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Introduction
The Irish healthcare system seems to be in permanent crisis. The symptoms are manifest: too few beds and staff, long waiting lists, patient care which fails to conform to the standards expected in one of Europe’s wealthier countries. What is less readily apparent is that Ireland has a healthcare system that almost defies rational analysis. The Organisation for Economic Co-Operation and Development (OECD) has diplomatically described the Irish health care system as “unique.” Others might consider its mix of the public and private, its state-funded institutional inequity, as bizarre.
Maev-Ann Wren1
On the surface, the Irish healthcare system appears similar to that of other developed European countries. (To avoid confusion: this article is about the Republic of Ireland; not Northern Ireland, in which Britain’s National Health Service (NHS) is in place.) There is a spread of hospitals, of varying vintages, around the country’s cities and towns. These are backed up by clinics, primary care doctors in general practice (GPs), public health nurses and other standard supports. The major hospitals have university affiliations. Medical school selection is extremely competitive, and training is lengthy and rigorous. Many doctors obtain further training and work experience overseas. Most nurses are educated to degree level. The medical staff are multinational. Yet, due to a combination of factors, both internal and external to the health service, it frequently scores low in outcomes, and is plagued by regular scandals.
In 1987, Ruth Barrington published a political history of the healthcare system: its opening sentence was: “How did we come to have one of the best health services in the world?”2 That seems unlikely to be written now. Since the mid-1990s, media reports have abounded with stories of great dysfunction in the system; frequently, there is near-chaos in hospital accident and emergency departments, with sick and injured patients languishing on trolleys, chairs or the floor for many hours before being attended to; long waiting lists, sometimes stretching to years, for routine investigations and procedures; and unending stories of neglect of patients, cover-ups of errors, and bad practice.
A selection of newspaper headlines from July to September 2018 give a flavor of the coverage: Children’s hospital apologises over death of baby;3 3,000 women may be caught up in cervical cancer...