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Annual Public Conference 2003
Oct, 03
The Adelaide Hospital Society's Annual Public Conference on the theme 'Equity and Access in Healthcare' took place in the Education Centre on Saturday, 11th October. The Conference was the best attended ever with delegates from statutory agencies and a very wide range of community and voluntary organisations.
Introduction
The Adelaide Hospital Society's Annual Public Conference on the theme 'Equity and Access in Healthcare' took place in the Education Centre on Saturday, 11th October. The Conference was the best attended ever with delegates from statutory agencies and a very wide range of community and voluntary organisations.
In his Address to delegates the Chairman of the Adelaide Hospital Society, Mr Richard Greene, called for a wide range of agencies to unite as a "common platform" to ensure that health inequalities are addressed. Mr Greene proposed that organisations such as Combat Poverty, The Disability Federation of Ireland, the Institute of Public Health, the Society of St Vincent de Paul, the Health Spoke of The Wheel, the Public Health Alliance and others should agree the "main planks" of this common platform and collectively mobilise public opinion to ensure the reform of Ireland's grossly unfair healthcare system. Amongst such 'planks' would be the adoption of the principle of social solidarity in healthcare, a comprehensive free primary care service and strong citizen participation in the direction of our health services.
The Conference was addressed by Dr James Kiely, Chief Medical Officer, Dr Joe Barry, President IMO, Professor Richard Wilkinson, an international authority on healthcare, Dr David McCutcheon, former CEO of the Hospital and now Deputy Health Minister, Ontario, Canada, Professor Jennie Popay, Lancaster University, author of Beyond Beer, Fags and Egg & Chips?, Professor Niamh Brennan, Chair of the Brennan Commission and Mr Fergal Bowers, editor, www.irishhealth.com.
'Equity and Access in Healthcare'
Address by Mr Richard Greene, Chairman, The Adelaide Hospital Society at the Annual Public Conference on the theme "Equity and Access in Healthcare" on Saturday, 11th October 2003 at The Adelaide & Meath Hospital, Dublin, Incorporating The National Children's Hospital
Call for Common Platform to ensure inequalities in healthcare are addressed
The Adelaide Hospital Society is one of a growing number of organisations which are gravely concerned about the stark health inequalities in Irish society. Organisations as diverse as Combat Poverty, the Irish Psychiatric Association, Disability Federation of Ireland, The Institute of Public Health in Ireland, The Society of St Vincent de Paul, the newly formed Public Health Alliance and others have documented or raised their voices to seek action to address the central issue in Irish healthcare: equity and access for all our citizens to appropriate healthcare when it is needed.
I hope that today's Conference on this theme will be further encouragement to all healthcare organisations and to indeed many other groups outside healthcare - such as our political parties, social partners and churches - to rally behind a common platform to ensure that as far as equity and access is concerned our healthcare practice matches our official rhetoric. As we know equity is supposed to be at the centre of our healthcare policy. In 2001 the Health Strategy declared
"Equity will be central to developing policies (i) to reduce the difference in health status currently running across the social spectrum in Irish society and (ii) to ensure equitable access to services based on need"
It is time to move from rhetoric to action; it is time to mobilise Irish public opinion so as to underpin the political will and courage required to achieve a common platform of change. Before suggesting some of the main planks in such a common platform it is essential to state that the primary cause of health inequalities in Irish society relates to income distribution. A society that tolerates so many individuals and families on very low incomes will be a society that is unequal and unfair in respect of health. There is convincing evidence that egalitarian societies are more healthy societies when compared with societies where the distribution of wealth and income is markedly unequal.
In addition to this overall challenge for Irish society in respect of creating a more just society I would like to draw attention to some less well highlighted aspects of the gross inequity which pervades our health services.
One such aspect is geographical: for example a survey of psychiatric services in Ireland this year conducted by the Irish Psychiatric Association shows that clinical resources in mental health are not concentrated in areas of greatest need but have been best developed in areas of greatest affluence. Rather than clinical resources following need the survey found that the reverse was true. It has been established that psychiatric morbidity and service utilisation is directly related to socio-economic deprivation. Yet we allow a glaring mismatch between need and resources to occur. This geographical inequity occurs in a range of other health services, such as cancer services: it also occurs in relation to choice and quality of service. If you live in Foxrock you have a range of healthcare services close by and you will have the resources to exercise a real choice. Exercising such a choice about a preferred healthcare provider should be available to all our citizens. We know in this Hospital, for example, because of our pluralist and patient-centred Charter that many people wish to receive their care here. It is the ambition of the Adelaide Hospital Society that each person would be treated in healthcare as they themselves would wish in every part of our healthcare service. Sadly we know from recent events, such as blood scandals, the Dr Neary case and other appalling failures, that the patient's views and needs have too frequently not been placed at all times first and foremost. Equity requires a totally patient-centred approach.
If you live in Leitrim you will have little to choose in respect of local healthcare services and you will have to accept whatever access you get locally and nationally. You may even have to read that the Eastern Region doesn't want you to access the overcrowded but concentrated services in Dublin.
Another aspect of inequity that I would like to highlight is that of age discrimination. Appropriate healthcare services for older people - and here we are speaking of a growing proportion of our population, one which will rise from 11% to 14% of total population by 2011 - are poorly developed and very inequitably distributed. Is it any wonder that Irish men and women have the lowest life expectancy at age 65 of all countries in the European Union? A major contributory cause of the low life expectancy is the high rate of cardiovascular disease (almost twice the EU average) and we know that cardiovascular services are more available to the better off than to the poorer social groups in society.
Public advocacy for older people is relatively underdeveloped in Ireland. Thus we allow glaring deficits in community care, long-term care, reductions in home help services and overt ageism in our healthcare system. For examples of ageism I might cite our breast cancer screening programme which has an upper cut-off at age 65 and there is clear evidence of less aggressive treatment for older people with many forms of cancer.
At this Conference many of the known facts about health inequalities in Irish society and how these facts compare with other countries will be set out. In particular I am sure our unique 'two tier' system of access which provides care according to income rather than need will be analysed. At the heart of the issues of equity and access, it seems to me, is a question of values. Either we as citizens see healthcare as a social investment and collective responsibility, or we see it as a 'commodity' to be 'rationed' according to income to 'consumers'. Healthcare as a collective responsibility leads to the principle of 'social solidarity' which is predominant in the European Union.
I want to suggest that the main plank in a common platform to address equity and access must be this principle of 'social solidarity': it is based on the value that all citizens must receive equal care and treatment upon the basis of their healthcare needs rather than their financial means. We need first to get our values agreed. Then whatever resources we have will at least be distributed fairly between all our citizens. It seems to me given Ireland's relatively well off economic and social conditions, that we do have the collective resources to provide sufficient capacity to meet all the appropriate and reasonable healthcare needs of all our people. Have we the values and the political willingness to do so?
One could point to other vital planks in a common platform which no doubt will be discussed today: there is, for example, a compelling case for a comprehensive free primary care service in order to shift healthcare from the current almost exclusive focus on curative services to one of prevention, early detection and health promotion. Such a primary care service would provide the essential foundation for appropriate secondary care hospital services. Currently many people cannot afford access to primary care which is a shocking indictment of Irish society in 2003: many as we know come to our overcrowded accident and emergency departments for 'minor' healthcare needs because of inadequate access to a proper primary care service.
Another essential plank in a common platform to address equity and access must undoubtedly be strong citizen participation in the direction of our health services. The Health Service Reform Programme announced in June 2003, with the objective of rationalising our health system, will fail unless the proposed new structures engage effectively with the people. Citizens must have a real sense of 'ownership' over both the structures and the decisions taken to reform the system so as to provide a more 'people-centred' health service as the Health Strategy suggests. We will be unable to have a people-centred healthcare service without a genuine commitment to decentralising power and decision-making and so encouraging people to participate actively in achieving better health outcomes for all. If women, the elderly, the geographically remote communities, those with expertise in various healthcare needs in our extensive network of voluntary healthcare organisations, and those in the new ethnic and diverse immigrant groups are not engaged effectively in our new health structures then such structures will not realise the vision of the Health Strategy. Effective engagement of people requires the development of skills and mechanisms for on-going consultation and involvement by all healthcare providers with those whom they serve.
The planks of a common platform which I am suggesting in order to address inequalities are
Adopting the principle of social solidarity in Irish healthcare
Building from the ground up a comprehensive free primary care service
Strong citizen participation in the direction of our health services
Let us remind ourselves of the vision of the Health Strategy launched in 2001: it is surely a vision that we do not want to lose sight of as we reform Irish healthcare.
"The Vision
A health system that supports and empowers you, your family and community to achieve your full health potential
A health system that is there when you need it, that is fair and that you can trust
A health system that encourages you to have your way, listens to you and ensures that your views are taken into account"
Quality and Fairness A Health System For You Health Strategy (Government of Ireland, 2001) p8.
Presentation by Prof. Niamh Brennan (pdf 58kb)
Presentation by Dr. J. Barry (pdf 210kb)
Presentation by Prof. J. Popay (pdf 45kb)
Presentation by Dr. J. Kiely (pdf 125kb)
Presentation by Dr. D. McCutcheon (pdf 200kb)
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