Minister for Health Leo Varadkar
So the Budget has come and gone and there has been no major transfer of funds to primary care or general practice, or even any firm indication that it will happen any time soon. This is exactly as I predicted here, but for those who are struggling to make a living as general practitioners, it is not yet a case of ‘abandon hope all ye who enter general practice’.
Yes, the arguments have been well made, and the practical case for siphoning a little bit of the flood of money towards a cheaper, more effective primary care service has not been acted upon, so it might seem – on first impression – that Minister Varadkar is cut from much the same stalk as Minister Reilly. It might seem that he is as intent as Minister Reilly was in maintaining the status quo.
We got an almost perfect illustration the week before last of how and why the health service is so dysfunctional, and how the bust and boom cycle aggravates many of the problems it faces. It’s almost certain that these factors – aggravated and intensified for political reasons – have caused deaths among the Irish population that would otherwise not have happened, so it is an extremely serious and important issue.
The event that demonstrated this fact so effectively was the protest at the Daíl by the National Association of General Practitioners, (NAGP) and the subsequent response from the Minister for Health, Leo Varadkar – which presumably will be his actual response in the upcoming Budget submissions for his Department.
There has been a Dr Casey working as a GP in Clifden since 1916. When the current Dr Casey’s father, Dr Michael Casey took over in the 1940s, he replaced another Dr Casey (no relation) and when he retired in 1974, his son, Dr John Casey took over.
But it’s unlikely that a Dr Casey will have been the local doctor in Clifden for a hundred years in 2016, despite the fact that Dr Casey’s son, (also John) has qualified as a GP and works in the practice with him.
There are at least three phrases the Irish people don’t want to hear again after eating the humble pie of an economic collapse.
Those post-prandial flourishes – “We are where we are”, “legacy issues” and “the actions of a previous government” seem like reasonable excuses, but not when the government seems hell-bent on creating the type of problems now that will come back to haunt us in the future.
One of my great heroes in journalism was the great John Reed who wrote the definitive book on the Russian Revolution, “Ten days that shook the World” and he did it mostly by being there. He happened to have had the fortune to be in Moscow in October, 1917, and so his eyewitness account of those events has become the standard by which all others are judged.
Limerick isn’t Moscow, and Ireland’s general practitioners aren’t exactly the lumpen proletariat, but last Monday night I got a sense of what John Reed must have felt at the beginning of a revolution. There was a sense that whatever comes next must be radically different from before – a sense that nothing could be the same again.
We have entered familiar territory with the controversies over Universal Health Insurance (UHI) and free GP care for the under-sixes. We are now, as we so often are, not on the edge of a brave new world, but in the land of political promises, where the fulfilment of a promise is the main aim – the introduction of some fairness, efficiency and quality in our health service is a mere by-product.
It all started so well. ‘Free’ GP care sounds like something good – who could be against something that would ease the weekly financial burden on families? Universal Health Insurance sounds wonderful too – the first real measure that attempts to provide healthcare on an equal basis to everyone, or so it would seem from the terminology.
The reality, of course, is much different.
The National Association of General Practitioners says that the primary care system is close to collapse.
Terence Cosgrave talks to three doctors about the choices and challenges they face and why one doesn’t regret his decision to emigrate.
CUTBACKS in general practice have reached a breaking point, with many GPs operating at a loss or breaking even. It means that many will have to reduce their service to the public or even leave Ireland to earn a reasonable income. The result could be a devastating blow to general practice in Ireland – a service that is universally acknowledged by the public as the one area of the health service that works.
Dr David Janes, for example, is a GP in rural Waterford near the town of Clonmel. He says that last month he worked for nothing, as by the time he had paid for all his overheads, there was no money left to pay himself a salary. With a wife and three children, that position is untenable.