Here I join Mick in commending Newton Emerson for giving a new twist to a familiar theme. He describes a linkage between a religious ethos north and south and a lack of resources not due to funding alone, that stands in the way of providing a better health service.
In the republic a partial solution has been reached for transferring the National Maternity Hospital to a new 300m euro building on the St Vincent’s Hospital campus. The governing body has accepted the assurance of the site owners the Sisters of Charity that the medical staff would be able to carry out any medical procedure permitted under Irish law. While this proclaims the supremacy of civil over canon law, it is not the legal guarantee that sceptics will continue to seek. No doubt the plans for staffing and equipping the new hospital were so far advanced that no other decision was viable.
The furious controversy over the hospital combined with the shock decision of the Citizens’ Assembly at Malahide to support abortion up to 12 weeks’ gestation shows a level of mature debate and accountability unknown in the North, where similar problems are equally prevalent but are suppressed by tacit agreement not between the usual opposite poles of the DUP and SF, but between social conservatives on both sides who hold a veto power against reform. There are clear implications for the North in the citizens’ assembly decision but these will no doubt be resisted.
Emerson lifts a stone to reveal a mare’s nest of health provision restricted not only by ethics but the increasing inability of NI’s hospitals to reach the critical mass needed to provide the range of treatment from top to bottom.
In 2004, a BBC investigation discovered 13 of the North’s then 15 accident and emergency (A&E) departments would not dispense the morning-after pill, in breach of official guidelines. However, this would have been due to Protestant and Catholic religiosity, so it raised no notable concerns.
Under devolution Northern Ireland’s hospitals have become increasingly reluctant to perform lawful terminations. Stormont health ministers have refused to clarify guidelines – despite 15 years of legal challenges to do so – while insisting that anyone who breaks the guidelines must be prosecuted.
But the Stormont ministers, the frightened staff and the colleagues they fear will report them are also a mix of Protestants and Catholics, so in the unique political ethos of Northern Ireland it all cancels out.
But the issues range beyond ethics to resources.
Debate instead centres on the size of our hospitals, and that has all-Ireland implications. It turns out Northern Ireland is just too small to sustain modern healthcare. As medicine becomes more specialised, it takes an ever-larger population to justify staff and facilities..
In the end the DUP had no qualms about a cross-Border solution ( to locate all-Ireland children’s heart surgery in Dublin) despite the obvious political symbolism and some republican gloating – and that is just as well because one by one specialisations will keep outgrowing the Border.
For example, NHS England now plans brain tumour treatment for minimum catchment populations of 2 million people. Northern Ireland’s population is 1.8 million.
Of course, most healthcare could remain viable on this scale for a very long time if the North had fewer, larger hospitals, hosting regional specialist centres.
Since the late 1990s there have been five official reports – each supposedly transformational – that have advised cutting the number of acute hospitals from 15 to four. Yet two decades on there are still 11 acute hospitals in Northern Ireland, including a new one in Downpatrick that was too small to be viable from the day it opened in 2010, and which has since lost its 24-hour emergency cover.
The same is now about to happen at Newry’s Daisy Hill.
Neither hospital is in financial difficulty. They cannot recruit enough doctors because they are not big enough to provide the teaching places junior staff need or the volume and variety of work senior staff need – in both cases as a career imperative.
However, people in Northern Ireland refuse to accept that small hospitals are doomed and potentially even dangerous.
The A&E closure at Downpatrick brought a 15,000-strong protest on to the streets – equivalent to every resident in the town.
In Newry this week, 800 people attended a public meeting just to hear local politicians pass the buck.
So, another cross-Border solution seems likely. Straws in this wind include the radiotherapy centre at Derry’s Altnagelvin hospital, opened in 2016 and shared with Letterkenny University Hospital, or Enniskillen’s new South West Acute Hospital, opened in 2013 and offering cross-Border vascular surgery.
Some cross-Border initiatives have taken place under EU or European Economic Area health-sharing schemes, but most have been arranged directly by Northern and Southern authorities and can continue after Brexit.
Newton goes onto discuss the cross border implications which for him might mean not secularism but importing the Protestant and Catholic ethos from the north to the south ( which amounts to continuing ethical restrictions over the whole island ).
The alternative would be based on a major expansion of north-south cooperation, with north and south ending their isolation on the treatment of women and importing GB specialists on a case by case basis for pioneering treatment which I know takes place. That clearly is the appropriate model not only for health provision but for coping with Brexit and relationships within these islands as a whole.
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