From Socialist Voice, October 2010

“Shock doctrine” tactics alive and well in health care

Renewed plans to strip the country’s acute hospitals of their emergency and intensive-care services have recently been unveiled by the Health Service Executive. The new hierarchy of hospital closures spells the end of small public hospitals throughout the country. These hospitals in some cases are larger than the small private hospitals so enthusiastically promoted by the Government.
     The new so-called four-tier hospital system is the 2010 version of the Hanly proposals. The Government is now using the recession to implement the Hanly Report. “Shock doctrine” tactics are alive and well.
     A new formula designed to conceal the mass closures of public A&E and intensive-care units throughout the country has now been devised, cynically dressed up as an attempt to improve care for patients. Several so-called patients’ groups—one of them an active promoter of pharmaceutical industry interests, the other a HSE-funded private charity—have been enlisted to promote it.
     Acute public hospitals that provided top-class care to their communities for many decades are now being reduced to bush outposts. Smaller public hospitals around the country are being stripped of their capacity to deal with trauma, heart attack, stroke and other victims.
     If these draconian cuts are implemented, seriously ill patients and traffic accident victims will now have to travel for hours to a public hospital casualty unit. Public A&E units that survive the coming purges will have a catchment area of 2,300 square miles.
     The costs to patients and communities of such robotic centralisation are savage. Elderly people, the less well off, children, the disabled and those without private transport will be hardest hit.
     Urban-rural inequalities in health are ugly. Trauma deaths are significantly higher in country areas. “Dead on arrival” rates for those brought to hospital following a road traffic accident, heart attack, stroke or similar event are three times higher for small-town dwellers than they are for those living in urban areas. Yet both the Government and the HSE pretend that no such disparities exist.
     “Distance decay” in Co. Monaghan alone has contributed to at least seventeen avoidable deaths. Medical records show that these are people whose lives could possibly have been saved had they not been taken to distant hospitals.
     Smaller hospitals now stand to lose their in-patient beds. As many as 1,200 beds have already been closed this year, according to the Irish Nurses’ and Midwives’ Organisation. The Government is actively looking to the private sector to replace beds.
     All services for particular diseases, such as cancer, be they primary or community, hospital, or continuing care, are being bundled together, and these bundles will form the basis of “integrated” packages, to be sold on the open market. So public money that until now has been earmarked for public hospital cancer services will, in the not too distant future, go to private-sector providers. Public hospital funding is being radically restructured to enable this to happen.
     The “national cancer control programme” is in fact a separate “business unit” within the HSE. All public money hitherto allocated to public hospitals for cancer care is to be withdrawn and made available to this unit.
     Public hospitals are being eviscerated from within.
     The new strategy will see control over a wide range of both emergency and elective services withdrawn from public hospitals. In addition to cancer, services for a range of conditions, such as heart disease, stroke, diabetes, mental health, emergency services, and surgery, will be managed directly by new business units, dubbed “clinical programmes.” These are based on American models of disease “management” and are to replicate the cancer business unit.
     These models are so new as to be experimental. No good evidence exists to show that they work well, or even that they work at all. So if the evidence is poor to non-existent, why the drive to privatise? Personal relationships are believed to influence political decision-making in Ireland to an inordinate degree. Private interests are facilitated by the revolving door that exists between the public and the private sector.
     The new HSE programmes are being driven by Dr Barry White, former medical director of Synchrony, the company that was awarded the co-location contract at St James’s Hospital in Dublin. How could he be opposed to privatisation?
     Then there is the faith in “the market,” the neo-liberal belief that the private sector can do it better. We now face a future where the medical services that we fund as taxpayers will increasingly be provided by private operators, some of them with a background in fraud in the United States. Zombified banks have not yet dimmed the Government’s faith in “the market.”

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