As the IMF demands further cuts to the Health Budget, Socialist Worker takes a look at ‘for profit’ revolution underway in the Health Services Executive. First Brian O'Boyle starts by looking at cuts that are taking their toll on vital services

This week saw the real possibility that many parts of our public health service will soon run out of money.

With an official over-run of around €280 million to the end of May, minister for Health, James Reilly, is not even bothering to promise that frontline services can be fully protected.

According to outgoing chief executive, Cathal Magee, the HSE budget is around €1 billion less than it was last year.

Almost 10,000 people have already exited the public healthcare system and the HSE has now officially banned recruitment because it simply cannot afford replacement staff.

Widespread hospital bed closures are also being implemented, adding to existing pressure on resources and staff moral.

Slashing beds and refusing to fill vital posts will inevitably lead to increasing waiting lists over the life-term of this government.

This breaks explicit promises from the Programme for Government, and the situation in metal health care has become particularly distressing.

Mental health

Mental health problems are widely accepted to increase during periods of economic crisis.
In the two years to 2009 Irish suicide rates jumped by over 16%, with around 1/3 of these cases being linked to the loss of employment in the previous 12 months.

Budget 2012 supposedly provided €35 million to hire 414 staff to help improve this chronically underfunded area of provision.

But eight months later none of these posts have been filled.

This is the human cost of the government’s austerity drive and unfortunately there is little good news on the horizon.

Despite a series of relentless attacks, the Troika is demanding a further €680 million of health cuts between 2012 and 2014.

This makes a mockery of the government’s commitment to provide a more equitable service for Irish patients.

The rich can already skip queues and demand the best attention from specialist teams.

The poor are meanwhile facing some of the longest waiting times in the whole of the EU.

Reilly looks to make a ‘Healthy Profit’ on Private Nursing Homes. Nichola Harvey reports:

A slowly simmering battle is underway on one of the most important issues facing every worker in the State. As the population continues to age the Government is attacking that most fundamental tenet of social decency – caring for the vulnerable in our society – by turning care of the elderly into a for-profit business.

While the number of people over the age of 65 increases exponentially, Minister for Health, James Reilly, is closing public nursing-home beds at rate of 75 a month, while helping his friends and supporters open private, for-profit beds at a rate of almost 60 a month.

The key differences between public and private long-stay nursing care? Care for care’s sake versus care for profit.

The increasing need for long-term care has been evident for years.

The Economic and Social Research Institute three years ago said the population of people over 65 would increase from 467,926 in 2006 to 792,067 by 2021.

The population over 65 with severe disabilities would increase from 94,400 to 147,677 in the same period, while the demand for long-term care places would go up from 22,500 to 35,800.

And the demand may even further increase as acute hospital beds are closed across the State.
Government spin

Instead of investing in long-term care for the elderly – which could be something any one of us will one day need – nearly 300 beds in public nursing homes have closed since the start of the year.

The HSE wants to close 898 beds by the end of 2012. Meanwhile the number of private beds has increased from 14,500 in 2002 to 21,000 today, the vast majority with the help of lavish tax-breaks.

Reilly and the mandarins in the Health Service Executive say public care is too expensive. They say the public facilities are out-of-date and need refurbishment and do not meet acceptable standards. They talk publicly about achieving “value for money”.

The strategy is clearly part of the ongoing agenda of this Government and their EU-IMF masters – to drive down wages, drive down services and turn everything possible into a commodity.

Cost

Let’s look at cost. According the Comptroller and Auditor General the average cost of a week’s stay in a private nursing home in 2010 was €865 while a public bed was €1,245 a week.

In Dublin the difference is greater - €1,200 in private care and €2,000 in public. The cost is greater because that is what it actually costs to provide decent care. There is also the fact that public homes must take high-dependency cases, while the private ones won’t.

Take into account the fact the private operators are making profits out of those lower fees and it is clear something is missing in the private care – decency. Decent working conditions, decent wages, decent care.

Quality

Let’s look at facilities and quality. Two recent battles tell a lot. In Galway the only public nursing home, St Francis in Newcastle, was closed by the HSE in May despite huge local protests to keep it open and glowing reports of its standard of care by the Health Information and Quality Authority (Hiqa). Local independent councillor, Catherine Connolly, who campaigned to keep it open, told Socialist Worker it was a “classic example of this Government’s policy to close down public beds”.

The 38 residents have been moved to a private home in Oughterard, which, according to Connolly, has been criticised by Hiqa for having insufficient staff. “And so the HSE West now has two HSE nursing managers in running the place. It’s bizarre.”

In Abbeyleix, Co Laois, the HSE announced plans in November to close the 33-bed community nursing home. A local campaign was mobilised immediately. Hiqa made an unannounced visit in January and inspectors were satisfied all residents’ nursing and healthcare needs were being met.

People power

A determined 3,000 people, including some of the elderly residents braved bitter weather in April to rally against the planned closure. In a letter read to the crowd, resident Brigid O’Neill (92) said she did not want to leave the friends she had made in her four years at Abbeyleix Community Nursing Home. She called on bully-boy Reilly to “leave us in peace”.

Catherine Kelly (94) said she and other residents were “just going to keep this hospital open”.
“This is our home and we’re not leaving our home. I don’t want to leave it. I’m very, very happy. We’re looked after the best. We’re all friends. We’re all one big family.”

Local GP, Dr John Madden said the home was a “role model for community care, with the medical conditions of many residents too complex to be dealt with in the private service”.

The HSE was unconvinced. It remained determined to close the “role model for community care”. It was when three of the residents threatened legal action that it backed down on its privatisation agenda and agreed to engage in consultations on the future of the home. Whether it is merely a sop remains to be seen.

The likelihood is that it is and the battle must go on. The closing date for submissions was last Friday 19 July.

This is a key moment in the battle for quality, publicly provided care. Public care is provided by unionised, highly-trained workers, paid decent wages and who are in a position to resist the constant pressure to drive down costs - and so the quality of care.

Reilly speaks of the need to “negotiate better value” in the private sector. Even the greed-driven private operators say if costs are driven down much further care is inevitably going to be affected. Private nursing homes have fewer nursing staff and a higher proportion of low-wage carers, all non-unionised.

Nursing Homes Ireland – which represents 357 private operators in charge of 436 homes – talks proudly of how its members deliver care at 42 per cent less than the public homes. It makes perfect sense for them to drive this agenda as they set their targets on the increasing numbers of elderly, vulnerable people, and their exhausted, anxious families, seeing them as nothing more than a never-ending flow of profit.

We must fight the commodification of our most vulnerable citizens. As further public homes come under the greed-driven gaze of the private sector we must rally to keep them in our hands. It cannot be left to residents to fight for their homes alone.

Home Help Services Face Threat of Privatisation. Tina MacVeigh reports on home help fightback:

In the midst of the scandal surrounding Minister Reilly's investment in private nursing homes, yet another attack on the vulnerable is being meted out by the Government.

It has emerged that HSE funding for the provision of community based Home Help and Care services are to be tendered out.

Voluntary Boards, who are currently funded to provide the services, will now have to compete with private companies.

As most Voluntary Boards face funding cuts, it is likely that private companies will be in a position to undercut them.

But these companies don’t care about the quality of the service provided, they care about profit.

Instead of the current practice where an hour is usually spent with the person being cared for, Home Helps will be expected to attend up to four people in one hour.

In fact, as Voluntary Boards prepare to compete with private companies, some have already implemented these changes to care time.

As the government paves the way for mass privatisation, the quality and quantity of vital care services to the sick, disabled and the elderly in our communities, is under threat.

Under the terms of the EU Fiscal Treaty, any public services that have a potential revenue stream are now subject to EU Competition laws.

This basically allows for mass privatisation of public services, not just care and home help, but transport, water and waste collection, among others.

While SIPTU are mounting a campaign against the privatisation of the Home Help and Care Sector, it is vital that communities come out in support of the workers, the people they care for and their families.

Getting Organised

In a series of People Before Profit meetings held in Inchicore, Ballyfermot, Rialto and Donnycarney, hundreds of workers have come together to get organised.

Community based support groups have been set up, local activities organised and motions drafted to bring to union meetings. These motions call for equalisation of conditions in the sector, the provision of free training to workers and a call on SIPTU to mount a national campaign.

It is scandalous that this vital community based service is coming under the hammer of privatisation. While the government protects Minister Reilly and his investments in private nursing homes, they are happy to launch another attack on the vulnerable – people will be forced out of their homes into hospitals and nursing homes.

As the provision of public hospitals and care services are slashed, the only option for people will be to rely on the private sector. Only those who can afford the services will get them.

If you are a Home Help or Care Worker and want to find out more about the campaign:

call John Lyons (North City) 087 772 9292 Brid Smith (Ballyfermot Inchicore) 087 909 0166 or Tina MacVeigh (Rialto Liberties) 086 871 5293.

Five Key Government Health Promises that have failed to Materialise

(1) Promise - Access to primary care without fees will be extended in the fist year of government to 56,000 claimants of free drugs under the long term illness scheme

Outcome – Four months into its second year of office and all of these patients are still waiting

(2) Promise - A new GP contract to provide incentives for GP’s to care more intensively for patients with chronic illness

Outcome – Talks with GP’s have not even started.

(3) Promise - Under a new contract, hospital consultants pay and conditions to be reduced

Outcome – unsurprisingly as a former lobbyist for consultants, Reilly has made a complete u-turn on this promise. Cuts for consultants are no longer on the cards.

(4) Promise- Claimants under the long term illness scheme will get free GP care

Outcome – to date nothing has happened on this issue.

(5) Promise – Breatcheck will be extended to all women aged 65-69

Outcome – to date this process has not started