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6th January 2023
It was about 8:30 pm last night when I happened to hear on the radio that Deputy Anne Rabitte had had a bag of ‘manure’ thrown at her at a public meeting, and my first thought was that the insult had been downgraded.
It had been previously reported on Twitter – by the TD in question – that the item thrown had been a bag of ‘sh.t’. And now that the…dust… has settled, it appears RTÉ are prepared to step into the definitional vacuum and pronounce the substance ‘excrement’. Good old RTÉ – stepping in to bring some measure of clarity to the situation, and to define the, er, issue for the nation.
We are, of course, in the netherworld between the figurative and the literal in this latest incidence of airborne insults, but what we are really dealing with is impotent frustration. It is only when the debate is pointless and a distraction to progress that someone feels the need to end it by hurling …well, you get my point.
Unfortunately, as has been said many times before, rage is an emotion, not a policy. Vilifying opponents or politicians might be satisfying in the immediate term, but it doesn’t move the debate any further forward, and, in fact, can have a very negative effect on the debate itself, by shutting down the positive aspects of airing all sides of an issue.
But in the case of Ireland’s overcrowded and dangerous Emergency Rooms (ERs) the debate has been won many times by the same side. The problem is that there doesn’t seem to be anybody to blame. There are no organisations, or politicians, or people who are ultimately responsible for this atrocious mess. We are all on the side of those who want decent conditions in ERs – we are all debating on the same side, opposing, apparently, no-one.
You might initially suggest that the problem comes down to a lack of funding, and that is mostly correct. The problem is really about a lack of funding – either today, or in the past. There aren’t enough beds, enough space, or enough doctors. Or nurses. So surely you would say that’s the fault of the politicians?
They haven’t provided the funding.
Except they have.
Instead of actual faeces, they have thrown money – to use that political cliché – at the problem. Health funding has gone up and up and up, and yet, it never seems to be enough. We now have the tenth highest healthcare spending per capita in the world, as the story below confirms, and we are still in a crisis situation.
But, of course, that argument is easily (and accurately) overcome by pointing out that there has been record under-investment in the past, and that there needs to be compensatory investment now to make up for this ‘lost’ investment.
There is also the fact that investment in health in Ireland has tended to go massively over-budget – as evidenced by the building of the Children’s Hospital in but one example – and there is a reluctance to spend more than what is considered a ‘proportional’ amount on capital infrastructure – before we even think about the substantial investment required in personnel.
Therefore, this current crisis of overcrowded ERs may actually help – in terms of politically allowing the government to direct even more money towards the health service, albeit perhaps with some increased monitoring of the value for money received. But we are unlikely to see that happen without some major changes in our approach.
Personally, I don’t buy the opposition argument that the Health Minister and the government of which he is a part is opposed per se to increasing health budgets. They and their predecessors have shown a willingness to do so in the past, and they have no ideological reasons to prevent them doing so now or in the future.
If they have reluctance to spend, it is surely based on the fact that they have seen a lot of money go to the Department of Health previously, and they don’t believe they’ve seen value in return. Value, in this case, would be the political kudos for solving the ER crisis. Money goes to the health service – bags of it – but nothing comes back by way of credit. Best to spend the money on a local road instead.
And then, there’s the timing. Elections are in the summer, ER crises are in the winter. I don’t want to oversimplify the political realities, but there they are. Politicians may be good or bad people, and surely there’s a mix of both, but they all know they mostly fight elections when people aren’t thinking about ER crises. And they mostly fight elections when the majority of people don’t currently have a relative stuck on a trolley. That’s the reality.
Health services, however, succeed or fail based on their long-term thinking and strategies. By the time those strategies can be seen to succeed or fail, the political opportunity to gain popularity from them is long gone. That’s why health spending is whatever is the lowest that the Minister for Finance can get away with, while resources are allocated elsewhere. (Why are we spending money subsidizing the horse and greyhound industries?)
A quarter of century ago I remember looking at some figures for Irish pensions. It showed a demographic timebomb for Ireland in terms of paying those pensions in the long term as the older population grew. But, as was pointed out to me at the time, whatever about the population ratio of people working vs. people on pensions, it made no allowance for the extra healthcare needs which all of these older people would necessarily imply because of their age.
And no politician gets elected for planning good stuff for 20 years hence. Consequently, nothing was done to rein in pensions, or to save for any of these long-term commitments. It’s always easier to kick that can down the road. Borrow from Peter Future to pay Paul Present.
We need a huge investment in health right now, and we can pay for it readily enough by reining in some of the other, more wasteful, government spending. But it won’t happen until health is acknowledged as a national priority, something that is more important than new aeroplanes for the Defence Forces, motorways or LUAS routes. Something that must be fixed not just for now, but for future generations.
Throwing bags (whatever they contain) at politicians won’t solve any problem – in fact, it makes everything worse. But as this crisis builds, we do need to analyse why it’s happening and what we can do to prevent it in future. Only a small minority of people are affected at any one time, but in time, we all are.
It would be opportune now for an announcement of a funded government plan to solve this problem for once and for all, and for the next generation. That would require the medical community to argue effectively for the right plan, the right spending and the right strategy. We already know what needs to be done. Surely we are capable or explaining that, negotiating for that, and getting it done.
It’s either that, or make a complete bags of it. 
Tagged with: comment Terence Cosgrave
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Everybody's talking about Bagism – Irish Medical Times
