Democratic Deficit

national | consumer issues | opinion/analysis Friday January 14, 2005 21:14 by Sean Crudden - impero sean at impero dot iol dot ie Jenkinstown, Dundalk, Co Louth. 087 9739945

The Proud Woman's Contumely

Will the democratic values of love, friendliness, listening, community, sisterhood, fun be squeezed out of the health system in my lifetime? What are the human priorities of the Health Services Executive?

Sean Crudden

"………………the whips and scorns of time,
The oppressors wrong, the proud man’s contumely,
The pangs of despis’d love, the law’s delay,
The insolence of office, and the spurns
That patient merit of the unworthy takes"

Shakespeare, in less than a half dozen lines sums up what has been common cause for many people in a lifetime dealing with government agencies - particularly in the fields of education and health.

Remarkably in 1973 when setting up the Health Boards the then Minister for Health, Erskine Childers, deliberately set about introducing devolution and a strong democratic element into the systematic provision of health services in Ireland. If he were alive now in January 2005 witnessing the demise of the health boards and he would have to admit that their performance in the intervening years (like the performance of the VECs over a longer period) hardly ever rose above the standards of Frank Hall’s "Ballymagash."

Of course there is no natural law that says the health services must be democratic. In fact the medical hierarchy and the professional administrator, it could be said, have combined over the last 32 years to starve any real democratic element in the system of the oxygen it needed. Really, I think (and I was at all times very much an outsider) the democratic pretensions of the system were little more than a charade.

Candidly my own impression is that there were improvements in the morale of patients and front-line staff in the last few years. However is outright paternalism (or maternalism?) beginning to slip in now? The desire to dictate and dominate are not far removed from naked exploitation and oppression. Are these outcomes more likely in a closed, secret context dominated by right-wing ideology and a "top-down" political point of view?

Perhaps we don’t need a public viewing gallery around each operating theatre and delivery room? Nor do we need an electronic extension of our ears into every consulting room nor a direct line into every health administrator’s computer?

However no-one can be so naive as to think that the procedures of professional medical staff and professional administrators are so sacred that they have to be hidden from public view. Nor is it credible that we are all too stupid to understand their work or that we are too indiscreet to be told what the issues are or that we are too aggressive to enter into consultation about the way our health is being looked after.

Frankly I do not accept that all is well in the best of all possible worlds where medical treatment is concerned in Ireland or anywhere else in the "civilised" world (medicine is now perhaps the largest business on the globe) in 2005.

Current legislation is fundamentally begging the question. It is based on the notion that medical practice has reached a final state of perfection that cannot be improved upon. The very state of health of the nation’s sons and daughters readily gives the lie to that.