The health of any nation can be measured in many ways. Life expectancy, infant mortality and mental health statistics are just some of the main measures.
All those statistics are in turn linked to the levels of inequality and exploitation in any society. The level of poverty, as a consequence, is linked to the quality of and access to adequate food, clothing, housing, and education. Your class governs the amount of leisure time, time for regular exercise, and quality of worry-free sleep—something the poor and working poor seldom experience.
These areas of human need are important ones in the “preventive care” areas of human wellbeing and health, physical and mental.
After the preventive stage of human health should come the treatment area. This normally begins with a visit to a GP. And now the problems begin.
Increasingly in the North of Ireland this first stage of diagnosis and treatment is practically non-existent. Even to be answered on the phone to make an appointment can take days to get through to a receptionist.
Then the inquisition begins to establish whether you are ill enough to even get an appointment. And these are lay people being forced (or find themselves replaced) to screen people to reduce the number of patients coming to see their doctors.
The horror stories are legion. People have died, and will continue to die, under this deliberately underfunded system.
When it comes to having to resort to going to A&E, very often after failed attempts to get a GP appointment—or even as a result of a successful GP visit—the nightmare really begins. Twelve or fourteen-hour waits, even days waiting just to be triaged, are not uncommon. A&E departments throughout the North are collapsing under the pressure of tactical and deliberate underfunding, resulting, ultimately, in the shortage of qualified staff, and medical staff leaving in their thousands.
Access to proper health services in the North really is as bad as in the poorest countries in the world. It needs to be said too that the health service in the South is as bad. Certainly if you are wealthy and have the highest levels of health insurance you have few worries about your access to proper medical care. But why is it that what should be a first-class health system, in the shape of the National Health Service, is on its knees? What happened to the ideal of a health service free to all at the point of access?
Firstly, there is no doubt that the “committees of the rich” in the governments of Stormont and Westminster are a big part of the problem. There is no doubt at all in the minds of activists here that there are well-advanced neoliberal plans to destroy the NHS and hand it over to transnational “health companies” (if you could call them that), and without doubt local ones too. Well over a hundred GP surgeries in Britain have been bought by at least one transnational health company.
We have what passes for a health centre in the village of Lisnaskea in Co. Fermanagh, with 15,000 patients, which has recently handed back its contract to the hospital trust and is now looking for new owners, that is, to buy the business.
And we have to be clear here: it’s a business; and a business has one purpose: profit. They are spinning the yarn that the care of patients is paramount. No, it is not: profit is what is paramount; “health” or “care” are not synonymous with profit.
We also have the most up-to-date hospital building in Enniskillen. It cost £250 million to build under a PFI scheme. Its cost is now £750 million, and rising. And the interest now stands at £20 million per annum, which comes out of the hospital budget allocated for the health service. Needless to say, the hospital is owned by a private consortium; so again it’s profit, not health.
Over the years there have been attempts by the Western Health Trust to close down important specialist departments in this hospital. An attempt to close the stroke unit a number of years ago was successfully resisted by local people power. Not happy with that, the health mandarins in the trust have now “temporarily” closed the Emergency Surgery Department, which they want to set up in Altnagelvin Hospital in Derry, two hours away. This will close other vital departments in the Enniskillen hospital. Ultimately the hospital will be downgraded to the level of an upmarket health centre; but worse, it is very likely to be turned into a private hospital.
The signs are not good. It is privately understood that the NHS, as we have known it, is finished. Campaigning must begin for an all-Ireland health service, free at the point of need, from the cradle to the grave. For certain, the transnational health vultures are circling the NHS and will shortly go for the kill.
The main excuse from the trusts (five of them) and the Stormont Department of Health is that they cannot recruit doctors, especially for the Enniskillen hospital. They also say that doctors don’t want to work or live in Enniskillen or Co. Fermanagh.
And the other continuous refrain is: We have no money. If we spend on that we will have to cut this or that service. And on and on the circular arguments go, aided and abetted by cute-hoor politicians.
All these points are a nonsense, and the trust has been found out telling porkies, quite a few times, with more to come.
But a central reason for lack of medical staff in general is that the government and the rest are not training enough people. Why? There are plenty of staff available through private agencies, which hire staff in the medical world at twice the price of the ordinary NHS staff. And an obvious question is, Where will the private companies find doctors, consultants and general medical staff?
This is clear evidence of neoliberalism at work and the preparing of conditions for the aforementioned health vultures to swoop in for the rich pickings of the NHS carcass.
Then we have the example of a supposedly Third World country having the best health service in the world, even acknowledged by their arch-enemies, the United States. That country is, of course, Cuba.
Cuba’s life expectancy is as high as or higher than that of the United States. Infant mortality is much better than the American rate. There is a doctor for every 1,000 or so people there. Doctors travel regularly to see their patients in their homes, whether they are needed or not; prevention is their biggest and best strategy. Then GPs and hospitals have a clearer patient cohort to deal with.
On top of all this, the Cubans actually send doctors all over the world to help other countries in need. There is no question about it, the thirty-two counties of Ireland need to be on their itinerary.
So why can an embargoed country, such as Cuba, population 11½ million, have a world-class health service and not even the six counties of the North of Ireland, population 1.9 million, can care for its citizens. When “copying the Cuban health-care model” was raised by me in the Belfast HQ of the full Health Board meeting a number of years ago there was stunned, even horrified silence, followed by nervous tittering, topped off with condescending smiles and mutterings. But no answers.
There is clearly no political or ideological will to introduce an all-Ireland health service modelled on anything even close to the Cuban system. That cannot happen: too close to socialism or, worse, communism.
In the meantime the working class, the poor and the working poor will continue to die younger than their rich neighbours across town. This bottom tier of society will continue to be treated by a cannibalised NHS. The rest of society will buy various levels of health insurance according as they can afford it or not. Inevitably, this will create a further tactical schism within the 99 per cent, the working class, and between those who can afford to pay at various levels and those who cannot—a status thing; sure we’re all right, Jack.
All the “health companies,” local and international, will rake in massive profits. The health of the nation or its people will not be their concern. But their profits will. And those who become really ill can either pay or die. You will have the choice.