Conor Reddy on how the emergency response to the pandemic has strengthened the demand for an all Ireland national health service
A particular effect of the pandemic has been the exposition of long running structural deficiencies in the provision of healthcare across Ireland. In the most acute phase of the pandemic, the real threat of hospitals being overwhelmed forced unprecedented action from governments North and South — budgets were increased, recruitment moratoriums lifted and private hospital capacity was taken into public control. Announcing the decision to take over private hospital capacity in the South of Ireland former Minister for Health, Simon Harris remarked, “For the duration of this crisis the State will take control of all private hospital facilities and manage all of the resources for the common benefit of all of our people. There can be no room for public versus private when it comes to pandemic.”
In the South, where healthcare is delivered through an obtuse and costly two-tier system, the promise of free access to hospital care based on medical necessity, rather than ability to pay, raised much deeper questions. In a country with the longest waiting lists for inpatient care in the EU, people began to ask why this principle should only apply in the exceptional moment of the pandemic and not universally. For years, the public hospital system has existed in a state of almost permanent crisis — overcrowded, understaffed and poorly resourced.
The public system in the Southern state has been contained by the Catholic church and a guild-like medical elite. Successive governments have suggested that problems in health are intractable, complex and unrelated to the two-tier, public-private model and its subsistence off the back of the public system. The effect of emergency measures was to shatter this illusion, giving rise to the popular demands for “No Going Back” to the dysfunctional pre-covid health service.
Another important development was mainstream consideration of an All-Ireland approach to healthcare. In March and April, divergent public health strategies on either side of the border meant that border counties had some of the highest infection rates in the country.
The existence of two different test and trace regimes and two opposing sets of public health guidelines operating side by side exposed the backwards logic of partition. This, coupled with the malignant influence of the Tories and their proposed herd immunity created a unique environment where liberal commentators such as the Irish Times journalist, Fintan O’Toole professed their support for a whole island approach to Covid-19 and even healthcare as a whole. The absence of an NHS-style system in the South is often seen as a major barrier to support for Irish unity in the North, the present moment has forced broad engagement with this concern and lent credibility to the idea of an All-Ireland National Health Service.
The specifics of these revelations and questions aside, it’s important to note the role of Ireland’s transformed political landscape. Over the course of the last decade the stultifying Church and state conservatism in the South is dead and gone. The victories of social movements for marriage equality and abortion rights, the experience of mass campaigns against austerity and the emphatic rejection of the conservative parties, Fine Gael and Fianna Fáil, that once dominated Irish politics, not only speaks to a deeply held desire for change but a new “People Power” politics, that radically challenges all aspects of the status quo.
People power politics has not been exclusively confined to the South, the push for abortion rights took on an All-Ireland character, with thousands of women marching and campaigning on both sides of the border. Derry Socialist, Eamon McCann fittingly described these mobilisations and other whole island protests at the time of the Belfast Rape Trial, as demonstrations of, and not for, a united Ireland. It was with all of this in mind that a group of activists and healthcare workers initiated the Campaign for an All-Ireland National Health Service back in May.
The Campaign is quickly growing as a united front, demanding a single-tier, national health service across 32 counties that would cover all aspects of health and social care, from the cradle to the grave. Having secured the support of several political parties, trades councils, scores of healthcare workers and health campaigners, the Campaign is aiming to mobilise people on a sustained basis — on the streets, in local campaigns and crucially, in healthcare workplaces. The historic strikes by nurses, midwives and healthcare workers North and South last year demonstrated the explosive power and moral authority of healthcare workers — their discontent today, in a unprecedented crisis is something the campaign seeks to engage with and channel.
Conor Reddy is the People Before Profit representative for Dublin North West, (SWN member)