Putting the politics into health

A number of politicians, particularly the ‘doctor’ members of parliament, are known for their focus on health service issues, but they are not the only members of the Oireachtas who campaign on health matters on a daily basis.

The health service is also a key area of advocacy for Independent Kerry TD Michael Healy-Rae. Indeed, the Kilgarvan TD made headlines in 2016 for submitting 115 health-related parliamentary questions (PQs) in one day alone to the Minister for Health, the majority relating to individual patient appointment times for consultants.

In an interview with the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>), Deputy Healy-Rae staunchly defended the role of politicians in healthcare and explained that while people might think he gets the same standard answer for patient query PQs, they draw attention to the plight of individual patients and put pressure on the system to improve waiting times. Citing one PQ he submitted after a teenage girl was told she had to wait four years for an orthodontic appointment for treatment of issues that made her so self conscious she did not want to leave her house, he said “it is that type of pressure that makes somebody decide, ‘oh God, yeah, maybe we should call her in sooner than four years’”.

He told <strong><em>MI</em></strong> that of the approximately 2,400 PQs he submitted last year, about half were do with the health service.

“Some people say ‘what role has a TD to play in the health service?’ Well, I can tell you, we have plenty,” Deputy Healy-Rae stated, citing the expansion, retention and introduction of new health services and, on an individual level, giving assistance in applying for medical cards, hospital appointments, explaining healthcare entitlements and how to appeal refusals for various services.

The Kerry TD receives so many health-related queries from his constituents, he has to file them meticulously by disease area “and track the dates, how long the person is waiting, and so on”. He also on occasion visits his constituents in hospital and sends them ‘get well soon’ cards.

Supplying information and advice on navigating health services is also a key part of the job, he said, giving an example of an 80-year-old man he knew experiencing chest pains in rural Kerry being driven to University Hospital Kerry (UHK) by a family member who rang him for help.

Upon contacting UHK, Deputy Healy-Rae found there were 24 patients in the emergency department (ED), as well as two arriving ambulances with accident victims, waiting to be seen by one doctor, so he directed his constituent to travel to the Mercy University Hospital in Cork instead, where the man was seen by a doctor within 40 minutes, underwent the necessary tests and got a bed quickly.

<strong>Michael Healy-Rae TD </strong>

“That story highlights that if you have a politician who knows the health service and knows their way around [they can help]. And if you are going blind or are in terrible pain with your hip or knee, you need somebody to tell you about Belfast [where patients can access care through the EU Cross-Border Healthcare Directive]. They tell you that politicians shouldn’t be ringing hospitals; that it is like looking for favouritism for your people. More bullshit. I ring hospitals every day. I can guarantee you today that I will talk to people at least five times in different hospitals, at least. That would be an average. Over 25 years, I have built up very close friendships with consultants, who are now retired but still at work. I have their mobile numbers and can talk to them about patients and let them know about a patient and let them know what way things are going. To me, it is politics working at its best… Nothing is as important as health. If I am stuck at a meeting at 11 or 12 at night and somebody rings me and says they have an urgent matter and if I am busy and can’t deal with it there and then, the first thing I will say is, ‘is it something to do with health?’, and if they say ‘no’, I say ‘fine, you can ring me back’. But if they say ‘health’, I will drop whatever I am doing and deal with it.”

Deputy Healy-Rae’s father, Jackie Healy-Rae, was also well known for his work on health service matters and when his son started out in politics, one of the first things he did was become a member of the old Southern Health Board.

“When the old health boards were done away with, Mary Harney and others thought it was a good idea to take politics out of health, which they did, as when the HSE [board] was formed, it had no politician members. The whole service got worse. The connectivity with issues on the ground was gone. Soon enough after, they changed the whole thing again and said ‘we better have politicians [involved]’.

Deputy Healy-Rae receives hundreds of constituent pleas for help in accessing medical cards. He notes that most people are unaware that for patients with a terminal illness, discretionary medical cards can be secured very quickly.

“That means so much to a person. People think it is all about money. In many cases, it is not. It is a recognition that people are in trouble and want the State to help them.”

He claimed “the biggest lie that is out there is on the [medical card application] form, where it tells you to get evidence from your GP… But once a medical report goes in and they see in the heading that it is from a GP, they actually disregard it. They take no notice of the comments that are presented. None whatsoever. The report now has to be from a consultant. And if it is not from a consultant, you will not get a medical card. Nobody will admit this in the health service… When I ask for cases to be investigated by supervisors to see why an application was not accepted on a discretionary basis, what I’m told is ‘lack of medical evidence’, even though the GP would have given detailed medical evidence. But the story is then, ‘well, get it from a consultant’.”

He described this phenomenon as showing “a total lack of respect for the integrity of our GPs”.

Rural Kerry, like many other parts of the country, is currently experiencing significant difficulties in attracting GPs to replace retiring GMS list post-holders. “People think that doctors make a lot of money but the viability of many of the practices in Ireland — and I’m not just talking about Kerry, but the rest of the country too — is actually in jeopardy because of the simple fact that if they have to provide premises, secure it, staff it and operate it and do all that, it doesn’t make sense for someone to be a ‘rural GP’. That would have never happened in the past; it would have been quite lucrative but not anymore. I have great concern about that. I asked the Minister for Health to look at this whole issue. We have to keep the tradition of locally-based doctors. If you don’t have that, you will have chaos in the health service, because if every person for every issue finds themselves running to the local hospital, that puts so much pressure on our hospitals — they won’t be able to cope. For the Department [of Health] to invest properly in our GP services would be money well spent. I really mean that. Every euro put towards securing GPs and making sure that they are there will pay off in the long run.”

<h3 class=”subheadMIstyles”>Waiting lists</h3>

Like the rest of the country, Kerry patients face significant waiting lists for public inpatient and outpatient hospital procedures.

Deputy Healy-Rae described hospital waiting lists as an “insane scandal”, citing cataract operation waiting lists in particular as “a disgrace”. He said one of his constituents went blind in one eye while waiting for a cataract operation and he thus insisted that the Programme for a Partnership Government, which he supports as an Independent TD, contain a commitment to reducing ophthalmology surgery waiting times.

Recently, 13 elderly patients from Kerry and Cork travelled by bus to Belfast to avail of cataract operations under the EU Cross-Border Healthcare Directive, in a trip that was partly organised by the Kerry TD’s brother and fellow TD Danny.

Deputy Healy-Rae said he has been directly involved with at least 16 Kerry patients receiving care under the Directive, and “recommends it every day” to his constituents calling about long operation waiting times.

He noted that the private hospital in Belfast where he directs patients under the Directive carries out operations “early in the morning, late in the evening, on Saturdays and on Sundays”.

“When are we going to shake the cobwebs off ourselves? We have facilities here in our hospitals and they are operating for four, five, six hours a day. Operate the damn things for 10, 12 hours a day. Why should we be giving money to a hospital in the north — and I am appreciative of what they do — when we could do them here… our archaic system of operating dictates that it is like we are in slow motion.”

Pressure on the ED in UHK has also increased in recent years — the number of patients on trolleys at the hospital increased by a third last year. Deputy Healy-Rae was particularly critical of the admissions pathway into public hospitals, with the majority of patients having to go through the ED, which he described as “crazy”. “There is no reason on God’s earthly world why such patients [with GP letters] should wait and clog and choke up an A&E facility to be seen by another doctor who will concur with the analysis their GP did. It is a duplication… That is crazy. It doesn’t make sense.”

The south Kerry TD is also currently campaigning to increase the number of consultants from Cork hospitals carrying out clinics in UHK so that local patients would not have to travel to Cork. “It doesn’t make sense to me that if a consultant is coming to Kerry to the Bons [Bon Secours Hospital, Tralee] to hold a private clinic, that if they are willing and able to also provide a clinic in UHK, why shouldn’t that be allowed happen… It is not happening yet, but I am not giving up on it and I hope it succeeds, because it would provide a [much-needed] service and would be a win-win situation.”

<h3 class=”subheadMIstyles”>Ambulances</h3>

Given its wide rural geographical spread, ambulance response times in Kerry can be poor, far exceeding HIQA targets, and Deputy Healy-Rae has long campaigned to increase the number of ambulances in the county.

In addition, he was critical of the centralisation of ambulance call centres in recent years, claiming that the loss of local knowledge, coupled with a lack of ambulances in Kerry, has put patients’ lives at risk, citing a number of examples of patients with critical injuries who had long ambulance wait times and negative outcomes.

“My experience of the health service leads me to believe that unless a person has suspected spinal injuries or anything like that, my advice to people is, do not wait for an ambulance, under no circumstances, as it is too dangerous to wait for an ambulance… it is a fairly serious thing to say to people, ‘don’t wait for an ambulance’, but I do it in the best interests of patients, as I have seen too many horror stories of people waiting with disastrous outcomes.”