Sir, – Deep End Ireland is a group of GPs working in areas of disadvantage, where death rates are up to three times higher for the main causes of death compared with the most affluent areas. Despite this, public health services are distributed according to numbers, resulting in much lower access to essential health services for the people who are the sickest and most likely to die. This is before even considering the impact of private healthcare. We are particularly concerned about the appalling levels of access to children’s mental health and disability services in these areas, despite the extensive research demonstrating that adversity in childhood has been shown to have life-long consequences for physical and mental health in adulthood.
For the first time in the history of the health service, Sláintecare contained an explicit commitment to addressing health inequalities, and it is profoundly disappointing to see the resignations of Laura Magahey and Tom Keane who had brought it this far. In general practice, we have already seen the benefits of Sláintecare’s commitment to strengthening primary care, with the rolling out of an initiative to provide direct access for diagnostics such as CT and MRI scanning for medical card patients over the past year. This has brought a significant improvement to access to care for those who need it most.
As GPs we have also been at the coalface of the pandemic, where we witnessed the astonishing speed and agility with which the HSE was able to implement huge change when given the resources and the political will (for example, e-prescribing, the Covid testing system and the vaccine programme).
The vaccine programme and hospital care for serious illness for Covid also gave everyone a glimpse of the reality of universal health care, where money could not help people jump the queue and people were treated according to need.
Slaintecare needs that same political will to be brought to bear now for its implementation if our health service is not to continue delivering the Inverse Care Law, where those most in need of care are least likely to get it. – Yours, etc,
Dr EDEL McGINNITY,
Dublin 15;
Prof SUSAN SMITH,
Dublin 8;
Dr PATRICK O’DONNELL,
Limerick;
Dr ANNA BEUG,
Dublin 8;
Dr CLIONA
WATERHOUSE,
Dublin 8;
Dr NIAMH IRVING,
Dublin 8;
Dr FIONA MONAHAN,
Cork;
Dr DAVID GIBNEY,
Dublin 9;
Dr RONAN MURRAY,
Dublin 24;
Dr KATE MacSWEENEY,
Dublin 5;
Dr VIVIENNE WALLACE,
Dublin 5;
Dr MUIREANN O’SHEA,
Dublin 8;
Dr NIAMH O’BRIEN,
Galway;
Dr BRIDGET KIELY,
Dublin 7;
Dr ORLA JOHNSTON,
Dublin 10;
Dr BRID SHANAHAN,
Dublin 1;
Dr EMER LOUGHREY,
Dublin 8;
Dr SARAH FITZGIBBON,
Cork;
Dr CLIONA O’RORKE,
Dublin 12;
Dr MARY FAVIER,
Cork.
Sir, – Patrick Broe, group clinical director of the RCSI Hospital Group, comments with regard to the Slaintecare consultant contract, "we will need all the available surgical and other medical expertise in the coming years, and now is not the time to impose a contract on our young consultants that will keep them 'locked into' the public hospital when even the largest of those hospitals do not have sufficient resources to keep their expert staff busy and productive throughout the entire week" ("Sláintecare meetings were largely a waste of time", Opinion & Analysis, October 2nd). He further suggests that we leave "ideologies aside" and "stop this nonsense which can only result in a new kind of two-tier systems where consultants are forced to choose between public and private system, and where patients could possibly be deprived of expert care in certain disciplines".
The ideology that Mr Broe suggests we dispense with is that of universal healthcare, adopted by almost every other country in Europe, where healthcare is accessed on the basis of need rather than the ability to pay. The consultant suggests that a modified Sláintecare programme “with insightful leaders who listen to those who know and understand what works” should be instituted. Perhaps a long walk in the deprived backwaters of Dublin would clarify the lack of logic to this approach. Prof Michael Marmot from the Institute of Health Equity in the UK published the groundbreaking report on the need to Build Back Fairer post-pandemic, to allow for health equity and dignified lives. Specifically, it calls for health equity to be placed at the heart of governance, including resource allocation, and for all policies to be geared towards achieving greater health equity. We would do well to learn the hard lessons from the pandemic and apply this thinking to healthcare in Ireland. – Yours, etc,
Dr CATHERINE CONLON,
Ballintemple,
Cork.
Sir, – It appears that Sláintecare is on life support. – Yours, etc,
HUGH MULLAN,
Strandhill,
Co Sligo.