Tag Archives: health service

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

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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.

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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

 

 

The Irish State’s pathological oppression of women

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1408603830298.jpg-620x349In Britain there is no higher loyalty than to Queen and country.  In Ireland loyalty is to the State via the Constitution.

From high oaths to common usage it is the Queen, and by virtue of this the nation that are her subjects, that is held up as the object of allegiance.  Proclaiming loyalty to the State sounds a discordant note.

Although in Ireland there is no less promotion of nationalism this does not find expression so much in calls for allegiance to the country, certainly not to the President, perhaps more so to the nation – although that now also has subversive connotations of actually including the whole nation i.e. all 32 counties – rather it is disloyalty to the state that would see you harangued in the Dail by the establishment parties.

Fine Gael sees itself as the unique guardians of the probity and righteousness of the state, having been the party of its creation, even in its declaration as a Republic, with what it considers unequalled adherence to its laws and devout devotion to its legitimacy.  Fianna Fail has seen itself as so embodying the identity of the nation that it has in the past seen itself as the body and soul of the state so that its own laws are also the laws of the state.  That means it doesn’t matter so much if you break them.

The Labour Party can be seen as the most inoffensive party in and with respect to the State.  Republicans, who once swore to a ‘second round’ of war against the Free State now bend over backwards to swear to the legitimacy of the state’s institutions, especially its police and security service An Garda Síochána.

The left wants the state to nationalise the banks and the economy, tax the rich, spend more money, take on more powers to put people in jail – that is those nasty bankers – and pass all sorts of laws against discrimination and for equality etc.  It wants a much bigger state that is a little bit more democratic.

But this week we have witnessed another grotesque illustration of the repugnant character of the real Irish State, the one beyond the idealised phrases uttered without reflection.  In particular it is the constitution which has once again been the grounds on which the denial of women’s’ rights has been based.  This denial is a product of the State’s view of the role of women in society spelt out in Article 41 of this constitution, which states that:

“The State recognises the Family as the natural primary and fundamental unit group of Society, and as a moral institution possessing inalienable and imprescriptible rights, antecedent and superior to all positive law.  The State, therefore, guarantees to protect the Family in its constitution and authority, as the necessary basis of social order and as indispensable to the welfare of the Nation and the State.  In particular, the State recognises that by her life within the home, woman gives to the State a support without which the common good cannot be achieved.  The State shall, therefore, endeavour to ensure that mothers shall not be obliged by economic necessity to engage in labour to the neglect of their duties in the home.”

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It is the State and its constitution’s treatment of women that has given display to its most cruel, repulsive and hypocritical features.  Its reactionary historical origins have imprinted on it a character that all pretensions to modern liberalism have proved unable to hide.  While capitalist development has undermined the holy foundations of the confessional state and its Catholic ethos it has done so in a manner different from that which a strong, vibrant, secular and socialist workers movement would have achieved and with different results.

The Catholic Church has lost mass-goers and much credibility but it still has patronage over the vast majority of primary schools, is still allowed to discriminate in appointing teachers and still imposes its dogmas in much medical practice.  The state it blessed, and which in turn blessed it with collusion in its violent abuse of thousands of women and children, and which paid for the cost of claims arising from this abuse, is now the primary mechanism that upholds its dogmas.

The decline in the ideological hold of the church has not been matched by its political decline and the political power it retains now owes more and more to the power of the state.  It is the State which stands more and more exposed, or should at least, as the rock upon which the oppression of women in Irish society rests, an oppression previously sanctified primarily by the Church and its institutions.

The state’s treatment of a teenage pregnant immigrant illustrates what this seemingly clichéd piece of jargon actually means.  The young woman at the centre of this latest tragedy was interviewed by Kitty Holland in ‘The Irish Times’.

The interview revealed that the young woman was refused an abortion after she had said that she had been raped, although she did not know she was pregnant until arriving in Ireland.  She was initially told she could have an abortion at 24 weeks but this subsequently changed and she delivered a baby by caesarean section.

“Yes, I would have preferred an abortion,” she said. “I was told the only way to end the pregnancy at this point would be a Caesarean . . . They said wherever you go in the world, the United States, anywhere, at this point it has to be a Caesarean.”

“I was raped in my country. I did not know I was pregnant until I came here.”  She was referred to the Irish Family Planning Association (IFPA), where her pregnancy was confirmed.  “It was very difficult for me. I cried. I said I am not capable of going through with this. I said I could die because of this… They said to me abortion was not legal here, but people like me are sent to England for abortions . . . I asked to go and they said they would have to arrange the documents and that could take six weeks.”

“They said it is okay because I was eight weeks and four days. After that day I hoped they were going to help me. I was shown documents that were filled in, and I understood that the process was under way.”  Over the following weeks, she says, she had a number of meetings at the IFPA and although the process seemed to be in train she was told some weeks later that the estimated cost of travelling to England, having the abortion and possible overnight accommodation could be over €1,500.  An individual in the IFPA, she says, told her the State would not fund the costs.  Remember this is the State that borrowed €64,000,000,000 to bail out the banks.

“In my culture it is a great shame to be pregnant if not married . . . I didn’t even know what [the medic] was saying to me.  “I said to her, ‘I could die because of this pregnancy. I am   prepared to kill myself’.”  At this stage she was 16 weeks’ pregnant.  “I said we’re getting too far, and she said, no, in England they carry out abortions up to 28 weeks . . . She said ‘that is not the problem. The problem is the money’.  She told the journalist that by then she had decided to kill herself.

She then made contact with a family friend who advised her to go to a GP and tell them that she was suicidal because of the pregnancy.  The GP referred her to a hospital, where she saw a psychiatrist.

“She had read the report and she said to me, ‘No, you are already too far pregnant’. I cried. She asked me lots of questions and I answered them, telling her everything I felt. Around 11pm I saw another psychiatrist. I told her the same thing. I spent the night there.

‘“The next day, around 10am, I was taken in a taxi to another hospital . . . When we got there I thought they were going to help me. They brought me to a room where they did a scan and the pregnancy was 24 weeks and one day . . .They said they could not do an abortion. I said, ‘You can leave me now to die. I don’t want to live in this world anymore’.”  She said that from this point a nurse was constantly at her bedside and was always accompanied to the bathroom.’

“They knew I was going to do myself ill. From Friday I did not eat. I did not drink. For four days I didn’t drink, I didn’t eat . . . I thought that way I could die…On Monday night two doctors came, a psychiatrist and a gynaecologist, and said, ‘We are going to carry out the abortion next Monday but you have to be strong. You have to eat. You have to drink.’ I started to eat and I drank.”  A few days later she was told that the plan had changed.

“They said the pregnancy was too far. It was going to have to be a Caesarean section . . . They said wherever you go in the world, the United States, anywhere, at this point it has to be a Caesarean.

“I didn’t know if I could continue to suffer.”  She says that a number of days later, two medics told her the authorities had been made aware of her situation and she would need a solicitor. “That really shocked me.”

A solicitor was appointed by the Health Services Executive.   “The solicitor said he was familiar with my case but it would be better to explain it myself. . . I didn’t eat again those days . . . On Monday evening a psychiatrist came again and said if I eat and drink they will try to do the operation on Tuesday.  I would have preferred an abortion.”

Was she told she had a choice between an abortion and a Caesarean?  “No. I was told the only route that remained was a Caesarean.”  She met the obstetrician she understood would perform the section on Tuesday, and this doctor told her about the operation.  “She said to me, there is a law. This law says abortion is prohibited but people like me can be helped. Abortion is allowed if the pregnant person wants to kill herself because of the pregnancy. “

“She promised they would do it [the Caesarean] on Wednesday. She showed me a document with three signatures, two psychiatrists and one gynaecologist.  She started talking about the negative effects [of a Caesarean section]. I didn’t listen. I didn’t have a choice. All the suffering I had gone through. Then on Wednesday at about 3pm they did it.

“When I woke up I felt sick. The following Wednesday I was let out.”  “I didn’t want to even know that I had a child. Still, even today, I feel really bad.”  She has seen a psychiatrist twice since she left hospital, provided for her by the HSE.

Asked if she has any friend to talk to about her situation, the young woman says she has not.  “No, I didn’t want people to know . . . For me this was shameful. In our culture if a girl gives birth to a child before marriage everything is finished. No one can respect you. As well as that, for me, with the rape, it was difficult.”

“Sometimes, when I feel the pain . . . I feel I have been left by everybody . . . I just wanted justice to be done. For me this is injustice.”

A spokeswoman for the HSE, when asked about the allegation that the woman was not offered a right to appeal the decision to carry out a Caesarean section, said that the woman’s request for a termination on the basis of suicidality was acceded to.  “It is important to note that a pregnancy can be terminated by way of delivery through Caesarean section, as it was in this instance.”  As they were acceding to her request for a termination of the pregnancy on those grounds, there is no requirement for a review.

It’s hard to know in what proportion this response of the HSE is composed of cynicism, mendacity and deceit; or how much to that infamous principle of conduct by the Irish State of ‘an Irish solution to an Irish problem.”  As the columnist Fintan O’Toole pointed out:

“At least 160,000 Irish women have had abortions abroad since 1980. That’s close to one in 10 of the female population aged between 14 and 64. These women are our mothers, sisters, daughters, friends, neighbours. Yet abortion is part of official discourse only when a new atrocity breaks the surface of a deep silence.”

An inquiry will be undertaken by the HSE which will, it is reported, establishe “all of the facts surrounding the care given to the woman” and will “end any inaccurate commentary surrounding this matter currently”, except that it “would not involve any review of the decision taken by the three clinicians who were empanelled to decide if an abortion was warranted under the 2013 Act .”

Meanwhile the Government through the Minister for Education Jan O’Sullivan has said that the constitutional ban on abortion should be revisited by a future government, but that the legislation introduced by the Coalition was “the best possible” under the circumstances.  A phrase that hardly comes anywhere near describing truthfully the circumstances of the case.

The announcement of an inquiry will attempt the same role as the inquiry called after the death of Savita Halappanavar.  Already we have been told that it may not be published in full and of course it is to be conducted by the same organisation, the HSE, which is squarely in the dock as the guilty party.

The Government has already ruled out doing anything so the exercise is entirely cynical and entirely in keeping with the history of a state that took 21 years to legislate for the X case.  It’s remarkable that at this time the Irish state could move at such speed in an attempt to prevent another young 14 year old rape victim threatening suicide from having an abortion in Britain yet took 21 years to legislate for the limited concession to women that resulted from the case.

The state has no role in limiting the participation of anyone in society or determining their role.  It certainly cannot be allowed to control the rights of women to control their own fertility or to endanger their health or their life because of doctrines dreamed up by a medieval institution that believes its leader is God’s deputy on earth.

Women must have the right to choose whether they will bear children without conditions being imposed.  The Constitutional impediments to this must be repealed and the fight to make their free choice a real one, which cannot be settled by any constitutional provision, must be taken up.

A way forward cannot be left to the existing State but requires a movement that not only campaigns for the freedoms and resources to make women’s self-determination a reality but starts itself to put in place the services that women need.

Lessons from the Grangemouth dispute

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GRANGEMOUTH_2700282bI received an email from Socialist Democracy inviting me to contribute to a discussion based on an article they have written on the lessons of the Grangemouth dispute in Scotland. This article sets out the devastating scale of the defeat – the freeze in pay, butchery of pension entitlement and castration of union organisation.  Many in the media called it an old fashioned battle of labour against capital, such was the unvarnished clarity of what was involved.

The questions to be answered are whether there could have been a different result and what lessons can be learnt?

The article does not say whether the result could have been different.  Given the circumstances I think not, but this means we must be clear what the circumstance were that lead to this conclusion.

As for the lessons the article posits two – that the entire strategy of the trade union leaders has been overthrown and that of union support for, and reliance on, the Labour Party is a mistake.  I believe that there is a third rather more basic one, which can be explained very much as the old fashioned relationship between labour and capital.  What is this relationship?

The relations of capitalist production are unequal as they involve capitalists as owners of the means of production, including oil refineries and petrochemical works, and workers separated from ownership of such means of production and dependent on employment by the capitalist for their livelihood.  In a struggle that does not threaten or weaken these foundations it is generally the case that the capitalists will be able to impose their wishes because these align with the power structures in society.

This does not mean each and every strike or struggle by workers is doomed to defeat but that in certain disputes this power of capital is fully deployed and the fundamental imbalance in power is cruelly demonstrated.  Were it otherwise capitalism might be able to find some stable compromise, some equilibrium between the two classes that would allow a ‘fairer’ distribution of resources.  No such stable equilibrium has been found.  Marxists have been confirmed in their view that the liberation of the majority of working people requires overturning the existing system and creation of one in which the monopoly of ownership of capital is destroyed. 

This is the basic case for socialism in opposition to all those who think a better world is possible while not overthrowing the fundamental structures of society.

It is not an all or nothing case.  It does not say that workers can do nothing to protect themselves short of socialism.  Struggles that do not threaten these fundamental relations can sometimes be victorious such as when the economy is booming, unemployment is low and workers can strike or otherwise bargain for higher wages without fear of being sacked and their place being taken by the unemployed.

Of course in an economic downturn the temporary leverage of workers and trade unions is undermined and the power of capitalists to do as they wish because of their ownership of capital is reasserted.

In the case of the Grangemouth dispute this means that no workers’ action no matter how brilliant, innovative or militant could prevent Jim Ratcliffe from using his ownership of capital to close the refinery and petrochemical works and throw thousands of workers onto the dole.

Of course if you were convinced he was lying about the profitability of the plant and convinced his threats to close were a bluff the solution is simple – call his bluff and tell him his demands will not be accepted.  Unfortunately his ownership means that only he and his management know the truth and his claims that the plant only had a future if he was able to put £300 million in investment into it were credible. The same system that decrees private ownership of a refinery also necessarily involves periodic overcapacity in production and this was held over the workers’ heads as the brute fact that required they surrender or face the sack.

Under such circumstances no one can be surprised the workers decided to accept the lesser evil.

The article is correct that simple strike action would not succeed.  It was the boss who went on strike – it’s called a lockout.  It is he who brought production to a halt and threatened to make this permanent.

Others called for widespread solidarity action perhaps secondary strikes.  Firstly these are illegal and related to this, workers have not yet the level of combativity to carry out such action, even those involved in the chemicals industry who would have lost their own jobs had Grangemouth closed.

If it is argued that this strategy is one we must argue for and attempt to build for the future then this is indeed an element of strategy.  In this situation however there is no reason to believe Ratcliffe gave a rat’s arse about the fate of the wider industry and of the other thousands of jobs that would have been lost.  If he was going to close Grangemouth then all these strikes would have made no difference to his plans.

A second possible answer was to call on the state to nationalise the refinery and works.  The problem with this is that neither the British State based in London nor that part that might go independent had no intention of doing so.  Both are ‘open for business’ only when it means private capitalism.  So who was going to nationalise the works?  If it is believed that strike action would compel such nationalisation then it would have had to be wider and deeper than that considered above and the first response of the State would have been to attempt to throttle it. Some people keep on forgetting the State is the protector of the enemy.

Some on the Scottish Left said the situation at Grangemouth showed the need for independence but this was not an immediate solution.  As we have just said, the Scottish National Party has no intention of nationalising private industry when private capitalists are prepared to invest if only the workers accept the necessary sacrifices.  Alex Salmond’s primary concern was with the exposure of his independence project, and the illustration of how weak the idea of a prosperous oil economy looks in light of this immediate threat to pull the plug.  Since the refinery provides fuel for northern England and Northern Ireland as well as Scotland the case for action to protect the service went beyond the border and thus implicitly provides the grounds for wide action to defend it.  It also undermines any case for a nationalist solution from the right or the left.

The article argues against the efficacy of such answers and proposes its own elements of a strategy.  Some of these are by no means very clear.

For example what does this mean? –

“The trade union and political fights have to be united around a movement that is willing to reject the claims of finance capital and to step in and expropriate capital where it is necessary to preserve the livelihood of workers.”

The only time a workers’ movement will be able on its own to expropriate capital is when there is a revolutionary situation. We’re not in one of those so it wasn’t and isn’t an answer.  (We’re also fighting industrial capital in this one.)

The article says –

“The Labour Party has promised a temporary freeze on prices, so a call could be made for a permanent cap . . .”

Just how are the laws of capitalism to be permanently abolished or even suspended when the system still exists?

They can’t.  The only way they can is if and when there is a revolution that creates the conditions for totally remodelling economic and social relations and even then prices will not be abolished for some considerable time.

The alternative proposed revolves around occupation and seeking an alternative to the Labour Party.

Once again however if the plant is really losing money and the threat of closure real then why would Ratcliffe not just let the workers occupy, sit in the refinery and – so far as he was concerned – rot away?  It would be just another way of closing the plant if he didn’t get the workers to accept his demands.

What the demand for occupation means is that workers take over ownership and run it themselves.  They cannot simply run it themselves without ownership.  No one would provide raw materials or other services without someone to contract with and you don’t form contracts with those in unlawful possession.  So the question is how would the workers take ownership?  How would they get the money to buy it and to invest perhaps the£300 million Ratcliffe says is needed?

Obviously this is much harder when pushed against a wall, with no preparation and no conception that this is the alternative.  Equally obviously if it is accepted that this is the road that workers in such situations should follow then it would be better to be prepared for such a challenge.  The challenge is precisely to the monopoly ownership of the means of production that we said at the start is the heart of the relationship between capital and labour and at the heart of capitalism.

The workers movement is big enough to fund research into the creation of worker owned businesses.  Workers might start to fight to gain control of their pension funds to invest in their own enterprises.  Money can be raised for investment from financial institutions or other funding means to be determined.    A network of employee owned cooperatives already exists.  What is involved is not utopian, in the sense it has never been done before, nor is it without rational calculation.

If workers could be ready for such an alternative the threats of closure would not be so conclusive.

In other words the alternative to capitalist ownership is workers’ ownership.  Not just in some indefinite future ‘after the revolution’ but now and not just for now but in order to build towards the future.

Finally the article criticises the unions’ support for the Labour Party.  It notes that organised workers continue to support their trade union and political leaders, although it only proposes that in order to fight both it is necessary to break from the Labour Party but not from the existing trade unions.  It calls for a ‘class struggle movement’ to be created across all the unions, which should call for a new working class party.

It obviously believes this fight can dismiss the Labour Party and need not go through it, although it does not explain how this can be achieved when it acknowledges workers continuing support for that Party.  Implicit is the view that a fight within that Party is not needed to convince workers to break from it.  This in my view is very doubtful.

It draws no lessons from its ridicule of the small socialist organisations which have attempted this road or what it correctly describes as the private character of their concerns; illustrated by their bizarre discussions and replication of policies that decades ago they excoriated the Labour Party for.  The articles’ own call for a revolutionary party is correct but of no help here since it is put forward, necessarily so, as an ideal future location.

Instead it states that – “there are many issues around which a fightback can be organised, but they cannot be organized by the current leadership of the working class . . . What it [Grangemouth] has shown up is the utter inability of the traditional leadership to defend workers and the demoralisation and lack of strategic vision on the part of the socialists.”

If what is being said is that a new leadership has to be created, and the existing one challenged, then this is correct.  If it is being said that this is a precondition for a fight-back then this is not correct. It is only in the course of struggle that existing leaderships can be defeated, as long as such objectives become part of the struggle by the mass of ordinary workers.

The workers at Grangemouth and, by extension, those beyond have suffered a cruel defeat.  One possible reaction is to be cowed by the power of capital to shatter livelihoods.  A second is to seek some magic bullet of a strategy that workers can employ to defeat such plans: a strike, secondary action or an occupation.

A third lesson is that very often workers are forcibly confronted with the reality that to secure a decent life they need to go beyond capitalism and that no amount of shifting it with militant action can change its fundamental nature.  This nature is one where capitalists own the means of production and they can open and close it when they want.  This is not a strong argument for capitalism but a powerful argument for changing society – for socialism.

As Marx said – “the working class ought not to exaggerate to themselves the ultimate working of these everyday struggles. They ought not to forget that they are fighting with effects, but not with the causes of those effects; that they are retarding the downward movement, but not changing its direction; that they are applying palliatives, not curing the malady. They ought, therefore, not to be exclusively absorbed in these unavoidable guerilla fights incessantly springing up from the never ceasing encroachments of capital or changes of the market. They ought to understand that, with all the miseries it imposes upon them, the present system simultaneously engenders the material conditions and the social forms necessary for an economical reconstruction of society. Instead of the conservative motto: “A fair day’s wage for a fair day’s work!” they ought to inscribe on their banner the revolutionary watchword: “Abolition of the wages system!“

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.