Health Service in Crisis: A Junior Doctor Speaks Out

Throughout the pandemic, the establishment have been quick to call frontline health workers “heroes”. Junior doctor Eóin Ó Murchú argues that lip-service is not enough, and COVID has put a spotlight on treatment of health staff in Ireland.

The arrival of SARS‐CoV‐2 in Ireland brought the capacity and robustness of the health service to the forefront of the public consciousness.

Politicians have stood on pulpits speaking in military parlance about the need to brace ourselves, bolster our defences, keep our guards up, and protect others. But the outpouring of concern for patients and for “frontline heroes” aroused uncomfortable emotions in doctors and other healthcare staff – this doctor included.

Just a little over a year ago, nurses who went on strike for better pay and conditions were threatened with the cancellation of agreed pay increases, if their action went ahead. Many of the same Fine Gael government faces now profess insincere gratitude to the nurses “battling the virus on the frontline”.

While glorifying the sacrifices of health workers, they have ignored the material conditions which have made those sacrifices all the more dangerous: the dearth of basic medical supplies like PPE, especially at the beginning of the pandemic; working over painfully long working hours in precarious conditions; and the impact of decades long under-staffing, underpaying, and resource rationing.

The case of Dr Syed Waqqar Ali most tragically epitomises this process. Dr Syed Ali, originally from Pakistan, gave 20 years of his life teaching doctors and treating patients in Ireland. On his 60th birthday this summer he was buried, after a three month stay in intensive care. He contracted COVID-19 while treating patients.

Dr Ali’s family had to set up an online fundraiser to cover the loss of household earnings, which was not provided for by his temporary contract. The official heads of the HSE (Health Service Executive) and the state referred to this undervalued and hyper-exploited physician as a hero without even a hint of irony. Where was this hero’s PPE? Where was mandatory sick pay for his family? Where was his permanent consultant post? It is hard to remain sanguine faced with this level of cruelty and hypocrisy.

Privatisation

In focusing on “heroism”, we lose sight of the broader context and the systemic political neglect and siphoning of funds away from the HSE’s frontlines over many years. The healthcare system lumbers from one crisis to another. Crises caused by privatisation and neoliberalism existed long before COVID-19 and have hindered our ability to react to it.

The trolley crisis has been almost synonymous with the last ten years of Fine Gael rule, but since 1980s the total inpatient bed capacity in the South’s healthcare system has fallen from 16,000 to around 12,000 beds. This represents a fall of capacity from 4.89 to 2.63 per 1,000 people.

There are roughly 844,000 people languishing on waiting lists in the HSE – that’s 1 in 5 people awaiting specialist care. Research by Julien Mercille in UCD elucidated this process well in a recent paper on healthcare capacity.

The INMO (Irish Nurses & Midwives Organisation) dutifully reporting the scandalous figures year on year. The IMO’s (Irish Medical Organisation) call for an increase of thousands of acute care beds, repeated ad nauseum, receives but a meaningless nod from those in power at each budget.

Meanwhile, the share of inpatient capacity that is represented by private for-profit hospitals has mushroomed from 0 beds in 1983 to just under 2000 beds in 2015.

The proliferation of private beds coincided with financial crises in 1980 and 2008 respectively. While frontline staff, community based services, and smaller and regional hospitals see their budgets cut; private insurance and hospitals’ shareholders reaped the rewards of these trickle up economics. It is exactly this process that healthcare workers must identify when justifying our demands for a national health service and a fair share of government funds.

A private system can only ever flourish on the back of an underfunded public one. Even surgeons, frustrated by lack of facilities and ability to treat patients in a timely manner will turn to private practice if they want to actually treat patients (with not insignificant financial rewards waiting for them.)

Inequality and Inefficiency

However it is this medical apartheid, this means tested cleavage in healthcare resources that stratifies and divides people according to the value assigned to them by the market. Healthcare delivered according to the market and not according to need. This is a principle that can only produce and reproduce resentment and reinforce disabling healthcare inequalities.

I have seen resentment in patients that don’t qualify for a free GP visit. Having to pay out of hand for frontline medical care. This is presumably a desired effect, dividing and atomising patients into anxious consumers that are forced to see healthcare as a commodity.

It is hard to forget the look on a patient’s face when told the length of public waiting lists for a surgery they’ve needed for years. The doctor on the other side of the desk, completely unable to offer anything but bland reassurance and perhaps an embarrassed apology for the inhumane healthcare system we have built.

I have also seen the frustration of specialist surgeons unable to treat their public patients in a timely manner and forced to use the dreadfully inefficient National Treatment Purchase Fund to give patients the care they need. The commandeering of private facilities during COVID did little to tackle the waiting lists despite the resources at hand. Consultant rooms lay empty but rent collected without fail each month.

The stigma of holding a medical card can affect patients’ experience of the healthcare system is something I’ve also encountered.

This is not a simple story of antagonism between good patients and greedy doctors but one of communities and their complex relationship with a Health Service Executive ostensibly designed to maximize the profits of the biggest rentiers in the business: private hospitals, insurance companies, and pharmaceutical corporations.

The small business model of general practice forces clinicians to see balance sheets where there are patients. And this is an inevitable truth of market dynamics.

Healthcare workers and patients rights advocates have decried these conditions for years but the government hasn’t heeded their calls for change. Now, the pandemic has exposed the irrational and cruel inefficiencies of our healthcare system.

Overworked and Underpaid

Ireland has one of the highest percentage of healthcare worker infection rates in the EU and the casualisation of work in the HSE has meant the many doctors, occupational therapists, nurses and physiotherapists find themselves without even sick pay during the height of this pandemic. This is unsurprising to those of us who’ve experienced HSE terms and conditions, but no less shocking.

When I read in the Irish Times on April 1 of this year that Irish doctors were working 24 hour shifts I thought it was a joke made in poor taste.

The fact that this could make a headline, considering the never ending reality of 24+ hour shifts doctors up and down the country work, speaks volumes about how unaware the public are of our working conditions, and how under reported it is. The outcry it provoked, however, offers a shimmer of hope for the overworked junior doctor staff.

The general population are always appalled to hear about the extreme hours worked by doctors. It frightens them to think that somebody expected to look after them in their time of greatest need could be on the 22nd hour of their shift.

It’s not allowed for nurses, airline pilots, or freight truck drivers, so why do we accept it for junior doctors? The fact that there still are 24 hour shifts legally rostered in Irish hospitals is a searing indictment of the leadership of the medical profession.

Moreover, recent surveys from the IMO reveal a massive discrepancy between the hours hospitals claim doctors are working and the hours doctors themselves report.

We are told our sacrifices now will pay off later. We are told to keep the head down and not to draw attention to yourself for causing too much trouble. Keep the head below the parapet and you’ll get the right references to impress the right people to get the right job.

This approach may work for the privileged few, but for the very many foreign doctors locked out of training this mantra falls on deaf and tired ears. EU legislation dictates that training positions must be given to EU candidates first relegating the foreign doctors hoping to make a career for themselves to a life of uncertainty.

Already there are calls in the north for all NHS workers to receive a pay rise. This call has been echoed across Europe, in countries like Spain and France.

We need organise in our union structures, in our communities, and on the streets, to demand a national health service is free at the point of access for all, with safe working conditions, increased training positions, and an end to discrimination for health workers. This needs to take place north and south in Ireland and include our other colleagues on the frontline.

If we have learned anything during this pandemic it is to smash the old lie that the budget for patients and the healthcare systems we work in should be reigned in.

Nothing is too good for the hospital patients in this country, or the workers that work with them, and the COVID crisis has exposed the urgency of the task ahead.