Rip it up and start again

We’ve had a lot of heat expended over the Irish health service over the last few years. You can take in the nurses’ strikes and the junior doctor dispute and now as I write, the public health doctors’ claim. Along the way we’ve also done deals with consultants and general practitioners. We’ve had health scandals (for example, the haemophiliacs treatment by the Blood Transfusions Board) and health tragedies. From alcohol policy to welfare services to children, the health system is involved everywhere. And it’s all over the place too.

Micheál Martin launched the Government’s health strategy over a year ago, apparently without the blessing of Charlie McCreevy. Health spending has gone up and up, and despite all the promises made about improvements, basically the health service is in shreds.

The contrast with Northern Ireland and most other industrialised countries is stark. Elsewhere, there is clarity and relative speed of response. Here, we have chaos. It has become like the justice system, where people don’t bother to report a lot of crime because it’s just not worth the hassle. Now, many don’t go for treatment, especially for non-life threatening ailments, because it just takes too long.

A number of reports will issue shortly analysing the problems, their history, their present contours and their possible resolution.

Many argue that the Health Boards are top-heavy with management, and safe havens for local politicians either on their way up or their way down. Others point out that Health Boards have become the kitchen sink of Irish social services. They don’t just do health, they do welfare as well. And some housing.

But there are also those who argue that the problem is management itself, that is to say, the very idea of management as it is understood and applied in modern Ireland. A ‘thin grey dust’, it has been called by one eminent psychologist. It is seen to be a stifling system, obsessed with figures and with judging effectiveness on the quantity of work done rather than the quality.

Management in modern Ireland prides itself on setting (generally numeric) goals and establishing systems and showing how the goals have been met. Shouldn’t it be preoccupied with setting standards and showing how they have been met? Instead of telling us how many beds and how many people have been treated and so on across the universe, shouldn’t we be hearing about how many people have been satisfied with the treatment they received and how few are left requiring treatment?

Before doctors get next or near a patient, a whole rake of paperwork is introduced. The numerical balance between professionals and managers has skewed – there are too many managers and too few professionals – and the health service is crumbling as a result.

Like the Naked City, the Irish health service has a million stories. Many of them are heartbreaking, with ordinary decent people, often suffering grave illness, being treated with contempt, not by individual health practitioners, but by an entire system.

One that caught my eye was the story of John Costello, who was featured in a report by Olivia Kelly in the Irish Times recently. He suffered head injuries in a car crash but because of the lack of services for brain injury victims had to be placed in an institution for the mentally handicapped.

Unbelievably, he was placed in the Learning Disabilities Unit in Peamount Hospital because the National Rehabilitation Hospital had no room for him. After 16 months there, his mother brought him home. She told Olivia Kelly that ‘he was going downhill’, that with brain injuries, “if you sit back and do nothing, the brain won’t develop.”

Meanwhile, Denis O’Brien accepted the Flame of Hope from Evangelina Panopopoulou in Athens. It is being carried along a 15,000km route to Dublin to arrive at the opening ceremony of the Special Olympics in a couple of days, at which a sixteen-year-old Derry boy will light the flame cauldron at the opening ceremony.

The president of the Games says that the Special Olympics will change attitudes to people with learning disabilities. And for many that is likely to be true.

Towns and villages across Ireland and Northern Ireland have reacted with great generosity and openness to the idea of the games and to the challenge of welcoming a host of special athletes. In the warmth of their welcome, they will make a grand statement about our better side.

But it is hard to reconcile this with the way our health service responds to those who are ill or indeed disabled. Despite the interest and commitment of many people in the health service, the nett effect is chaotic, hostile and ineffective.

In truth, the shabby, dithering response to the participation by athletes from SARS-infected areas seems a far truer reflection of our health service than does the warmth and energy of our response to the Special Olympics themselves.

Compare and contrast. On one hand, you have vibrant communal organisation, and voluntary at that, commitment, generosity, social responsibility and a thoroughgoing can-do spirit. On the other, you have poor management, over-management, greediness on some parts, callousness on others and a generalised self-interest.

It’s time to rip it up and start again.

As for the Special Olympics, they will be what they are, and all the better for that, in a world of superstars and celebrities. They’ll crown the summer, and the best of luck to them.