Tag Archives: Vincent Browne

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Dr Edel McGinnity

Dr Edel McGinnity, of Riverside Medical Centre, Mulhuddart Village, Mulhuddart, Dublin 15, spoke on Tonight with Vincent Browne last night about what it’s like being a GP in her area.

Dr McGinnity had given a presentation for the Irish Cancer Society about the chaos in the health service’s primary care and the inequality this represents for people from disadvantaged communities.

Edel McGinnity: “I’m a GP in northwest Dublin, in Mulhuddart. I’ve been there since 1995. I trained in Dublin, worked in Mozambique for a few years and then came to work in northwest Dublin.”

Vincent Browne: “What’s it like in Mozambique?”

McGinnity: “Well, it was very different, it was very interesting, it was a really stimulating place to work. It was the poorest country in the world at the time but it had a very, highly developed primary care system so I actually loved it there. It was very tough work, it had very high mortality there but I really liked working there.”

Browne: “Like, better than working where you work now?”

McGinnity: “No but, as I say, different. But I didn’t expect to find, that I would find the work just as challenging when I came back to Ireland. I had expected that it would be easier because Ireland is such a better off country.”

Browne: “Ok, how is it challenging?”

McGinnity: “Well, people who live in areas of most disadvantage in this country are three times more likely to die from cancer than people who live in the most affluent areas. They’re more likely to die from all causes, they’re twice as likely to die from all causes but they’re three times as likely to die from cancer. And they die younger and they get multiple illnesses at a much earlier age. So that’s been a difficult thing to deal with over the years.”

Browne: “Tell us about you practising medicine and what do you come across in relation to all that?”

McGinnity: “Well, for example, in my practice last year, in people under 65, where the mortality is more noticeably higher in these areas, there were 10 deaths in my practice last year, in people under 65, where you would expect the national average, now not the most affluent, but the average death rate you would expect between four and five deaths a year and in mine there were 10. So that reflects the part of northwest Dublin that I’m in, it actually has the highest cancer rate mortality in the country from a recent health-geo-infomatics study, from Maynooth….Inequality is the biggest predictor of early mortality.”

Later

McGinnity: “If you have a health service that’s distributed according to numbers, as opposed to need, then what you have is, for example in southeast Dublin, which is an affluent area – you have, we’ll say 1,000 patients. So you’ve got one GP, one public health nurse, one service, one physio, for those 1,000 patients.
But if you have the same service then, in northwest Dublin, one GP, one physio, one whatever service but you have twice as many people who are going to die within those 1,000 people. Twice as much sickness. So, in fact, you have twice as much sickness but you still have only the same number of health service provision, so you’re actually offering people half the service. And I’ll explain to you in a moment that, in north Dublin, there isn’t even one professional GP for 1,000 patients because the provision of GPs in northwest Dublin is so poor. So that’s a sort of double whammy.”

Browne: “And the reason for that is because of the extension of GP care to over-70s people and to people over-70s and people in the higher income, that GPs will look after the people who are better off and have medical cards, get paid more for looking after those people than they get paid for looking after people who are less rich?

McGinnity: “Yes, that’s one factor. That’s definitely one factor.”

Browne: “It’s quite astonishing.”

McGinnity: “It is astonishing, yeah.”

Browne: “It’s led to a situation where GPs have migrated from the poorer areas into richer areas.”

McGinnity: “Yes and there’s a number of reasons why GPs won’t work in areas where I work – the work is complicated, there are more people, they are more sick, there’s a lot of risk involved, risk with mental health problems, with addiction, with child protection – it’s very stressful work. The medical card system is paid according only to age with no provision for need. So, whether a patient attends once, ten or 100 times, or no matter how complicated that visit is, the payment is still the same and because it’s age-related, in big parts of the peripheries of the major cities, where the populations are very young, the payment is actually 30% less than the average. So you have a lot of people who are much sicker and the payment is actually 30% less. So that’s why it’s impossible to get a GP. There’s one GP for 2,500 people in the greater north Dublin area. In northwest Dublin, it’s one GP for 3,500 people and the national average is one GP for 1,600. So in northwest Dublin you have half the GPs for people who are twice as likely to die and twice as sick. That’s the inverse care law.

Later

McGinnity: “We have a whole other type of Tiger mother out in Blanchardstown, just busy, out, hunting and foraging and protecting their kids and their families and they don’t put their own health needs first. So they don’t respond well to screening. Then, when they do have a GP, as I said, in parts of northwest Dublin, many of them don’t have access to a GP.

Even when they have a GP, it’s not so easy to actually do things like cancer screening and prevention because of the nature of the problems that these people come in with. So a typical patient in my practice, for example, I’ll call her Catherine. Fifty-three-year-old lady, comes in with, she has diabetes, she’s chronic lung disease, and she has eczema. Now that’s very typical of any patient, anywhere across the country. We don’t just do blood pressures like people think, we all manage chronic illness and complex illness, all the time. But what makes it different is that there are more of these patients, they’re younger, with their multiple illnesses and they’re really complicated by social problems.
So, in the case of Catherine, it’s that she has a 14-year-old who has behaviour problems. In the background, she’s still smoking, her diabetes isn’t controlled, and her smear has been overdue for a year. So before I call her in, my computer system tells me, this smear is overdue, you’ve got to do it. She’s missed her nurse’s appointment. So she comes in, she has a chest infection today and a flare-up of eczema and we start dealing with all of those. And then the phone rings, this is very typical of a day in my practice, the phone rings and you wouldn’t dream of answering the phone when a patient was with you but, in this case, it’s child protection social worker, these things crop up all the time and I have to take the call. So Catherine has to leave the room, I take the call, I make the notes, Catherine comes back in and then she tells me that her niece died three weeks ago and she’s really upset about that and she hasn’t been sleeping. She needs a letter for clothing which is really urgent and she needs it today. And her son has just been suspended from school. So she’s really worried about that. So we start into all of that and meanwhile, the waiting room is filling up, there’s more Catherines outside, waiting to get all these things done.
So we work our way through all that. We deal with the chest infection, the eczema, we look at her diabetes medications but, actually, she was eating very badly all around the time of her niece’s funeral so we postpone that until things are better. We talk about her sleep and the bereavement and all the other bereavements. We talk, at great length, about her son, and I undertake to do a letter later for the child psychiatry service and for the school. We make another appointment, we do the clothing letter because that has to be done right there and then. So we do all that and then we remember the smear and that we haven’t talked about her smoking. But I don’t feel like talking to her about her smoking today after her story about the bereavement. And I say to her, ‘we’ve got to do this smear’, ‘oh’, she says, ‘I’m just not in the humour, doctor’. And, you know what, I’m not in the humour for the smear either, after all that. And that’s how it is, these patients don’t get the care that they should have because they have two many acute health problems and acute social problems for us to be able to deal with all of that in the ten minutes that’s allocated to a GP consultation.”

Later

McGinnity: “The vast majority of GPs in this country are available every day for people so we are very accessible to people. We could reach the hard to reach but we’re too busy dealing with the day-to-day stuff to be able to do the really important work so, even if you do suspect cancer then, when you get a patient who..it’s really important to say that if you seriously think somebody has cancer, you get that patient seen. If I contact any of my hospital colleagues with a fax or a phonecall saying, ‘I think I’ve somebody here that has cnacer, they will be seen very quickly’. But there are 24 million consultations in general practice every year – you can’t send everybody for scans and tests and to the hospital. So if you’ve a patient who’s in that inbetween group where you’re this worried, but you’re not sure…say, for example, you had a middle-aged patient who has abdominal pain, out of the blue, a tiny bit of blood test changes in their liver for example and you’d really like an ultrasound, it could be something simple. It could be gallstones, it could be just fatty liver, it could be nothing at all but it could be pancreative cancer, it could be ovarian cancer in a woman. So an ultrasound is really helpful.

My patients in northwest Dublin wait an average 11 months for an ultrasound. If you live in southeast Dublin, and you have a medical card, you can have an ultrasound in eight weeks and, if you have health insurance, you will have an ultrasound tomorrow. Or, if you can pay, you can have it tomorrow

The inequality within the public system. I mean, if you have private health insurance, that’s another level of inequality but even within the public system there are huge differences. So my part of the city, where people have the highest death rate from cancer, have the least access to healthcare. Colonoscopies are another example of a service that is really good for diagnosing colon cancer – the second most common cancer in this country. I had a patient last November who presented, again with not a definite worry – you know it wasn’t the so-called red flag, didn’t have weight loss, didn’t have bleeding but he had a change in bowel habits and, you know, essentially, I needed to know well why is this happening. I’d like him to have a colonoscopy. He waited seven months for that colonoscopy publically. And if he had been a public patient in South East Dublin, it would have been done in three months.”

Browne: “If he was a private patient?”

McGinnity: “If he was a private patient,”

Browne: “Or a public patient…”

McGinnity: “Yes, a public patient. If he’d been a private patient, he’d have had it in two weeks. So, you know, so that’s the kind of barriers you’re up against when you work in these areas. And, finally, and even when people do get into the hospital system, that’s not so easy either because they’re notoriously unreliable. Patients, we’re accused of having them where they don’t, where there’s been disappointments. And, you know, the hospitals then, it’s kind of one strike and you’re out now. If you miss one appointment you’re out, you’re back to the bottom of the list.
And I mean the reason people miss appointments…it’s obviously very frustrating for the hospital but the hospitals are rigid, they’re set up to suit themselves, they don’t make any provision for the kind of complications that people have in their lives, like I mentioned about the screening, moving house, there’s a huge flux in housing in the area that I work in or phone numbers changing or simply the vicissitudes of life. I mean, in the area that I’m in, a couple of weeks back, three young men died in the space of a week. And the whole community was devastated, you know, so people were too busy going to funerals that week to keep appointments. Now, in our practice, we have a system for that where, if we know they have an appointment – which we don’t always know, because the hospitals don’t always tell us – we will take the time to phone them and text them about those appointments to remind them because it’s coming from us ,and they trust their GP, they’ll often respond to that and go but that’s very time consuming for us.”

Browne: “So what can be done?”

McGinnity: “Well the most important thing that can be done is to allocate resources according to need and not according to numbers. There are, you know, we know there’s no money – that has been repeatedly stated, although there is money for bridges and road and stuff, whatever about that. But even within the health service, where there’s no money, I would challenge where the money goes. For example, the new proposals to give free GP care to under sixes. I mean it sounds good, it sounds equitable and universal and all children of the country will be treated equally but actually that’s a direct aggravation of this inverse care law. While there are patients getting half a service, people with the highest mortality are getting half a health service and yet money is being targeted at the healthiest people in the country, under sixes with, you know, higher incomes. There are examples of targeting resources where they’re needed. My practice is involved in a methadone protocol which is a special system where resourcing care for drug users who have the highest mortality of anybody under 65 and it’s a fantastic scheme that has made a huge difference to patients and all their families so I would, that would be the biggest thing, to direct resources to where they’re needed most, to where the people are sickest and most likely to die.”

Watch back in full here

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Health Minister Leo Varadkar appeared on Tonight With Vincent Browne last night, along with Sinn Féin senator David Cullinane; Fianna Fáil TD, Sean Fleming; and People Before Profit Councillor at Dublin City Council, Brid Smith.

Mr Varadkar was asked what people should do, if they can’t afford to pay their water charges.

David Cullinane:If I can ask you an honest question, Leo?”

Vincent Browne: “Make it quick because we’ve gotta go to a break.”

Cullinane: “There are many families out there who can’t afford to pay their mortgage, can’t put food on the table, can’t put oil in their heating tanks. When they get their water charges bill in January and they can’t afford to pay it, what bills should they not pay? Should they not pay their mortgage? Should they not put food on the table? If they genuinely can’t pay, if they don’t have it, what should they do? What advice would you give them?”

Leo Varadkar: “Well that’s a very po-faced question because if you look at…”

Cullinane: “It isn’t, it’s a question…”

Talk over each other

Browne: “We’ve got to go to a break…”

Varadkar: “I’ll tell you why it is because if you look at your alternative budget, for example, you propose a standard rate…”

Browne: “Answer his question. Answer his question. Answer his question. What should people do? When people who are living on the margins have a choice of paying a water tax or paying for a essential necessities in their families, of their families. Which choice should they do…”

Varadkar: “What they should do is…”

Brid Smith: “Don’t pay the water taxes.”

Varadkar: “What they should do is enter into an agreement with the utility which is what they would do currently with the ESB, it’s what they would do currently with the…”

Smith: “Leo you live on another planet, people simply don’t have it.”

Watch back here

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Margaretta D’Arcy on TV3′sTonight With Vincent Browne Show last night

Journalist Dearbhail McDonald hosted the Tonight With Vincent Browne Show last night and spoke with Margaretta D’Arcy at the beginning.

Margaretta, 80, was released from Limerick Prison last week after she was jailed for refusing to sign a bond stating she would not enter restricted areas of Shannon Airport, following her arrest for protesting at the airport.

Dearbhail McDonald: “Can you rule out going and doing that again?”

Margaretta D’Arcy: “So long as the escalation of war, and we certainly now know what’s happening in Gaza. And I heard this morning that, actually, the military planes coming in from the US are carrying weapons and hardware to help Israel.”

McDonald: “And can you say that definitively? That Shannon Airport…You can’t.”

D’Arcy: “Well, neither can you say it’s not happening. Exactly, so therefore, why doesn’t the Irish Government…if there is nothing going on in the planes wouldn’t it be the simplest thing for them to examine the planes and be able to tell us there’s nothing on there or tell the world there’s nothing on there. Why are they so silent about it? That’s what I want to know. And we cannot find out.”

Later in the show, United Left Alliance TD Clare Daly – who, along with fellow TD Mick Wallace, was arrested during the week when they approached two US military planes in Shannon Airport with the intent to inspect them – told the show that, in the last 12 months, more than 630 US military aircraft stopped off in Shannon Airport.

Watch back here in full here

Previously: Margaretta D’Arcy on Broadsheet

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Last night’s Tonight with Vincent Browne was hosted by Tom McGurk and its panel included  Labour Party TD, Michael McNamara; United Left Alliance TD, Clare Daly; Deirdre Duffy, of the Irish Council for Civil Liberties; and Michael Clifford, of the Irish Examiner.

A short clip of Sir Nigel Rodley’s final comments at the UN Human Rights Committee in Geneva, Switzerland yesterday was played during the show, specifically this comment:

“The Magdalene Laundries, the Mother and Baby Homes, the child abuse, the symphysiotomy – it’s quite a collection and it’s a collection that has carried on [for a] period that it’s hard to imagine any state party tolerating. And I guess I can’t prevent myself from observing that [they] are not disconnected from the institutional belief system that has predominated in the state party.”

The panel then discussed this comment.

Tom McGurk: “Is it the fault of the State? Is it the fault of society? Has it got historical roots? Is it just fair to blame the State as simple as he is doing there?”

Clare Daly: “I don’t think it was simple at all. I think he was quite clear, I think his contribution was very much a solid defence of human rights and I think it was a vindication of a huge number of campaigning Irish groups, particularly women’s groups in some ways, to feel what they’ve been saying, maybe crying in the wilderness for years, has actually been vindicated now because on the whole symphysiotomy issue which was the first time that group ended up in front of the UN. I mean the committee were clearly horrified at what had gone on. These women had been butchered in their prime. He made the point that the UN had serious concerns about the fact that the redress scheme, that the government has put in place, is not compatible with our human rights legislation which I think is a hugely important step, because these elderly ladies have been trying to make that point here. When somebody externally makes that point which supports them, it actually shores up what they’ve been saying in an important way.”

McGurk: “Sure, but did it not need context, to understand where all of this came from? I mean it’s a very complicated…”

Daly: “It’s not that complicated really.”

McGurk: “Well explain what the medical profession were doing and where that came from.”

Daly: “Well this is a very simple issue of gross medical negligence, which is a point that the Irish State seemed to have not taken on board because it was never medically acceptable in the period in which these were…”

McGurk: “But where did it come from Clare? Widespread practice…”

Daly: “It came from, I suppose the belief is, a Catholic ideology existing in some of the private hospitals which felt that if you were a woman of child-bearing years well then your Catholic duty was to procreate as much as possible. And if your body, if you like, didn’t allow you, because of your shape or whatever, Caesarian sections obviously limit the amount of pregnancies you could have. So they chose, instead, to carry out this butchery of literally, and you know, the testimony is horrific but carving people up with saws in some instances. Instead to facilitate them childbearing, but it led to a lifelong disability, incontinence, lack of interest in sex, and huge difficulties in all of the years. And the idea that that would not be acknowledged is wrong which it hasn’t been by the Irish State. It’s just appalling to these women and instead we have this shabby little redress scheme with a paltry amount of compensation and that the women have to forfeit all of their legal rights before they can even access it. It’s completely wrong. This is gross medical negligence and should be compensated as such.”

McGurk: “Michael, has it been accepted as wrong?”

Michael McNamara: “By the State?”

McGurk: “Yeah.”

McNamara: “Well, I mean there is an ex-gratia compensation scheme but one of the issues with the State, I understand, is criticised for, and I didn’t see the entirety of the hearing, was the fact that there wasn’t a proper process of finding fault, in effect, and apportioning blame. But I suppose there has been a compensation scheme and I suppose, to many women, that will bring closure, but obviously the human rights committee…”

Daly: “The women have met, hundreds of them met last weekend, and it’s been unanimously rejected. I mean if you compare for example the Lourdes Hospital redress scheme where the women’s wombs were taken, there was €45million allocated to that scheme. The amount of payment was substantially more and it was deemed to be medical negligence and in this scheme the courts have awarded between €300,000 and €600,000 and yet this scheme is saying between €50,000  and €150,000 for permanent  lifelong disabilities and pain, that’s no compensation. But I think what’s more affront for the women is that nowhere has the State recognised and this is what the UN validated today, if you like, that it was a violation of human rights and  that it shouldn’t have happened, it was medically unwarranted, it should not have happened.”

McGurk: “Do you see Deirdre this as having considerable impact?”

Deirdre Duffy: “Yes, I do and I think…”

McGurk: “It’s different to something before, in many ways?”

Duffy: “Well, I think it can have as much impact as we want it to have, as a country, as a society, as a Cabinet, a Government that’s going to move on now. And Tom, you asked a series of questions about what happened back in the day, why did this occur, and that actually is what Sir Rodley was getting at. Michael [McNamara] used the term blame but actually the word that he [Rodley] used was accountability. So what he said was that even though this Government has put in place a redress scheme, they’ve allocated money, they’re focusing only on the pecuniary impact of this or the pecuniary redress. So what he’s saying is that you need to look further, you need to look at truth finding and accountability mechanisms because, you raised the questions yourself, it’s not clear to everyone within Ireland, why this happened..and how this happened.”

McGurk: “Yes, where did this come from?”

Duffy: “Now there have been reports, a number of independent reports from survivors and also  State-sponsored reports which survivors claim were not independent and not thorough and would find numerous faults with. But I think what’s important for us right now is what Sir Rodley said around the collection of activities that I suppose produce a, or refer to our past, past abuses. So issues like the Magdalenes, the mother and baby homes,  the symphysiotomy and the child abuse, these are relics of our past that we need to deal with and  sweeping them under the carpet and allocating some form of  monetary compensation to women – because it’s all women – is not going to be good enough. It does not meet the…”

McGurk: “So ideally, how should the State deal with this? Spell it out then?”

Duffy: “Well it should set up independent inquiries. It’s something that the ICCL, the Survivors of Symphysiotomy and other groups, Justice for Magdalenes,  have been calling for for a number of years. We know we’re going to get an inquiry into the mother and baby homes, under the Commission of Investigations Act 2004, so why not have an inquiry into this collective, as Sir Rodley called it, series of abuses?”

Watch in full here

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Dr Julien Mercille, UCD lecturer and author of The Media and the Irish Economic Crisis: A Political Economy and Dr Mercille with journalist Margaret Ward, Mick Clifford, of the Irish Examiner, and journalist and author of The Frontman Bono (In The Name Of Power, Harry Browne, on last night’s Tonight With Vincent Browne, hosted by Tom McGurk

Dr Julien Mercille on Tonight With Vincent Browne last night discussed the subject of Ireland’s political correspondents.

In particular he took aim at the political editor of The Irish Times, Stephen Collins.

Tom McGurk: “Can we talk about the political correspondents? Those people who dwell on the…what do they call it, outside Leinster House?”

Mick Clifford: “The plinth.”

McGurk: “The plinth. The plinth dwellers, right. To what extent do they protect the politics of this country? To what extent are they part of the problem too?”

Clifford: “Well, in a small country, you’re going to have an atmosphere whereby there is a certain consensus, whatever. Within that context though, to be fair, I don’t think you can just label political correspondents as one. I think there is a diverse group within them. But it’s inevitable, it’s inevitable in any type of set-up where you’ve…”

McGurk: “But they’re your consensus journalists, aren’t they? They’re down the middle of the line, aren’t they?”

Julien Mercille: “There’s a lot of very good examples but let’s take like Stephen Collins, of The Irish Times. He wrote a piece a few weeks ago, saying that Enda Kenny was doing well for the country because Enda Kenny was happy, or was smiling or something like that. That makes no sense whatsoever. I mean, and that passes for…”

McGurk: “Well, he’s not here to defend himself…”

Clifford: “Aah, I don’t think that’s very fair to be honest.”

Mercille: “Well, that’s what he said. He said that he was doing well…”

Clifford: “I think now, to be fair, I’ve read his columns and whether you agree or disagree with them, there’s a certain analytical element to them.”

Mercille: “There are some good columns. I’m giving one example of a column. Another very good one was a piece about Christine Lagarde, IMF chief, saying how good she was at yoga and how good she was an negotiating with a scarf, with men and turning down the thermostat. That’s like, that’s not…”

McGurk: “But we complain consistently about the political classes so on and so forth but you rarely find any of the political journalists saying that, do you? They’ve got to survive in there, haven’t they?”

Harry Browne: “They’re effectively honorary members of the political class.”

McGurk: “And should they be in there for a long time? Or after two years shouldn’t they be taken out?”

Margaret Ward: “No, why aren’t they rotated? I mean, again, this would be normal journalistic practice.”

McGurk: “They go native if you leave them in there too long?”

Ward: “You would be rotated from a beat after two years. So, if you’re covering politics, after two years, you have to move on to something else, to something else. That keeps you from getting too close to your sources. The closer you get to your sources, the more reliable, the more reliant you are on them and therefore it becomes a little too cosy. And as you [McGurk] said, half these people all live in the same part of Dublin 4 or 6. Their kids go to school together, they play golf together, you know, they’re in the same restaurants..”

Browne: “Rotation is a great point because specialisation can be overrated, I think a really good journalist is someone who can pick up a subject and by the end of the day, or by the end of the week, or the end of the month, depending on the complexities of the subject, they’re expert enough to tell that story.”

McGurk: “This is a very depressing consensus we’re building: they’re all playing golf, they’re all going to the same schools and they’re all saying the same thing.”

FIGHT!

Watch back here in full from 19.50

Previously: Lookin’ For Bubble

For Those Who Shouted Stop, He Salutes You

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Last night, Tonight with Vincent Browne held a debate between the candidates running in next week’s Dublin West by-election, following the resignation of Patrick Nulty.

After the debate, the results of a public poll asking if the Labour Party deserve to retain Mr Nulty’s seat were revealed..

Ouch.

Previously: Last Lap

Pic via Oireachtas Retort

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Last night on TV3′s Tonight With Vincent Browne, Senator Eamon Coughlan, of Fine Gael – who is running in next week’s Dublin West by-election following the resignation of Patrick Nulty – regaled those present and those watching with a story about a constituent he met while out canvassing.

Jay.

Kers.

H/T Luke McManus

Update:

byeDublin this morning.

Jane Gallagher writes:

“An election farewell….”

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This morning.

The launch of SIPTU’s Communities Against Cuts opposed to the “privatisation of community programmes” at Buswells Hotel, Dublin this morning.

From top: Social researcher Brian Harvey and Project Co-ordinator Deirdre McCarthy; Community worker Tommy Coombes and Vincent Browne.

Campaigns Against Cuts (SIPTU)

(Laura Hutton/Photocall Ireland)