Eamonn Kelly: Dysfunction Unmasked

From top: Chay Bowes (left), HSE CEO Paul Reid; Eamonn Kelly

Chay Bowes, former head of the VHI Homecare division, spoke to Cassandra Voices last November about the HSE and the dysfunction he witnessed within the system. What was chilling about the interview was that the dysfunction was not accidental, it was as good as designed, specifically to benefit the private medical sector.

Bowes met with considerable obstacles when he tried to establish a community care model to alleviate pressure on over-crowded hospitals. He worked with elderly patients in St James’s Hospital as a phlebotomist (the guy or gal who takes your blood samples), where he formed the opinion that health care in Ireland seemed to be focused more on “financial outcome than patient outcome”.

It seemed to him that a lot of elderly people were making needless trips to large general hospitals for routine interventions, where they mingled with others and picked up colds and flu and God knows what else. That these visits to large hospitals, far from being good for their health, as intended, were actually a health liability.

Community Care

Bowes saw an opportunity to develop a community-care business whose basic idea was to bring the hospital to the elderly rather than the other way around. The idea suited the elderly, suited their families, suited over-worked staff in the always-busy general hospitals. Suited everyone in fact, but the managerial fraternity of the HSE.

Bowes’ business, starting off with himself working alone taking blood samples in people’s homes rather than having them sit all day in some hospital waiting room, developed through several incarnations until he finally had 200 people working for him and held a contract with the HSE worth €14 million, the company now called Tara Healthcare.

The developing community-care scheme, which really had the effect of taking “business” away from hospitals, was met with scepticism by the medical establishment, with petty rivalries causing some hospitals to refuse to send patients to Tara Care because this guy didn’t like that guy, and so on. Schoolyard stuff.

Then, following the financial crisis of 2008 the HSE closed the contract for Tara’s services, despite pressured hospital staff lobbying to be included in the service.

Bowes recalls:

“They had to pay us a penalty for terminating the contract prematurely, which cost them more than running it for the subsequent two years.”

Which suggests that the financial crisis was used as an excuse to cull the service rather than a pressing and necessary cutback. A senior HSE person told him:

“What you’ve done in Dublin is almost too good. Everyone’s going to want it. They’re going to want it in Galway. They’re going to want it in Limerick.”

Yes, you heard that right, the HSE refused to fund a successful community-care service, which everyone wanted, because the service was “too good”.

Dysfunction Pays

Bowes concluded from this that people in the HSE, at management level, were personally benefiting from the HSE’s dysfunction, to the extent of perpetuating that dysfunction for profit. This perpetuation of dysfunction involved, as we saw, needlessly summoning elderly people to large hospitals for routine procedures that could easily be done in the comfort of their homes.

The bottom line is, that “the hospitals want to hold onto patients because without patients occupying beds, they can’t justify their budgets.”

But Bowes’ perception of this needless use of old people goes far deeper than just working an angle to procure public monies. To Bowes, what he was witnessing was an antiquated class system of prejudice and disregard towards those dependent on the public health service, describing the large general hospitals as”

“Victorian constructs, where we put all the sick people who are susceptible to infections, so that they can mix with other sick people.”

So, the necessary over-crowding of hospitals by hospital management, to justify the continued procurement of public funds, is based partly on an attitude of disregard for the health of a certain class of people: that is, poor people dependent on the public health service. To simplify it even more, they needlessly endanger the health of poor and vulnerable elderly people to justify maintaining their standards of funding.

As Bowes put it to Cassandra Voices:

“…because budgets are pinned to occupancy and the size of the facility, hospitals seemed slow to manage overcrowding at the cost of lesser funding.”

Waiting Lists

According to Bowes there are now almost a million Irish people on hospital waiting lists. Some will never be treated. They will literally die waiting. That is one-fifth of the population, waiting, often for rudimentary treatments, in a system where the same doctors and consultants that occupy and derive payment from the public health system can offer private treatment for the same ailment “tomorrow”, if you have the money.

Bowes says:

“it just so happens that the man running the show, Paul Reid, has no specific health care experience… The UK’s NHS employs around 1.4 million people to serve a population of nearly 67 million. Its CEO Simon Stevens is paid €210,000 a year, while Ireland’s HSE employs around 102,000 people with a population of only 4.9 million, Reid is astoundingly paid over €426,000 a year.”

When he puts it like that the HSE really does sound like a bit of a racket. He goes on to describe the Irish Health Care system as medieval, dysfunctional and immoral.

“We have a segregated, apartheid system in health care. It simply isn’t based on needs of the patients… There are super doctors out there, super surgeons, super nurses and staff operating in the health system. It’s definitely a case of lions being led by donkeys.”

In other words, as I understand it, the managerial structures of the HSE exploit even the good will and intent of serious medical personnel, for profit.

Health policy in Ireland, Bowes told Cassandra Voices, reflects,

“the laissez faire attitude of a class of people who are running the medical system, advising the agency and the legal system. They of course all have health insurance. I don’t know anybody who served on the board of the VHI or any doctor working in the system who doesn’t have private healthcare… unlike more than 50% of the most needy In our society…”

The question is, is the health service that Bowes describes an outlier in the Irish system of public services and the wider social strata, or is it just the grossest example of an institutionalised attitude towards public money, public services and poor people? Do we live in an apartheid state based entirely on land and wealth acquisition and possession, or is the HSE an anomaly?

We Are Stardust

On this 41st anniversary of the Stardust fire I see Charlie Bird made the point again that if this fire had occurred in a more salubrious neighbourhood that the families wouldn’t have been waiting for over 40 years to learn what caused it.

The unspoken belief (it can’t be spoken for legal reasons) is that business interests were protected from liability through a process of official “forgetfulness” and neglect. This studied neglect seems like yet another fractal of the larger neglect of ordinary people by Ireland’s elite.

On RTE’s Claire Byrne Show last night any time the subject of class division was raised it was quickly talked over. As comedien Martin Beanz Ward put it, They are now doing to ordinary “Irish people” what they used to only do to Travellers.

Eamonn Kelly is a Galway-based  freelance Writer and Playwright.

Previously: Eamonn Kelly on Broadsheet

Getty/RollingNews

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