Mary Harney did great harm to Irish health
See here for article on this in today’s Irish Times or below for unedited version..
Mary Harney has done great harm to the Irish people. Ever before she took on the health ministry, PD ideology (under her leadership) has had disproportionate impact on government economic and social policy. Their agenda has caused particular destruction since 2000 when the PDs began to meddle with health policy and from 2004 when Mary Harney became Minister of Health. For the last decade, the lethal recipe of Fianna Fáil’s high, but ineffective, public spending and the PD’s low tax policies contributed to the economic mess we are now in. And although the tax base was driven down and public spending increased, Irish social spending over the past 13 and a half years is still close to the bottom of OECD averages. There is a direct relationship between levels of social spending and health status and between poverty and health. With hindsight, policy under Harney as Tanaiste and PD leader, will be shown as harmful to Irish people’s physical and psychological health and to have bolstered a growing gap between rich and poor. Each year, 5,000 Irish people die prematurely because of the income inequality perpetuated by this government. It is not known how many people die prematurely due to the systemic inequality in the health system because no one bothers even trying to count these people’s lives. Not to mind how long it takes public patients to get into the system. Ever before Mary Harney became the Minister of Health, the PDs were busy putting their stamp on Irish health policy. The rejection of a common waiting list for all patients in public hospitals was heavily influenced by Mary Harney’s position at the cabinet table in the run up to the publication of the health strategy in 2001. This directly contributed to the continuation of the apartheid, two-tiered system of hospital care. The National Treatment Purchase Fund was another coalition compromise to the PDs in the run up to the health strategy launch. The changes to the Finance Act in 2001 and 2002 introduced by then finance minister Charlie McCreevy led to a multiplication of beds in for-profit hospitals and nursing homes. These small, unpublicised modifications were directly in line with PD policy of incentivising developers to enter the healthcare ‘market’ through generous tax breaks. Their developments were unplanned and unregulated and have resulted in the abuse of patients, nowhere so evident as in the Leas Cross nursing home. There is no doubt that Mary Harney opted to go to the Department of Health six and a half years ago with the conviction that she could reform the health system. However well-intended, Mary Harney made fatal mistakes along the way. Her first error was to drive through the establishment of the HSE in January 2005. Everyone close to the health system knew the HSE was not ready to go ‘live’. With an ex-banker as acting CEO, it had no clear plan, the structure was flawed and the strategy was without vision. Although Harney inherited the plans for the HSE from Micheál Martin, she drove them through and significantly handed over the vote (control of the health budget) from her own Department to the HSE. She also oversaw the last minute deal that was done with the unions. That ‘deal’ ensured nobody from the old health boards lost their jobs despite the logic that the amalgamation of dozens of health agencies into one should inevitably bring about rationalization, not duplication, of managerial posts. The Health Act, which established the HSE, considerably changed the roles of the Department of Health as many of its prior responsibilities were handed over to the HSE. Yet over six years on from the Health Act, under the consistent stewardship of Mary Harney, the Department of Health remains an unreformed, dysfunctional organisation, criticised by the government’s own reports. The long fought negotiation of the consultants’ contract is another of Mary Harney’s most high profile ‘reforms’. While the new contracts allows for longer working hours and team working, crucially it further enshrined the two tiered nature of the public hospital system, over pays Irish consultants 70% of whom continues to practice privately and publicly in public hospitals. Improvement in cancer care is an area where Mary Harney can and will get credit. Taking cancer care out of 30 unsafe hospitals and centralising it into eight specialist centres is an achievement. Despite progress in this area, contradictions remain – simultaneously to reorganising cancer care in public hospitals, government tax breaks were funding private for-profit hospitals to provide cancer care where ever they chose. National breast and cervical cancer screening as well as the HPV vaccine and planned colorectal screening are also to her credit. But fundamental to Mary Harney’s reform is her philosophy. Speaking at a conference last April, Mary Harney admitted she was ‘a fan of co-payments’ ie sharing the cost between the State and the patient. And she stands by her word. Despite all the data against them, Mary Harney has overseen the introduction of charges for prescriptions for people with medical cards and throughout her regime has systematically transferred costs from the State to the patient. The debacle of withdrawing medical cards from over 70 year olds demonstrated her determination to withdraw one of the last remaining vestiges of universalism in Irish healthcare. The so-called Fair Deal for nursing home care is another example of this policy of making people pay more for services which they were previously entitled to free or with a minimum charge. The international evidence in this area is clear – that good quality, accessible, universal health services, free at the point of delivery are better for everyone. The research also shows that complex systems which charge at the point of access put people off getting what may be essential care and certainly delays them getting in to care. Harney’s pet project of co-locating private hospitals on the grounds of public hospitals look destined to be consigned to the history books. However she has been more successful with privatising other aspects of health care evident in the NPFP, the increased contracting out of care and Fair Care driving more and more people in private, profit-driven nursing homes. In both her role as Tanaiste and as Minister of Health over the last thirteen years, Mary Harney has been an essential cog of a government that has failed miserably to provide universal, accessible, quality health and social care. Isn’t it ironic that Mary Harney who propped up this government for so long eventually was the tipping point that led to the long awaited announcement of the general election? The only redeeming aspect in the appointment of Mary Coughlan as ‘caretaker’ in the Department of Health is that she won’t have the time nor the wherewithal to do more damage.