Sláintecare and lessons from the pandemic

Sir, – In an optimistic assessment of the future envisioned by Sláintecare, Chris Fitzpatrick starts and concludes with reference to Aneurin Bevan's postwar establishment of the National Health Service (NHS) in the UK. He broadly suggests that when Covid-19 forced such egalitarianism on Ireland, it brought out the best in our medical staff, eliminating administrative red tape and obstacles ("Covid gave us a taste of what Sláintecare would be like", Opinion & Analysis, June 24th). Furthermore, as "there are no private ventilators", access to care was based on need and we thereby got the best outcomes we could deliver as a community.

Before we accept such a version of events, it’s worth looking in detail at how the outbreak was handled under Bevan’s system and how ours differed from it.

The UK has had 87 per cent more deaths from Covid than Ireland has, precisely a rate of 1,876 against 999 per million, as recorded on the Worldometer website. This is despite having essentially the same demographic make-up. Much of the adaptation Prof Fitzpatrick refers to entailed our Government taking over private medical facilities, some of which have intensive-care units and, hence, “private ventilators” which were used equitably. These hospitals exist due to our unloved two-tier system, which may be an inconvenient truth, but it is the truth nonetheless. As an intensive-care doctor, I feel our ability to cope and adapt was indeed laudable, if unsustainable in the long-term. I don’t doubt it offers insights that should inform future pandemic responses. We might indeed look at the outcomes experienced by the UK and Ireland retrospectively, and seek to identify the factors that protected us. But on the headline data, this was not the NHS’s finest hour, and the key question will be one of why our system came out ahead and, thus, in what relevant respects we differed from the UK.

The idea that a fully public system will be rapidly adaptable, as “red tape is slashed” is surely contrary to much modern evidence. Famously, plans to build Tallaght hospital and the Blackrock clinic were announced at roughly the same time. The former took about 20 years to build, the latter about three. Current projects to build a National Children’s Hospital and to relocate the National Maternity hospital will certainly be measured in decades from planning to completion, assuming they ever are completed. Budgets for these endeavours have crept into the millions per bed, and are now multiples of original estimates. I assume this will be the only form of expansion possible under Sláintecare, or at least I cannot see a reason to think otherwise.


Should we seek to implement a system based on Bevan’s, it’s wise to recall his most famous line on that achievement. Explaining how he persuaded doctors to embrace the NHS, his reply “I stuffed their mouths with gold” is widely quoted. Similarly, the only debate about doctors salaries under the new arrangement is of how great the increase will be.

Like Prof Fitzpatrick, I saw much to be proud of in how we healthcare workers coalesced to fight Covid, and I was inspired by the sacrifices and idealism of many colleagues. But, from Ireland, the outcomes of the pandemic under the NHS might be better cited as an argument against a single-tier system rather than as a reason to pursue it. – Yours, etc,



Co Cork.