Citizen power, now being manifested by the Home Sweet Home activists, is urgently required to drive change in a healthcare system which recently left a 103-year-old woman on a hospital trolley for 15 hours before getting a bed.
Since the founding of the State the Irish Healthcare System has evolved in a piecemeal way. It has largely been shaped by politicians, health professional and religious organisations.
Historically Irish citizens have had minimal opportunities for direct engagement with the organisation, construction and delivery of health and care services.
Each of the HSE’s four administrative areas has a regional health forum, which includes representatives from the city and county councils within that area.
The forums make representations to the HSE on the range and operation of health and personal social services in their area, and the HSE in turn provides administrative services to the forums.
However, the HSE is not accountable to the regional health forums and the public representatives sitting on them are appointed by their respective local authorities.
Not a viable mechanism
The Health Act 2004 empowers the minister to appoint a national consultative forum to advise him or her. The minister has total discretion in deciding whether to appoint a forum, its membership and how it should operate. It is, therefore, not a viable mechanism for holding the healthcare system to account.
Essentially the Irish Health System is informed by a top down decision making model of organisation – a centralised command and control structure.
Civic engagement by the key stakeholder in the system – the public – is not facilitated by these arrangements.
The ongoing crisis in our formal health system is well documented. Hospital waiting lists are at record levels. Emergency departments continue to be unable to meet the needs of those attending within a reasonable timeframe. Wards are overcrowded.
On any given day clear evidence that the health system is dysfunctional is readily available from the Irish Nurses and Midwives Organisation website’s trolley watch.
November’s figures for admitted patients on trolleys – a staggering 9,306 – was the worst on record since counting began. We are barely into the new year and already 612 patients are stacked up on trolleys.
The limits of the State’s “treat and cure” model of health care are highly visible to citizens who are kept at arms length and left on the sidelines, while politicians, managers, medics and the religious exercise control and influence over the major institution of the State. A health social movement is the only answer.
It does not have to be like this.
Fundamental change
A bottom up approach is urgently needed to create pressure for fundamental change and transformation of the health and care system. Social movements in one form or another have been in existence from about the middle of the 18th century.
Their key characteristics are that they represent a politics of conflict and contest which strives for fundamental change, are rooted in strong informal networks and have a long-term strategy. They are different from short-term protest movements. There is no one template for a social movement given that they are open to all comers, flexibly structured and dynamic.
Old-style social movements focused on class and materialist struggles whereas new social movements have pursued welfare and wellbeing agendas through community organising strategies.
Community organising has been successfully mobilised by Citizens UK to campaign for a living wage and positive social integration in the UK. Community Organising is based on the principle that when people work together they have the power to change their neighbourhoods, cities, and ultimately the country for the better.
It starts with a mobilising ideal communicated across key civil society groups - schools, trade unions, religious, community and voluntary groups – and is promoted by leadership capable of forging cohesive relationships which are the building blocks of collaborative action.
A health social movement would provide a platform for purposeful citizens to stand up and speak out for the issues that matter to them and their loved ones. It would also be disruptive as it would encourage a shift in thinking about health and bring about change in the experience and delivery of health care.
It would ask serious questions about the socio-economic and political determinants of health and the cultural and societal norms which privilege the health of some citizens above the health of their fellow citizens. Above all it would be a catalyst for new health innovation and policy processes.
Most importantly it would provide an opportunity for ordinary citizens to achieve positive change. It is time for trade unions, religious organisations, schools and civil society community and voluntary groups to get together and create a people powered health movement.
Colm O’Doherty is a lecturer in social studies at IT Tralee