Cassandra Voices

Tag: Paul Reid

  • Spina Bifida Parents Demand Treatment

    The HSE, and health care access more generally in Ireland, has never been under such scrutiny as has been the case in recent times. From the handling of the pandemic to the chaos witnessed during last year’s cyber attack, we now face recent revelations about utter confusion in the handling of funds and a recruitment crisis, exposed in leaked tapes published by the Business Post.

    HSE CEO Paul Reid also admitted in a recent News Talk interview how, particularly recruitment issues, were “not going to be solved in one year.”

    It is reasonable to assume that addressing structural dysfunctions in health services will take time, but we often forget the real impacts, and often irreversible damages on our most vulnerable members of society, caused merely by the passage of time. This applies especially to the treatment of complex conditions requiring a multi-disciplinary approach.

    A most striking example is the effects on those children awaiting treatment for Spina Bifida/Hydrocephalus, and their parents.

    We recently spoke to Amanda Coughlan Santry, the co-founder of the parent-led advocacy group Spina Bifida & Hydrocephalus Paediatric Advocacy Group, which has been active since 2017. It raises awareness around the lack of access to care for children affected by the condition, and actively engages with the institutions to address what seems one of the worst failings by the State in contemporary Ireland.

    Amanda, along with other parents Una Keightley, Stefania Opinto, and Orlaith Maher Lalor, joined us for an in-depth interview which we hope can draw further attention to the current situation.

    The group have recently launched a website www.sbhpag.com in which sixty-nine children’s stories are presented. Here one can discover the scale of the challenges surrounding their access to treatment.

    We heard of children being left on waiting lists for surgeries for over a year for treatments, which in other European countries are urgently attended to. There have been years of complaints, which went for the most the most part unanswered and, most distressingly, in the last few months, parents of children in pain, have felt compelled to refuse to leave A&Es for days on end until their children were treated.

    Daniele: Can you tell us more about this condition?

    Amanda: Spina Bifida is described as one of the most complex conditions compatible with life; a baby’s spine and spinal cord does not develop properly in the womb, causing a gap in the spine. Spina bifida is a type of neural tube defect. The neural tube is the structure that eventually develops into the baby’s brain and spinal cord.

    Most people with spina bifida can have surgery to close the opening in the spine. But the nervous system will usually already have been damaged, which can lead to problems such as weakness or total paralysis of the legs, Urological, Bowel and Renal issues.

    Many babies will be born with or develop hydrocephalus which is a build-up of fluid on the brain. This requires a V.P or a shunt to drain the excess fluid from the brain into the abdomen or the heart.

    There are about approximately 550 children under 18 living with Sb/Hydro in Ireland. Ireland has one of the highest rates of neural tube/SB birth rates in the developed world.

    Daniele: Can I ask you for a little bit of context to give an idea of the extent of the services needed?. What are the types of care that your children need?

    Amanda: Our children need proactive care and what they are receiving is often reactive care via emergency intervention. This is often too late and results in long term damage and loss of function. These children need timely access to care particularly in relation to Orthopaedics, Urology, Ophthalmology, Neuropsychology and Neurosurgery.

    Daniele: How are these types of care being delivered in Ireland and is the capacity in the health service enough to address the scale of the problem in Ireland?

    Amanda: Currently the care in Ireland is sporadic, chaotic, under-funded & under-resourced. Some children have access to a Multidisciplinary Spina Bifida Clinic, others do not. There is no clear pathway of care for children living with Hydrocephalus alone. An annual MDT SB clinic is international best practice. We estimate 85% of SB children are not receiving this and the percentage is higher in children born prior to 2009.

    Daniele: I gather that the waiting times are causing actual daily pain and suffering. If someone breaks a bone or a dislocation, he gets treated in a fairly short time. How’s that different from the pain that your children suffer? And what happens if you go to the A&E?

    Amanda: I know of a child that received her surgery last month because the mother took the drastic measure of taking her daughter to accident and emergency and refusing to leave. She dug her heels in the A&E in Temple Street, until she was admitted. And once she was admitted sat for two and a half weeks before the child had her surgery.

    In that process, the CEO of the National Children’s Hospital Group, Joe Gannon, subsequently wrote to one of the politicians in government who had been trying to fight for this child’s case, and told the politician that she was currently an inpatient and that she was going to have her surgery on the 17th of January.

    He made it sound that it was a planned admission and that she had been given a date and they had come in.

    Actually what happened is that the mother refused to leave until her daughter’s medical needs were met and also the child did not have her surgery until a week later. The mother is very grateful to all the doctors involved as they all told her that she was doing the right thing not to leave and were very supportive. She was supported in that sense by us as well but she should have never had to take such a drastic step.

    We’ve had another number of families that have had to do this since last September.

    Another mother went in on a Saturday with her son, who had dislocated hips for four years, the child is six, and she refused to leave until they were admitted. And once they were admitted, they couldn’t see the surgeon because he wasn’t there. They refused to leave and sat there for 10 days until their child had the surgery. 

    Daniele: How did your organisation come into being?

    Amanda: We’re all parents of children with spina bifida or hydrocephalus that came together to advocate for better services for children, under the age of 18, living with Spina Bifida/Hydrocephalus in Ireland.

    Our group was formed in 2017 and have been trying to work in a proactive and collaborative manner with all relevant stakeholders since then.

    My own son was one of the children failed, he sat on a waiting list from 2014 to 2016, and by the time he’d seen a spinal surgeon in 2016, we were told it’s too late.

    So my son lives with inoperable scoliosis and he cannot be helped by this campaign or anything else but I wanted to do something to stop this from happening to other children. Una Keightley was one of the very first to come on board when we formally launched the paediatric advocacy group.

    Daniele: Una Keightley, what pushed you to take a more proactive role in dealing with the issue?

    Una: I suppose it did become quite apparent that no matter how many letters you wrote, like what Amanda had said, the situation didn’t improved. She wrote to everyone, she had highlighted it. And it just really concerned me. And I’m a health care professional. I’m a radiation therapist and it was just unbelievable to me that this was going on. And I suppose at that stage my child was younger when we came together. Once we talked to more and more parents we realized that people were actually lodging complains but they were going nowhere.

    So we started to proactively inform the powers that be and Children Health Ireland asking them to do something about it.

    Amanda: There is a cohort of children born prior to 2009 who had no access at all to this to the Spina Bifida team in Temple Street Hospital because there was no urologist on that team. So it was decided it was safer to leave the children in Crumlin Hospital and move them at a later stage. A urologist didn’t come onto the team at Temple Street until 2014, and the children were never moved. So a lot of our children were receiving inadequate services are no service at all.

    We highlighted this problem in 2018 with the CHI board. In that meeting, they asked us, our advocacy group, to go back to the families and identify whether they felt that they weren’t receiving a timely access to services or any services at all. So we did, which was a big job being undertaken because we’re volunteers.

    There was also a cohort of families who thought that their children were being treated but many other that did not.

    Una: In the beginning of 2019, we gave Children’s Health Ireland a list of 133 families and children who felt that they weren’t receiving a proper service. There was then so many e-mails back and forth between Amanda and CHI. We asked them: When can we meet? What are we going to do about this? And the answers were like: “We’re verifying the list.” “We are analysing the list.”

    We have screen shots of these emails.

    That one way communication continued for probably 18 months until, after March 2020 they just ignored us.

    Entering 2021 we felt we had to do something but, on top of that, I need to say that I suppose a lot of parents were fearful. If they talk out, maybe the care standard that would be provided to their child would be diminished. Now, I wouldn’t have that fear, and I don’t think any of us would.

    It was especially after Professor McCormack and Prof Connor Green had presented before the Oireachtas health committee in November 2021 that things were very desperate, that it became blatantly obvious that it was a systemic failure for our children.

    It was then when we decided to publish online our children stories. Which is something that distressed us greatly but we felt we were left with no choice.

    We had requested to meet the Minister ever since he took up office. He wouldn’t meet us. The Minister for Children wouldn’t meet us. The Minister for Disability wouldn’t meet us. Nobody would take up and highlight what was happening to these children. So the parents as a group decided that we were going to have to do something fairly drastic to get their attention. So that’s what we did.

    Daniele: I have noticed an increase in media attention to the issue in 2021, also thanks to your campaigning. Are you hopeful that increased scrutiny could move things in the right direction?

    Amanda: Yes, people now view our children as the vibrant individuals they are as opposed to a number on a list or a medically complex child that is unrelatable. The support received initially from media, County Councils, and local representatives across all 26 counties has been immense. This has stemmed from the proactive and

    drastic measures taken by the Paediatric Advocacy Group and the families to highlight the failures in care for their beloved children.

    People have been shocked by the current state of medical neglect that has

    been inflicted by the Irish state on our children. They are not willing to allow a further generation of children to be failed and to turn a blind eye to the historical neglect that has been allowed to happen.

    Daniele: After years of campaigning, countless letters to TDs and local councillors, you have finally met with Minister Donnelly along with Spina Bifida Hydrocephalus Ireland and other stake holders last February in relation to the abnormal waiting times that are now in place for paediatric orthopaedic treatments. Plans have been presented and funding – as much €19 million that the HSE made available to CHI –, albeit with little information on the specific break down. The Minister also set some clear goals, including to limit the waiting time to four months at first with the aim for this to be reduced to zero, and to provide a number of additional treatments. What’s the reaction from you and your organization to these pledges?

    Amanda: There aren’t many details released yet, and there is still a draft in formation. What they told us is that they have ring fenced €19 million for children with spina bifida, but also to children with scoliosis.

    They have also said that clinically no child should wait for more than four months for surgery. So that is very ambitious and while we’re glad about these pledges, we’re not blindly trusting. There’ve been promises made before not only to us, but to the scoliosis advocacy groups as well. So yes, the funding is great, but we need to see that the funding is going to make a real difference in these children’s lives.

    One of the government target is to “treat an additional 107 Spina Bifida cases” but we don’t know how they come up with that particular number. There is no database within CHI of how many children are living with the condition. So how do you come up with a number if you don’t know how many children you’re treating, do you know? So we’re a little bit dubious about it and we don’t want to be tied to that number. What we want is to fund and to reach as many children as possible.

    Daniele: Did the Minister agree to regularly update your organisation while they endeavour to deliver these pledges?

    Amanda: We do have a commitment from Stephen Donnelly and Children Health Ireland, to regularly engage with us and we do now have a contact with one of the Minister’s special advisers. So if an issue comes up or we want to speak to Donnelly, all I have to do is give the special adviser a ring and he will relay any information and if need be  we speak to the Minister directly. So that’s the promise we have. So we are we’re optimistic and he seemed very genuine when we spoke to him. But don’t intend to take the pressure off until this gets sorted. We intend to stay very, very focused.

    Daniele: Are there any kind of league tables or other international comparisons that can be drawn on?

    Una: It would be difficult because we have such a high rate compared to a lot of the world. What we do know is that in Ireland it is not the expertise that is missing but proper funding and organization. Cases are picked up in pregnancy here more than they are in other countries, probably because the stenographers are looking for them due to the high incidence.

    Daniele: What kind of challenges are you dealing with as mothers and what are the support needed for families at large?

    Stefania: My daughter’s name is Aurora and she’s just turned three. From her birth in February 2019 until August 2019 she was in hospital as she was born with Hydrocephalus.

    I found out about that on my 26 week scan here in Ireland and to be honest with you I didn’t know what it  meant so I had to do my own research. They didn’t explain to me exactly what it was. So I had to go back to Italy, and I went to the hospital in Genoa to try to get different opinions.

    Once she was born, here in Ireland, she needed to go straight for surgery because there was too much pressure on the brain because of these fluids. And so we got transferred first to Temple Street, and after two weeks to Crumlin.

    I just want to clarify that doctors and nurses were fantastic to me, to my husband and to Aurora. She wouldn’t be here if the surgery hadn’t been successful.

    Having said that there definitely gaps in the communication between the two hospitals. They were relying on the parents to get the information, which is not ideal because I’m not a doctor and that created frustrations and fears.

    When our daughter was released from hospital we were pretty much left to  our own devices. She had just one appointment in Temple Street during  her first year. And after that, I’ve been told that I needed to wait another year. Initially I thought that such a long time between visits was just because she’s doing well but It’s not the case. There was lots of information that I had to get elsewhere, and not from the professionals. In terms of psychological support for parents, we were very much left on our own. So you either cope and become resilient or probably you’re not going to make it mentally. I’m grateful I found this group and that these  ladies became my source of knowledge.

    Una: In terms of the financial support as well, like. Many of us received no financial support because our husbands or partners were too high earning So although your child has very high medical care needs – you could have a child who’s on oxygen 24 hours a day – you won’t get one penny from the government.

    Orlaith: In my case, my daughter is 20. We were under a multi-disciplinary team but with only three consultants in it. And after 2008, Crumlin finished up its spina bifida clinic. We then ended up being spread over four hospitals which don’t share files. So as Silvana said earlier, it is up to the parent to bridge the gap.

    When she was born she was very ill for the first four and a half months. We lived in the hospital paying for parental accommodation.

    I had my dream job. I worked in the Irish Times and I was part of the first team to ever bring in supplements into a broadsheet newspaper. I went on carer’s leave and eventually ended up leaving my job.

    There was no support for children with hydrocephalus. It’s not considered an intellectual disability. So, you know, you’re very much left on your own. My husband had a good job. I’ve never received Carer’s allowance after the first four or five months that we spent in hospital with her.

    When my daughter was seven they took away her medical card. In this country, when the medical card is taken away, your medical hardship scheme is directly attached. So a lot of the equipment you need you have to pay for it yourself.

    At nine she had three failed shunts, and two brain bleeds ending up spending nearly four months in Beaumont Hospital. I had to pay for my parking every day, for my accommodation and my food. Thousands of euros. I can’t claim back anything on that. And we still had to pay our bills and our mortgage.

    There’s a lot of stress around dealing with the child that’s sick and sure, you’re not failing your special child as you’re doing the best you can. On top of that, you’re fighting for everything. You’re fighting for therapy, you’re fighting for access to care, you’re fighting for basic things like my daughter’s incontinence and the allocation of nappies. It compounds into a heavy psychological weight. It’s not the disability alone, it’s the lack of support; the lack of access to timely care and that constant heavy worry all the time. They need help. I can’t get them help. I can’t force my appointments. I can’t force the consultant to do this or that. My daughter has now aged out of paediatrics and there’s no transition pathway. So now my job is going to my GP all the time. She had her first orthopaedic appointment in five years two weeks ago, and that took 16 adult consultants to refuse her before we got that orthopaedic consultant. So there’s lots of stress on you all the time.

    Here in Ireland, we have great nurses, we have great doctors, and I wouldn’t made it without them, but they’re not resourced and there doesn’t seem to be a willingness to accept we have such a high rate of these cases and that it needs to be invested in.

    Amanda: In the space of 18 months, my son went from needing care to becoming completely inoperable. For the first couple of years. He had a lot of appointments. Then it that stopped.

    My relationship with my partner deteriorated and broke down, very early on due  to the stress and the strain of trying to care for a very medically vulnerable child. I suddenly became a single working mother with two children, one with massive medical need and not financially supported by the state. I worked full time, paid a huge amount of rent. I’ve subsequently remarried and have gone on to have other children. Thankfully, my husband came into this with an open eyes.

    We wouldn’t change our children, what we would do and what we want to do is to change the services for them. They can become independent within their capabilities, and live their lives to the fullest without the need to be in pain or to have their parents struggling and fighting for services.

    https://twitter.com/BillyRalph/status/1458052402372923392

    Daniele: Over the last two years of pandemic, and with the HSE coming under cyberattack, your stress levels must have been almost unbearable. Having said that it is quite evident that these dysfunctions were there prior to these. How have you coped?

    Amanda: I’ve spoken to numerous families about this and we acknowledge that the pandemic and the cyber-attack happened, It was very scary and nobody had to protect our children more than we did.

    But what happened in the pandemic? The small amount of services and extra curriculum activities that our children were receiving stopped.

    Physiotherapists, occupational therapists were all redirected to COVID services and we understand the need for that. But there was also a huge recruitment drive by the HSE up thousands of health care professionals, like myself were ready to help but weren’t called up.

    We know now that during the pandemic, orthopaedics accident where less frequent so why weren’t our children’s needs met within this timeframe when obviously there was the space to meet them given the cessation of extracurricular activities?

    As parents,  we would call the pandemic and the cyberattack, the new great excuse for not giving us an appointment.

    Our children didn’t just freeze their conditions for two years or three years. You know, they continue to deteriorate.

    Stefania: My daughter Aurora, she has malformation of her ribs and she has never seen an orthopaedic surgeon in the last 3 years.

    It’s not that the doctors aren’t aware. Her Cardiologist took her case to his heart and did his best to advocate within Crumlin Children Hospital and he really fought for me but it’s not his job to organize a better multidisciplinary care structure.

    Daniele: That would be the job of the administration I presume. To conclude, how do you think Irish society perceives disability and how can awareness be promoted?

    Amanda: Irish people generally would be viewed as very laid back and positive.

    Therefore, there is an element that “disability cannot happen to me!”. It is only with an ageing population, inaccessible public transport, inaccessible housing, and educational facilities that the message is relayed to the ordinary person about how vast the inequality is between the non-disabled & disabled communities in Ireland.

    Over the last few decades Ireland has become a more diverse nation. Our children are exposed to more languages, ethnicity and religions than has ever been present on this island.

    These are the children of a new and inclusive Éire and as such, they do not have the same prejudices and intolerances as those who have gone before them. Our children living with disabilities are accepted by their peers and integrated more within society.

    It is deeply distressing for us that the relevant stakeholders within government and the Irish health care system, have not adopted the same attitude and continue to treat our children like second class citizens.

  • Chay Bowes: HSE Perpetuating Dysfunction

    In the controversy surrounding the leaking of a confidential document by then Taoiseach Leo Varadkar last year, a key point has been missed regarding whistleblower Chay Bowes’s motivations. As an insider and former head of the VHI Homecare division Bowes gained significant insights into the operation of the Irish health system, especially the HSE. This interview probes into the obstacles he faced in attempting to deliver an effective model of community care away from overcrowded hospitals. He argues the HSE perpetuates dysfunction to the benefit of the private system.

    Innovator

    Chay Bowes first interfaced with medicine through the Irish Army Medical Corps in 1988. This stoked a passion for healthcare which led him to take up a job as a phlebotomist, where he encountered an older generation of hospitals, such as St James’s, where he worked with elderly patients in the country’s public health system.

    This experience coloured his view of the health system as it evolved to become, as he puts it, ‘more focused on financial outcome rather than patient outcome,’ and led him to set up his own company, focused on clinical work in people’s homes.

    He had found that general hospitals tended to be ‘Victorian constructs, where we put all the sick people who are susceptible to infections, so that they can mix with other sick people.’ He concluded ‘that much of what happens in the hospitals doesn’t really need to happen there, and a huge volume of those patients could be treated at home in a cheaper and safer holistic fashion.’

    After the dismantling of small, community hospitals Bowes observed ‘pressure building on the larger general hospitals to become the catchall for all kinds of diseases and complexities,’ and that this ‘contributed to the ongoing perpetual dysfunction which is today what we call the HSE.’

    Taking out a bank loan, he purchased a van to move around the nursing homes, taking blood samples. By that stage he had observed thousands of elderly arriving into hospital in taxis and ambulances for routine blood samples. There they were catching flus and colds, so he said to himself: “why don’t I develop a system to treat those people out in the community?” This was back in 2004-2005, but he was told that’s not how things are done.

    Undeterred, he decided to take an extended leave of absence from the hospital to set up a service doing these blood tests in the community, which proved very successful. The only limitation was that he was working alone.

    At that point, he expanded his service to give vaccinations in the community too and took on a few employees. The first company evolved into another, leading to a contract with the HSE in 2007 worth €14 million. That business was focused on patients with chronic obstructive pulmonary disease and chest diseases. Its rationale was to keep various types of patients in the community, who were repeatedly being admitted to hospital with lung diseases.

    ‘So, they didn’t go into a hospital, where people tend to get sicker, particularly those with lung diseases. It also helped these patients,’ he says, ‘that their social networks were intact.’ Soon there were two hundred working for the company.

    Resuscitation room bed after a trauma intervention.

    Tara Healthcare

    At that point he brought Dr. Gerry McElvaney on board, ‘a really patient focused guy,’ he says, ‘who was highly intelligent and super-committed to doing things differently.’

    Together, they pushed forward with what became Tara Healthcare. When patients were surveyed, he says, ‘ninety-eight percent preferred to remain in the community under our scheme rather than go into hospital: all the data was saying that this was a much safer.’ It was also cheaper to deliver, and the patients’ families were delighted to remain with their loved ones.’

    He argues that they had created a perfect example of how a community-based scheme could be delivered cheaper with better patient outcomes, and where staff were really happy too, as they could get out of the acute hospitals.

    However, he encountered, ‘an incredible level of scepticism around innovation in Irish healthcare.’ In one case, he says, there was a hospital in Dublin, which ‘wouldn’t send patients to this new service, because they didn’t like our medical director because he came from another hospital group. Professional rivalry is rife in Irish Medicine, sometimes to the detriment of patients.’

    HSE Logic

    Time and again he was met with the perverse HSE logic of ‘it’s doing really well, so let’s shut it down and send all these patients back into the hospital.’

    The HSE’s reaction to the Financial Crisis of 2008 was just like its dysfunctional approach to COVID-19 he argues. They closed his operation down because hospitals ‘which were in perpetual crisis wanted us to move this service into their area.’ A senior HSE figure told him directly that ‘“what you’ve done in Dublin is almost too good. Everyone’s going to want it. They’re going to want it in Galway. They’re going to want it in Limerick” So, they wouldn’t fund it because they were already funding the dysfunction.’

    Acute beds per capita in Ireland, March, 2020. Source: https://twitter.com/kevcunningham/status/1245060194356379648/photo/1

    Essentially, Bowes argues:

    The agency funds the dysfunction to a certain level of service with tens of billions of euros. And when something outside of the system comes along and demonstrates efficacy, financial viability, and good patient outcomes, that’s irrelevant because they still have to fund the dysfunction. It’s like trying to repair an airliner in mid-air – you don’t want to land because it could expose the rottenness of the system.

    So, we sent the patients back to hospital, further highlighting the dysfunction of the HSE at the time. They had to pay us a penalty for terminating the contract prematurely, which cost them more than running it for the subsequent two years.

    Working for the HSE he found innovation was met with suspicion: ‘the hospitals want to hold onto patients because without patients occupying beds, they can’t justify their budgets.’

    And because budgets are pinned to occupancy and the size of the facility, hospitals seemed slow to manage overcrowding at the cost of lesser funding.

    Fair Deal?

    He argues that we should ‘evolve to a place where we simply don’t treat people with certain uncomplicated infections in hospitals, like in Canada and Australia.’

    Now, he says, the only fast track for vulnerable patients is into a state or private nursing home, which is excessively expensive, ‘or their home is taken from them in what the government very cynically calls a Fair Deal:

    someone works all their life, pays taxes, builds a home for their family, and contributes to the state and to society. But when they get ill, go into a nursing home or require dignified care the state wants to take their home from them to pay for that care.

    Moreover, despite earning huge praise from patients, peers and when he presented the scheme to the NHS in the UK, he found the HSE ‘were always finding fault with what we were doing.’

    ‘I became used to that,’ he says ‘and very quickly realized the only thing the Irish public system does very well is perpetual dysfunction. It manages to procure massive budgets from the State, and despite this consistently overspends,’ despite ‘terrible outcomes for patients.’

    He suggests that it takes ‘a concerted effort to continually do health as badly as we do in Ireland’, a system of public health, ‘with such huge budgets for such a small population.’

    He says it is important to question why, given a very small and young population, ‘half of that population pays out of pocket expenses, approaching €2 billion, for private health insurance.’ He reckons this is ‘to protect ourselves from the dysfunction of the public system.’

    Knock, Knock

    ‘It’s a very simple problem,’ he says, ‘too many of the same actors are involved in the public and private systems.’ The analogy he uses is of two separate doorways in a clinic: the public and the private:

    You knock on the public door, and say, “Look, doc, I’ve got a terrible hip. It’s really hurting me. And he goes: “Yeah, you need a relatively simple, hip replacement, but it’s going to be probably three, three and-a-half years, because the system is overloaded.”

    But the doctor adds unless of course you’ve got health insurance. So you say, “OK, I’ll go and get health insurance.” But by this stage you are too old to avail of this. But what are you going to do now, as your hip is only going to get worse?

    You’ve been to the first door, where you met the doctor in the public system about the hip, who we’ll refer to as Dr Jim. Then you go ten feet down the corridor and knock on the door. “Who’s there? Why it’s Dr Jim again!’” And you say “Hey, Dr Jim, you just told me that you couldn’t fix my hip for three years.” and he responds: “not exactly. I can fix it if you pay me via your insurer.”

    In a country of five million people, we have almost one million people waiting for care of one sort or another in a public system, which is one of the best funded systems in the developed world.

    And, Bowes says, ‘it just so happens that the man running the show, Paul Reid, has no specific health care experience, for example. The UK’s NHS employs around 1.4 million people to serve a population of nearly 67 million. Its CEO Simon Stevens is paid €210,000 a year, while Ireland’s HSE employs around 102,000 people with a population of only 4.9 million, Reid is astoundingly paid over €426,000 a year.’

    We have hundreds of people who work for the agency on long term sick leave. The dysfunction runs into every fractional part, IT, training, resourcing, recruitment, and services. The dysfunction is almost at a cellular level. But again, we are consistently told that we can’t land the jumbo jet to fix it, because if we do that, what will happen?

    COVID-19

    When COVID-19 landed, Bowes says, ‘with the stroke of a pen, we bought up every single private bed in the State. This occurred despite people saying since the foundation of the State, “Oh, you know, you can’t publicize the private, it would never work, but it was done overnight because the will existed.’

    Health policy in Ireland, he says, reflects:

    the laissez faire attitude of a class of people who are running the medical system, advising the agency and the legal system. They of course all have health insurance. I don’t know anybody who served on the board of the VHI or any doctor working in the system who doesn’t have private healthcare. I myself have to admit that I took out private health insurance purely because I know how difficult it is to access care via the public system. It’s sad but true and I am lucky enough to be able to pay, unlike more than 50% of the most needy In our society who cannot.

    ‘Irish People’ he says are dying ‘for the lack of basic diagnostic care.

    Bowes muses on how: ‘The further up the pyramid you go around a health product in Ireland, the less you hear about the patients. And when you get to the board level, patient outcomes are in some way superfluous to the real issues, which are profit and the market.’ He argues that there ‘isn’t a single private provider in the country here’ which ‘isn’t preoccupied with profit.’

    He says:

    We’re happy to ostensibly starve a public system and propagate a private system which is absolutely predatory on the dysfunction in the public system. And in many, many cases, the people providing the care in the public system also have been or currently are providing care in the private system.

    That’s our medieval, dysfunction and immoral system. It’s actually, and I don’t use this term lightly, an apartheid system. We have a segregated, apartheid system in health care. It simply isn’t based on needs of the patients. Ok, obviously, if someone’s at death’s door, they’re going to get seen, but I’m talking about this grinding dysfunction, where both sides are nodding to each other as they pass each other in the night, knowing that it’s so wrong. It’s so wrong. There are super doctors out there, super surgeons, super nurses and staff operating in the health system. It’s definitely a case of lions being led by donkeys.

    Staffing

    Bowes muses ‘I have no problem with doctors wanting to make a decent living. You’ve got to pay people appropriately. But now we’re flooding the system with locums from overseas who are often poorly trained and have poor English and patient interaction skills .’

    And points to another ‘incredible dysfunction, which is again, state sponsored.’

    We train more doctors than any other country of our size in the world, but we export them to Australia, New Zealand and the UK. It costs the state a significant amount to train these guys, and then they can just catch a plane to Bondi Beach. Of course, we can’t force people to work here – no more that we can force a health care worker to take a vaccine – but there are ways to incentivize the system, and develop better methods of training doctors, because we still use the archaic Leaving Cert as the basis for deciding who we train as doctors.

    He also wonders:

    How is it that while we train more doctors than anyone else that we are importing more doctors and nurses than anyone else? Countries like the Philippines, India and others are being bled of their precious nursing and medical staff to come to Ireland to look after our sick. There’s something wrong, right? But in the Irish system nothing changes. No wants to take on the vested interests. No one wants to take on the big personalities in health care and medicine. The political nexus between medicine, law and politics in Ireland is so tight because of insular practices and local allegiances trumping national welfare with some of the biggest political donors and influencers being waist deep in the sector.

    He wonders ‘Who’s going to challenge the vested interests and speak out for vulnerable patients? The CEO of the HSE? Absolutely not. The past CEOs of the HSE seem to be only good at one thing, which is saying, “We’re trying…” But they walk out at the end of the end of their contracts with a big pension and usually into guess where? Yes, you guessed it, the private sector.’

    He reveals how ‘a former CEO of the agency said to my face that he was the most powerless man in the health system.’

    Image (c) Daniele Idini

    Dysfunction Funds Profit

    Bowes wonders:

    How can you operate a business with a hundred and twenty thousand employees and seem to be powerless to sack people for not delivering, or in many cases simply doing their job wrong? Where’s the accountability in that system?

    And looking back on the foundation of the HSE in 2005 he wonders:

    How can you amalgamate numerous health boards which are operating as satellites into a single “dynamic entity” and nobody loses their job? Not one manager is made redundant. Not one of them is even sanctioned.

    How can a health system pay out tens and tens of millions in malpractice claims for egregious malpractice and incompetence in both governance and clinical care? For essentially killing women who are pregnant by denying them an abortion? By condemning young women to terrible life ending illness by failing to diagnose their cancers? How can you pay out these tens and tens of millions again and again, year after year, and nobody is sanctioned for it? How does that work?

    It works because the dysfunction funds profit, and that profit is harvested by vulture funds, by private hospitals and private investors, by their legal advisors, some of whom don’t even pay taxes in this country, and who pays the price? The citizens that languish on public waiting lists accruing ill-health because they can’t pay for treatment. The man with the simple requirement for treatment, he’s invisible to the system, he is superfluous to the profit motive.

    The poor he says have no bargaining power because:

    the bargaining power is money and influence, and the people who have the influence to change the system are receiving huge salaries to manage and essentially perpetuate dysfunction. Again, the private system predates on the mismanagement of the public system. If it functioned there would be no need for a private system, right? Therefore, you have to wonder, who does the current dysfunction benefit? It’s an easy one: the private providers. But nobody who is of the machine is working against it. No one in Leinster House is saying to the CEO of the HSE: “What are you doing for your four hundred grand? We’ve got less intensive care beds per capita than Lithuania or Latvia. Two years into a pandemic, we still don’t have a dedicated COVID hospital which is just insane.

    Apparatchiks of a state system who’ve worked, like Paul Reid in state jobs are seen as a safe bet. They’re nominated in as managers, managers of dysfunction, gatekeepers for their political sponsors and marked for future cushy roles on the private side of the wall.

    Image (c) Daniele Idini.

    Perpetual Crisis

    He adds that ‘things like this mysterious and much vaunted “Cyber Attack”, which apparently “destroyed the abilities of the system” seem to be a perfect excuse to deflect from the internal failures of HSE management and external incompetence of its political masters.’

    Bowes says: ’what I know, and anyone that has worked in the system knows, is that there was and is no viable system to attack.’ The HSE have ruminated for decades on the implantation of an electronic patient record: they have spent millions evaluating, re-evaluating, procrastinating, and failing to implement a viable solution.

    Months after this “Attack”, you’re still running Windows 1998. Somebody needs to be held accountable.

    But, he says: ‘the Minister doesn’t talk to the to the HSE, the relationships between the “Three Masters” of Health are utterly flawed, the Department of Health is cumbersome and cautious, the HSE is a lumbering leviathan with no real direction other than self-preservation, and the Minister is preoccupied with surviving a potentially career ending stint in the mire of the Irish Health system.’

    Consider this, with such a huge annual Health budget and such poor outcomes for patients alongside such terrible value for money, the dysfunction and paying for it becomes central to the rational of the organisation. They actually need this dysfunction. Without the dysfunction, they’d be screwed because there would be an open accounting of what we’re doing in a system which is delivering horrendous results.

    He also criticises Stephen Donnelly’s policy of giving more money to the National Treatment Purchase Fund, which sends public patient overseas for treatment, arguing that ‘this is not the same as a really equitable national health system where everybody gets treated on the basis of need.’

    He says that people could argue that in a free-market economy if someone wants to purchase health insurance it’s up to them: ‘However, that’s different to paying almost half a million a year to a CEO to perpetuate a dysfunctional system.’

    He says the HSE is only interested in crises, ‘in things like COVID’ and saying ‘but COVID is why the system is screwed, or we’re dealing with the cyber attack, which has caused this perpetual dysfunction, which is, you know, all entirely untrue.’

    His conclusion is ‘the managers, architects and political apologists for the segregated and morally bankrupt system have done an exceptional job of screwing the Irish people out of their tax dollar and their rights to health and dignity. I’m not sure they are capable of doing anything else. It’s time to demolish and rebuild.’

    Featured Image by Gareth Curtis

  • Covid-19: A New Irish Social Contract?

    Surveying the demise of the Celtic Tiger, Fintan O’Toole devoted an opening essay ‘‘Do you know what a republic is?’ The Adventure and Misadventure of an Idea’ in Up the Republic! Towards a New Ireland (2012) to assessing the health of the Irish Republic. He considered its vitality based on the presence, or otherwise, of three indicators: Non-Domination; Mixed Government and tolerance of Obstreperous Citizens.

    These features of a healthy republic, he wrote, diverge from a narrow form of republicanism associated with Rousseau ‘which argues for the notion of a single, sovereign popular will: ‘the People’ effectively taking the place of the king in a monarchy.’ Up to that point in Ireland, O’Toole argued, this latter, narrow version had predominated, which he associated ‘in vulgar terms’ with appeals being made to ‘pull on the green jersey’’; and where ‘an idea of accountability implicit in mixed government is ditched.’

    ‘For most of the history of the state’, O’Toole concluded that the state ‘failed miserably in the basic task of ensuring citizens were free from subjection to the arbitrary will of others.’[i]

    Now, as Ireland slowly unwinds from an interminable lockdown that tendency of Irish governments to pull on the green jersey, avoid accountability, reject obstreperousness and a conspicuous failure to ensure that citizens are free from the subjection to the arbitrary will of others, is evident once again. This regression has arrived especially through what O’Toole himself described on April 28th, 2020 as the ‘top-down, command-and-control approach’ of the National Public Health Emergency Team (NPHET), which the elected government has deferred to throughout most of the pandemic.

    Times of War

    The COVID-19 pandemic is likely to reshape the Irish political landscape, eroding foundational certainties of left and right. When the dust settles new formations may crawl from the debris, with democracy itself in peril, as the coalition government chooses to extend emergency powers until November, while other countries such as Denmark aim for a swift return to normality.

    In terms of the pandemic’s wide-ranging impact, there are parallels with the outbreak of a global war. As Hannah Arendt put it: ‘The days before and the days after the first World War are separated not like the end of the an old and the beginning of a new period, but like the day before and the day after an explosion.’[ii]

    Placing billions under lockdown around the world had a shuddering effect on daily routines, altering intimate exchanges and gestures, besides radically reducing the ambit of daily peregrinations. It’s a very modern form of trench warfare that confined most of us to within 5km of barracks – spilling out invective on (anti-)social media.

    In Ireland, with the advent of bigger government, there is a confidence among some on the left that their time has arrived, and that a relatively youthful population will vanquish age-old privileges of wealth and caste through a permanently enlarged state.

    However, as Eric Hobsbawm records, one reason Engels (and even the late Marx) ‘began to turn away from calculations that the international war might be an instrument of revolution was the discovery that it would lead to ‘the recrudescence of chauvinism in all countries’ which would serve the ruling classes.’[iii]

    Similarly, nationalism chauvinism – ‘excessive or prejudiced support for one’s own cause, group, or sex’ – has been witnessed throughout the pandemic in Ireland. This is perhaps unsurprising as, historically, infectious diseases have given rise to, and fed, plagues of prejudice and outright racism; the diseased ‘other’ at the gates of the city is a recurring theme. Ruling classes have often put forward strongman rulers to harness this xenophobic sentiment.

    Since March 2020 we have poured over spreadsheets of daily deaths, infections, testing rates and vaccine roll outs to determine how ‘we’ are doing relative to ‘them.’ In Ireland we tend to measure achievements and failures against the noisy neighbour next door, whose boorish leader has somehow managed to transform one of the world’s highest death tolls per capita from Covid-19 into a great British victory pageant, through a rapid vaccine rollout. Boris now looks unassailable, notwithstanding Brexit storm clouds, Dominic’s revenge, Indian variants; and just the suspicion that the vaccine may not prove quite the panacea it seems now in winter 2022. Time will tell.

    Indeed, the narrative arc of Boris Johnson’s response to the pandemic should serve as a warning to the Irish left that ruling classes can easily steal their best clothes. In this respect, Johnson operated with far greater flexibility than Donald Trump, shifting from a ‘take on the chin’ herd immunity approach in March, 2020 to championing what he would have previously decried as a ‘nanny state’ lockdown. He and his chumocracy used the pandemic as a pretext for introducing draconian legislation against protest and civil disobedience, apparently aimed at movements such as Extinction Rebellion.

    Recovery Position

    Similarly, though less dramatically, Leo Varadkar resuscitated his political career after Fine Gael’s disastrous performance in General Election 2020, donning proverbial scrubs for the initial phase of the pandemic. Having identified himself with “early-rising” middle class voters Varadkar was smart enough to realise that his preferred Thatcherite policy of reliance on an Invisible Hand of market forces could lead to a public health disaster during a pandemic.

    Since entering the coalition, Fine Gael Ministers have emphasised a law and order approach – Simon ‘TikTok’ Harris was quick off the blocks denouncing as ‘disgusting, grotesque and obscene’ a comparatively unobstreperous anti-lockdown protest in Dublin by European standards. Fine Gael have also allowed Fianna Fail to act as a mudguard for a failing system of public health: Ireland’s health expenditure is the third highest in the EU, yet we have only 5 ICU beds per 100,000, compared to 35 in Germany and 28 in Austria.

    Fine Gael represents itself as a centrist party, placing emphasis on its belated support for marriage equality and abortion referendums, which obscures from a failure in government to address structural inequalities and ongoing environmental damage. Replacing James Reilly as Minister for Health in 2015 Leo Varadkar promptly abandoned universal health insurance (UHI).

    After becoming leader of Fine Gael and Taoiseach, Leo Varadkar claimed he would represent thrusting early risers – tantamount to saying he would not alter structural inequalities that are most apparent in access to housing. In combination with Fianna Fail, Fine Gael has represented the dominant interest of large property owners, indifferent to whether their wealth is maintained via independent corporate entities, the state, or as in Ireland’s case increasingly, a corporate-state nexus.

    Simple distinctions of left and right are often misleading. Thus, when considering the virtues, or otherwise, of big government it should be clear that administrative levers and patronage may drive inequality; most obviously through mind-boggling salaries, such as the €420k paid to the Director General of a dysfunctional HSE, Paul Reid – ironically a former Workers’ Party activist. Reid has no medical or scientific qualifications, and previously acted as chief executive of Fingal County Council.

    Moreover, left-wing politicians and their supporters are often drawn from higher income groups; a tendency that within Fine Gael circles used to be referred to as noblesse oblige – accompanied by the obligatory glass of fine Cognac – of which the Just Society was the apotheosis. But a left-wing identity may be superficial, as the distribution of state largesse, or patronage, apart from being expressed in high public sector salaries, often benefits established professional elites of lawyers, academics and indeed doctors.

    Leprechaun Economics

    Big government patronage motors along fine in Ireland for all concerned as long as the tech and pharma sectors do the heavy economic lifting. This is the ‘Leprechaun Economics’ that Paul Krugman referred to dismissively. But now the Biden administration’s taxation proposed changes to the global tax system may make the current Irish model unworkable. The ECB is also likely to desist eventually from quantitative easing, with inflation looming.

    Renewed fiscal rectitude and the prospect of multinationals leaving a perpetually unaffordable capital city for workers, will place increasing reliance on those indigenous SMEs that have endured the Crash of 2008, and the unprecedented challenges of the pandemic. Yet whole sectors have been furloughed for over a year, with some such as events and tourism wondering whether they have a future at all. The Central Bank has warned that one in four firms could fail when pandemic payments cease.

    It should be unsurprising, therefore, for a small businessperson living from transaction to transaction to be wary of parties promising higher taxation on the left, and instead be attracted to politicians on the right, or even far-right, that are acquainted with the language of commerce, however superficial this may be, in the case of Leo Varadkar at least, whose concern for SMEs has disappeared after his supportive comments proved unpopular last October.

    An objective for a progressive left should be to attract support from an increasingly marginalised mercantile class, emphasising that a favourable environment for entrepreneurship, as in Scandinavia, is enabled by efficient public service, including a one-tier, functioning health system. The left can argue that leaving healthcare to market forces – as in the U.S. – is not only deeply unfair, but also, crucially, leads to greater costs than a functioning one tier public system which also – as in most European countries – delivers better outcomes overall.

    The inherent danger of Ireland’s two-tier model, where health care provision is subject to market forces is epitomised by a question recently posed by a Goldman Sachs executive: “Is curing patients a sustainable business model?” In an age of profound health insecurities – which are amplified through subtle advertising cues – market forces will continue to distort public health priorities.

    It was the father of economics Adam Smith who warned: ‘People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.’ However, while resisting a buccaneering tendency in the delivery of a vital government service such as healthcare, the left cannot afford to dismiss the dynamism of entrepreneurship in society at large. Just imagine the food you would be served if the government was running all the restaurants.

    Following Public Health Guidance

    While there are a range of financial supports available to SMEs, the world-beating length of Ireland’s lockdown has made trade impossible for many businesses, some of which may never recover. The failure of the two centre-right parties in government to represent their concerns arguably, lies at the heart of Ireland’s deeply flawed response to the pandemic.

    From March to June, 2020, 96% of additional deaths related to COVID-19 in Europe occurred in patients aged older than 70 years. Yet, despite having the youngest population in the Union, according to a Reuters by February Ireland had endured 163 days of workday closures. This was the highest, by some measure, of all the European countries surveyed at that point. By contrast, Denmark had lost just fifteen days, having experienced a death toll almost half that of Ireland’s per capita.

    The uncritical attitude of mainstream Irish left wing parties towards public health officials should also be reconsidered. Recall the major mistakes in particular by Chief Medical Officer Tony Holohan, who saw nothing wrong with fans going to Cheltenham in early March, 2020, ordered care homes to re-open to visitors that same month, and then transferred 4,500 untested patients back into care homes – surely contributing to the second highest level of care home mortality in the world during the first wave. Yet Irish left wing politicians have consistently complained about the government failing ‘to follow public health advice,’ despite Holohan’s long history of cock-ups and cover-ups.

    Even before Christmas NPHET – a body composed primarily of career civil servants and notably short on scientific expertise – seemed to have been all on board for the ’meaningful Christmas’ of Micheal Martin’s imagination. The only significant deviation between the government’s approach and NPHET’s advice was that the latter preferred to permit household gatherings rather than opening the hospitality sector. Cue raucous Christmas house parties, as opposed to what were mainly orderly affairs in pubs and restaurants.

    In fact, Ireland’s ‘third’ wave, which coincided with the more transmissible B.119 variant (although apparently not more lethal as was widely reported) actually commenced in week 48 of 2020 (22/11/2020), while the country was still under Level 5 Lockdown restrictions, according to a report by the HSPC.

    Sadly, public health obscurantism has also brought denial of their own data, which said outdoor transmission of Covid-19 is about as frequent as curlew sightings.

    The latest embarrassment over NPHET refusing to acknowledge the benefits of antigen testing, underlines that if left-wing politicians are slavishly going ‘to follow the public health advice,’ and whatever Yes Minister civil servant advises then we won’t see radical reforms in Ireland any time soon.

    Frank O’Connor

    Guests of the Nation

    Over the course of the pandemic Irish attitudes have hardened against the free movement of people in and out of the country, culminating in the introduction of mandatory hotel quarantines for some foreign, including EU, arrivals at the end of February.

    Contemporary Irish attitudes to hardworking foreigners resident in Ireland recall Frank O’Connor’s classic 1931 short story ‘Guests of the Nation.’ Set during the War of Independence 1919-21 it portrays a bond of friendship that grows up between two IRA men, Bonaparte (the narrator), and Noble, who are detailed to guard two captured English soldiers Belcher and ‘Awkins who have a natural affinity with the country:

    I couldn’t at the time see the point of me and Noble being with Belcher and ‘Awkins at all, for it was  and is my fixed belief you could have planted that pair in any untended spot from this to Claregalway and they’d have stayed put and flourished like a native weed.

    Ultimately ‘Awkins and Belcher are sacrificed at the altar of of a narrow nationalism, just as a today the Populist appeal to ‘protect our own people’ has ordained that the rights of immigrants in Ireland, and abroad, to see their families was disregarded.

    This appears to stem from a widespread notion that ‘we,’ like faraway New Zealand and Australia, can eliminate the disease from ‘our’ shores altogether – devolving into the juvenile #wecanbezeros hashtag adopted by some politicians on the left. The problem is that ‘we’ are a society with lots of ‘them’ immigrants living here, and an enormous diaspora of ‘us’ beyond the shores of an island divided into two jurisdictions, highly dependent on international trade in goods arriving on trucks (with drivers).

    Moreover, apart from the extreme geographic isolation and sparse populations of Australia and New Zealand, ‘we’ in Ireland have legal obligations to preserve freedom of movement under European treaties and the Good Friday Agreement, enshrining a porous open land border. Apart from committing economic hari-kari, pursuit of ZeroCovid appears legally impossible, unless of course we want to pursue an Irexit and build a wall along the Northern border.

    Nonetheless, egged on by febrile – ‘if it bleeds it leads’ – coverage in a national media increasingly reliant on government advertising, a prevailing view is that all deaths from Covid are essentially preventable; emanating from the failing of the state, or the reviled Covidiot, rather than being the tragic consequence of a pandemic, the death toll from which has been systematically exaggerated.

    Moreover, intercepted correspondence within the ZeroCovid ISAG group of independent scientists – who have taken on the Opus Dei role to the Catholic hierarchy of NPHET – reveals, among other disturbing insights, that they were looking ‘for ways to increase insecurity, anxiety and uncertainty.’ As these revelations first appeared in right-wing Gript, however, the left-wing echo chamber refuses to acknowledge it is being played.

    Are you right there Michael?

    Nonetheless, a number of politicians have come forward representing an anti-authoritarian left, concerned by the harms of lockdown and favouring a targeted approach – protecting the elderly – and building up ICU capacity. In a recent blistering Twitter attack the independent (and former Labour) TD for Clare, barrister Michael McNamara – who as chair of the Oireachtas Committee on Covid-19 Response became as well acquainted as any Irish politician with diverging epidemiological assessments of the pandemic – identified a recurring Irish deference to vested authority.

    In response to a Fintan O’Toole article critiquing the DUP McNamara wrote: ‘Instead of criticising unionism, let’s look at the complete mess we’ve made of Irish nationalism and nationhood. We’re ruled by a junta of medics, just as we were Rome Ruled for 7 decades. The Orthodoxy changes but the crawthumping remains the same.’

    He continued: ‘If it wasn’t for Unionism, we’d be like Hoxha’s Albania now. There’d be no way off this island. But there is a beacon. Belfast Airport and Larne are beyond the reach of NPHET, just as surely as the rule of the Archbishop’s palace in Drumcondra didn’t pass the bridge in Portadown.’

    He added more controversially:

    ‘We can’t blame the medics for their experimental therapy, any more than we could blame the clergy for their zeal.  Successive governments have abdicated their democratic responsibility throughout this State’s short history. So why would Unionists want to be “governed” by Dublin?’

    It was a fair question, when one considers the North is reopening far sooner than the Republic. Although this has arrived after a rapid vaccine rollout, the experimental nature of which McNamara raises problems with.

    Facing Up to Errors

    Here we come to the crux of an unhelpful cultural division between left and right that the ruling parties will use to divide and conquer. This is the new identity politics arising out of the pandemic, epitomised by attitudes towards face masks.

    For too many on the left the science on this issue is proven as opposed to followed. Wearing a face mask now appears to have become an article of faith. Yet a recent report by the European Centre for Disease Control and Prevention entitled ‘Using face masks in the community: first update – Effectiveness in reducing transmission of COVID-19’ stated:

    The evidence regarding the effectiveness of medical face masks for the prevention of COVID-19 in the community is compatible with a small to moderate protective effect, but there are still significant uncertainties about the size of this effect. Evidence for the effectiveness of non-medical face masks, face shields/visors and respirators in the community is scarce and of very low certainty.

    Additional high-quality studies are needed to assess the relevance of the use of medical face masks in the COVID-19 pandemic.

    Moreover, the Irish left should consider our dependence on pharmaceutical behemoths that jealously guard intellectual properties, notwithstanding huge state aid grants, and indemnification against adverse reactions. It is akin to the dependence of small farmers in developing countries on genetically modified seed, under a model of Philanthrocapitalism overseen by Bill Gates, who according to a recent article by Alexander Zaitchik has shown “a lifelong ideological commitment to knowledge monopolies,” and devotes hundreds of millions of dollars each year to whitewashing his reputation through “charitable” media grants.

    Moreover, all too often, media debates around Covid-19 fail to acknowledge the link between pre-existing morbidities – ‘underlying conditions’ – and morbidity and mortality from Covid-19. Thus, US Studies have shown that having a BMI over 30—the threshold that defines obesity—increases the risk of being admitted to hospital with covid-19 by 113%, of being admitted to intensive care by 74%, and of dying by 48%, making it almost as relevant a consideration as having been vaccinated.

    In Ireland, moreover, Mayo coroner Patrick O’Connor recently questioned the attribution of deaths to Covid-19, saying: ‘In reality, a lot of people have terminal cancer or multiple other serious co-morbidities. People can die from Covid and or with Covid. I think numbers that are recorded as Covid deaths may be inaccurate and do not have a scientific basis.’

    https://twitter.com/SunTimesIreland/status/1383791062846562307

    Furthermore, by embracing ZeroCovid Utopianism many on the Irish left failed to focus on the failings of a decrepit Irish health system. This epitomises a tendency among politicians to dance to the tune of a corporate media that has placed relentless focus on the disease itself, regularly interviewing mendacious ISAG figures, while generally ignoring underlying social and environmental factors that drive morbidity and mortality.

    The canard that Ireland could simply shut its borders and reach ZeroCovid perhaps points to the need for reform of an Irish secondary educational system, which according to the a rather unkind assessment from the OECD’s Andreas Schleicher is designed to produce ‘second-class robots.’ Perhaps too many of us are lacking the requisite critical faculties to look beyond news headlines.

    In fact a radically different, defiantly left-wing approach to the pandemic been put forward by, among others, Harvard epidemiologists Katherine Yih and Martin Kuldorff in The Jacobin. They pointed out:

    Elites have seen their stock portfolios balloon in value, and many professionals have been able to keep their jobs by working from home. It is the country’s poor and working-class households, particularly those with children, who have borne a disproportionate share of the burden. Lower-income Americans were much more likely to be forced to work in unsafe conditions, to have lost their livelihoods due to business and school shutdowns, or to be unable to learn remotely.

    Beyond ZeroCovid, the Irish left should emphasis the harms of Ireland’s reliance on lockdowns, and harness the malcontents of the poorest, including small business owners. Otherwise they court irrelevance as the traditional ruling parties have already taken on the role of ‘caring’ for the people, while retaining the power to ease restrictions in the face of opposition from the left.

    Science and Technology are not Neutral

    Also, as opposed to running in fear from being labelled anti-vaxxers by a cheerleading corporate media, the left might at least consider the wisdom of foisting vaccines that have been granted under emergency use conditions on all age groups. Indeed, many on the left in Ireland seem unwilling to question dominant institutional narratives, a tendency recently criticized by the Greek socialist Panagiotis Sotiris in The Jacobin, who said: ‘What is missing here is something that used to be one of the main traits of the radical left, namely, an insistence that science and technology are not neutral.’

    It remains unclear whether universal immunization will bring about long-term ‘herd’ immunity; while in the absence of long-term safety data the benefits to young, healthy subjects of vaccination may not outweigh the cost in terms of adverse events from treatments granted under emergency use licences. Sober assessment seems to have given way to an ideological and, at times, a coercive approach.

    In terms of the efficacy of the Pfizer vaccine, writing in the British Medical Journal, Peter Doshi, pointed to how in the media ‘a relative risk reduction is being reported, not absolute risk reduction, which appears to be less than 1%’ for severe disease.’ Ollario et al in The Lancet referred to absolute risk reductions of ‘1·3% for the AstraZeneca–Oxford, 1·2% for the Moderna–NIH, 1·2% for the J&J, 0·93% for the Gamaleya, and 0·84% for the Pfizer–BioNTech vaccines.’ The authors also pointed to how ‘considerations on efficacy and effectiveness are based on studies measuring prevention of mild to moderate COVID-19 infection; they were not designed to conclude on prevention of hospitalisation, severe disease, or death, or on prevention of infection and transmission potential.’

    Doshi has also objected to the undermining of ‘the scientific integrity of the double-blinded clinical trial the company—and other companies—have been conducting, before statistically valid information can be gathered on how effectively the vaccines prevent hospitalizations, intensive care admissions or deaths.’  This came after Pfizer pleaded an ‘ethical responsibility’ to unblind its trial and offer those who received a placebo the opportunity to receive its vaccine.

    Doshi argued that ‘there was another way to make an unapproved vaccine available to those who need it without undermining a trial. It’s called “expanded access.” Expanded access enables any clinician to apply on behalf of their patient to the FDA for a drug or vaccine not yet approved. The FDA almost always approves it quickly.’

    An alternative policy would be to reserve vaccines for those most susceptible to severe symptoms – the old and the obese – along with healthcare workers and others unavoidably working around the world in congested environments. Devoting scarce resources to increasing ICU provision to bring us into line with European averages might be a better approach than relying exclusively on the quick fix of the vaccine.

    The Irish left should now desist from identity politics around vaccine uptake that the centre-right is relishing. ‘Tiktok’ Harris previously stoked tensions with talk of mandatory vaccines and promoting vaccine passports. The left should resist vaccine apartheid, nationally and globally, while demanding the release of patents earned through state supports.

    On the Horizon

    Ireland can expect significant social problems to emerge out of our world-beating lockdown strategy that recalls a prior devotion to austerity; a mental health pandemic and mass youth unemployment are upon us already. Moreover, the young are currently denied the safety valve of an easy hop to another English-speaking country for work. This may be a recipe for radicalism, but unfortunately genuinely dark forces on the far-right are ready to pounce on malcontents.

    It is surely vital that we maintain our European connections, thereby scrapping Mandatory Health Quarantine that is an insult to immigrant groups in Ireland, as well as the diaspora. 90% of scientists believe that Covid-19 will be with us forever, so it seems there will always be ‘variants of concern’ to contend with, just as there are with influenza.

    As a country Ireland has serious work to get on with in terms of addressing a housing crisis and improving our environment. A narrow focus on the pandemic should not be allowed to derail these efforts. This may be like a war but it is not a war. Even prior to vaccines, this is a virus with an infection fatality rate of less than 0.2% in most locations. Moreover, up to 86% of those infected may not have symptoms, such as cough, fever, or loss of taste or smell, according to a UK study from October. We require better provision of public health and an adequate plan to address the ongoing obesity pandemic.

    We also need to start thinking more critically — and speaking more cautiously — about Long Covid, considering ‘at least some people who identify themselves as having Long Covid appear never to have been infected with the SARS-CoV-2 virus.’

    We need to start thinking more critically — and speaking more cautiously — about long Covid

    A New Social Contract?

    The pandemic calls for a new social contract to be negotiated in Ireland that acknowledges republican values of Non-Domination; Mixed Government and tolerance of Obstreperous Citizens. The French COVID-19 Scientific Council led the way in a paper for The Lancet:

    it is time to abandon fear-based approaches based on seemingly haphazard stop-start generalised confinement as the main response to the pandemic; approaches which expect citizens to wait patiently until intensive care units are re-enforced, full vaccination is achieved, and herd immunity is reached.

    They continue:

    Crucially, the new approach should be based on a social contract that is clear and transparent, rooted in available data, and applied with precision to its range of generational targets. Under this social contract, younger generations could accept the constraint of prevention measures (eg, masks, physical distancing) on the condition that the older and more vulnerable groups adopt not only these measures, but also more specific steps (eg, voluntary self-isolation according to vulnerability criteria) to reduce their risk of infection. Measures to encourage adherence of vulnerable groups to specific measures must be promoted consistently and enforced fairly. Implementation of such an approach must be done sensitively and in conjunction with the deployment of vaccination across the various population targets, including all generations of society.

    They argue against reliance on lockdowns:

    Using stop-start general confinement as the main response to the COVID-19 pandemic is no longer feasible. Though attractive to many scientists, and a default measure for political leaders fearing legal liability for slow or indecisive national responses, its use must be revisited, only to be used as a last resort.

    To date, many on the Irish left appear to have had their heads in the sand promoting a Utopian ZeroCovid solution. This should give way to a more balanced appraisal that considers the interests of all of Irish society. With the youngest population in Europe, and as one of the richest countries, the Irish government could have preserved a far higher standard of living for the population during the pandemic. We now need to draw up a social contract that takes a more balanced approach.

    Featured Image: Daniele Idini

    [i] O’Toole, Fintan (editor), Up The Republic: Towards a New Ireland. Faber and Faber, London, 2012, p.1-52.

    [ii] Arendt, Hannah, The Origins of Totalitarianism, Penguin, London, 1966, p.22

    [iii] Eric Hobsbawm, How to Change the World, Tales of Marx and Marxism, Little, Brown, London, 2011, p.79