Many editions of Shakespeare’s plays include the general stage notes like ‘exeunt all’. One I have always liked is ‘alarums and excursions’. It has so many applications, not the least of which is to Irish political life. It sums up past and present tensions very well indeed.

The alarums include the continuing fall-out of the McCarthy report and the present dispute between the HSE and the pharmacies. As for excursions, well that’s the two Sligo Fianna Fáil TDs stepping away from the party whip because Sligo isn’t to be developed as a centre of excellence in cancer treatment.
These health disputes raise, once again, one of the fundamental issues in modern Irish life, the best word for which is access.
Policy is both recommended and made by people who live in urban strongholds, that is, by people who are close to services of various kinds and who have their own transport or convenient and frequent public transport to convey them.
These people have almost no appreciation of what it’s like to struggle financially, to live at a distance from services (such as health or transport), to not own a car, and to be dependent on public health services.
This is not to diss the individuals – they just have no experience of what it’s like for large numbers of people. So, for example, the HSE thinks it’s acceptable to have pensioners traversing the south east for, literally, days on end, to get necessary prescriptions filled.
One New Ross man, interviewed on an RTE programme, having failed in his mission in Waterford said he was then told ‘go to Tramore’…
The assumption (also made initially by the reporter) was that he could hop in the motor and go. But he couldn’t. He didn’t own a car.
Now, this condemns him to a much greater excursion than that made by the Fianna Fáil TDs. Yet they too are highlighting the same essential point. One certainly endorses the notion of centres for excellence, but why is it that none will be found north of a line between Dublin and Galway?
All of us, more or less, know someone who has had cancer. We know the terror and upheaval it generates, the dread sequence of invasive and pervasive treatments, the consequent exhaustion and uncertainty and, where radiotherapy is involved, the tedium of attending a centre on a daily basis.
All this is hugely compounded by distance and bad roads. It’s just not good enough for someone to talk about efficiency. Effectiveness is an issue too.
But of course, part of the problem is that we are in a boss-culture phase in Ireland. Consultation is seen as a very bad thing. It’s associated with the partnership process. It is regarded as slowing down decision-making and generating compromises with interest groups. The new mood is top down, hardline, we know, and will do, what’s best for you.
The thing is, real consultation isn’t a bad thing and isn’t about simply funding wish-lists. In fact it’s an extremely effective way of involving people, whether in a workforce, a community or a general population, in agreeing on where everyone wants to go and how to get there in bad times as well as good.
But the HSE has played it very tight and hasn’t drawn the general population into its confidence. Is there a grand plan that will make sense of all this?
Who knows?
Maybe there is. And, of course, the HSE can only influence what is within its own control. Whatever about health services, it can’t tackle the general issue of access. It doesn’t do roads, buses or trains.
And when you remember that the McCarthy report also has things to say about uneconomic rural transport that, if implemented would reduce such services as currently operate, things will not be getting better for the users. In contrast, in most other European countries these operate in a coherent way that facilitates access…
Here, you can safely say that, whatever the plan, the actual implementation of policies on health is entrenching the disadvantages of the less well-off. And that’s always the key isn’t it? Judge people by what they do, not what they say, evaluate their performance by the results rather than the rhetoric.
The short odds are that all this will work out better for the HSE (in terms of expenditure) and worse for the patients to whom a substantial proportion of the costs will devolve (in terms of time and cash, through having to travel significantly further).
The year 1969 saw the end of one phase of optimism in the world, the peace and love of 1967/8 falling before Altamont and Nixon and Manson and the so-called Prague Spring being crushed by Soviet tanks…
It took another twenty years and a wave of revolutions across eastern Europe to revive that sense of hope in 1989 and yet another twenty years for it all to fall apart again right here right now.
Not Soviet tanks this time, of course, but the air has certainly turned authoritarian. Indeed, there is even an anti-democratic tendency evident among some mainstream media commentators.
The dialectic unfolds and is unfinished. More change will come. Each hinge of history is accompanied by alarums and excursions – so too this.
Fasten your seatbelts.