By Finghín Kelly and Cillian Gillespie
The Irish health system is entering the Covid-19 crisis in a very poor position. Before the virus hit, it was already at breaking point. This is a result of chronic underfunding by successive governments stretching back decades and made worse in the last decade of austerity. Despite the spin from the government, the Irish state is actually one of the lowest spenders on healthcare in the OECD.
An estimated 1.9 million people could contract the Covid-19 virus in the State. A feature of the infection for some is respiratory difficulties. It is estimated that 5%-10% will need more intensive treatment in hospitals and up to half of them will need access to ventilation equipment. There is a real fear on the part of working class people generally and of course healthcare staff of the impact of COVID-19 in the context of an underfunded and overstretched health system.
Ireland has 5.2 intensive care (ICU) beds per 100,000 people. This compares to an EU average of 11.5 ICU beds per 100,000. In Italy, where there are reports of a severe crisis, with the government seeking international assistance for ventilation equipment, the rate is 12.5 per 100,000 people.
Theatre facilities which also have respiration equipment will likely be used to treat people. This could lead to drastic knock-on impacts on surgery, resulting in paralysis spreading through the hospital system.
If Covid-19 takes hold it will mean that potentially thousands of beds will be needed to care for those who are impacted. In the Health Capacity Review, which does not take account of Covid-19, there is a recommendation that between 2,600 and 5,500 new beds are needed to just keep up with demographic change. However, mirroring their inaction on housing, the government has completely failed to deliver beds. In the last year the government struggled to open less than 100 beds!
There is clearly a strong desire among workers in the health service and people generally to do what they can to assist in this crisis. This is very positive. However, it is vital that this goodwill is not used to stretch health workers. All overtime hours should be paid, and all new hires, including temporary staff, should be paid full pay and have full union rights.
The health of healthcare workers must be protected, for the sake of them and their patients. The appropriate safety equipment must be available to all healthcare workers. No worker should be forced to choose between their own safety and the caring for their patients. Where health workers need to self-isolate there should be no pressure to come back to work early.
The government has spoken about the need to use private beds to alleviate the crisis. This should be done immediately. It is a scandal that thousands of beds and vital facilities should be in private ownership, not being used where the need exists. However, this should not be done on the basis of millions of euros of public funds being handed over to the health profiteers. For years the two tier system has taken billions from the health service and has contributed to one of the most unequal health services in the developed world.
Private hospitals, along with labs that are engaging in testing for Covid-19, should be brought into public ownership with no compensation. On this basis we can free up and utilise their beds, theatres and medical equipment, along with the capabilities of their staff for the benefit of all, not just for those who can pay for it. No price should ever be put on the health of human beings, particularly in a crisis like this, and no one should be allowed profit from it either.
A lack of sufficient money should not be a reason why you cannot access top-quality healthcare. This is why we need a one-tier, secular health service that is free at the point of use. Bringing the private health system into public hands can be an important step towards bringing this into existence. Already, under the pressure of this crisis and the real mood for action from below, such measures have been taken in the Spanish State. This crisis is likely to pose a fundamental question mark over the existence of private health for profit, much in the same way the Spanish Flu of 1919-1920 did. This was a horrendous pandemic that cost the lives of 50 million people worldwide.
Need not profit
In a crisis like this there should be no barriers for the state to access much needed medical equipment such as ventilators. Fifty percent of ventilators in acute hospitals worldwide are manufactured in Ireland, according to the IDA. Again, in a crisis such as this companies producing such equipment should be requisitioned. This should be linked to a broader question of not allowing medical equipment or drugs to be produced on a for-profit basis; these companies and big pharma should be brought into democratic public ownership.
Crises such as Covid-19 dramatically lay bare the inability of private profit to meet our most vital needs such as our healthcare. The question is where to find the resources to fund the existence of a publicly-owned and funded national health service. The resources and wealth are there, there are simply in the wrong hands – the super-rich, big business and developers. This wealth must be seized from their hands and brought into public ownership so we can organise the whole of society on the basis of need not the profit of a small elite.