The health of the nation

Public health in the global north is being hollowed out, having been underfunded and privatised bit by bit for many years.

Twenty years ago in Italy there were almost 6 doctors to every 1,000 people; today there are 4.1. Similar statistics can be found all over Europe as the neoliberal agenda of privatisation reaches a frenzy.

Cuba stands alone by continuing to increase the ratio of doctors to population, which now stands at 8.2 doctors for every 1,000 citizens—twice the figure for Italy, despite more than sixty years of imperialist interference and an economic blockade.

Here in Ireland we have two health services: the NHS in the North and HSE in the South. The NHS in the North is the worst-performing region of this once-excellent health service. And the HSE is in crisis.

The health service in the North, compared with that available to people in England, is as dysfunctional as a cable car with no cable. At the end of 2019, 41 per cent of inpatient waiting-times exceeded 52 weeks. There are no regions in England or Wales where the equivalent figure even exceeded 1 per cent. By comparison, only 0.06 per cent of inpatients in the midlands of England waited more than 52 weeks for admission to hospital; the probability of waiting over a year for hospital admission in the North is 650 times higher.

Of the 3,108 patients admitted for ENT surgery in the Western trust area of the North in the second quarter of 2019, 59 per cent had been waiting for over a year. By comparison, 41 per cent of patients in West Lancashire waited less than six weeks.

Spending on the health service in the North is quite similar to that in other regions of the NHS, but with a much worse outcome. There are a number of contributing factors: for example, one in eight health service positions in the North is vacant; so the more expensive option of agency staff is used to bridge the gap. And many sections of the service have been privatised, which also costs more.

The damning factor, however, is pointed out in a report by the Northern Ireland Public Service Alliance, which states that 20 per cent of health outcomes are related to clinical care and 10 per cent to physical environment but that 40 per cent is related to socio-economic factors—that is, education, employment, social support, and community safety.

The North is the poor relation: a British colony where wages are lower, public services are lower, housing quality is lower, poverty is higher, inequality is higher, and suicide rates are higher.

The trade union movement in the North is unionist in outlook, reflecting the fact that historically more jobs were distributed to the unionist population in the Orange carve-up, so more union members were unionists. Sadly, because of this built-in prejudice they find it impossible to break off the attachment, the nostalgic loyalty to empire and a yearning for the glory days of its once-great National Health Service.

The research by NIPSA shows that hospital waiting-lists in the North are the longest in Europe. You are 48 times more likely to wait for more than a year than a person living in Wales. 64,000 people have been waiting over a year for their first outpatient appointment: that’s 25 per cent of all those on the waiting-list. In England, by contrast, about 1,500 people are waiting over a year, a mere 2 per cent of the number in the North, for a population 30 times larger. NIPSA also reveals that A&E patients in the North have the longest waiting-times of any region of the NHS.

Sadly, the trade union movement seems to be blinded by misplaced loyalty and nostalgia for the glory days, and are failing to draw the necessary conclusions of their own research. Citizens in the North have been cast aside by the British regime and set adrift. The border has now retreated back to the Irish Sea as the reunification of Ireland is hurtling down the tracks. The fundamentalist zealots have been thrown under the bus by their London masters in a farewell package of marriage equality and abortion rights.

British rule is imperialist rule, whether the government is made up of Tories, Liberals, or Labour. Despite years of bluster by the likes of Jeremy Corbyn, there was no sign of Britain leaving NATO under Oh-Oh-Jeremy Corbyn’s Labour Party, or scaling back the armed forces or nuclear weapons, or pulling out of the North, as any socialist worth their salt would have to do.

NIPSA also remind us in their document that after only five years from the original founding of the NHS the British Labour Party attempted to impose charges for its services. What for, pray tell? To increase the pension? A temporary national emergency? In fact it was to flex their imperialist muscles by doubling military expenditure, at a time when they were actually spending more than the United States.

That’s the true nature of the British Labour Party: for king, country, and empire.

Unlike our trade union brothers and sisters in the North, in the South we are not afraid to state that the health service has failed the people and is not fit for purpose. There are excessive waiting-lists, and a poor doctor-to-citizen ratio (3.1 per 1,000—slightly better than Britain’s 2.8).

These are two failed entities. They cannot be reformed: they need to be dismantled and built into an all-Ireland health service—a new beginning for a new Ireland.

The reunification of Ireland is inevitable; on demographics alone it will happen sooner rather than later. We must learn from history and not repeat the mistakes of the past.

Only a socialist republic can remove the unnatural division created by the British state, which has kept our people at each other’s throats for generations. A good starting-point and the foundation stone of any socialist country would be a fully funded all-Ireland health service, free at the point of entry, from the cradle to the grave: from child care to nursing-home and everything in between.

If you do not condemn colonialism, if you do not side with the colonial people, what sort of a revolution are you waging?”

Ho Chi Minh