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Nurses call for health system based on social solidarity not private profit

category national | worker & community struggles and protests | feature author Wednesday May 10, 2006 17:18author by Annie Winters Report this post to the editors

featured image
INO Conference

The anger was palpable at last weekend’s INO conference in Cavan as nurses from around the country took to the floor to speak out about the woeful state of the health service and to demand better conditions for themselves and their patients. As professionals working at the coalface of the health care service, nurses witness the effects of under-funding, bad management and creeping privatisation in terms of their own working conditions and the level of care they can provide to their patients every day. As the government pushes for privatisation of our health service with incentives for construction of private hospitals nurses witness the erosion of our public health services. Motions brought to the conference by union delegates highlighted the many concerns held by nurses. Motions addressing privatisation, pay, severe understaffing, inadequate support, lack of respect and censorship of nurses were all put to the floor
Read on for a report on the conference and an interview with an INO delegate...

Related Links:
Keep Our Hospitals Public Irish Nurses Organisation Mary Harney should resign - call from PB4P

Harney & Privatisation
Nurses' total mistrust of the current PD minister for health Mary Harney and her neo-liberal politics was underlined by a vote of no confidence based on her “failure …to ease accident and emergency overcrowding, lack of clarity over how to address problems facing the public health care service,” and “her negative and antagonistic attitude” towards nurses. Harney’s privatisation plan for the health service was dammed in a motion passed in which the conference “condem[ed], and call[ed] for the immediate reversal of any and all strategies which move to introduce privatised health care.” The devastating effect of the privatisation of health care for both patients and staff in terms of access to and provision of care, pay and workers' rights was underlined by guest speaker Professor Alyson Pollock who spoke about the gradual privatisation of the British NHS, profit-driven health care and the campaign against this. Pollock reiterated the sentiments of many of the INO delegates calling for a health care system based on social solidarity not private profit.

Harney who had been scheduled to address the delegate’s conference failed to show citing a “diary issue” but, perhaps, the recent jeering of British Health Secretary Patricia Hewett at the Royal College of Nurses annual conference in Bournemouth was playing on her mind. Brian Lenihan, minister of state for health, attending in Harney’s stead, received a similar treatment. Irish nurses, like their British sisters, booing and jeering as Lenihan spoke of government plans for privatisation of the health service. INO President Madeline Spears accused the PDs of privatisation policy of “destroying our communities and our health service.” Her resolve to “wipe the PDs off the face of the planet” was met with rapturous applause from delegates.

Pay and conditions
The key demands articulated by nurses in relation to pay and conditions pertain to relative pay and hours of work. The struggle for parity of pay with other health-care workers has been an ongoing battle for nurses. The issue of ‘pay anomalies’ was highlted - i.e., nurses being paid less than other health care workers who are less qualified and hold less responsibility (such as social care workers). They are also demanding a thirty-five hour week in line with other health care professionals.

A presentation about the ‘pay campaign’ was made by INO deputy secretary Dave Hughes. Hughes outlined the INO pay campaign’s demands and proposed methods. He stressed that the union was not ‘threatening anybody’ with strike action and that demands could be won through ‘procedure’ and political means, urging delegates to ‘use your vote not your feet’. A ‘pay rally’ at Croke Park is planned for the 14th June at 3pm.

The aptness and political significance (or lack thereof) of the rally’s proposed venue was questioned by one delegate who recommended instead, marching on the Dáil. This suggestion was dismissed by Hughes who said the time might come for such actions but that it was not now. He encouraged nurses to put their faith in procedure, lobby at local level, use their vote and pack the busses for June 14th. Scepticism at the effectiveness of Hughes’ plan was vocalised by some of the nurses I spoke to. It is apparent that while the INO rank and file are fed up, pissed off and hungry for change, their union leaders do not want to rock the boat. As a body that has been demanding better pay and hours for over twenty years, one would question the merits of “not threatening anybody.”

Understaffing
A central theme at the conference was the severe understaffing that is prevalent in the Irish health service. A blue banner reading “safe staffing saves lives” hung at the top of the conference hall. Several motions brought the issue of understaffing to the floor. In terms of the negative consequences for patients, nurses spoke about how current inadequate nurse-patient ratios prevent nurses from “delivering the care we want to deliver.” In terms of working conditions “unacceptable levels of stress and occupational injury,” resulting from understaffing was highlighted. Connected to the issue of understaffing is that of overcrowding - the chronic A& E overcrowding and lack of hospital beds, which face already stretched nurses. A resolution calling for “the formulation of a capital building program” was passed - delegates stressing the need for more public not private hospital beds.

Lack of respect, lack of consultation and censorship
Many delegates spoke out at what they see as the disrespect for the nursing profession. One delegate commenting that, “we are ignored and treated differently because we are a workforce made up largely of women.” In terms of policy nurses complained that those working at the grassroots are not consulted about decisions that affect them. Concerns about the ‘hierarchical’ and ‘top down’ organisation of nursing were also raised in specific motions.

The issue of censorship of nurses who speak out about substandard conditions by the HSE was raised. A resolution was passed that nurses who “present to the media…a truthful reflection of the state of their working environment” do not face obstructions, threats or other sanctions from the HSE. The delegates warmly supported this motion, Liam Doran union secretary exclaiming that nurses “cannot be silenced by bureaucrats sitting in ivory towers.” A motion calling for the support of whistleblowers was also passed.

Nurses, funding the health service & giving away our resources
Nurses working in the frontline of the health service witness daily the under-funding and inadequate input of resources, preventing them providing the care they want to deliver. In its heyday, nursing was seen as a vocation. Nurses were called to care; while they are now seen as skilled professionals, that vocational spirit applies to a degree. Nurses are not only advocates for themselves (demanding the pay and conditions they deserve), but also advocates for the patients they treat and care for. As one delegate commented, “When patients are suffering we have to stand up for them.” The current mismanagement of the health service in Mary Harney’s PD hands, is resulting in both, inadequate services for patients (overcrowding, hundreds of patients waiting on trolleys, understaffing, waiting lists), and well as poor pay for nurses. Instead of investing in the health service it is purposely degraded as privatise hospitals are subsidised and the neo-liberal agenda is pushed.

As Harney claims there is not enough money for decent service or to pay nurses the amount they demand and deserve, the state has given away billions of euros worth of our natural resources in the form of the Corrib gas field to private oil companies. As well as 100% ownership of the gas field thanks to Ray Burke’s scrapping of a state stake, the consortium of oil companies in control of Corrib, will pay no royalties. A slashed rate of 25% tax courtesy of Bertie Ahern (in his capacity as minister for finance in 1992), and a tax write-off for production, development and exploration costs back-dated 25 years ensure that they will pay either low or potentially no tax at all. The billions from Corrib should be paying nurses the wages they demand and deserve. It should be paying for a free accessible public health service for us all.

Interview with INO delegate.
‘Rose’ is a public health nurse and has been nursing for over forty years.


IMC: As a nurse how would you describe the current state of the health care system in Ireland?
Well I’m a public health nurse and in that area I see, you know, lots of shortages and lots of shortcomings. And while the aspirations are very good and noble and high-minded, there doesn’t seem to be the commitment to putting in resources and putting in the services on the ground. In theory, big advances have been made in supporting people at home but, when it comes to the reality, I just find that the resources are not on the ground. So there’s a lot of frustration, both in terms of families receiving services and, you know, people on the ground such as pubic health nurses trying to man the services. I see lots of shortcomings in terms of areas not covered fully, half cover, no cover for days off - issues that would have arisen from the commission of nurses that haven’t been fully implemented.

IMC:Have you seen changes in your time as a nurse, have there always been frustrations or is this a recent phenomenon?
It would be fair to say that there’s always been some level of frustration but it’s very pressing at the moment.

IMC:What are the most important concerns facing nurses at the moment?
Well I’m thinking of the young graduates now coming out with their honours degrees and I’m sure they will be expecting to be heard and remuneration for the effort and the work they put in to attaining their degrees. So I suppose the pay anomalies are still very much an issue, and I suppose nursing is still very much hierarchical and its kind of from the top down and that people should be given more autonomy on the ground. The shortages of staff, that’s a big issue. It’s a big issues because it’s so difficult to retain people. The system is being bled of highly qualified nurses because there are better terms and conditions abroad and just retaining nurses in the system is difficult because of the poor conditions and because how overstretched and how stressful the situation is. And then because the remuneration too is not as it should be.

IMC:Do you feel nurses have a voice to speak out about these issues?
I think there’s a huge potential for nurses to speak out and yet we don’t seem to the culture seems to be ‘just get on with it’ and that I suppose that will change slowly.

IMC:What’s your response to the proposed rally in June?
Well I see it as a move in the right direction and I’m glad that the pay issue is being addressed and that the people at the top will be made aware at the frustrations and the shortcomings that there are for nurses. Whether the venue (Croke Park) is appropriate is debatable but at least it will be a step in the right direction and we’ll take it from there.

IMC:Whats your opinion of the INO?
Well we’re told that our union is doing most for nurses, that’s its very instrumental in getting things done and yet you wonder, as I sit back here now I ponder over what’s been done over the last number of years? why are the frustrations there that are there? And you know are they really being heard and is there more that could be done? Because just coming from conference I’m just wondering why are terms and conditions for nurses so appalling and why have we left ourselves in such a vulnerable position?

I suppose one has to exercise a degree of scepticism and I you would hope that our union officials and those at the top are genuine and have the best interests of nurses at heart. It concerns me greatly that because were a body of women, you know is this something to do with it. Are we just easily put off, easily appeased are we easily satisfied? And I couldn’t see for the life of me if it was the same, if this was a male run service that we would have the conditions that we have. Were just being seen as handmaidens and easily satisfied and given token gestures.

author by John - dunaree2000publication date Mon May 08, 2006 13:15author address author phone Report this post to the editors

Surely the type of health service we have should be the one that achieves the best results for patients in terms of actually curing them of their illnesses? Would you agree with that statement? Would you further agree that, in order to ascertain which type of health service achieves the best results, it might be useful to study the health outcomes of different countries with different types of health service and compare the results? You are obsessed with trying to promote the view that a state-run health service achieves the best results. You disparage all those who believe that there is a role for private sector involvement in the health service. But, you offer no evidence to support your view that giving the state a monopoly of healthcare provision would actually lead to improved outcomes for patients. Why don't you do some proper research instead of repeating tired old left-wing cliches? If you did, you would discover the following:

(1) Mortality rates in Ireland have fallen more in the past decade than in any other EU country.

(2) In 1986 mortality rates in Ireland were almost identical to those in Scotland. By 2005
mortality rates in Ireland were almost 20 per cent lower than those in Scotland. In Scotland
there is very little private sector involvement in the health service as compared with Ireland.

(3) Excluding Scotland, the country with the highest overall mortality rates and the highest
cancer mortality rates in the old EU-15 is Denmark, which has an almost completely
state-run health service and which prides itself on the fact that private healthcare is
more or less forbidden.

(4) In the late 1980s, just before the collapse of communism, mortality rates in eastern
European countries like Hungary, Czeckoslovakia and Bulgaria were almost twice as
high as in western European countries.

If all this is news to you, then it proves you haven't been doing any proper research on the subject of what type of health service provides the best results. If not, why not? Perhaps you don't care what type of health service provides the best results, but simply want a socialist health service for ideological reasons rather than for any benefits it would bring patients?

author by Topperpublication date Mon May 08, 2006 14:44author address author phone Report this post to the editors

Excellent report, thanks for that, and of course all sane people will ignore John and his childish rantings - of course you understand the needs of the health system better than the people who work for it, John! Sure they're only women anyway, who cares what they have to say!

author by Seán Ryanpublication date Mon May 08, 2006 16:46author address author phone Report this post to the editors

I didn't enjoy your article Annie. Eventhough you did an excellent job writing it.

Tis one thing me considering our health 'service' to be in a state of emergency, I don't know my colon from my ulnar, so I see an emergency in the health service as being confined to me and my like, ie. the poor.

When experts like the nurses declare an emergency, and our Governmental health department, headed by the poster-child for the health services offers plattitudes, accusations and lip-service as answers - well that scares the hell out of me.

I would suggest that the nurses and those associated would join with the general population and force those in power to practice 'active listening' and to take on board and act on what has been said and is being said.

Another suggestion - continue to publish here, you'll get to say what it is that you want to say.

This whole country's coming apart at the seams.

The sooner we fix it, the sooner we fix it.

author by dunkpublication date Wed May 10, 2006 17:42author address author phone Report this post to the editors

Alternatives to Neoliberalism
Conference back in march : some shocking things happening right now

health in ireland
speaker : maura o'connor
http://radio.indymedia.org/uploads/lib3-health.wav
10.21 mins

Related Link: http://www.indymedia.ie/article/74802
author by Shipseapublication date Thu May 11, 2006 09:41author address author phone Report this post to the editors

John's post above is a classic example of how a little information in the wrong hands can be a dangerous things. He talks about 'proper' research and yet the wild conclusions he extrapolates from the data quoted are as unprofessional a use of research data as you are likely to find. He shows no correlation whatsoever between the mortality rates in the countries mentioned and the private/public nature of the health services in those places. In fact, in both Denmark and Scotland there are critical dietary , alcohol and other social problems which are completely ouside the control of their health services although it certainly falls to them to deal with the consequences. In all probability, if it were not for their public health services, their situation would be infinitely worse.

As to Irish mortality rates, again you have to look at who is collecting the statistics: PDs and FF. This government is one which has a deliberate policy of refusing to collect accurate, comprehensive data on social issues. They understand, you see, that if you know the size of a given problem it becomes much more difficult to justify inadeqaute funding for it. To take just one example. In calucalting the effects on health of people living, say, near an incinerator, the rates of death and illness in that area are seriously distorted by the fact that the place of death is said not to be in the area in which the person lives, but in the place in which they finally die: e.g. the hospital which is often miles away. By this sleight of hand agencies such as the Environmental Protection Agency will dishonestly assert that the impact on the locality is less than they really know it is. Statistics for people with disability is another example: the government does not include any person on it's database of people with disability who has ASD, and then it claims that notions of an epidemic of autism are exaggerated, that the figures dont support that fact. One cherry picked, senior psychologist, responsible for services in the west of the country said to one parent that he 'didn't want it getting about that there was an epidemic of autism'.

Speaking as a person whose father died of MRSA in an Irish hopsital a few years ago, I'm sure that like many others in the same position, the spectacle of Harney's arrogant and dismissive grandstanding about the disastrous state of the health service is enraging. Just a few weeks ago, my elderly mother fell at home. She injured herself in several places, including her head. Eventually, picking herself off the floor she telephoned her GP who, without any offer to come and see her, advised her to call a taxi and take herself to A&E. This to a woman of 81 years of age. Is that not a clear cut case of professional negligence? When she finally got to the hospital, the nurses were so overstretched, she had to wait three hours in the pblic waiting area before anyone could ask exactly why she had come. By the time one of us was able to get there she had been sitting on a chair in the A&E corridor for a further three hours. Three hours after that again she was finally seen by a doctor. Throughout, she was badly shocked, in pain and unable to lie down or rest in any way. A&E is now a dangerous place to go if you have suffered any kind of medical trauma. There was no question of admitting her, they said, despite the risk of stroke and other factors which clearly indicated that she needed to be monitored for a couple of days at least. And bad though it was, this experience is mild compared to the things others have suffered in A&E.

A few months ago, I was refused treatment at a major Irish hospital on the erroneous grounds that my condition predated the point at which I had taken out insurance. The irony is that the insurer made strenuous attempts to persudade the hopsital that they would cover the treatment. And who was making the decision to refuse my admission? A consultant? A doctor of any kind? No ladies and gentlemen, it was the credit controller - a man with no medical qualifications whatsoever. Every patient admitted to that well-known hospital is first and foremost referred to this person. That is the priority - the reality of private health care.

Does Mary Harney not yet realise that every time she and her fellow PDs open their mouths to speak, they offend huge swathes of the population? That their best electoral strategy would be to shut the fuck up and stay out of sight? Harney and her husband (who is the real Taoiseach of Ireland) are rampant ideologists, running riot over the fabric of Irish society, gorging themselves and their friends on our taxes. Subsidies available on demand for the wealthy; vulgar incivility and contempt for those whose money they are in control of and who are being used to create the conditions that make it possible for the likes of Harney to thrive. Of course they are not entirely alone: when you read that Trevor Sargent, the leader of the Green Party for Christ's sake, is poised to collect his SSIA dividends, (that's electoral bribe to you and me) you begin to understand how sick Irish politics have become. Nurses, people with disability, environmentaly endangered communities - we've all begun to join the dots at last. It's time to put these bastards on the run.

author by Dr Universal Healthcarepublication date Thu May 11, 2006 16:59author address author phone Report this post to the editors

Excellent article. But just to address John's misleading claims based upon 'international experience' (experience from some other dimension/planet it seems).

Real world non-selective international experience shows that healthcare systems with a large degree of private for-profit healthcare cost more than those with public healthcare along with having the worst outcomes.

For instance look at that nation which has the highest level of private healthcare; the US, its the most inefficient in that it spends the most for the worst outcomes! I wonder why John dunaree omitted that one...

Also, the extra cost is ancillary to privately run for profit hospitals and those built by the private sector (in particular see the disastrous PFI in the UK).

Between the late 80s and the early 90s about 6,000 beds were cut here. This has had an effect on the comparison of care and resultant outcomes in the last twenty years, as has the somewhat healthier lifestyles led by many (I refer to the lack thereof in the Scottish example and the lack of a like for like, private in comparison to public study within a nation provided by john handedly I provide them below ;) ) The extra spending in healthcare has tried to address this infrastructural gap but is being diverted into expensive and unnecessary private hospitals and delivery. The Irish system also includes figures for child services and mental health etc which other systems do not so the actual figure is even lower in Eurpoean terms. Despite this lack of funding, the public hospital sector here is far and away more efficient in comparison to the more costly private sector. One would think that the latter is therefore surely the logical destination of improvement.

An even cursory look at international statistics* and many different studies** show the above to be the case.

Private for-profit hospitals avoid the riskier unprofitable procedures and go for riskier procedures (high cost operative) if they're more profitable, for instance the US treat heart disease surgically as opposed to medically bot achive the same result but happily the former is more profitable for the for-profit sector.
As are routine procedures which the for-profit cream of at a cost...
...the wondrous private ophthalmic treatment in UK from Netcare
'Faults' of NHS provider
http://www.channel4.com/news/special-reports/special-re...=1294

With private for profit healthcare we pay more for worse outcomes. But the purpose of this militant- business-union, PD led, government is to deliver the assets of the state to corporations that're managed in interests at variance with the public's.

Fair play to the nurses!

-------------------------------------------------------------------------------------------------
*See the total expenditure and related outcomes etc from the World Health Organization from the below
http://www.whc.ki.se/index.php
http://www.whc.ki.se/files/whydownload.php
“The World Health Organization and the Karolinska Institute in Sweden have published figures showing the United States to have worse longevity and infant mortality rates than many other countries that are spending far less on healthcare. Data indicates that the British treat heart disease medically and the Americans do so surgically, addressing the same incidence of heart disease and producing the same mortality results. We spend far more to do it. Should we be searching for a better way? Perhaps we, as design professionals, should be questioning the number of operations being done at our client's institutions.

Each year, approximately $1.3 trillion is spent on healthcare in this country. That's 15 percent of our gross domestic product. U.S. healthcare costs are double that of any other industrialized nation. We spend about four times as much on healthcare as we spend on national defense, and about two times what we spend on education. The average expenditure is more than $4,000 per person a year. Those over 85 years of age—the fastest growing age group in our country—spend an average of $20,000 per person a year.”

**
Some studies from respected medical journals such as the New England Journal of Medicine, The Journal of the American Medical Association, CMAJ....

The high costs of for-profit care
http://www.cmaj.ca/cgi/content/full/170/12/1814

Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis
http://www.cmaj.ca/cgi/content/full/170/12/1817

Costs of Care and Administration at For-Profit and Other Hospitals in the United States
http://content.nejm.org/cgi/content/short/336/11/769

Conclusions Administrative costs as a percentage of total hospital costs increased in the United States between 1990 and 1994 and were particularly high at for-profit hospitals. Overall costs of care were also higher at for-profit hospitals.”

Effect of the Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation
http://content.nejm.org/cgi/content/short/341/22/1653

Conclusions In the United States, for-profit ownership of dialysis facilities, as compared with not-for-profit ownership, is associated with increased mortality and decreased rates of placement on the waiting list for a renal transplant.

The Association between For-Profit Hospital Ownership and Increased Medicare Spending
http://content.nejm.org/cgi/content/short/341/6/420

ConclusionsBoth the rates of per capita Medicare spending and the increases in spending rates were greater in areas served by for-profit hospitals than in areas served by not-for-profit hospitals.”

Going for the gold: the redistributive agenda behind market-based health care reform
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retri...tract

Can markets give us the health system we want?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retri...tract

When Money is the Mission — The High Costs of Investor-Owned Care
http://content.nejm.org/cgi/content/short/341/6/444

"Market medicine's dogma, that the profit motive optimizes care and minimizes costs, seems impervious to evidence that contradicts it. For decades, studies have shown that for-profit hospitals are 3 to 11 percent more expensive than not-for-profit hospitals2,3,4,5,6,7; no peer-reviewed study has found that for-profit hospitals are less expensive.... "

For-Profit-Hospitals Costlier and Less Efficient
http://www.pnhp.org/news/1997/october/forprofit_hospita...s.php

"Bureaucracy costs jumped sharply when non-profit and public hospitals were purchased by for-profits. If all U.S. hospitals became for-profit, hospital paperwork would rise by $14.8 billion annually," noted Woolhandler. She continued: "It's a myth that for-profit hospitals are efficient. They save money by laying off nurses, then hire consultants and bureaucrats to figure out how to avoid unprofitable patients and maximize revenues. For-profits increase costs, decrease care, and generate windfall profits, like the $359.5 million pocketed by Rick Scott of Columbia/HCA in 1996. They're fat and mean." [New England Journal of Medicine, March 1997]

-------------------------------------------------------------------------------------------------------

Few trends could so thoroughly undermine the very foundations of our free society as the acceptance by corporate officials of a social responsibility other than to make as much money for their stockholders as possible.
— Milton Friedman

Of all the forms of inequality, injustice in health care is the most shocking and inhumane — Martin Luther King

author by Shipseapublication date Thu May 11, 2006 17:53author address author phone Report this post to the editors

The Irish Examiner today reported the following facts and statistics:

Ireland has one of the worst outcomes for stroke patients among 11 countries in Europe and also in Canada

One in five sufferers in ireland died within 180 days of a stroke. All Germans survived this period. In Finland, 4% died.

Ireland ws found to have the worst overall record, with 67% of stroke sufferes dead or dependent after six months.

The name of the study is not given in the report but it can be read in the Journal of Neurology, Neurosurgery and Psychiatry.

Other data about strokes:

Around 10K people suffer stroke each year in Ireland, leading to about 2,500 deaths

Stroke accounts for more deaths than breast cancer, lung cancer and bowel cancer combined

More women die of stroke than of breast cancer

30,000 people live with residual disability from stroke

author by John - dunaree2000publication date Thu May 11, 2006 23:31author address author phone Report this post to the editors

Three days since I posted and nothing whatever by way of response from those who initiated this thread. Why the silence? Among the others who did respond the silliest was the one who claimed that mortality statistics in Ireland are collected by FF/PD politicians. No they're not. Don't be daft. They're collected by the Central Statistics Office and published every quarter. The CSO is drawn from the entire population and its statisticians comprise every shade of political opinion from right to left. No one has attempted to argue with or contradict the four points I made. One poster implicitly acknowledged that they were correct but blamed the high mortality rates in Denmark and Scotland (much higher than in Ireland) on bad diet and alcohol consumption rather than the fact that these two countries have almost entirely public health services. It is of course a well known fact that no one drinks alcohol in Ireland.

author by Dr Universal Healthcarepublication date Fri May 12, 2006 02:55author address author phone Report this post to the editors

No one has attempted to argue with or contradict the four points I made.

Again John wades in with his selective (if humourlessly blinkered) approach while ignoring the mass of empirical evidence to the contrary with respect to worse mortality figures in private for profit and much higher unnecessary costs.

{as to a child} Perhaps you might want to try some studies within a nation so as to try and limit everything from diet, religion, income inequality etc from your ridiculous 'argument'. Or even addressing decades of extensive research documentation which highlight the same, or anything which quite obviously "argue with or contradict " your points groan. {/as to a child}

For an example of the excessive costs incurred by private care here look at the shocking example of dialysis at Beacon clinic, and indeed the higher mortality study I provided earlier.

As is well known at this stage, international health statistics show that the best outcomes at the lowest cost are those from free-at-the-point of access, universal (in the main) public healthcare systems. So I agree that the type of health service we have should be the one that achieves the best results for patients in terms of actually curing them of their illnesses and also at the lowest cost as shown by international experience....

Effect of the Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation
http://content.nejm.org/cgi/content/short/341/22/1653

Conclusions In the United States, for-profit ownership of dialysis facilities, as compared with not-for-profit ownership, is associated with increased mortality and decreased rates of placement on the waiting list for a renal transplant.

Also
Infant mortality rates among industrialized nations
http://www.mchb.hrsa.gov/mchirc/chusa_04/pages/0405iimr.htm
“Although the U.S. has greatly reduced its infant mortality rate since 1965, the nation ranked 27th among industrialized nations in 2000. ”
- Infant mortality rate, deaths per 1 000 live births
http://www.oecd.org/dataoecd/7/41/35530083.xls

http://www.monbiot.com/archives/2005/10/11/better-off-w...-him/
Cross-National Correlations of Quantifiable Societal Health with Popular Religiosity and Secularism in the Prosperous Democracies: A First Look. The Journal of Religion and Society, Volume 7.
http://moses.creighton.edu/JRS/2005/2005-11.html

author by John - dunaree2000publication date Fri May 12, 2006 10:33author address author phone Report this post to the editors

You still haven't answered my four points. All your references are to the United States, not Ireland. Ireland's health service is nothing like that in the United States. What has the United States got to do with Ireland? Apart from having a totally different type of health service, the United States also has 50 million immigrants from largely third world countries like Mexico, Cuba, Haiti etc. The last time I checked Ireland was in Europe. It would therefore be logical to compare Ireland with other European countries rather than the United States. That's what my initial post did. You still haven't answered it. The bottom line is this. Ireland, Scotland and Denmark are similar in almost all health-related respects. They are broadly similar in size, in population, in GDP, in climare, in diet, in levels of alcohol and tobacco consumption. The only major difference is that both Scotland and Denmark have almost totally public health services while Ireland's is part-public part-private. If your argument was correct, then Scotland and Denmark would be reducing their mortality rates by more than Ireland is. But they're not. In the past two decades Ireland has reduced its mortality rate by far more than either Scotland or Denmark. Can you explain this? You have to admit that there must be at least a possibility that its due to their health services not performing as well as Ireland's. I think the least you should do is investigate that possibility before inflicting Scotland's and Denmark's type of health service on Ireland. Simply calling it 'childish' to raise this point is pathetic. You're the one proposing a Danish-type health service in Ireland. Give me a satisfactory explanation as to why Denmark's mortality rates are so much worse than Ireland's before you expect me to buy your proposal.

author by pat cpublication date Fri May 12, 2006 10:48author address author phone Report this post to the editors

Why do you think private hospitals would be better? They have to pay out a dividend to their shareholders so there is less money available to be ploughed back into resources. In 2004, the Blackrock Clinic alonepaid out €3.3 million to its shareholders. Thats in addition to fess paid to the consultants, many of whom double as shareholders.

author by seedotpublication date Fri May 12, 2006 11:14author address author phone Report this post to the editors

When I had a look I found that Irish mortality rates were higher than the European Average (Eur-A) for every group except males between 30 and 55.

Graphed here

Overview here

These are the 2004 figures from the World health organisation. So what figures are you talking about?

author by John - dunaree2000publication date Fri May 12, 2006 12:49author address author phone Report this post to the editors

At last! An intelligent comment. The one from seedot, that's worthy of reply. This is the way these things should be discussed, not by hurling insults.My original post made no mention of the EU-average, but referred specifically to Scotland and Denmark. If you check the WHO figures, you'll see it confirmed that Irish mortality rates are indeed now much lower than in both those countries, having been much higher than in both of them in the early 90s. Your point about Ireland's mortality rates still being higher than the EU-average acording to the WHO figures is valid. However, my reply is as follows. WHO figures are somewhat out of date. If you look up the WHO mortality database, you'll find the latest figures for Ireland are for 2001 (at least, the last time I checked a week or so ago they were). But, the figures published by Ireland's CSO go up to 2005. These show a dramatic improvement in Ireland's mortality figures in the past 5 years. The reality is that for decades up until the late 90s mortality rates in Ireland were the highest in western Europe. But, starting in 1999/2000 they started to drop dramatically. This is not yet fully reflected in the WHO figures which are somewhat out of date. The latest CSO figures show Ireland's mortality rate (age-standardised) falling from about 800 per 100,000 around 2000 to about 635 per 1000,000 in 2005. That represents a transition from around 15 per cent above the EU-25 average around 2000 to virtually level with the EU-25 average by 2005. Feel free not to take my word for it, but to look up the CSO figures yourself. Eventually the WHO database will include the up-to-date CSO figures (although international organisations like that often lag years behind). Another interesting comparison is between the Republic of Ireland and Northern Ireland, which also has an almost totally public health service. Up until 2000 mortality rates in the Republic were consistently about 8 per cent higher than in Northern Ireland. A number of reports (e.g. the All-Ireland Cancer Report) highlighted this fact, but using data that only went up until 2000. Naturally, and with some justification at the time, the comparatively better performance in Northern Ireland was used as an argument in favour of the Republic having a similar type of health service to that in Northern Ireland. However, since 2000 mortality rates in the Republic have fallen by twice as much as in Norhern Ireland, so much so that by 2005 the mortality rate in the Republic was 2 or 3 per cent lower than in Northern Ireland. Again, feel free not to take my word for it but to look up the CSO figures and the Northern Ireland equivalent for yourself. I am reliably informed from inside sources that an official report will be published later in the the year highlighting this fact. Maybe the debate should be adjourned until then. Expect the FF/PD propaganda machine (of which I'm not a member) to go to town on it when it is published. So, don't say you weren't warned. Simply trying to be helpful. Regretfully, I will not be able to continue this debate until next week, as now off to sunny Portugal for a long weekend. And before anyone starts talking about the idle rich, I should say that, thank's to capitalism in general and Ryanair in particular, the return fare is about 50 euros.

author by Brian Borupublication date Fri May 12, 2006 15:24author email mango2002 at imagine dot ieauthor address author phone Report this post to the editors

The problems with the health-service have less to do with resources than with outdated practices. Specifically:

A: Consultants rejecting a new contract to confine them either to public or private practice as in England. At present, they are allowed to serve both sectors. So they are not devoting themselves to just one or the other. Public-patients suffer as a result. Harney is trying to remedy this but as usual the consultant "No Brigade" are moraning again.

B: Nurses working-hours ending a 17:00pm. Too early.

C: Drunks gratuitously turning up drunk out of their brains at A+E every weekend. They should be redirected to drunktanks and fined heavily as a warning. It is a total disgrace that the elderly have to compete for beds with these people.

Health-spending is now higher per capita than France. It is risen from €3 billion in 1997 to €12 billion now, and there are 40,000 medical staff. The problem is the tendency of the medical staff in the public-sector to block all reforms intended to fix this mess, or to use the govt's desire for reform to try to extract concessions on pay etc. This has to stop. If necessary give the public a referendum on reform plans to bring maximum pressure to bear on these people.

author by Dr Universal Healthcarepublication date Fri May 12, 2006 16:39author address author phone Report this post to the editors

John lets use some non-selective statistics. I've provided a link to this already in my previous post but the site below has an easy explanation.
(note that the percentage of children surviving to age 5 reflects the health of the whole population and that in high-income oecd nations 99.4% of children survive. Also note that Denmark is well ahead of Ireland here )

-------------
The World Health Chart program
http://www.whc.ki.se/index.php

And
Human Development Trends 2005
http://www.gapminder.org/index.html#softwares
http://www.gapminder.org/index.html#pdfs

Infant mortality rates among industrialized nations
http://www.mchb.hrsa.gov/mchirc/chusa_04/pages/0405iimr.htm
“Although the U.S. has greatly reduced its infant mortality rate since 1965, the nation ranked 27th among industrialized nations in 2000. ”
- Infant mortality rate, deaths per 1 000 live births
http://www.oecd.org/dataoecd/7/41/35530083.xls

See from the link below

Infant deaths and neonatal deaths (where Ireland is the second worst remember the point above about the percentage of children surviving to age 5 reflects the health of the whole population...... )
http://www.euro.who.int/eprise/main/WHO/Progs/CHHDEN/bu...23_17
---------------

Now taking in the complete picture I've outlined above, (as opposed to your selective approach -which is kind of similar to the rights use of GDP statistics which don't take income inequality into account)Consider those other factors I included in my previous post on Denmark (you know where you assumed I failed to address your points..) . A study between regions and disciplines can not be methodologically sound unless adjusted for extraneous factors studies taking into account factors: age, sex, ethnicity, income, education, religion, crime, drug taking etc etc
So a factor, the unusually high prevalence of smoking in Denmark particularly amongst women

----------------
Increased mortality among Danish women: population based register study
http://bmj.bmjjournals.com/cgi/content/full/321/7257/349

...At the beginning of the 1990s, Danish women had the highest prevalence of smoking in the 87 countries in which smoking among women was recorded.2 The life expectancy of Danish women is shorter than that of women in other western European countries.3 ...
[.....]
...Danish life expectancy cannot be improved greatly without a substantial reduction in tobacco consumption. Furthermore, the present high proportion of smokers among adult Danes will continue to affect the mortality pattern far into this century. Clearly, if it were not for tobacco, Danish women would have experienced a considerable reduction in mortality....

Long term mortality trends behind low life expectancy of Danish women
http://www.google.ie/url?sa=U&start=20&q=http://pubheal...P7_Uc

• The high risk of dying among Danish women is associated
with being born between the two world wars.
• We suggest that future studies focus on differences in living
conditions between the high and low risk generations.
• The framework of age-period-cohort modelling presented in
the study may be useful for analysis of long term mortality
trends in other countries.

[.....]
A standard interpretation of a cohort effect on mortality in adult life would be an influence from conditions in fetal life. However, the missing cohort effect for men suggests the
importance of factors occurring later in life and affecting women and men differently.
Studies on the present causes of death in Danish women show that tobacco related causes play 11 an important part. This fits well with the fact that our high risk generations of women were the first Danish women with 12 a substantial proportion of smokers at the age of 20.
Smok-ing, however, also started early in the later generations of 13 Danish women.
Among Danish men,the majority in both the 1920–1935 and previous generations were smokers at the age 12 of 20. Our high risk generations of women were in part the 5 mothers of the baby boomers, and the women most heavily hit by the epidemic of sexually transmitted diseases in the mid-14 1940s. These generations of women further more entered the 3 Danish labour market in massive numbers in the 1960s.


also see

Highlights on health, Denmark 2004
http://www.euro.who.int/eprise/main/WHO/Progs/CHHDEN/bu...310_3
For lung cancer, Danish men are following the downward trend in Eur-A, while Danish women are following the upward trend in Eur-A. Yet Danish women have levels of mortality from lung cancer and from chronic obstructive pulmonary disease that are almost three times the Eur-A average; deaths from the latter cause have dramatically increased in the last 15 years.
-------------------

I have already provided a peer-reviewed study published in a respected medical journal (to go along with scores of studies across decades) which shows the higher cost of private healthcare in comparison to public non-profit healthcare within a nation taking into account variations within that nation. Many others show the same in countries that have recently introduced private for-profit healthcare. You have not addressed this.
Nor have you addressed similar studies showing the worse outcomes from for-profit healthcare.

I used dialysis and unnecessary (if profitable - very do no harm I'm sure...) heart surgery earlier as an example of paying more for worse outcomes in private for profit but there's also evidence of worse outcomes in many other areas such as with cataract surgery in private clinics (I'm aware of terrible cases in both the UK and Canada) and in other farmed out and in many cases unnecessarily duplicated areas.

And John, no matter how you try and restrict it this debate is about the efficiency and outcomes of public versus private irrespective of international differences. Your preference for the non-inclusion of the US in this debate is understandable to your argument but it is a developed Oecd industrial nation and should be included. I'm also thinking of Harney's launching a private health conference recently with American for-profit healthcare companies such as GE (general electric) healthcare and welcoming the highly expensive likes of Comfort keepers in, after the old running down of the more efficient public home help service here. http://www.indymedia.ie/article/75642

for example Australia's exerience of health 'reform'
see
Australia's Experience with Health Reform: Are there lessons for Canadians?
http://www.albertaconsumers.org/WYNNELP2710.pdf

Finally what I find strange (well not really) is why are you being so selective in your reasoning and then assuming that your points have not been addressed when they most certainly have been? As seedot has pointed out 'Where are you getting your figures John?' and why are you ignoring those others have raised?

author by Shop Stewardpublication date Fri May 12, 2006 17:52author address author phone Report this post to the editors

Ok, lets assume (cos I can't really be bothered to check the figures) that Ireland's mortality rates HAVE actually improved by more than Scotland's and/or Denmarks over the last twenty years. Good. A lot done - more to do....... So what conclusion can be drawn? It does NOT follow that the reason for this must be the mixed public/private health sytem we "enjoy" here. It could also be, for example, the pretty major increase in government spending on health here in recent years compared to the absolute dearth of spending in the 80's. I don't know - i'm not an epidemiologist or a statistician. But your case is unproved, John. At best.

BTW, Ireland has a much higher rate of cystic fibrosis than either Denmark or Scotland. Your logic would suggest that this is due to the mixed public/private system too???

author by John - dunaree2000publication date Fri May 12, 2006 20:41author address author phone Report this post to the editors

Excellent post, Dr Universal Healthcare. Unfortunately I'm now out of the country and using my decrepit old laptop from my hotel room. So, I'm unable to look up all your links. Will be happy to do so on my return on Tuesday. However, I have been able to look up the link to the WHO/Europe website, the one you gave for the infant mortality figures. These confirm what you say. Out of about 20 or so European countries Ireland had the second worst figures for infant mortality rate. Here are some of them (not all for reasons of space):

Croatia 7.0 (infant deaths per 1,000 births)
Ireland 6.0
Belgium 5.6
U.Kingdom 5.2
Netherlands 5.1
Portugal 5.1
Greece 5.1
Switzland 5.0
Italy 4.7
Germany 4.3
Austria 4.1
Sweden 3.7
Finland 3.0

At this point, its 15-love to you.

But, if you look at the table in that same website you'll see that it clearly states that the Ireland figure of 6.0 is for the year 2001 (as are many of the others, although some are for 2002).

But, that's my whole point. I've never disputed that up until about 1999/2000 Ireland's mortality figures were much worse than other European countries. But, crucially, since around 2000 they've shown a dramatic improvement which is not yet fully reflected in the figures published in the websites of international organisations, which are invariably years out of date. If you want to know how Ireland's infant mortality rate has fared since 2001, you need to look up the website of the CSO in Ireland. I've just done so and this is what it gives (the figures are in the Annual Summary of Vital Statististics or Quarterly Summary of Vital Statistics):

for 2001, the CSO gives a figure of 5.8 for Ireland's infant mortality rate(close enough to the figure of 6.0 given in the WHO website for 2001)

for 2002, the CSO gives a figure of 5.1

for 2003, the CSO gives a figure of 5.1

for 2004, the CSO gives a figure of 4.9

for 2005, only the first three quarters' figures are available - these are:

for 2005 quarter 1, the CSO gives a figure of 4.2
for 2005 quarter 2, the CSO gives a figure of 4.6
for 2005 quarter 3, the CSO gives a figure of 3.1

the average for the first three quarters of 2005 is 4.0 - I believe the figures for the final quarter of 2005 are due out before the end of May

So, you can see that Ireland's figure is coming right down, going from being the second worst in 2001 to among the best in 2005. No doubt some will accuse me of making these figures up. But, you are obviously an intelligent man, Dr Universal Healthcare. So, while I sun myself here in Portugal over the weekend, why don't you look them up in the CSO website yourself and confirm for our more cynical posters that these figures are indeed correct? And, if I can find them out so easily, I don't think the FF/PD propaganda machine will have much trouble uncovering them before the next election campaign. Before you ask, yes I have looked up the websites of individual countries to check out how their infant mortality rates have changed since 2001 and I can confirm that none of them show anything like the improvement recorded in Ireland.

author by Dr Universal Healthcarepublication date Sat May 13, 2006 15:51author address author phone Report this post to the editors

An interesting if usual angle John. But I understand how compromised you are in your Portugal sojourn and that this must have understandably prevented your running of the World Health Program or even the Human Development Trends 2005 etc– you know from the pool side laptop (as an aside; I use webcafes whilst travelling myself, although installation can be a problem. Although it has to be said that this does not cover your avoidance of points raised in response to your initial contribution - all prior to your holiday of course...)

But if you had succeeded in applying yourself yesterday, I'm sure your superior intellect would have seen that say, the World Health Program ( to use just one of 'the missed') is of course not up to date in every nation as that is practically impossible in this area. However it and worldwide human develpoment statistics shows a direct linkage in health outcomes to the increase in wealth of a nation (with a running time scale – eh Ireland not excluded, nor is infant mortality or any other selection you'd like to pick.) and that used in a world health sense picking one statistic outside this or any other is, well pretty stupid, hence my post.....
I'm sure that with that prior knowledge, you wouldn't have gone to the trouble of writing an entire post centred on infant mortality statistics from the CSO ( see http://www.cso.ie/releasespublications/pr_bdm.htm ) whilst ignoring everything else from this and indeed other posters contributions.
Unsurprisingly the recent data of the last four years or so conform to, this but (yet again) all of this line of argument is, completely, utterly, and conveniently, outside an empirical, real world, public versus private healthcare debate - and indeed come to think of it now, as is practically all of your points and avoidances!

Finally, I suggest you read the Shop Stewards' succinct and very apt post. To use your tennis analogy, I fear he may have just grand smashed you.

author by John - dunaree2000publication date Sun May 14, 2006 13:37author address author phone Report this post to the editors

Dr Universal Healthcare. It was YOU who raised the subject of infant mortality rates, not me. YOU did so in your previous post where YOU claimed that Ireland's infant mortality rate was the second worst in Europe. It was YOU who provided a link to the WHO website that contained the figures YOU were using to support this claim. I merely looked up YOUR link, spotted straight away that the figures referred to the year 2001 and then, because I have a better instinct than you for doing up-to-date research, looked up the CSO website to obtain more up-to-date figures. These show Ireland's infant mortality rate coming right down in the years since 2001. Surely you would agree that proper statistical research and the search for truth requires using the most up-to-date figures that are available? What sort of researcher would try to base an argument on figures that are five years old when figures from a year ago are now becoming available? You certainly don't make any attempt to deny the infant mortality figures I gave. You also seem to be rather annoyed that Ireland's infant mortality rate has come down so much in the past four years. Surely it should be a matter for rejoicing? I'm sure that when I look up your other website links on Tuesday, they will also turn out to be using out-of-date data.

author by Dr Universal Healthcarepublication date Mon May 15, 2006 00:08author address author phone Report this post to the editors

John you are correct (if hardly astute) in your assertion that I raised the infant mortality statistics but eh I think you need to read the rest of my post and it's trust...

However outside your reading ability, I think your dislikeable tone throughout this site continues in your tagged on assertion that I'm in some way 'annoyed' at this! I have to say I'm appalled at that accusation - albeit it is indicative of your posting style.

But putting it aside, I think even you should be able to see from my second last post how Ireland's overall statistics improved in line with it's increase in wealth. Now why would I highlight one section (as I did in >Denmark< for instance....) and then contradict it in the wider statistical research I provided?
I fear John in your attempt to constrict what is (to repeat yet again) a debate on private versus public healthcare you have fallen into a repeated fallacy of Composition ( http://en.wikipedia.org/wiki/Fallacy_of_composition ) in this case it's the the infant mortality statistics, previously it was a selective ascribing of values to (favourable to your argument) systems of no consequence to the matter at hand and without any reference or link towards empirical peer reviewed research to back up your arguments. You then repeatedly and arrogantly ignore and even dismiss! relevant points raised which contain the same.
Again I suggest you read Shop Stewards' post.

Also this is pretty stupid “What sort of researcher would try to base an argument on figures that are five years old when figures from a year ago are now becoming available?”

But finally, before you respond again I hope you will not include similar trollish accusations as before.

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