Category Archives: health service

The reality of the Good State

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Some readers of this blog might think that I’m labouring the question of nationalisation and state ownership and its identification with socialism. While I believe it is a question of fundamental political importance its practical significance has been vividly illustrated in the last few days.

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In Britain the report from the fifth investigation into Stafford hospital has been delivered, prompting David Cameron to say that he was”truly sorry” for what had happened, which was “not just wrong, it was truly dreadful.” Previous investigations had already established in harrowing detail the abuse and neglect that took place from 2005 to 2008.

Between 400 and 1,200 more deaths took place than would have been expected between these years, although it is stated that it is impossible to say whether all of these patients would have survived had they received better treatment. Receptionists were left to decide which patients to treat, inexperienced doctors were put in charge of critically ill patients and nurses were not trained how to use vital equipment.

The National Health Service, so beloved of the British nation that it featured in the opening ceremony of the Olympics, has been damned from top to bottom.

Trust management ignored patients’ complaints while local GPs and MPs also failed to speak up, the inquiry said.

The local primary care trust and regional health authority were too quick to trust the hospital’s management and national regulators were not challenging enough.

Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.

The Department of Health was also criticised for being too “remote” and embarking on “counterproductive” reorganisations.

The findings of the report cannot be regarded as an aberration as it follows repeated damning judgments of care provided in Britain, especially care of the elderly, and news that five other hospitals are to be investigated following Stafford.

Yet the NHS is the crown jewels of the social democratic state.

The inquiry’s head said that patients “were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.”

Many on the left speak and act as if the only problem with the health service is a lack of cash but this is much less than the full story and money will not deal with what has been referred to as the cultural changes that are required.

Working class people in Britain and Ireland are all too aware of the shortcomings of the health services. While those in Ireland may wish for their own NHS those in the UK know its limitations and going to hospital is more and more regarded as something you really don’t want to do unless you have to.

Those with elderly relatives in care are all too aware of the possibility of mistreatment.

Only yesterday Channel 4 news reported on the death of an elderly person left with no domiciliary care for 9 days when the service she was receiving was closed by immigration police, who had raided the office of the private organisation providing the care. When the care provided by this organisation stopped the council never picked up on the elderly woman who had no relatives. She went without her medication and died hungry, thirsty and alone.

Two days ago the illegal charging by the Irish State of people in long-term care again became news. As early as 1976 the State, through the Department of Health, knew its charges were illegal. In 2005 the Government attempted to make them legal retrospectively although this was stopped by the Supreme Court.

The Government knew exactly what it was doing. The Minister of Health Mary Harney said that “more than 300,000 people were charged illegally during 28 years. This was entirely wrong. They were old, they were poor, they suffered from mental illness, they had intellectual disabilities, they were physically disabled. As vulnerable people, they were especially entitled to the protection of the law and to legal clarity about their situation.”

And yesterday the report on the Magdalene Laundries was released, which revealed some of the State’s role in the incarceration of thousands of women in institutions run by Catholic religious orders, compelled to work for nothing and stigmatised as ‘fallen women.’ “A very Irish form of slavery” as the Sinn Fein TD Mary Lou McDonald put it. Over one quarter of the women were put there by the State. The last laundry only closed in 1996.

The State again attempted to cover up and lie over its role.

In 2009 the Minister of Education Batt O’Keefe said that “the Magdalene laundries were privately owned and operated establishments which did not come within the responsibility of the State. The State did not refer individuals to the Magdalene laundries nor was it complicit in referring individuals to them.” Not true.

In 2011 Sean Aylward, secretary general of the Department of Justice, speaking in Geneva at the UN Committee Against Torture said “the vast majority of women who went to these institutions went there voluntarily or, if they were minors, with the consent of their parents or guardians.” He knew this because he had met some of these women.

Yet not one of the five women he had met had entered the laundries voluntarily or with the consent of their parents or guardians. Over eighty three per cent who entered the laundries were put there.

What all these examples demonstrate is that the capitalist state cannot be relied upon to provide services that working people, especially the most vulnerable, require. Some, like the Magdalene laundries, are now easy to denounce but none are models of socialism. Far from uncritically defending these services socialists must educate and agitate for a workers’ alternative to how they are currently organised and managed. The very last thing we want to do is proclaim these services as exemplars of socialism and the state that runs them as the font of this socialism.

Savita Halappanavar and the demand for the Truth

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Minister for Health James Reilly

In this post I warned that the State was going into defence mode in order to protect itself from the fall-out from the death of Savita Halappanavar who, from all accounts, died in agony while the hospital in which we was being treated refused to terminate her pregnancy because this would necessarily result in the death of the foetus. “This is a Catholic country” she and her husband were told.  As a result her life was unnecessarily put in danger and she died.

The response of the Government and many others, including the anti-abortion lobby, is to emphasise the uncertainty around events and to defuse the response to them by calling inquiries which, on the face of it, have no credibility.

Consider the following.

Mr Halappanavar heard nothing from the Irish authorities until he made the tragic death of his wife public.

The Government then announces an inquiry by the hospital group where Savita died and one by the employing body, the Heath Services Executive (HSE).  In effect both bodies would be investigating themselves.

Such is the arrogance and panic of the organs of the State concerned that they include three doctors in the HSE inquiry from the Galway hospital where Savita died!  When I first heard this on RTE news I was struck immediately with complete incredulity. Did I hear that right?  Mr Halappanavar has pointed out that there were five members of the medical staff in the room when he was told that she could not have a termination because “This is a Catholic country”.

The Chairman of the inquiry says he needs these medical staff in order to “find out about their standard practice.”  In other words those investigating the death would be asking themselves what goes on!  This is independent?

As Mr Halappanavar and his legal advice say – the inquiry is private, it is confidential, evidence will not be taken on oath and there will be no cross-examinations.

The Government makes a partial retreat by removing the local medical staff but then puts pressure on Praveen Halappanavar to accept the HSE inquiry.  The HSE know he is unhappy but then claim it is only the participation of the three staff that evoked his concern.

It is then pointed out that he didn’t know about the three internal staff at this time and had in fact objected because the HSE was running the inquiry (into itself) and would not be holding hearings with witnesses.  So he could not have objected on the grounds claimed by the HSE.

Praveen Halappanavar’s solicitor also claims that the medical notes of Savita  given to Praveen have parts missing.  They contain records of requests by Savita for tea and toast and a blanket but no written information about her repeated requests for a termination nor of the consultant saying “This is a catholic country”.

A spokeswoman from the HSE is then quoted as saying that she was sure no notes were withheld for “spurious reasons”.  Indeed.

Yet we are expected to believe that the State and its inquiries will give Praveen Halappanavar and everyone else the truth.

The courageous stand by Praveen Halappanavar has stripped the State inquiry of any credibility and it cannot now perform the function assigned to it by the State.  The huge march in Dublin has demonstrated the anger and determination of many not to accept the death of Savita or accept that it might happen again.  So far the anger of many women and men, along with Praveen Halappanavar’s determination, has forced the State to retreat and put serious pressure on the Government.  The pressure is particularly strong on the Labour Party, which claims progressive credentials.  Fine Gael on the other hand has always been a reactionary tribe. It is so far an open question how far and for how long a more or less spontaneous reaction can threaten this Government and advance women’s rights.

The emphasis on legislating for the X case, while this would be an advance, also runs the real risk of duplicating the uncertainty which already exists but which thereby provides the certain barrier to women’s realisation of their right to control their own bodies.  A limited, confused and contradictory constitution and legal view is just as liable to bring forth another limited, confused and contradictory piece of legislation, and would the Government really mind that?

The spontaneous eruption of women and men claiming their rights has an unrivalled quality of energy, hope and passion but the force and determination of organisation and strategy is, as time goes by, much more likely to bring what is required.

Politicians are manoeuvring to avoid the blame or claim the leadership of the demand for women’s rights.  The not-so-united United Left Alliance has put two separate amendments to the Sinn Fein motion in the Dail calling for legislating for the X case, putting a large question mark over its ability to perform this latter role.

This role is not to seek immediately to lead this spontaneous movement but to help it find organisation, a strategy, its own leadership and to fight for a women’s right to choose as the only certain route to establishing the rights of women.

The Left, with its history of political sectarianism, would have to change its instrumental approach to campaigns if this were to happen and they become able to play this role.  There are reasons why it might not do so but there are many, many more why it should.

 

 

 

What is certain about the death of Savita Halappanavar

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The husband of Savita Halappanavar has been very clear.  His wife was refused a termination of her pregnancy although the foetus would not survive, because the foetal heartbeat was still present, and Savita and he were told, “this is a Catholic country”.  He later said that he was convinced she would have lived had this medical intervention taken place.  All this appears pretty clear and it adds up to a shattering condemnation of the Irish State and the reactionary forces within Irish society which have denied the rights of women to control their own bodies.  What has happened is indefensible not least because the Indian nationality of Savita Halappanavar means it has become an international story.

The Irish State has gone into defence mode and sought to do so through diversion.  First it is hoped the issue can be immediately defused and closed down at least temporarily by the call for an enquiry that, it is stated, will take three months.  We are expected to believe that the truth will emerge from a government that couldn’t even give clear answers why two health centres are to be built in the Minister of Health’s own constituency.

For those opposed to women’s rights there is nothing wrong and women can rest assured that whatever medical treatment is required for their good will be provided, a claim that flies in the face of all that we know about what has happened.

More dangerously the issue has been diverted by the repeated calls from politicians and commentators that what we need is ‘legal certainty’ as if this is the problem.

This is not the problem.

Thousands of Irish women travel from Ireland to receive abortions because they are all too certain that they cannot control their own bodies within Ireland.  It is all too clear that there are no abortion facilities in Ireland and it is all too clear and certain that all the political parties don’t want to change this.  They have had twenty years to bring the slightest doubt to such a judgement and they haven’t even tried.

Secondly we are meant to believe that certainty can be delivered from this piece of the constitution: “The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.”  Given the history of this question it is as likely that legislation would result in the same certain denial of women’s rights as currently exists.

Thirdly, and most importantly, lack of certainty isn’t at all the issue.  It is the right of women to control their own bodies, to make their own decisions.  We can be certain that had Savita Halappanavar’s wishes been acceded to there would be no question of medical practice being based on theology.  We can at the very least say that her chances of being alive today would be higher.  Isn’t that what hospitals and health services are supposed to be for?

It is not a question therefore of the State being certain about the restrictions that they impose on women’s rights.  It is not an answer that the medical profession be clear when they must let a women die in agony because the law is certain when they can and cannot intervene.  It is not enough that women travel abroad because it has been made crystal clear that they cannot vindicate their rights to control their own fertility within the Irish State.

What has happened to Savita Halappanavar has been portrayed as an extreme case and in an obvious way it is.  But by its very extremity it has demonstrated that women’s rights to control their bodies will be prevented on anti-abortion grounds, even when it leads to a woman’s death.

The staff at the hospital must be asked to reveal the full decision making process that went on.

What must be made clear to the Government is that the rights of women will not be dismissed and we will not be diverted into accepting a new certainty as to the restrictions placed on them.  Legislating for the X case would of course be welcome but it is not enough.

The demonstration outside the Dail last night and actions elsewhere were exactly what was immediately required.  This must be followed up by demonstrations and a campaign that demands the full rights of women to control their own fertility including safe and legal abortions with all the necessary facilities to provide them.

Savita Halappanavar told “This is a Catholic country.”

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Savita Halappanavar, who was 17 weeks pregnant, arrived with back pain at University Hospital Galway on October 21st but was found to be miscarrying.  Doctors told her the baby wouldn’t survive but it would all be over in a few hours.  Her agony lasted until 28th.

Her husband says she asked several times that the pregnancy be terminated but that this was refused because the foetal heartbeat was still present. Her husband reported that the doctor “told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately the baby wouldn’t survive.”  There followed three days, he says, of the foetal heartbeat being checked several times a day.

He says that, having been told she was miscarrying, and after one day in severe pain, Ms Halappanavar asked for a medical termination.

This was refused, he says, because the foetal heartbeat was still present and they were told, “this is a Catholic country”.  She spent a further 2½ days “in agony” until the foetal heartbeat stopped.  When the dead foetus was removed Savita was taken to the high dependency unit and then the intensive care unit, where she died of septicaemia on the 28th.

“Savita was really in agony. She was very upset, but she accepted she was losing the baby. When the consultant came on the ward rounds on Monday morning Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said, ‘As long as there is a foetal heartbeat we can’t do anything’.

“Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita said: ‘I am neither Irish nor Catholic’ but they said there was nothing they could do.

“That evening she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics.  “The next morning I said she was so sick and asked again that they just end it, but they said they couldn’t.”

When the foetal heart had stopped Ms Halappanavar was brought to theatre to have the womb contents removed. “When she came out she was talking okay but she was very sick. That’s the last time I spoke to her.”  At 11 pm Ms Halappanavar’s husband got a call from the hospital. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren’t functioning. She was critically ill. That night, we lost her.”

On the face of it we have a desperate tragedy that could possibly have been avoided. That it has not is because of the continuing power of a state colluding with an institution, the Catholic Church, which, despite being increasingly discredited, continues to wield enormous power.  This includes its patronage of hospitals and influence on medical practices.

The Church has been found guilty of systematic and widespread child abuse in report after report.  It has defended itself first by cover up and denial, relying on the state, including the Garda to protect it; and finally by expressions of sorrow and regret while making the minimal of changes.  The Church has still been allowed to continue to ‘self-regulate’ while it being obvious that the resources provided to protect children are woefully inadequate. The Church has shown not the slightest sign of willingness to pay for its crimes.

Above all it has been the state which has been the last line of defence for the institutional power of the Church and this is so despite the much publicised criticism by politicians, including Enda Kenny in the Dail, and the weak measures to reduce Church patronage of schools.  Such criticism is designed to save the Church from itself and reduced patronage is acceptable to it, if it is limited, because the Church has already stated it is currently over-extended.

For years the Irish State has been under an obligation to legislate for abortion where the life of the mother is threatened and all the political parties have avoided discharging this obligation.  How bitterly ironic then that the Expert Group set up to report on this issue, in reality a device to kick the question further down an infinite road, reported its findings to the Government last night.  We can be absolutely certain that this procrastination will continue now that the report has been completed.

The expressions of sorrow from the politicians in the Dail this afternoon are nauseating and hypocritical.  If the facts are as they are now understood then their defence of Catholic Church teaching has led to a result that has been both foreseeable and foreseen.  Two internal inquiries into what has happened are to take place, one by the hospital itself and one by the Health Services Executive.  Those who work in the hospital should, through their trade unions if that is easiest, report what has happened or at the very least prevent any cover up.  Much better would be a workers enquiry made up of health service staff and users of the services. Neither of the internal inquiries can be trusted to reveal the truth of this case.

Most fundamentally this is because, while this is a personal tragedy, it is the result of a political system that still defends the reactionary social teaching of an increasingly disgraced institution.  It does so because of the independent power of that institution, the historical ties that bind and the need for the Irish State to hold to whatever forms of legitimacy it can, no matter how tattered.  The Church and its teachings remain a powerful reactionary force in Irish society notwithstanding the scandals.  This is an earthly power with deep roots.

Some on the Left appear to believe that confronting the power of the Catholic Church in Ireland is a battle won when in fact it has been battles fought by women and the self-inflicted wounds of the abuse scandals that have weakened its authority.  It is now well past the time that the Left demanded the rights of women to control their own bodies, with the right to choose whether they have an abortion or not.  This requires the complete separation of the Church from the State and the expulsion of the Church from education and health services.  Safe and legal abortion services must be provided by the health services free at the point of delivery.

We should expect to see the deputies of the United Left Alliance excoriate the political leaders who have allowed this to happen.  It is one of the few truly useful functions a TD in the Dail can perform.  This is not a tragedy above or beyond politics but is something a rotten political system and its defenders made inevitable.