Health, Medicine & Politics in Ireland 1900-1970 by Dr Ruth Barrington is a fascinating and very informative read covering the key events, legislation and personalities that created healthcare structures in Ireland up until 1970 which in the main persist to the present day.
Although the books endpoint is before the creation of the Health Boards, the massive cutbacks of the 1980s the escalation of the 1990s waiting lists, the scatter gun spending plans of the 2000s along with the creation of the HSE (a NHS style bureaucracy without a NHS), the book is nonetheless an instructional guide into the thinking that continues to surround how our politicians approach health policy and play political football with the institutional vested interests (not necessarily bad groups, just people with a professional interest in getting the best deal for their profession) at the expense of the general population and a more affordable equitable and even better system.
One of the most surprising insights from reading the book is that for the first 25 years of independence there was no real reforms to abolish the Poor Law system of healthcare and social supports carried over from British rule and that true change came only during The Emergency A.K.A to the rest of humanity World War Two, anyway I digress. As I referred to in my previous post regarding Dr. James Deeny serious reform began to occur during this time culminating with the drafting of the 1945 Public Health Bill. This Bill which was chopped, changed and bulked up but in essence it was the core of all attempts at reform into the 1950s and within it was contained the popularly known Church-State controversy; the Mother & Child Scheme, what was but a minor element of massive change – an attempt to provide Ireland with its own National Health Service.
Dr. Barrington presents what I would consider was an early post-revisionist text on the controversies of that period by accessing documents from all the protagonists, Hierarchy, Department and Irish Medical Association, all demonstrating that when it came to the providing for those most in need, the people, their interests were rarely considered, understood or welcome. Instead a paternalistic and detached hierarchy, manipulated by a distrust of the civil service and a blind devotion not just to Christ but the professions, damaged their long-term credibility with the general populace by poorly choosing it’s battle-lines during the entire Mother & Child Scheme controversy.
The hierarchy may have succeeded in delaying change and getting an easy win over a dysfunctional Inter-Party Government and a Minister for Health who appeared not to be in the best of his mental abilities, quickly found themselves suitably challenged by Dr James Ryan and Taoiseach Eamon De Valera in round two less than two years later. Throughout the book positive and effective reforms followed the constant tale of self interested lobbying against politicians attempting to bring worthwhile changes for the benefit of the people.
Every chapter in this book kept highlighting to me, reading in 2012, all the missed opportunities in the last ninety years for the state to provide comprehensive, well organised and common-good orientated health service but that these proposed reforms were stymied by effective lobbying by the medical professionals and politicians lacking bravery and enough faith to trust that the ‘silent majority’ would back them in battles against these interest groups.
This repeating tale is beginning its overly familiar opening paragraphs with the current coalition governments plan to introduce a Free GP service and Universal Health Insurance, hopefully Minister Reilly has read Dr Barringtons book. The challenge is, can a former president of the Irish Medical Organisation achieve a true volte-face for the common good?
Early indications are not positive. Plus ça change!
Image Credit: National Archives of Ireland (NAI, Department of the Taoiseach, S 14997A)