Health Apartheid For Our Children



From top: Health Minister Leo Varadkar with the proposed site of the Children’s Hospital with Nathan Evans (left) and his sister Olivia; Dr Rory Hearne

Ours is a deeply unequal health system where sick children who are reliant on the public system are left waiting for months and even years while children whose families can afford it are avoiding the waiting lists and accessing care through the private system.

Dr Rory Hearne writes:

The numbers of people on hospital waiting lists in this country are truly shocking. There are now almost half a million (that’s ten per cent of our entire population!) waiting for various forms of treatment or assessment in our public hospital system.

If we look at children specifically we can see that the numbers of children waiting to be seen in hospital day cases has risen by a third (33.7%) in just over a year (from December 2014 to March 2016).

Meanwhile the number of children on inpatient (often surgery) waiting lists has increased by 18% in the same period.

This shows just how far away we are from putting in place the aspirations of the 1916 Proclamation that aimed to cherish “all children of the nation equally”.

So while the state splashed out on the recent celebrations and commemorations over ten thousand sick children (11, 145 to be exact) are waiting to be seen for an appointment in our public hospitals.

What a Republic to be proud of!

While most of the media coverage so far has looked at the overall waiting lists numbers, including both adults and children, I have analysed the waiting list figures released by the National Treatment Purchase Fund to look specifically at the numbers of children who are waiting to be seen in our hospitals. I also looked back at the figures for 2014 to see how the waiting lists have changed.

The graph below shows that things have worsened considerably in quite a short space of time. We can see that the numbers of children waiting over six months on day case lists has increased by three quarters (75%) from 1675 to 2944. While there was an increase by 40% of children waiting longer than six months for inpatient care.

Just stop and think about this for a moment. Six months is a substantial length of time in a child’s life. As a parent I know about the reality of waiting for health care (in particular for dental treatment) but fortunately my children have not required to be on a waiting list for something very serious.

I can only imagine the stress and worry on those parents and the needless suffering of children waiting month after month and in some cases, over a year, to be seen in a hospital for illnesses relating to Ear Nose and Throat, Respiratory illnesses, Cardiology, Surgery, Orthopaedics and even Radiology.


The waiting lists differ from hospital to hospital. In the graph below I show the hospitals with the highest waiting lists in 2016. We can see that for hospitals like Our Lady’s Hospital Crumlin the numbers of children waiting for day cases increased by 43%.

Some of our regional hospitals like Galway and Waterford are also notable for their high waiting lists and significant increases over the last year.


The reasons for waiting lists are complex but there is no doubt that the austerity cuts and the failure to provide sufficient funding to our public health system is a large part of it.

There has been some debate in the media recently about the “high” level of spending on our health services and the resultant claim that the system is the problem.

But the system is in chaos – with underpaid staff, closed beds, inadequate facilities – not because of the lack of effort or capabilities from the people working in the health system but due to its chronic under resourcing.

If we look at the actual numbers we can see from the graph below that Ireland’s spending on health as a % of GDP at 8.1% is below the OECD average of 8.9%.

And most importantlyy only 68.5% of health spending in Ireland is public (i.e. 31.5% is private) versus the OECD average of 72.7% and countries such as the Denmark where it is 84.3% and the UK where public spending is 86.6%.

This means that only 5.5% of GDP is spent on public health care in Ireland versus 7.3% in the UK.


We can see that a relatively high proportion of spending on health in Ireland is private. This means that access to health care in Ireland is strongly influenced by private individuals’ and families’ ability to pay for it privately.

The public health system in Ireland does not provide universal comprehensive accessible healthcare like the National Health Service in the UK. So those who can afford it are clearly buying a greater access to healthcare than lower income households in Ireland through the private hospitals and clinics (who highlight this point in their advertising).

Also people who don’t have a medical care or health insurance are charged for use of the public system as well.

This is a deeply unequal health system which results in these massive waiting lists and the inequality whereby sick children who are reliant on the public system are left waiting for months and even years while children whose families can afford it are avoiding the waiting lists and accessing care through the private system.

This can be classed as nothing other than an apartheid health system. This is grossly unfair and unequal. It is reinforcing an already unequal society for tens of thousands of children.

The waiting lists show that we need a properly funded universal public health system that can provide equal and timely access to high quality treatment for all our citizens.

The public demonstrated in the recent election that would rather forego tax reductions such as the USC in order to see a properly funded universal health system.

So whatever never government is formed has the public support to do it – it just has to have the political will to implement it.

Dr Rory Hearne is a policy analyst, academc, social justice campaigner and  independent candidate for the Seanad NUI Colleges Panel. He writes here in a personal capacity. Follow Rory on Twitter: @roryhearne

44 thoughts on “Health Apartheid For Our Children

  1. 15 cents

    anything that isn’t related to business and economy is of no interest to Fine Gael. And in response to questions about health, housing crisis, non-economic matters, Fine Gael brush off by saying it’s a top priority and theyre working on it, while having no intention of doing so. you got the leaders you deserved. vote how you voted, and thats what you get. then we all have to suffer, just because your local FG candidate showed up at your grandads funeral and goes to all the gaa matches. fupp this country im done with it, its broken and beyond repeair.

      1. Disasta

        This is what happens you put a doctor in charge of a large organisation.
        Or a teacher in a charge of a country.

        Or what happens when you put anyone totally unqualified in a position..they make a mess.

    1. Tish Mahorey

      “anything that isn’t related to business and economy is of no interest to Fine Gael”

      Very true but health IS of a business interest. They’re hard at work running the system down so that privatisation looks like the better option. It’s a well known tactic around the world and every single economist and investment banker knows this. It’s openly discussed in their fora.

      1. 15 cents

        thats really scummy. knowingly toying with peoples health, for their own agenda. not surprising tho. but completely disgusting.

  2. Owen C

    “This can be classed as nothing other than an apartheid health system. ”

    Definition of apartheid: ” the term is currently used for forms of systematic segregation established by the state authority in a country against the social and civil rights of a certain group of citizens due to ethnic prejudices”

    Do we have an apartheid housing system? And clothing system? And holiday system? And car system? Etc etc etc. No, we have an optional private health insurance system that anyone in the country can avail of if they have the means (and, unlike the US, at starting rates of 35 quid per month per person, it is not outrageously expensive)

    We have a dysfunctional health service which needs an equal dose of investment and reform. But it is certainly not apartheid. Throwing around inflammatory terms for serious issues is not a responsible way of using the Broadsheet (or Seanad) soapbox.

    1. Anne

      “that anyone in the country can avail of if they have the means ”

      You define the apartheid yourself in that sentence.. those who have the means and those who don’t.

    2. Anne

      The prejudices might be different, but the segregation/different access to healthcare is there nonetheless. There’s a two tier system.. that’s apartheid. It might be inflammatory but it’s true.

        1. Anne

          We’re talking about health Owen.
          Why are you relating healthcare to the whole economy… to cars, to clothes even?

          1. Owen C

            because the same thing happens in those sectors. Some people, through their higher means, have access to better/bigger houses, cars, holidays, clothes, jewelry. Why does no one call them out for what they are, system of apartheid? Do we have an apartheid education system in terms of public vs private?

            Apartheid literally means systemically denying people access to something. No one is systemically denying anyone access to the private health insurance market. People’s individual circumstances and choices are denying them access to it.

          2. Anne

            Healthcare access in a civilised society in my opinion, should be based on need, not means Owen.

            And it’s not a case of anyone being denied access to the private healthcare market..that’s kinda like saying homeless people aren’t denied access to buying a home. eh, duh.
            It’s the fact that people are being denied access to healthcare because of not being able to afford private healthcare..

            ‘ People’s individual circumstances and choices are denying them access to it.’
            Circumstances like children who are born with certain conditions or diseases is it? They’re just denied access because they’re unlucky that way is it? You might say it’s their parent’s who deny them access by their circumstances and choices is it? What if they have illnesses themselves? Tough luck then?

            It doesn’t seem a very civilised way to run a society Owen.. not when all of us contribute to the running of a society, and the wealthy in particular avoid contributing at all costs.

          3. Owen C

            Anne, look at chart of private vs public spending on healthcare in the OECD that Rory used in his post – every single country has a material element of private sector healthcare spending. Is there no civil society’s in the world? Do they all have some elements of apartheid within their healthcare systems?

            Underresourcing, dysfunctionality, and inequality in society do not equal apartheid. Using grown up words incurs an element of responsibility. Dr Hearne is a lecturer at NUI Maynooth i believe. You need a certain amount of CAO points to access courses there. Is our leaving cert and college entry system ridden with educational or intellect-based apartheid? Why can’t someone with very poor grades gain access to these courses?

          4. MoyestWithExcitement

            Yep. Stormont had a law that only homeowners could vote in the local elections “coincidentally” when very few Catholics owned any. I guess that wasn’t apartheid either. I mean, sure Catholics could have just bought a house if they cared about all that. Poor people get lower quality health care than rich people. That’s an apartheid system.

          5. Owen C

            that is absolute gibberish. Private health care is not a constitutional right, or a universal democratic right that something like a right to vote could be considered to be. Fail.

          6. Anne

            Again, what’s a person’s intellectual ability got to do with healthcare Owen?

            Should we leave the poor and uneducated to die if they become ill and can’t afford to pay for treatment? Is that what we should aim for?

          7. MoyestWithExcitement

            “Doctor, please help my wife, I think she’s having a stroke.”
            “How much money do you have?”
            “We’re on the dole.”
            “OK. Wait in this room for junior doctor, I have to help these accountants.”

          8. Owen C

            Anne, why cant people with bad grades take Law in UCD or medicine in Trinity? Isn’t that intellectual apartheid? Access to education is actually a “fundamental right” in the constitution. Access to healthcare, as far as i can see, is not.

          9. Anne

            Owen, Ireland is party to the UN International Covenant on Economic, Social and Cultural Rights.

            Even the programme for government has the aim of equality in healthcare access.

            The core of the Government’s health reform programme is a single-tier health service, supported by Universal Health Insurance (UHI) and designed in accordance with the principles of social solidarity. This will mean that: the population will have equal access to healthcare based on need, not income;
            everyone will be insured for a standard package of curative health services;
            there will be no distinction between “public” and “private” patients;
            we will introduce universal primary care, with GP care free at the point of use for all;

            Need, not income Owen

          10. Owen C


            “everyone will be insured for a standard package of curative health services”

            So there will be access to a premium package for some people, above this standard package?

          11. Anne

            Yes Kieran, a bit of Annesplaining has to be done and then.. :)

            I don’t know Owen.. they didn’t implement any of it either way.
            But they probably mean a standardize package.. universal.. single tier – “everyone will be insured for a standard package of curative health services” Everyone.

            If there’s to be no distinction between public and private, as mentioned also, I doubt it.

          12. Owen C

            Anne, i, and i reckon most other people, would be very surprised if UHI meant the end of private sector coverage. I think the main purpose of UHI was simply to mean there was no need for it for “curative health services”, rather than it being ended by government decree. Private maternity care sure as shizzle aint gonna end anytime soon, UHI or not.

        2. MoyestWithExcitement

          Sooooo voting for a county councillor is more of a right than getting help to not die? OK then.

          1. Anne

            Down with that sort of gibberish Moyest.. :)
            No one is stopping them paying, don’t cha know.

          2. Owen C

            Without being flippant, but yes. Without the right to vote freely and create a democracy, what point are any of the other rights? Lots of people give up their lives in order to obtain the right to vote. You’re not very insightful as regards people’s fundamental rights in modern society.

          3. AMam

            So which one of my twins will I choose to insure for private healthcare. I did the math before getting pregnant. Knew i could afford one child but got two. Will you help me choose Owen?

  3. scottser

    More cynical posturing from this self serving Muppet. Resorting to ‘wont someone think of the children’ to get yourself elected is something you wouldn’t even see from a blue shirt.

  4. JD

    The more I see of Rory, the less likely he is to get my vote in the Seanad. We need more than a capacity to state the obvious in attention seeking way…

  5. some old queen

    So Ireland’s spend on Public health is lower than 24 other countries within the OECD. Has that rating gone up or down since the last Government took power I wonder?

  6. Alex Francis

    Rushed my 3 year old to Crumlin in January of this year after a severe reaction to something she ate. We spent almost 2 weeks in that filthy hospital (child picked up 2 hospital related infections while there). We have an appointment for allergy testing for the middle of 2017. “Cherish all the children”????

    I remember when we went to register her birth down on Lombard street and it struck me the most important aspect was the attribution of a PPS number to my daughters name. A number that will tie her to paying tax when she starts to earn.
    My daughter will one day repay & finance the state for the care it provided her with. I’ll remind her of the quality of that care.

    1. Harry Molloy

      absolutely it would, given our MNE investment. But it wouldn’t suit the narrative that the HSE is underfunded when it fact it is overfunded but inefficient.

      Health spending per capita is a little more accurate here

  7. Tish Mahorey

    The reason the Irish health service ‘appears’ to be in such dire straits is to fool people into thinking the Government just can’t run it and we need professionals instead (e.g. full on privatisation).

    The main focus is around waiting periods, the very thing which your private insurance will circumvent. So by allowing waiting periods to increase and make headlines, people are more inclined to buy health insurance to avoid the prospect of a delayed diagnosis for a serious illness which could be treated or cured if caught early.

    Private health insurance means private hospitals which means wealthier people get better care and poorer people wait in line until the wealthier people get seen to first.

    If you’re poor in Ireland, you’ll die younger. And not because you’re less healthy. It’s because when symptoms of something present, you will wait much longer to be seen that someone with insurance.

    It is apartheid. And Ireland engages in social apartheid on so many level, in health, education, housing, media coverage, community facilities, justice, politics, business.

    A nation of self serving individualists who think they are not complicit in the causes and consequences of a deeply unequal society.

    And this includes people from all social classes. It includes the tax dodgers, the fraudsters from all walks of life. The Mé Féiners who take take take and never pay their tax, leave their suppliers unpaid for months on end, or the lazy slobs who never do a day’s work in their lives and claim compo for the slightest upset.

    We need citizenship classes in schools.

  8. Peter Dempsey

    Money is tight with me at the moment.
    I continue to pay for private health insurance while sacrificing socialising in the pub and eating out for lunch etc.
    I drive a 2002 car.
    That’s my choice.

    1. Cromuel

      You’re wrong in seeing medical treatment as a commodity like fashionable clothes or alcohol or eating out.

      And while it’s nice for you that you have so much disposable income that you can choose to spend it on insuring your health, this may not always be so. Tens of thousands of people in Ireland paid health insurance for 40 years or more, and then when their work went from under them were no longer able to pay. Despite all those years of paying, they are now, in old age, quoted impossible amounts to ‘join’ the same health insurance scheme, and even if they succeed in paying, they are told that existing conditions won’t be covered by their ‘new’ insurance for the ‘first’ 10 years.

      No, health is something that should be a mutual expense covered by the whole country, like paying for the roads or the libraries or the schools or the public service. It doesn’t even cost that much to do it that way; have a look at this piece by an American living in Sweden:

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