enormous advances in healthcare technology, which often seems miraculous but never cheap, combined with an older population, are making that remit look less feasible. Combined with the Irish approach to income tax, where about half of workers pay none and the bulk of it comes from about 10 per cent of earners, it was probably never a realistic proposal, and becomes less so every day.
Ultimately this leaves citizens of Northern Ireland facing issues in healthcare access that are not unlike those in the Republic, and are really global. We are challenged by the downside of an enormous upside. We live much longer than we used to, and there is a great deal more that is medically possible than in previous generations. How to fund it equitably remains the problem and neither opposition nor government politicians, on either side of the Irish Sea, are addressing this matter credibly. – Yours, etc,
BRIAN O’BRIEN,
Kinsale,
Co Cork.