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Democratic Deficit

category national | consumer issues | opinion/analysis author Friday January 14, 2005 21:14author by Sean Crudden - imperoauthor email sean at impero dot iol dot ieauthor address Jenkinstown, Dundalk, Co Louth.author phone 087 9739945 Report this post to the editors

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
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.

Related Link: http://www.iol.ie/~impero/
author by Liam Sheppardpublication date Sat Jan 15, 2005 03:18author address author phone Report this post to the editors

Hi Sean

All the health service executive really want is a good pension for when they retire.

author by Seanpublication date Sat Jan 15, 2005 18:47author address author phone Report this post to the editors

Howya Liam?
Really I think your comment is a little cynical. I have just looked up on the web the names of the people on the interim Health Services Executive and while I know next to nothing about any of them I suspect that some of the women, at least, on the board may prove to be good progressive and democratic advocates for the future.

author by Michelle Clarke - Social Justice and Ethics Pleasepublication date Mon Jan 17, 2005 22:57author address author phone Report this post to the editors

Sean, I wholly concur with what you have to say.

My parents were doctors, my father held the dispensary post, in a rural location.

Aged 12, I can recall the changes mooted and put into effect by Erskine Childers - Health. These changes required administration to put into effect and this administration blossomed forth to today. Now this administration has become a stranglehold and leads to gross inefficiency and considerable negative effect. (Pre-accident I was a secretary and know just how bungled administration can be).

A little history applies at this point. The Dispensary System came about in the 1800's for people of impoverished circumstances. The basics involved a mapping scenario and dispensary areas were allocated to appointed doctors who in turn worked for the Local County Council for a salary; a pension; the provision of a house and for 6.5 days per week.

In England, the route was for an overall free of charge service for patients. This was to apply to Ireland but the forces of a combined Church and Medical Profession dictated otherwise. Money was too lucrative and they knew they had the control. The outcome was the pre-1973 adapted dispensary system.

To me, in retrospect, these conditions were unfair and divisive. The salary and conditions did not reflect an equitable situation.

The trade off for the dispensary doctors was that they could 'see' private patients on dispensary time and dispensary property. Here one has that veil of secrecy that leads to an inner conflict for the doctors and leads to instability and insecurity.

The 1973 solution was about Equity but also 'Motive' to see medical card patients. The answer was called 'Fee per item'. It does not take a genius to grasp what happened. The dispensary system faded away; while fee per item placed hard-working and highly motivated General Practitioners to earn quite vast amounts of money.

This in turn left the higher level of the professions slighted financially. Meantime, this was all about a festering administrative body subdividing into bodies and lots of paperwork and people to oversee the paperwork and check the GPs were not overvisiting.

I ask who calls the Tune?
What is the motive financial reward or the humanity part of medicine, you speak about Sean.

I have had lots of illness in the last 12 years and quite strangely it may have been in the back to basic hospital in Zimbabwe that I felt most reliant on what I had been told.

You see in Ireland, the Insurance culture has numbed the medical profession, as has perhaps overpayment and under-involvement with their patients.

This kicks back into non interactive response to patients.

I can only say as a patient with short term memory problems, I need my 2 page list and background data to keep me informed.....I was relieved to hear one consultant say that this was a good idea...........I believe I ought to be able to go to my doctor and say I think this might be part of my programme to recovery, what do you think?.......and it work on that way.

Primary care ought to be free. Hospitals like Baggot Street ought to be used as a primary care base with GP's available at all times. (It ought to be an all inclusive 'no frills' service.

Think of this equation. I need monthly drugs - one location; Consultant to oversee and examine in another location, then to GP another location; then bloods required so another script; then to hospital; then back to GP and then back to Consultant.......not to add in low immuno problems and other infections.........All I can say being sick; the routinizes factor can never facilitate my recovery.

One more point: Research is vital but the motives are equally important. I like the saying 'beware of the vested interest'....

You ask why.......Because research in Ireland and particularly the medical profession/sociological/psychological profession are driven by the pharmaceutical companies.

I want to know why 'patient's like me' receive no response from universites like Trinity neuological etc. when I provide my unusual case history.........Education is surely about learning. I am saying not even the courtesy of a response. (Are they afraid of being sued?)

University research techniques proved to me that often the answer was known before the research was done.......those researched were expected to just comply with the academics thought function.


Enjoyed your article Sean..........The sea represents my mind......................or as I often say my abyss....

author by frankpublication date Tue Jan 18, 2005 15:49author address author phone Report this post to the editors

"All the health service executive really want is a good pension for when they retire".

Kevin Kelly probably doesnt. I'd say he looked after himself during his time in AIB during the 80s and 90s.

author by Michelle Clarke - Social Justice and Ethics Pleasepublication date Tue Jan 18, 2005 20:40author address author phone Report this post to the editors

Fully endorse your comment re. pensions. Civil servants appear to be always covered in this regard as are senior members of the Corporate sector unlike others who by life circumstances are have pensions on the low side of the list of priorities.

Todays news indicates a change in policy in some of the large employers in Ireland, with many people no doubt with mortgages and children facing unemployment..........Redundancies always play hell with pensions......Just remember the 1980's.

We have to be realistic and now cheaper labour sources in Asia; and Eastern Europe are real.


author by Michelle Clarke - Social Justice and Ethics - Pleasepublication date Fri Jan 21, 2005 21:37author address author phone Report this post to the editors

How come, without the backing of the Irish Medical Council, Blanchardstown hospital is to have a dramatic name change?

James Connolly Memorial Hospital short-circuited for convenience of ambulance drivers, staff and others to 'JCM'. Today, the change was being put into effect......the hospital is now known as Connolly Memorial.

Where is the logic? Has our present government become so 'socialist' averse that they have decided to obliterate our historically named buildings etc. The works of James Connolly are recognised internationally. He was shot after the 1916 Rising.

Why Govt choose the economic value as distinct from our very awe inspiring Political Culture......recognised worldwide.

What costs are involved? Who benefits? Is this another form of PR stunt????


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