An exchange of views on ‘Public Sector’ vs ‘Private Sector’

Posted on September 9, 2023 by irishmarxism

The comment below to a previous post is almost perfect in illustrating the illusions that exist on the role of the state and for which the series of posts were written. It is therefore worthwhile bringing greater attention to it along with my response:

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I would have reservations about what you say about the State and capital relationship. Both sides of the equation seem to be too general, categories that are not specific to time and place. I find the categories of the public sector versus the private sector a little more specific. The key thing here is that there has occurred over the last thirty years a major transformation in the relation between the two sectors. In short hand, there really is no public sector to talk about in the way we once did. One should preface talk about the public sector with the phrase ‘so called public sector’. The public sector has been taken over by the private sector yet throws over this capture an appearance of being in the hands of and being managed in the interest of the public.

When you use the public health service it is easy to believe that you are being served by what used to be known as the public sector, when in fact your are not, most of the services are provided to the hospital you are using by many private companies. This is just one example of many. It is interesting to see how in Britain many of what you would once have thought of as classic public services are in fact in the hands of private companies like SERCO.

I read the policy documents of the World Economic Forum and everything is dressed up in the clothes of Public Private Partnerships, something designed to deceive. What we mostly end up with, are private companies extracting money from what used to be called the Public Purse. Even the Dole broadly defined is operated by private companies pretending they are public bodies.

In a nut shell it is important to keep up with changes that have only recently occurred, over the last 30 years, not to get stuck using doctrines about State and Capital that are so universal that they pass over the particularities that now prevail.

RTE was once upon a time a part of the public sector, yet the funding came from both the licence fee and income raised from commercials. A model I have to admit I never liked, when I watch it I can’t stop moaning about the deluge of commercials, I have to sit through, more frequent than the those you get with British commercial television, four breaks for ads every hour. So the public broadcaster always had one foot in the commercial private sector. I wonder if State capitalism ever actually existed in the Republic of Ireland. When I travel from the North to the South I am struck by how more commercial the South seems to be, maybe this is too is deceptive.

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You write that the categories of State and Capital “are not specific to time and place” and that “the categories of the public sector versus the private sector [are] a little more specific”, and that the public sector gives “an appearance of and being managed in the interest of the public.” Of course, the opposite is the case.

“Public” and “private” in these contexts are empty abstractions designed precisely to obfuscate the real situation and to give appearances that essentially deceive. So-called public sector organisations are presented as if they serve the public but experience illustrates otherwise, as the posts on RTE demonstrate. The reformist left pretends that failures are due to the corruption of ‘public’ sector ownership by ‘private’ interests but the ‘public’ (however understood) does not own or control it; as we have seen from their sale and from the complete and utter lack of democracy and accountability in their operation.

Even ‘private ownership’ is no longer dominated by single ‘private’ capitalists but by collective pools of capital, including pension funds of workers, as well as pools of money of separate capitalist companies and ultra-rich individuals. Capital is being socialised but is still capital, so operates according to the laws set out by Marx, while the state is not the depository of the ’public’ or general interest but of the interests of the capitalist class as a whole. Again as set out by Marx.

It is a body separate and above society, which, while it rests on society, has its own interests that are intimately tied to the capitalist system and to various fractions of the capitalist class or to individual capitalists. Precisely in what way permits greater specification of their forms that are “specific to time and place”, which you see as the shortcoming of these categories. The general abstractions of ‘public’ and ‘private’ go nowhere, while the Marxist categories of ‘state’ and ‘capital’ have engendered whole libraries of analysis and empirical studies.

As I wrote on Facebook about the controversy at RTÉ – ‘it wasn’t commercial interests that decided to pay one presenter over €500,000 per year. It wasn’t they who doctored the accounts to hide this. It wasn’t they who cut other RTÉ workers’ salaries and conditions, and it wasn’t these interests who wasted millions by, for example, buying thousands of euros worth of flip flops on ‘barter accounts’. So what is it with “public service broadcasting” that requires so much forgiveness and support?’

Illusions in the ‘public sector’ are deep. Consider these facts:

During the Covid-19 lockdown everyone was invited to clap for the NHS in the North and in Britain when it had closed its doors to other services, with lasting effects we still suffer from, while it spent billions of pounds on useless equipment from the cronies of the Tory Party. Everyone now complains that they struggle to get a GP appointment, and that the service is crumbling, while more and more are signing up for private healthcare if they can afford it. If the ‘public’ sector really was there to serve the public none of this would be happening. If it really belonged to ‘the public’ it could be stopped but it can’t in its present form of state ownership.

The NHS is a bureaucratic monster. We recently learned of the neonatal nurse, Lucy Letby, who murdered at least seven infants and attempted to murder at least six others in her care between June 2015 and June 2016. The worst serial killers in British history have been ‘public sector’ employees paid to care for the public. It would be possible to write these off as tragic anomalies were it not for the fact that such scandals are exposed on a regular basis and are certain to recur. Only when workers and patients have the power to control and make accountable these services will this change, and this will only happen when these services are removed from bureaucratic state control.

You write that “most of the services are provided to the hospital you are using by many private companies” but this has always been the case. One of my first jobs was processing invoices from these companies in the NHS, from medical devices to food to pest control. The use of agency staff, employed indirectly through private companies, has certainly increased, but this is because the terms and conditions are better in some ways so workers such as nurses would rather work for an agency. In the last year millions of ‘public sector’ workers have gone on strike to get higher wages in defence of living standards ravaged by inflation, in the teeth of opposition by their state employers. Many workers in the private sector have already achieved higher pay increases without even having to go on strike.

You are correct to say that many previous state services have been privatised and often this leads to attacks on workers’ terms and conditions as well as deterioration in services. This often obscures the poor services previously provided under state ownership, as evidenced by telecoms in the South of Ireland. Much of the left opposed the creation of a single water authority in the Irish State, forgetting the failure of the previous mode of state ownership.

While it is correct to oppose privatisation it is no alternative to champion ownership by the state. The use of the term Public Private Partnerships, which you state is “something designed to deceive” is only true in one sense, for those with the illusion that state ownership is on behalf of the public. The purpose of the capitalist state is to protect capitalist ownership of the means of production, which is a sort of partnership. The use of the term Public Private Partnership is therefore not “something designed to deceive” but is actually a more accurate description of the relationship between State and Capital.

The alternative is workers’ ownership and not the belief that capitalist state ownership can be made democratic. This, of course, does not prevent us furthering any democratic changes that are possible without illusion that they are adequate or any sort of solution.

Covid and the failure of the NHS

Posted on November 19, 2021 by irishmarxism

Thirty-six years ago I had an interview for a temporary clerical officer job in the local hospital. One question was – ‘Who is the most important person in the health service?’

Thinking on my feet as I sat in the interview I answered – ‘the patient.’

Which is the right answer.

Although this doesn’t appear to be the case today.

While I was recruited to possibly the very lowest rank in the health service all those years ago, those today at the very top appear to have a different view.

Last week the Minister for Health at Stormont, Robin Swann, issued a public consultation on whether new staff recruited to the health service and social services should be compulsorily vaccinated. The Minister both in the consultation and in interviews more or less ruled out vaccination of all staff, considering it relevant, or perhaps only possible, for new and agency staff.

It should be remembered that the Minister and Executive ensured that all health service staff, including office staff with no contact with patients, were offered vaccination last year before patients described as extremely clinically vulnerable – those with suppressed immune systems for example.

When some of these patients were sent the draft of a letter proposing that they ensure all visitors to their homes take a Covid test, the project disappeared when it was returned with a question whether this would also include the visit of district nurses.

The public consultation launched last week mentions that “Trade unions, employees and employers will have a key role in this consultation, but the views of the general public will also be very important.” It also mentioned relatives, and failed to mention patients.

This week the Minister announced he wanted the introduction of a mandatory Covid-19 passport scheme and this has been agreed by all the parties except the DUP. So, while the Minister wants anyone going into a restaurant or pub to demonstrate that they are vaccinated, or not otherwise a risk, he thinks it’s acceptable for nursing staff dealing with the care of vulnerable patients to be excused this requirement.

Part of the reason for the recent increase in Covid is obviously the partially seasonal nature of the virus. In the case of Northern Ireland however it is also due to the relatively lower numbers vaccinated than Scotland, England and Wales, despite having had a head start on them. It currently has a higher number totally unvaccinated and a lower number fully vaccinated with a booster shot.

Not only has this probably led to increased severity of infection – requiring hospitalisation – but also increased the sickness level of health service staff (up to 20% among nurses). Media reports following Freedom of Information requests indicate potentially lower vaccination rates among nursing and social services staff than among the rest of the population.

The trade union UNISON has opposed mandatory vaccination of nurses and called for a voluntary approach of persuasion. The union might appear to be on more solid ground if it did not make the stupid point of asking why health service staff should be singled out. Management might also strengthen its position if it were to at least mention the needs of patients, that their views should be canvassed, and that protocols were in place to ensure that the most vulnerable patients were not unnecessarily exposed to unvaccinated staff. Both might have more of a point if they had followed through on their argument and were to point to a rigorous campaign to get staff to voluntarily vaccinate.

Unfortunately, as argued before, the needs of the NHS bureaucracy have been put before the needs of the people it is supposed to serve; summed up in the mantra that we must ‘protect the NHS.’ Politicians wave the possibility of the closure of Emergency departments; of the health service “about to topple over” if immediate action is not taken; and warnings by senior medical staff that “this phase of the pandemic is now the toughest”.

Just like the Tories in Britain, they point to the crisis they helped create in order to point away from their own culpability. Instead, it becomes an alibi that implicates those subject to a collapsing service who are blamed for not following guidance and advice.

They congratulate the staff on their heroism in order to absolve themselves while making their heroism a continuing requirement of their work; wrap themselves around the NHS brand in order to avoid and deflect away from their role in its failure, and threaten future collapse as a move to pre-emptively protect . . . themselves.

This partially explains Swann’s particular penchant for lavishing praise on NHS staff with ‘proof’ of seriousness by repeated announcements of additional funding. When advertising the gruelling pressure on doctors and nurses dealing with the pandemic, he presents himself as a vicarious fellow sufferer. Identification of the NHS with himself reaches a pinnacle when he says that “I don’t have enough nurses, I don’t have enough doctors.”

Additional funding, as he acknowledges himself, cannot conjure up and deploy staff out of nowhere; its announcement is instead more usefully deployed as a response to internal requests for action by medical staff raising concern at where services are heading. Additional funding cannot immediately increase capacity, especially if it is non-recurring and limited to a one-off injection, but unfortunately long-term planning has not been a strong feature of the NHS.

So, we are now enjoined to accept renewed restrictions involving Covid-19 passports in order that the NHS not be overwhelmed. Unfortunately, it is abundantly clear that the NHS has already been overwhelmed. While pointing to the crisis and away from themselves we are supposed to listen to the words of politicians and not recall their responsibility and years of inaction.

Years of unprecedented underfunding of the NHS are now presented as a historic problem that attaches to no one in particular today. We are simply reminded that the task now, our task, is to ‘protect the NHS’ in an unprecedented pandemic.

Many socialists get very defensive about criticism of the NHS, as if it were some sort of socialist enterprise in the midst of capitalism. The reasons for this are numerous, including that it is free at the point of delivery, is not run for a profit and is owned by the state.

Except that it is not free, and is funded by a regressive taxation system; many private companies make a lot of money out of it; it is owned and managed by a capitalist state, and having worked in it for 22 years I can confirm that there is nothing democratic about the way it is managed. Like all state ownership, it is bureaucratic and unaccountable, as repeated scandals exposed within it testify.

It is not therefore simply a question of underfunding, and to uncritically defend it because the only alternative is conceived as privatisation is a mistake. Socialism involves different ownership of the productive forces, including those that protect and improve our health, and this democratic workers’ ownership is not a question of a name on a title deed but of how productive forces are organised and developed.

Workers are not ignorant or indifferent to the bureaucratic failings of the NHS because they are the ones who use it, while some better off workers, middle classes, and definitely the richest all use private health care to one degree or another.

It is argued that the pandemic is unprecedented but the longer restrictions continue the more circumstances can no longer bear the description of exceptional. The lower rate of vaccination might go some way to explaining the greater effect of increased incidence of Covid than in other countries, while the later roll-out of booster vaccinations than in other countries might similarly explain renewed restrictions. Nevertheless, it is the declared necessity of protecting the health system that is employed as justification for the new restrictions announced this week.

We have been informed repeatedly about the pressure which health service staff have been put under, and our reliance on them has been reason enough for most people to accept restrictions. That this pressure has been harsh is real enough but this in itself does not permit the demands of the politicians and bureaucrats to go without challenge.

There have been enough first- and second-hand reports that not all NHS staff have been under similar pressure to ask why this organisation cannot more effectively and efficiently deal with Covid and the other demands placed upon it. Some of the reasons we have mentioned above – that the NHS is a bureaucracy in which individual talent and commitment can only have individual effects.

That the NHS is failing is shown by some of the latest statistics from the Northern Ireland health service which show that between the years 2019/20 and 2020/21 total admissions to hospitals fell by 30%; average occupied beds fell by 17.9% and total theatre cases fell from 110,605 to 59,762, a fall of 46%, and 50% on the previous year’s figure.

What these figures show is that it was not simply a question of capacity but the capability to use that capacity and the inability to use it efficiently. A factor in this will no doubt be increased sickness of staff, but the higher rate of unvaccinated staff contributed to this. Other factors will be the inability to institute infection control without reducing capacity with the creation of much-hyped ‘Nightingale Hospitals’ illustrating the problem.

The results of this failure can be seen in increased waiting times; for example in the 112,915 patients waiting to go to hospital at 30 June 2021, up from 97,243 at 30 June 2020, and 88,203 at the same time in 2019; an increase of 28% over the two years. This is an example of only the most obvious and measurable outcome, which most damaging effect is in the impact on health.

The British government has successfully protected itself by using the NHS as a shield because its popularity has facilitated this, which in turn is partially because the only alternative to it is perceived as privatisation, which is widely unpopular. Much of the Left, with its state-centred view of socialism and greater predilection for knowing what it is against rather than what it is for, has put itself in no position but to follow the government, with the add-on of demanding more money.

When the London Olympics opened nearly ten years ago, it was noted that the NHS was part of the show, a tribute to its place in the national psyche. What it wasn’t was a tribute to socialism, no more than was the presence in the show of James Bond and the Queen.

People before Profit’s ‘Zero Covid-19’ Strategy

Posted on February 14, 2021 by irishmarxism

This week the Dáil debated a motion tabled by opposition parties calling for a ‘zero-covid’ strategy. It was supported by People before Profit and repeated a number of measures published in their strategy document. Their approach has been supported by much of the Left in Ireland and in Britain. What can we make of it?

A number of questions are immediately raised that the strategy would have to answer. How long would lockdown have to last to achieve its objective; how much would this cost not only financially but also in the well-known drastic effects of lockdown, and what lives and health would be preserved by the strategy compared to the costs? Is it demonstrated that the costs will not exceed the benefits?

You will search in vain for answers to any of these questions in the PbP document.

Government strategy is based on a balance of restrictive measures and permission to do certain things that have previously been taken for granted. It is accepted that this involves costs but also benefits that justify the costs, while some costs it refuses to accept. The financial cost to the state in 2020 is estimated to have been €20 billion and Leo Varadkar has speculated that the final cost may be €50 billion.

The ‘zero-covid’ strategy means the balance is wrong but doesn’t say what the financial cost is of drastically shifting it (or the other non-financial costs e.g. deterioration in mental health, rise in domestic abuse and restriction of basic civil rights etc.). The People before Profit (PbP) document calls for the ‘closure of all non-essential workplaces’ but doesn’t say what they are: how many more would be closed compared to the current lockdown? Would the difference be significant? What work is currently not essential and what would be the impact on the economy and the workers in the closed sectors?

PbP say that profits are being put before health but since we live in a capitalist society production is both for profit and to meet needs. Socialists object that the former is an obstacle to satisfaction of the latter but they don’t claim that under capitalism needs can be met by closing down production for profit. Even their organisation’s name seems an unconscious acceptance of this (and you could write a whole post on how incoherent that name is).

PbP says that Governments only care about people working and spending, but working class people care about these things as well, for quite obvious reasons, although this seems to escape those seeking to drastically reduce both. Socialists of the Marxist variety also don’t believe that pieces of paper, or electronic data in bank computers, are a substitute for the actual production of the goods and services people use and consume. The pieces of paper that capitalism presents as the universal equivalent of real wealth is useless without the production of that which really embodies the potential satisfaction of needs.

Their demand for economic security as a fundamental requirement of public health is equated with state welfare that has always been a permanent source of insecurity, as well as a more or less inadequate safety net. Welfare systems are not meant to provide economic security for working class people and it fundamentally miseducates them to say they can.

So, the ‘zero-covid’ strategy doesn’t answer basic problems or objections. To make big claims requires big arguments and big evidence but even obvious questions are ignored.

A second problem concerns the idea of the strategy itself. It is called ‘zero-covid’ but appears to accept that you can’t get to a situation of absolutely zero. Having reduced the number of cases to a low level it still envisages periodic eruptions of cases. It does not mean ‘eradication’ but repeats that it does mean ‘elimination’, which means that control measures will still be required. The problem is that for a zero-covid strategy these measures mean punishing lockdowns.

So, the ‘zero-covid’ strategy actually involves severe lockdown of indeterminate duration to reduce cases to very low numbers whereupon lockdown is relaxed, cases will again increase, which will require further lockdowns. Its advocates think these lockdowns can be achieved by testing, tracking and isolation but widespread asymptomatic infection, incentives not to report, ineradicable errors in testing, more transmissible viral mutations, and drastic quarantine measures to impose isolation all point to something much more sweeping.

It should not be forgotten that cases reduced dramatically during the summer to something close to what I assume ‘zero-covid’ supporters would aim at, but was then replaced by an increasing number of cases giving rise to new lockdowns that the same supporters called to be more drastic. Rather than the strategy looking like an alternative to repeated lockdowns it looks like a mutant variant of it, following what currently appears to be seasonal eruptions of infection.

The analogy used to describe the strategy provides something of an understanding of what is intended but analogies have a habit of leading to misunderstanding. The example is put forward of a forest fire that requires maximum effort to put out, while recognising that embers may still remain that require to be put out when they again spark new localised fires.

The analogy fails because while forest fires destroy everything in their path the Covid-19 pandemic does not, and while new local fires can be quickly identified and ring-fenced new outbreaks of covid-19 are often without symptoms and can quickly become far from localised.

This brings us to a third failure of the strategy, which is really incredible but says a lot for its affinity to the current approach and its even worse failure to identify what the danger of the pandemic is. While noting the importance of targeting Covid hotspots and ensuring the safety of vulnerable groups, it mentions in this category workers in meat plants, those in direct provision and migrant detention centres, and travellers and homeless people. It fails to say anything at all about the vulnerable most at risk of dying. Neither does the Dáil motion, which mentions that women are disproportionately bearing the burden of the pandemic.

Nothing is said about the median age of those dying being in their eighties or about over 90 per cent of fatalities having an underlying condition. Nothing is said about the scandalous multiple deaths in residential care homes, where older people should have been made safe. Nothing about the failure of the state to secure them in its dedicated facilities or of the general failure of health services to protect them. Nothing about the infection of older people by the heath service either in hospital or through then discharging them into homes. Instead, infection rates in healthcare staff are put down to lack of money, as if infection control should not be a standing requirement. The actions of the Health Service Executive has on the contrary demonstrated that this has not been seen as an absolute priority.

To say any of this would undermine the zero-covid approach advocated by PbP, including its reliance on the state and its determined refusal to accept the very limited risks posed to all but the identified vulnerable groups. To do so might be seen to rob the situation of the sense of extreme crisis so necessary to its attempt to talk up the murderous policy of putting profit before people, and the hope that workers will wake up and smell the coffee.

What we therefore have is a strategy, not unlike the current one, that has ignored the real pandemic that has taken place, and has bought into the idea that it is a threat to everyone equally when patently it is not. The priority given by the virus in killing people is ignored by a strategy that wants zero cases for everyone, and in doing so has ignored the priority of those whose lives are threatened by it.

The health bureaucracy has moulded its response in its own image to put itself in charge. The left has moulded its response in the image of its own misguided political conceptions, including the potential benevolence of the capitalist state, despite that state’s obvious failure. Which brings us to a last major failing of the strategy.

Again and again the state, especially in the form of a national health service, is held up as the answer when a quick look across the border will show that the NHS in the North has failed, has ceased to become a health service and become instead a covid-19 service. The cost of this in future illness and death has not been a first concern. Long waiting lists have become even longer while the latter is blamed on the former and previous failure becomes the excuse for its extension.

The PbP strategy is replete with references to the recruitment of new healthcare staff ‘to dramatically increase capacity’. It wants ‘more public health specialists’ and to ‘recruit extra nurses and doctors’ but there are definite limits to how much can be done quickly. Really significant increases cannot be created in months but only over years. As an answer to the pandemic today it is a wish list that can only promise salvation sometime in the future.

It says the problem with the health services is ‘structural’ but then contradicts itself by saying it arises from lack of funding and ‘neoliberal’ management, and further contradicts itself by calling for the ‘nationalisation of private hospitals’, imposing the same structural model that has failed.

Because PbP believes that state ownership is socialist, and they think they’re socialists, then the solution is state ownership when the ‘structural’ problem is precisely this form of ownership and control. An ownership and control beset by bureaucracy and bedevilled by narrow professional hierarchies and egos.

The problem is not a style of management but that health services are bureaucracies that privilege themselves, with the most powerful within them being best able to do so, including medical consultants who prioritise private work, although this is only one feature of the state capitalist service. The policy of Governments to portray health service workers as heroes beyond all reproach is resisted by some staff but is pursued in order, not to protect the interests of these staff, but to protect the bureaucrats and politicians who govern the system. The blinkered approach to the health system leads to mistakes such as the widespread responsibility for infection by hospitals and care homes being either ignored, downplayed or excused.

The absence of answers to key questions posed by the strategy; the inadequate understanding of what it would actually mean in Ireland; the failure to even identify the main threat from the pandemic, and the call for measures that cannot be implemented quickly enough to make the difference its authors say is needed; all this points to an underlying impotent political programme summed up at the end of the strategy document:

“. . . most of all, we will need to clearly articulate a vision for an alternative to the destructive instability of capitalism – in Ireland we can play our part by popularising the call for a Transformative Left Government that would reorganise the economy under democratic control, as part of an ambitious Just Transition. . . . A left government supported by people power and workers organised in fighting trade unions can deliver real change . . .”

Capitalism will not be changed by a ‘Left Government’, by a group of politicians seeking to transform society through wielding the power of a state that exists to defend it. Neither can the economy be ‘reorganised’ top-down by such a Government that will in some way, somehow, then be subject to democratic control. If anyone in PbP still subscribes to any of the fundamental ideas of Marxism they will know all this is false, and being false it is dishonest to sell such a strategy, which is why it is so threadbare.

It is not in any sense a socialist strategy either at the level of transforming society or in dealing with Covid-19, as ritual references to emulating New Zealand, Australia and Asian countries demonstrates. In what way are any of these socialist? In what way are they safe from future infection, if it at any point they cease to separate themselves from the rest of the world in a way simply impossible for Ireland? Australia itself provides evidence that there is no such thing as one big final lockdown that breaks the back of infection. Numerous mutations in many countries belie the idea that these are necessarily foreign and can be avoided by border controls over any extended period.

The great advantage of the zero-covid strategy is that it presents an ideal outcome that compares brilliantly with any other potential approach; the more so since no cost is admitted and no account taken of any problems arising from, or consequences of, its practical implementation, even were such implementation possible in any relevant timescale.

That is why it is also ideal, unreal and hollow. Not so much transformative as transcendental.

A year of Covid-19 (4) – a tragedy to be forgiven?

Posted on February 4, 2021 by irishmarxism

It’s almost as if someone has been reading these posts on the course of Covid-19 in Ireland. Fintan O’Toole’s latest column (paywall) in ‘The Irish Times’ also notes some of the mistakes made in its early management and, while he treats the Irish approach as one of ad-libbing and improvisation, he lends a sympathetic ear to the early performance. To what extent is this justified?

Well, let’s start with the scope afforded by this forgiveness: “when it’s all trial and error, no one should be tried for making an error – even when, as in the case of nursing homes and residential institutions – the flaws were fatal.” But consider if we change the tense of the sentence – ‘even when . . . the flaws are fatal’.

‘Error’ he goes on to say ‘is moreover built into the structure of science . . . but science isn’t a set of certainties . . . to follow science is to follow evidence and with a new disease the evidence has been constantly evolving.’

Well, yes and no. The important link between the worst effects of the virus and a person’s underlying conditions has been more and more understood. On the other hand, as I noted at the end of the previous post – ‘one aspect . . . has appeared stubbornly consistent, the median age of those dying was reported in mid-January to be 82.’ Most recently, of over 1,500 deaths in care homes 369 were in January alone, a five-fold increase from December to January.

The Health Service Executive (HSE) noted on 21 January that the 27^th of the month would be the anniversary of the first meeting of the National Public Health Emergency Team (NPHET), the crisis management team for the pandemic. It was noted in April that no mention of nursing homes had been made in its first 11 meetings, with the HSE claiming that the Health Information and Quality Authority (HIQA) that attended the meetings were supposed to represent the interests of older people.

While boasting of the support given to care homes the HSE officials were at this time unable to provide up-to-date figures of deaths within them or a breakdown between state and private providers. Neither did they answer as to whether any of the deaths could have been avoided.

Around the same time that NPHET was being set up a number of important academic papers were just being published on the effects of the new disease (here and here), including evidence of the effect of the pandemic in China. The notable paper from Imperial College in London included further disclosure of the much greater threat to older people posed by the virus. While the infection fatality rate was 0.002% for children aged 0 – 9, the rate for those 80+ was 9.3%, 4,650 times higher. While these absolute figures were too high the relative differences remained.

Clearly avoiding infection was many multiples more important for older people than for the very young. Even between the age groups 40 – 49 and 60 – 69 the relative fatality rate was nearly 15 times higher for the latter group. So protecting the older age groups was vital, which involved isolating them from potential infection. How could these most vulnerable people be effectively separated?

Fortunately, many of these people were already relatively isolated in social care facilities, while identification of those in the community would be relatively straightforward. Unfortunately, this relative isolation was not a protection.

While the health regulator was supposed to represent the interests of older people the HSE was there to protect the health of the whole population. It became apparent however that the facilities they managed, controlled and regulated had become prime sites of infection, all while the NPHET engaged in interminable debate about opening or closing shops, hospitality, schools and workplaces etc.

When it wasn’t about the various levels of lockdown that were never applied at the levels specified, it was about testing and tracing, which didn’t identify where the virus was coming from and was later no longer advised for close contacts of confirmed cases. So, what had been the point of it?

At the beginning of this year ‘senior sources’ were reporting the exhaustion of their approach, admitting that there was “not much else that can be done”, which didn’t stop the debate of vanishing returns continuing. Today it revolves around rules for entry from outside the state, which is almost a moot point given the levels of domestic infection. More honestly, it is being reported that ‘Ministers and senior officials’ view it as ‘more about politics than public health.’

Yet the places where around half of the deaths have occurred – residential homes and hospitals – are spared the outrage they properly deserve. On 26 January it was reported that the level of infections among staff and patients in health care settings had never been higher. And three days later the Chief Medical Officer was explaining that there was an “exceptionally elevated” infection rate among those aged over 85; that 55 recent deaths were associated with hospitals and 140 with nursing homes; and that we could “expect a large number of additional deaths in the coming weeks.” Not much had changed over the year despite the ‘trial and error’ of ‘following the science.’

The state has incurred increased debt of around €20 billion in 2020 through various lockdowns but it is still unable to target resources effectively at the greatest problem: the daily death toll for Tuesday was the highest of the pandemic and the median age is still 80+.

It cannot be that a targeted prevention strategy would cost too much or that resources could not be prioritised – €2 billion would go a long way towards protecting older people never mind €20bn. If even half the current death toll had been avoided and it was now around 1,750 who had died, would this justify the lockdown of society along with its enormous cost? Would it not have been possible to identify those with the underlying conditions that make them vulnerable apart from advanced years, accounting for well over 90% of deaths? And would it then not have been possible to recognise the difference between those dying with Covid-19 and those from Covid-19?

But why would new problems be adequately addressed by the Irish health system when forever problems have not? When it turns out that the new problems are really the old ones? As was pointed out by one TD early on, the Health Regulator – supposed to represent the interests of older people – had already reported that in care homes the compliance rates for risk assessment and infection control had fallen from 27 per cent to 23 per cent between 2017 and 2018.

Repeated problems identified have never been adequately addressed, with the HIQA complaining in November that nursing home residents were picking up the infection in hospitals and then being returned to their homes, while care home staff were being lost to contact tracing teams and agency staff were not being included in testing.

As Prof Sam McConkey, an infectious disease specialist with the Royal College of Surgeons, put it “nursing homes have been chronically under-staffed for several years. They are going to have to start cherishing their staff as the most important thing they have.” If staff were paid adequately they wouldn’t have to take second jobs, which might for example go some way to addressing the problem that staff weren’t turning up for testing and some were showing up for work while showing symptoms.

Some care homes were simply too small with too few resources. In some residential facilities for people with disabilities derogations were given to staff to continue working though they were identified as having possible close contact with infection. They had not been tested and it was not clear when they would.

Yet, repeatedly bizarre statements have been issued by those in charge, including that NPHET was proposing setting up an infection-control team – in mid-December! As if infection control was not a standard and routine hospital requirement. Or that there were difficulties in approving employment of nurses for care homes from India, Philippines and other countries outside Europe, reported in January, when many problems were the result of shortages of staff.

All this was occurring at the same time as repeated statements were made by the NPHET, which we noted in the previous post, that “there was simply no way of protecting nursing homes or any other institutional setting if we don’t control the spread of this infection in the community.” Then saying that vulnerable groups in care settings were a priority although also saying that it was “not realistic to think we could keep it out of homes.”

Unfortunately, seeking to prevent community infection through a generalised lockdown makes all talk of prioritisation a nonsense. A general lockdown is precisely not to prioritise, and the actions and non-actions of the state are convincing evidence of this lack of ordering of risk. To talk then, as O’Toole does, of inevitable mistakes is itself to fall into the error of identifying policy as simply mistakes. Even in the case of vaccination, the representative body of private nursing homes has complained that just 10 per cent of the initial 77,000 vaccinations administered by mid-January were within nursing homes.

The identification, right from the start, that Covid-19 represented a specific threat should have been met with targeted and focused measures to protect those most vulnerable. The ramshackle and incoherent attempt to lock everybody up, that cannot be sustained, has diverted attention away from this task.

That diversion continues with a false debate over a ‘Zero-Covid’ strategy, which is simply a variant of the current approach. Like the existing approach, it targets what measures are required to support closing society instead of what measures are needed to keep it open. It again ignores experience of just who is threatened and how specific measures might be implemented to protect them.

Both the current approach and its extension into a ‘Zero-Covid’ one can’t tell us how long we would have to be locked up for and how we could be sure that whatever metric of success is decided upon could be achieved on a sustainable basis. What ‘Zero-Covid’ would gain in reducing deaths associated with Covid-19 would be more than offset by the costs of an intensified and indefinite lockdown, which if the advocates of it had been followed, would have been in place since March. Both ultimately can only be sold to an increasingly weary population by promising something that they can’t deliver: the development of the pandemic has had more to do with the weather than lockdown measures, and the end-point of immunity through vaccination may be illusory if new variants are impervious to the vaccines just developed.

In this case, and it may be the situation anyway, living with Covid-19 will be required and immunity through infection become the outcome, if not the objective. In any case and in the meantime, the policy should be directed to protection of the most vulnerable. In relation to the assessment of O’Toole, the prerequisites for forgiveness do not exist.

Back to part 3

A year of Covid-19 (3) – the Irish experience of following ‘the science’

Posted on February 2, 2021 by irishmarxism

Following ‘the science’ and its scientists that we looked at in the two previous posts does not look well in hindsight, as a short review of the course of the pandemic in the Irish State demonstrates. In the early days these were forecasting 20,000 deaths, six times the current figure which is just over 3,300, and an even greater over-estimate than the influential Imperial College paper that forecast a possible 500,000 deaths in the UK.

At the start, what characterised the response, just like Britain, was complacency. On 4 March the Chief Medical Officer Tony Holohan of the HSE stated that “as things stand” there was no reason why the St Patricks day festival could not go ahead, and he did not believe that it was proportionate to prevent Italian rugby fans from visiting Dublin for a cancelled match. The attendance of thousands of Irish racegoers at the Cheltenham festival also went ahead. From the point of view of the generalised lockdown that was later to be implemented this was a catalogue of mistakes.

The State supposedly had a policy of test and trace, in which all cases could be identified and followed up to ensure isolation. The system and its resources were quickly shown to be inadequate, with it only subsequently being admitted that test and trace did not identify where infections came from. Prof. Philip Nolan from the National Public Health Emergency Team (NPHET) stated that “we would like to go back and find out where people are getting the virus, but we don’t have the time or resources to pursue this academic exercise”. In any case, in October researchers from Beaumont reported that up to two out of every three infections could be missed through poor technique when people are being swabbed.

At this early stage the policy on testing was confused: so to be tested before March 12 a person had to be symptomatic or either in close contact with a confirmed case or have travelled from an affected area. Then having one symptom was required, then the list of symptoms changed, and if this threshold was passed the person needed to be in a priority category.

These early mis-steps have led many to see the issue as being one of weak or incomplete implementation of policy rather than the policy being misconceived in the first place. The record suggests the latter.

The island of Ireland could not isolate itself from the rest of the world so could not avoid importing the infection. Having imported it, it was always going to be impossible to identify all cases since most were asymptomatic. Social distancing and isolation of suspected cases was considered to be the equivalent of the mass quarantine implemented elsewhere but was not. The measures adopted simply slowed the spread of the infection, justified to protect the health service, but with the by-product that doing so gave it time to mutate, as it did.

Much bigger ‘mis-steps’ were made at this time, again flowing not from failure to adequately implement policy but as a result of its conception. On March 6 the representative organisation of private nursing homes, Nursing Homes Ireland, (NHI) banned all visitors to its homes. Four days later Tony Holohan of the NPHET questioned the closures “before they are really necessary” while the Department of Health only eventually gave approval to the action ten days after NHI had introduced the restrictions.

In early March Holohan was claiming that ‘we had reacted very early and with significant action compared to other countries’, although the performance of these other countries seemed to be held up as some sort of exculpation rather than a pointer to a failing common approach. For the Chief Medical Officer their response “in the first instance had to focus on dealing with community transmission of this virus. There was simply no way of protecting nursing homes or any other institutional setting if we don’t control the spread of this infection in the community.”

NPHET later claimed that it was not until late March that research pointed to the threat of asymptomatic transmission in care homes although by the end of May Paul Reid, chief executive of the Health Service Executive (HSE), was acknowledging that “there are obvious gaps in clarity and responsibility in the overall governance and oversight of private nursing homes.”

By mid-April Holohan was stating that vulnerable groups in care settings were a priority, but by that time there were 330 outbreaks in residential cares facilities, with concern expressed about under-reporting. While boasting of the “unprecedented level of support” given to homes the HSE was unable to provide up-to-date figures for deaths.

Not much later Holohan was stating that it was “not realistic to think we could keep it out of homes”, while by the end of April it was reported that 735 people had died in residential community settings. By early May the mortality rate in nursing homes was three times that among the rest of population, accounting for 61 per cent of deaths (including those in other residential facilities).

By the end of May the Department of Health had been warned by the health regulator of more than 200 “high risk” nursing homes, while receiving “just an acknowledgement” and “no response”. NHI had quickly raised concerns around PPE and hospital discharges, but by late March 88 per cent of homes had bought either their own PPE or used home-made. Almost half of nursing homes said that they had to wait 10 days for test results to come back, and publication of cases in particular homes was not provided (unlike for hospitals).

By June it was apparent that nursing and other residential facilities were not the only health and social care facilities where infections were occurring. At the start of the month, it was reported that more than 200 people had contracted coronavirus while in hospital in 102 outbreaks. By the end of August, it was also reported that about 90 per cent of all cases among over-65s were of nursing home residents (between March and end of June), amounting to almost 6,000 cases resulting in 968 deaths (56% of the total at that point).

By the beginning of the following month concern was again being expressed at the rise in cases among older people. In early October a NPHET letter noted a ‘sustained increase’ in cases, with home residents accounting for more than half of the 1,810 virus-related deaths, but with Holohan again asserting that it was not possible to document all patterns of infection and that measures directed to the whole population were needed.

The Health Information and Quality Authority (HIQA) expressed concern that there was no “consistency of approach” on whether nursing home residents should be tested where staff had tested positive. The HSE chief clinical advisor claimed that older people could not be “siphoned off safely” but the chief inspector of HIQA stated later that “not all centres where staff have tested positive have undertaken a programme of resident testing.”

In November, NPHET priorities, according to Holohan, were protection of the most vulnerable, continued resumption of non-Covid health and social care services and education of children; but by mid-November it was reported that in the week up to Oct 31 there were 56 outbreaks of infection in nursing homes and 33 associated with hospitals.

Lockdown however appeared to be getting some results, even if this was little more than postponement rather than eradication. This was now success, as was the perceived protection of a health system unable to adequately do its own job of protection.

By the beginning of December the Irish state was hailed, especially by itself, as the best performing in Europe measured by the average number of new cases. Unfortunately, even in success the most significant threat remained, with Holohan expressing concern at the level of infections in nursing homes despite the highest Level 5 lockdown. Hospitals also remained a problem, and on 13 November it was reported that pre-admission tests for Covid that had been recommended for hospitals were not being practised by all. Anne O’Connor, the chief operations officer of HSE, stated that guidance had been changed in the previous two weeks.

By December the problem with hospital acquired infection was continuing, with over 200 confirmed cases in the four weeks up to 13 December and more than 400 picking it up in hospital in two weeks in January. By the new year the Irish State had gone from the being the best in Europe to being the worst in the world in terms of growth in cases. The State went from 80,000 cases in nine months to doubling this total in three weeks.

Since there had been a partial opening before Christmas this was held up for blame but there remained no evidence that cafes, hairdressers or clothes’ shops were a problem; it was a question of a seasonal infection flourishing in its best environment with any human interaction facilitating spread.

Doing away with the latter altogether was the only logical extension of the existing policy and all the variations on the different social distancing rules were the proverbial number of angels dancing on the head of a pin. Very few wanted to go there, and those who might would face the difficulty that closing down sites of infection might have to start with hospitals and nursing homes, with 100 outbreaks in the former from July to mid-December and 93 in the latter. A study in mid-January reported that the rate of infection among hospital staff in Galway and Dublin was six times that of the local community.

Despite the months of restrictions and despite the worst-in-the-world figures there did not appear to be excess deaths. The prevailing narrative appeared to tell a story that did not add up. One aspect however appeared stubbornly consistent, the median age of those dying was reported in mid-January to be 82. This outcome was consistent with the North despite its apparent different path, with people aged 75 and over accounted for 77.7 per cent of ‘coronavirus-related’ deaths and with 91.5 per cent having some pre-existing condition, Dementia and Alzheimer’s disease being the most common.

Back to part 2

A year of Covid-19 (2) – following doctor’s orders

Posted on January 27, 2021 by irishmarxism

The view that there is a single scientific approach to the Covid-19 pandemic has had a number of consequences.

Firstly, it became simply a scientific question; at most politicians had some discretion to accept or reject the extent of the measures proposed by the scientists and doctors, but no wider political questions were involved despite the dramatic effect on people’s everyday lives, their employment and their freedoms. Any regard to these was argued to be putting ‘the economy’ before lives and particularly denounced by some on the Left. The Government could pay for any of the economic consequences and let the science-led effort to control the virus take effect. Anything else was letting politics interfere and was by definition unjustified.

Secondly, because there was a single science, whatever scientific approach was adopted was the right one, again with only a difference of degree acceptable, so that whoever was appointed the scientific leadership was by definition the single scientific authority. Others could comment, but as we saw in the links in the last post, the scientists themselves were under pressure to accept that there was a single scientific approach, resulting in censorship and self-censorship of critical views.

One example of this was the criticism of the voluntary approach adopted by Sweden, pointing at certain times to its relatively high death toll, while failing to highlight that this had resulted from the failure to protect the elderly in care homes. Yet exactly this same failure was held up to excuse the record of the Irish state, which pointed to the failure of other countries to protect its elderly population as some sort of exoneration. In April the Health Service Executive national clinical advisor was pointing to the failure in Ireland not being unique and that many countries were struggling with outbreaks of infection in homes.

At this stage between 45 and 60 per cent of all Covid-related deaths in the UK, Belgium, France, Spain and Italy had been of residents of nursing homes. Yet rather than this being a series of warnings, of wake-up calls that something was wrong with the prevailing approach, it was accepted. The chief medical officer Tony Holohan later stating that it was “not realistic to think we could keep it out of homes”.

In 2017 the Irish State had adopted a management plan to deal with emergencies, which it then ignored when the pandemic threatened. Instead, it made the top leadership of the Health Service Executive the scientific leadership, which almost immediately appeared to have so much authority devolved to it that it also appeared to have almost total control.

This in itself was pretty extraordinary since the HSE (and the Health Service in the North) was widely regarded as being something of a disaster, while the bureaucrats with medical qualifications that had presided over the failing health systems, along with the various governments, were for that reason considered responsible.

In the North, the extent of the failure was brought home when it was reported that Poles living there travelled home for treatment rather than wait years on a waiting list; and that one GP had disclosed that some of his patients who had fled the war in Syria were in ‘disbelief’ at the state of the North’s health system. The same one sometimes held up as a model for the two-tier service in the South.

Such was the moral panic induced, the responsibility for the ability of the health services to do its job, to protect the health of the population, instead became the responsibility of the population to ‘protect the health service’. In this, the situation in Ireland North and South was the same as in Britain, the architects and executive of the failing system made their failure the responsibility of the people they had failed.

Since the health services could not protect the people and had already failed, it was clear from the start that the people would fail to protect the health service. Simple and routine daily activity became the occasion for berating the public that they were letting the health service down, or as the Health Minister in the North put it, was equivalent of going into a hospital and ‘slapping a nurse.’

The blinkered approach that considered there was a single scientific approach, and the domination of this approach by a medical bureaucracy, meant that wider considerations were ignored. It became a situation I have described before as one in which those with only a hammer perceive every problem as a nail. This was obvious when the strategy adopted became subject to the inadequate resources of the acute health systems North and South.

It is important to recognise the domination of health services by the acute sector, the hospitals, which always downgraded social and community services and public health; the price of which in the pandemic has been paid in lost lives. It is not as if the problems with this have never been acknowledged. In the North the necessity of greater emphasis on community services has been repeated in reports as often as it has been disregarded following their publication. Public Health has always been the Cinderella service, although at least she got to go to the ball; in the health service she would have got to go to the laundry in the outhouse.

The National Public Health Emergency Team (NPHET) married the erroneous view that there was a single scientific approach with the acute services bias common to many health systems. This common bias helps explain the similar failed approach adopted by so many countries that ironically justified each other’s failure by their own. Yet the nature of the threat has been obvious from the start.

In the last week of December, it was reported that a majority of the 2,150 deaths in the Irish State were accounted for in nursing homes and that in this, and in infections among hospital staff, it was among the worst in the world. In the North it was reported that 39.2 per cent of all Covid-19 related deaths in 2020 were of care home residents in hospital. In effect, the gathering of the vulnerable in enclosed locations became not protection but helpless confinement, and the mechanism to provide treatment the instrument of infection.

The common approach of generalised lockdown was justified by the need to protect an inadequately resourced health service that precluded targeted protection of the vulnerable in homes and outside. Yet it is admitted in NPHET minutes reported over a week ago that “the majority of the excess hospitalisations, intensive care admissions and deaths would be amongst those aged 60 – 79 Years”. The policy of precisely targeted measures and resources to protect these people was rejected on the grounds that this would lead to unsupportable demands on the heath service. Was it not taken into consideration that targeted protection would act to reduce potential demands on the health service?

Despite all this, the authority of the medical leadership has withstood the outcome of the failed approach adopted, in Ireland and in other countries. Instead, the measure of success is not avoiding failure, but failing better. That is, not being so bad that the country comes out looking worse than others. The performance of the Boris Johnson government has therefore been a bit of a get out of jail free card, and the Irish is not the only political leadership on these islands that has relied on nationalism for political protection, not excepting the Johnson government itself.

Forward to part 3

Back to part 1

Covid before cancer. Or maybe not.

Posted on November 16, 2020 by irishmarxism

The Northern Ireland Health minister was interviewed on the BBC here. After first saying that he didn’t want anyone in the health service to be put in a position of making ethical decisions to deny essential medical treatment the interviewer told him that the Chief Executive of the Belfast Health Service Trust has said that they are already being made, and are life and death decisions. Does Swann deny this or say he will investigate? No. He immediately and without hesitation attempts to justify something he said he didn’t want to happen, as if it hadn’t been happening.

He says that these decisions have to be made – “the ethical decision is could we turn a Covid patient away? The answer is no.” For other patients, “sorry your operation, your scope your diagnosis is going to have to be put off.”

When it is put to him that what he is saying is that a Covid patient won’t be turned away but that the result of this is that a cancer patient may die his answer is “yes, that’s as black and white as it is.”

So how is this ‘black and white’? There has been no medical assessment provided that this blanket prioritisation is justified, in fact it is presented as if its justification is self-evident, an obvious ethical decision. Except it’s not obvious and it is without justification, in both senses of that term – it has not been justified and any attempt to justify it would be wrong.

Swann says that we ‘cannot turn a Covid patient away’ but we already know that while over 50,000 people in the UK and over 3,000 in Ireland have died with Covid it is not at all clear how many of these have died of Covid. So how can this particular disease be prioritised?

More people die of cancer than Covid-19. There are around 165,000 deaths from cancer in the UK – that’s every year. In 2018 over 4,000 people died of cancer in Northern Ireland. In the Irish state over 9,000 die every year.

It cannot be because of the severity of the disease: cancer kills cancer patients because of their condition, while for most sufferers of Covid the disease is so mild they may not even know that they have had it. If someone with Covid has a serious underlying condition making them vulnerable to death compared to a relatively healthy person with the same disease, what is it that makes the difference between survival and death? Covid may be the proximate cause of death but Covid may not be the underlying condition without which death would not occur. If this is not considered an important distinction then presumably the health service and whole swathes of the economy will close down during the next flu season. A report from the Health Information Quality and Quality Authority shows that not all ‘Covid deaths’ should really be counted as such (see below).*

There is little that can be done to avoid many cancers; even those who don’t smoke, eat healthily and exercise fall prey to it. Hospital treatment is necessary but can sometimes require less serious intervention if caught earlier, although this is precisely what is being deprioritised. Those most vulnerable to Covid on the other hand can take many of the measures we have all become accustomed to including social distancing etc. The most vulnerable received shielding letters informing them of their vulnerability and measures they might want to take to limit exposure to infection. Swann and his chief medical advisor have decided that these letters aren’t necessary this time but provided no real explanation why. What has changed from the first lockdown?

Why is the protection of those most likely to suffer fatalities from Covid not the major focus of protection, support and prevention from these political leaders and bureaucrats? Is it not really that, what both measures have in common – prioritisation of Covid patients within hospital and lack of focus on those most vulnerable – and what is being protected, as they have made clear repeatedly, is the NHS? Protected from doing a job they know it will fail? And by their association, responsibility and accountability for it, protection of themselves?

The NHS in the North of Ireland is the worst in the UK. There are, for example, more than 2,500 nursing vacancies. As I have said before, Covid-19 may overwhelm the resources of the health service but is in itself not overwhelming. It is only so because the NHS is already in crisis, and what we are asked to do is also to accept that we must collude in covering up this permanent crisis, including through regular speeches telling us how difficult it has been for the staff.

This message is all the more powerful, and successful, because it is largely true – many health service staff have been under enormous strain but this should not be an alibi for failure of the bureaucracy that is the NHS as an organisation. As I have said before, the demand to protect the NHS, when it is supposed to be there to protect us, is an admission that this responsibility of the NHS will not be met.

The unjustified blanket prioritisation of Covid patients in hospital and the failure to issue shielding letters to the vulnerable are political decisions and have been successful because of a political campaign to justify lockdowns. This has involved not only politicians but also senior health figures, who have given legitimacy to their decisions. One such figure has been Gabriel Scally who has regularly intervened to argue that policies in the North and the South should be the same, as if two wrongs make a right. He has stated that ‘the figures speak for themselves’ when it is well know that they don’t, and has stated that over 50,000 have died of the disease without recognition that dying with it is not the same as dying of it. That such basic errors are repeated by a respected public health doctor illustrates the scope of the group think that has developed.

So egregious was the Health minister’s statement that the Department of Health put out a tweet entitled ‘Myth Buster’ with ‘myth number 1′ being “are Covid-19 patients being prioritised over other patients?” To which the answer was “No, they are not. Patients are treated according to clinical priority.” Swann pitched in with “it is untrue and offensive for anyone to accuse frontline staff of prioritising one condition over another.”

Since it was Swann who said that prioritising was ‘black and white’ perhaps it is himself he is referring to as being offensive. So who is right – the Department or the minister, and which version of the minister?

It would be difficult to deny that senior health staff would not be so stupid to as to admit such crass medical practice but easy to understand how Stormont politicians could grandstand with this level of idiocy and ineptitude.

The real problem is not that some politician has instructed hospital doctors to relegate individual cancer patients in order to prioritise Covid patients but that this is what has and will continue to happen by political decisions on allocation of resources that constrain individual medical assessments. These individual decisions rely on higher level decisions on allocation of staff, wards and beds to deal with Covid that in the first wave witnessed empty Covid beds in the Nightingale hospital while other treatments were stopped.

Lockdown is a political decision involving an analysis not only of the disease but the potential impact of the response. It is not a question of medical expertise determining the correct approach, even if one were naïve enough to believe that the medical profession is a paragon of virtue and wisdom. The advocates of lockdown refer regularly to the number of cases, hospitalisation cases, numbers in ICU and deaths but rarely to the costs incurred by lockdown. To do so would invite a critical debate they are ill prepared to have. Swann’s mistake was to take soundbites to their logical conclusion and blurt it out. It denotes the logic of the current approach but too crudely expresses its effects.

It is tempting to see in Swann’s first statement the chaos and breakdown of the functioning of the Stormont Executive that because of its reaction to the pandemic was seen for a while as an example of the political arrangements working. No one is pretending they’re working now. However, the real political weakness lies not in the political primitiveness of Stormont but that such crass political interventions elicit no popular opposition. Unfortunately on this score looking for the left to offer one would be a complete waste of time, as we shall look at in the next post.

* HIQA: ‘The officially reported COVID-19 deaths may overestimate the true burden of excess mortality specifically caused by COVID-19. This may be due to the likely inclusion within official COVID-19 figures of people who were known to be infected with SARS-CoV-2 (coronavirus) at the time of death who were at or close to end-of–life independently of COVID-19 or whose cause of death may have been predominantly due to other factors.’

https://www.hiqa.ie/sites/default/files/2020-07/Analysis-of-excess-all-cause-mortality-in-Ireland-during-the-COVID-19-epidemic_0.pdf

‘Protecting’ the NHS

Posted on May 1, 2020 by irishmarxism

I watched the BBC Panorama programme on the NHS and the Government failure to prepare properly for the Covid-19 pandemic, despite warnings. It focused on its failure to stock and resupply adequate amounts of appropriate Personal Protection Equipment, and to spin the amount of PPE newly received by, for example, counting a pair of gloves as two items and including cleaning disposables as equipment.

The Tories cannot legitimately complain if they have made the NHS the centre of controversy because it is they who put it to the fore – ‘Protect the NHS’ is the slogan, with ‘success’ of its whole effort defined as the NHS not being overwhelmed by casualties of the virus. It is important we don’t buy into this.

We are implored to ‘Protect the NHS’ when it is the function of the NHS to be the last line of defence for us. Instead it has become the last place anyone wants to go. Having scared everyone by the lockdown, vast numbers of existing and prospective patients have either been told not to attend, had their treatment cancelled or postponed, or have been unable to get diagnoses and tests they badly need. The NHS isn’t dealing with them – it has been estimated that 18,000 extra deaths from cancer might result, currently around half of those recorded as dying from Coronavirus.

Not only has the NHS moved from defending us to us being exhorted to defend it, but the NHS is actually a threat, including to its own staff, over a hundred of whom have been estimated to have died from the virus. While appointments and operations are cancelled, and Emergency Department attendances have collapsed, we are invited to acclaim the empty Nightingdale hospitals and empty beds as a success! We are expected to recognise as successful an NHS that has become the site of infection and the one certain place to avoid unless you have absolutely no choice.

We are to applaud a service that has stopped being a National Health Service and become a National Covid Service following a transparently political agenda. As I have written before, we are invited to ‘Protect the NHS’ when truthfully what we are invited to protect is the Government that has so denuded the NHS of resources for so long, and made such a mess of the current outbreak, that it simply cannot cope with doing its day job and deal with the virus at the same time.

By making sure that the NHS is able cope we ensure that the cuts and their effects are hidden despite the crisis; but rather than seeing this as a grotesque choice we have been forced to accept we have been invited to greet it as ‘success’, as Johnson so glibly and cynically put it.

And we do this because the NHS is one indivisible saintly entity without a bureaucracy that heads it, or an amoral Government that directs it, that unproblematically reflects the innate compassion of humanity – despite the evidence that doctors, nurses and purchasing managers have all complained that this organisation is failing its own staff never mind those it is there to serve.

The NHS, created to put an end to dependence on charitable provision, has become the biggest charity case in the country. No doubt many people want to help, but the greatest help is not the individual resources many have had to fall back on but development of critical political consciousness.

We are supposed not to pay attention to the censorship of NHS staff who complain about their lack of protection but invited to applaud every week the protection these people are supposed to give us. We are simply to accept that cancer patients will not get their treatment because on balance they would then have their immune system too compromised if they became infected, which is only the proper choice if we already accept that they cannot be protected.

We are to ignore that the NHS has taken PPE from elderly care homes while moving infected patients from hospitals into them: ‘Protect the NHS’ does not apparently mean Protecting Social Care. Their clients’ deaths weren’t even counted in the headline daily total until very recently.

It becomes ‘pragmatic’ to downgrade the level of PPE required by NHS and care staff because the real scientific advice, unencumbered by Tory political pressure, would demand a level of PPE that the NHS cannot provide. So the ‘objective’ scientific advisors objectively become conspirators in covering up Tory austerity, neglect and incompetence.

This is a surreal world of spin and lies and suppression of facts, fairness and free expression that has worked because of fear and ignorance and lack of accountability, and because we really do rely on the NHS.

The Government has not been held to account by the Labour ‘opposition’, has only begun to face some media criticism recently, and has benefited from the social isolation of social distancing. This distancing includes distancing from reality, substituted by what Marxists call reification and alienation that amplifies the worst media influences and instincts to defer to authority. This authority would have us rally round flags standing either side of Government spokesmen who substitute for the primacy of the people clichéd totems of Britishness and itself. Real solidarity is replaced by calls to the police by snitches reporting neighbours who don’t get out to clap the NHS and its workers.

So, in Belfast we were told that 15,000 people would die but now only 1,500. We have appointments and procedures cancelled and postponed and over 70 Covid-19 beds created, that last week saw only around half occupied, while a further 200 plus have been set up. A hotel has been taken over but only one floor is so far used. Never mind, this may be ready for the next surge in September – October, which will perhaps translate as another Johnsonian ‘success’. Ring for a service and you can be told that resources are being devoted to the treatment of Covid-19. Appear in the City Hospital and find yourself inside a ‘clean’ area that unfortunately has just had red signing put up to indicate Covid-19 areas as the green signs disappear. In some locations work is hectic while in others activity has hardly been lower and there are only the rituals of infection control. Similar stories could be told across the NHS but it is all socially and politically invisible.

The NHS is a bureaucracy as well as a service, but it has become a saintly institution which it is blasphemous to criticise, and one that the Government has wrapped round itself to shield itself. In the Orwellian world of 2020 those who have spent ten years weakening it are holding up the banner of its defence against those whom it should serve and have suffered from the years of austerity inflicted on it. Just as NHS staff have been blamed for PPE shortages so patients are held responsible for its inadequacy.

It is therefore not ‘Our’ NHS. It doesn’t even belong to those who work in it. Working people should be asking themselves how all this is the case and what it is we really should be defending. Socialists should ask themselves just what a genuinely socialist service would look like. The NHS hasn’t been hijacked, it’s simply following orders

The Irish and British responses to Coronavirus – different or just equally bad?

Posted on April 10, 2020 by irishmarxism

The British Government’s approach to the Coronavirus has been the subject of much, almost smug, criticism on this side of the Irish Sea. In the North nationalists, and not only they, have called for an all-island approach and rejection of the British strategy of ‘herd immunity’. Every British failure has been criticised and the response of the Irish Government lauded.

This was boosted enormously by the speech of acting Taoiseach Leo Varadkar, standing between the Tricolour and flag of the European Union, in bright contrast to the performance of Boris Johnson, sandwiched between two union flags. The serious and statesmanlike approach of Varadkar was taken as so much more apposite than the unpredictable and sometimes incoherent ramblings of the Tory leader. The two countries were adopting very different approaches and there was no doubt which was the better, even if Varadkar did a Churchill by saying ‘never will so many ask so much of so few’.

However, when all is said and done there is more than a little bollocks to such a view. There are certainly more similarities than differences, starting with the flag waving as the cover for a host of failures.

Ostensibly, the Irish approach is to avoid exposure of the population and to reprise the South Korean model of testing, contact tracing and then appropriate isolation. It has also taken more extreme measures to lockdown the population, for example by limiting outside exercise to within 2 kilometres of the home, and appearing to close down its economic activity even more drastically than the British.

The perception that this is a more responsible and sensible approach is one reason it has received popular support, although the same forces of compliance and deference apply in Ireland as much as in Britain. Rallying round together in face of the enemy is a natural response even if it is conflated with rallying round a political leadership that has done nothing to deserve it. And that is the most obvious similarity between the two countries.

But not only that. The NHS has been subject to at least a decade of underfunding and misleadership that has led it to be woefully unprepared for any crisis, never mind this one. The current Fine Gael administration is the most openly right-wing and pro-free market of all the parties, which caused it to be decisively rejected at the last general election, not least because even in an economic boom the Irish health services are seen as a mess.

In February it was reported that 677,344 cases were on the waiting list with over 12,000 left on trolleys in January, the second worst month on record. 2019 was the worst year ever for hospital overcrowding as 118,367 patients were left without beds during the year. This level of overcrowding showed that the Irish health system had insufficient capacity before the crisis and is utterly unprepared to deal with much greater demands now. The ‘Irish Times’ reported on the front page of its 9 April edition that ‘emergency care doctors have expressed concern that the peak of the most critically ill coronavirus patients has yet to hit hospitals as existing intensive care units approach full capacity.’

As for the expected surge, the chief executive of Nursing Home Ireland has said that ‘nursing homes are effectively dealing with the surge that the hospitals were expecting.’ This has led to ‘clusters’ of the virus appearing in 137 nursing homes and other residential facilities, up from 4 on 21 March. It is primarily the old who are dying, with the last reported median age of fatalities being 81. The Irish State is proving no more capable of protecting its older citizens than the British.

The Irish health system is so bad the NHS is held up as an examplar, mainly because of the gross inequality in Ireland arising from health insurance that gives you greater access than public patients.

While, just like Britain, the policy is to protect the service, both states are near the bottom of hospital beds and ICU beds per capita. The Government has hatched a deal to use private hospitals for public patients but this has led to protests from consultants that their private patients will not receive necessary treatment.

In both jurisdictions the Government has promised levels of testing that they have completely failed to deliver, which is possibly even more egregious in the case of Ireland given its so-called strategy. Johnson and his Government have gone from promising 250,000 tests a day, to promises of 100,000 by the end of the month (made at the start of it), while on 8 April Public Health England was reporting a testing capacity of 14,000.

In Ireland the Minister of Health promised 15,000 tests per day on March 19, while two weeks later the total was 1,500. Almost a week after that, Dr Jack Lambert from the Mater Hospital in Dublin was asking ‘how can you talk about flattening the curve where you’re testing such small numbers of people and people are queuing up to get testing?’

In nursing homes some tests have taken 10 days or more for results to come through. There are also reports of delays in tracing people having contact with those testing positive, making a total nonsense of the supposed strategy. Never mind, the Irish Minister of Health has promised action by the end of the month as well.

Shortages of Personal Protection Equipment exist in Ireland just as they exist in Britain, exposing health and care workers to the virus and onward transmission to the patients, clients and residents they care for. Again, the chief executive of Nursing Home Ireland has said that nursing homes are suffering severe shortages, with just 51 receiving enough, and then only for three days normal usage, while 63 others are still waiting for a delivery. Promises made by the Minister of Health to the sector have not been delivered. Not that hospitals have all they need, St Vincent’s in Dublin has warned that it is facing ‘considerable difficulty’ in sourcing masks, and that the ‘ongoing availability of masks cannot be guaranteed’.

In Britain there are numerous reports of threats to NHS staff who go to the media to explain the consequences of Government failure. Weekly clapping on behalf of NHS workers is evidence of widespread support for the service, but the silencing of NHS workers demonstrates that the NHS is not ‘our’ NHS; it is owned, run and controlled by the same state that has so abysmally failed to protect its own workers. Were the NHS really an example of socialism we would not have its workers afraid to speak out – they would own, run, and control it and be able to speak openly.

In their place we have daily press conferences, where questions routinely don’t get answered, including by the experts, while data is misleading – the figures of those infected are next to worthless and the total number dying isn’t even accurate. But at least in Britain they have daily press conferences where questions are asked, and there is a pretence at answering; the Irish Government has distinguished itself by its even greater secrecy, opposition to accountability or examination of its policies. Instead, as everywhere else, moral commands induce moral outrage as a substitute for critical engagement.

Even that voice of the restrained and sober middle class, ‘The Irish Times’, has editorialised on the difficulty of obtaining information, e.g. on waiting times for test samples, on the backlog of tests, the state’s stock of protective equipment, the real-time state of ICUs, and how the virus is interacting with other conditions. It has noted the ‘discomfort with scrutiny’ and Ministers’ requests that questions be sent in advance.

This follows the Executive’s attempt to shut down debate in the Dail, which was rejected. This, from a Government without a mandate, that has shut down large parts of the economy sending unemployment rocketing; instituted strict limits on free movement, and introduced draconian measures that give the Garda the power to arrest you for refusing to obey instructions or to give your name and address.

We are informed that the decisive intervention that ensured the Garda got such powers was the Garda itself, through the Commissioner Drew Harris, ex of the Royal Ulster Constabulary and Police Service of Northern Ireland, recalling for me that the date of birth question was always the one that refusal to answer might lead you to being lifted by the RUC.

We can see that the Irish State has done nothing to warrant either the praise or trust it has received. Yet it cannot hide forever from the inadequacies of the health system for which it is responsible. It will also not be able to make good its promise that the cost of shutting down the economy and temporarily supporting incomes will not lead to austerity further down the line. This is simply a lie.

At the same time as coronavirus has consumed attention, the politicians and media have been obsessing over the formation of a new Government, with the prospect of a coalition between the two reactionary civil war parties, ruled out so categorically, now looking more likely. The complaint of both is that no other Party wants to join them, such is the distrust. Except for Sinn Fein, which says a lot about all three.

However, rather than the problem being lack of a Government, the problem is lack of an opposition. The trade union movement is disarmed because of state subsidies for those affected by unemployment although this is unsustainable and will not be sustained. The left is in thrall to massive state intervention, which it talks and acts as if is some sort of socialism, when it is not. The authoritarian measures are opposed but not vehemently because these have not yet become unpopular. Not for the first time the potential to present an alternative is lost, because no alternative is presented.

Repeal the Eighth!

Posted on May 17, 2018 by irishmarxism

It is one of the ironies that afflicts the Irish State when it comes to its treatment of women that the last couple of weeks has seen its health services in the dock for its disregard for their health at the same time as the climax to the referendum on whether to repeal the amendment to the constitution that criminalises abortion.

The Health Services Executive (HSE) decided that it would not inform women that the cervical smear test that showed a negative result was wrong, and that they did in fact have cancer. At least 162 were not informed about their findings. Of those who could have had earlier intervention if the tests had not been false 18 have died.

Politicians are now declaring their shock, and sympathy with the women and their families, while they sit on top of a state with a long, long history of such secrecy and disregard for women’s rights. In fact, many are now defending this denial of rights through their support to retain the eighth amendment, which has led to women dying because of its elevation of the foetus over the woman who carries it.

The issue in both is about control. Do women have control over their own bodies?

In the case of the cervical smear scandal, it was the state and its medical professionals who decided that women would not know about the potential threat to their life. In the case of women who seek to control their own bodies through control of their womb, it is the state and its medical professionals who are held up as arbiters of the extent of this control, with some seeking to limit it altogether.

If tragedies alone led to change then fundamental change would have happened a long time ago, but it has taken the struggle of women and the revelation of the scandalous behaviour of the Catholic Church to bring about change.

The failures of the outsourced cervical screening service and the HSE were exposed not through any change of heart by the state, but by the bravery of one woman suffering from terminal cancer, who took a court case against the US testing company. In the case of the fight for abortion rights, it was not the X case or the death of Savita Halappanaver or any of the others that has made repeal of the eighth a possibility. These would have shocked and appalled and led to nothing but the next tragedy, were it not for the movement to demand the rights of women, led by women themselves.

A vital factor nevertheless has undoubtedly been the crushing of the reputation of the Catholic Church, whose moral authority has been fatally undermined for many because of the child abuse carried out by its priests and ‘holy’ orders; its actions to protect the abusers by moving them around the country so they could abuse again, and their failure to pay the minimal compensation to their victims that they campaigned shamelessly to reduce or avoid.

Yet still, despite this litany of infamy, they control the vast majority of primary schools and have massive influence over health service provision. They continue to do so because of a continuing alliance with the state.

On 25^ththere is a chance to continue the campaign to reverse this, and repeal the eighth amendment. Opinion polls show a reduced but still substantial lead in favour of repeal, with support for repeal highest among the young and urban population, especially in Dublin. Views on both sides appears to have strengthened, hardly surprising given the age-old tactics of the reactionary ‘pro-life’ campaign.

If repealed the Government has promised to legislate for limited abortion rights up to 12 weeks and the anti-abortion rights campaigners have claimed this will open up Ireland to UK-type abortion provision, including abortion of the disabled. Nothing they can do however will prevent UK abortions, including those of the thousands who travel from Ireland to have the procedure carried out. Not that it hasn’t been tried, but imprisoning 14 year old rape victims who become pregnant was not a popular policy.

The growth in support for women’s rights among the young and urban population testifies to a transition and transformation in views, also reflected in opinion polls. While 54% of respondents in the latest agreed with the statement that they have reservations about provision of abortion but feel the 12 weeks in proposed legislation is “reasonable compromise’; 62% also agreed that “the law in Ireland needs to recognise a woman’s right to choose to have an abortion.”

This movement for, and of, women to take control is reflected not just in the possibility of repeal but in the potential for a continuing movement to advance women’s rights and in the courage of some to express their support for abortion rights and opposition to the insults of its reactionary opponents.

Working class women will not gain control over their lives without a veritable social revolution that they can only achieve in unity with working class men, but such unity is impossible if women are unable to control their own bodies and own lives in the most basic of ways. For a socialist, these are aspects of a single struggle against oppression and for a new fee society in which everyone can flourish.

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Sráid Marx

An Irish Marxist Blog

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