POLICY STATEMENT ON HEALTH SERVICE

Health Service Demands to put People Before Profit

At the beginning of 2011 overcrowding in A&E and hikes in VHI again showed the long-term problems of capacity and funding in the Irish health service. Government policy since the 2001 ‘Health Strategy’ was to increase hospital beds by 3000 in order to bring up the total to 15,000 beds.

Mary Harney, however, tried to pretend that private ‘collocated’ beds would provide extra beds but even these were never built. Instead the INMO now estimates 1,700 more acute beds in public hospitals have been closed since 2008 leaving us with just over 10,000.

Market madness has seen VHI increase their subscriptions by almost half. Fear of long waiting lists and unequal access to consultant specialists has pushed half the population to take out private Health Insurance. The cancellation of Risk Equalisation to favour the other ‘for-profit’ Health Insurance companies means ‘Community Rating’ (everyone pays the same subs) is now a farce.

All of this indicates that the whole ‘two-tier’ system is what needs to be changed. Fine Gael’s proposal to force everyone into the Private Health Insurance market would be a disaster. Costs would skyrocket through billing, marketing, profits, legal and accounting fees and massive executive salaries and bonuses as well as the duplication and distortion caused by organising care on the basis of money rather than medical need. These extra administration costs and wastage are why costs are so high in health systems that rely on for-profit private healthcare corporations: the US spends twice as much on health as other countries; rated number 1 for cost but rated 37th for quality of care. This is because so much of ‘health’ spending in the for-profit systems is not spent on healthcare.

In Ireland, Hospital Consultants doing private practice are already on a salary of €200,000 a year but get the same again in fees. That is over €300 million a year wasted. Insurers pay tens of millions for advertising. Instead of markets and insurance, truly Universal healthcare needs democratically elected Community Health Councils to ensure profiteering or political corruption do not get in the way of well-planned Health services.

The People Before Profit therefore advocates:

1. The creation of a National Health Service that is Universal, Comprehensive, Democratically planned, Funded by Progressive taxation and Free at the point of use. The essential principles of an Irish NHS are that it should be:

a. Based on universal, comprehensive healthcare.
The health service should be ‘universal’ covering everybody and ‘comprehensive’ covering all their health needs (including drug costs, psychotherapy, physio and other therapies and care for teeth, eyes and reproductive health). ‘Universal’ means little without ‘comprehensive’.

b. Funded through progressive taxation and free at the point of use.

‘Progressive taxation’ is a fairer and more efficient way of funding healthcare. It means the more you earn the higher rate of tax you pay. Insurance is regressive (flat rate), causes duplication waste and leads to unequal coverage. Direct charges for use (user fees) are regressive and discourage the less wealthy from using necessary services.

c. Democratically planned.

Services need to plan ahead based on knowledge of the local population and their health needs. The Fine Gael mantra that ‘Money should follow the patient’ is really a mechanism to insert even more market mechanisms in health. But it ignores the fact that money doesn’t put services in place unless they are planned ahead.

People Before Profit argues that ‘Money should go ahead of the patient’ instead. Democratic control by the local community and frontline workers is necessary to ensure healthcare (rather than profit or political careers) remains the priority.

2. No more hospital closures, service reductions or staff cuts.

Reopen closed wards and increase bed capacity to 15,000 beds nationally.
Increase health staffing to at least EU average levels.
Stop the covert implementation of the Hanly report. Proposals for ‘improvement’ in services should be approved democratically by the local communities affected, informed by all the best options for improving care. Any useful private facilities could be incorporated into the public system by nationalising them. The drive for profits in Nursing Homes is undermining standards of staff numbers and training.

3. Improve care and respect for elderly people in an ageing population. Throw out the ‘Fair Deal’. Plan for an ageing population with a full range of services: proper free state nursing home care, sheltered accommodation/retirement villages, house adaptations, home care, community services and respite for carers. Reverse the cuts and increase the Carers allowance.

4. Increase funding for Mental Health to at least 10% of health budget. Improve access to social support, Occupational Therapy and psychotherapy as alternatives to medication and ECT. Improve access for children to prompt, good quality mental health and developmental assessments and therapies by staffing Child Mental Health and Early Intervention Teams to age 18. Improve liaison with and availability of school supports including small class sizes, Resource Teachers, SNAs and NEPS psychologists. Highlight the role of unemployment in suicide and encourage a public works programme as a positive approach to suicide prevention.

5. Improve cancer care including screening, access to diagnostic tests, radiotherapy/chemo close to home and transport to regional centres as required.

6. More ambulances and air ambulances to reduce transit times in emergencies. Guarantee response to medical emergencies by ambulance within 12 minutes and transit time to emergency healthcare to be less than one hour in total

7.  End ‘outsourcing’ of catering, cleaning and security as wasteful and dangerous.

Good health services require good treatment of patients and staff

8. Fund the health service through progressive taxation. Cut profiteering in healthcare: Cut private healthcare and drug company profits by taxation earmarked for healthcare.

Any money saved by cutting waste such as the duplication and profits of private medicine should be earmarked for reinvestment in the health service.

9. Replace the HSE Board with elected Community Health Councils for democratic planning of health services.

Ensure representation by user groups and health workers.
Root out corruption in healthcare delivery by local and national politicians.

10. Develop a system of preventative medicine to cut costs.

Prioritise preventative medicine and target poverty and inequality as key factors in improving community health and social well-being.
Each citizen should have an annual check and receive comprehensive advice on diet, exercise, stress reduction and methods to improve health.
Providing nutritious food in schools and proper exercise facilities will help to reduce the rise of obesity and diabetes in childhood.
Preventative care will lead to a reduction in hospital use.
Develop a proper system of primary care centres on a non for profit basis.

11.  Reduce costs though use of generic drugs and abolition of rules on intellectual property. 

The big pharmaceutical industry uses a ‘me too’ strategy of making unnecessary near-replicas of existing profitable branded drugs to rip off public health systems.
They also make minor modifications to existing drugs to prolong patent privileges and charge extra.
Ireland should take a lead in breaking from this practice.
Similarly, the health system should promote a principle of sharing knowledge in order to improve health and oppose the extension of intellectual property.