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John McManus: Is this the best little country in the world for lockdowns?

Ireland lacks institutional wherewithal to do anything but lie low til Covid passes

As every day goes by, it becomes clearer and clearer the Government has opted for a second lockdown because we can’t do anything else. Photograph: Paul Faith
As every day goes by, it becomes clearer and clearer the Government has opted for a second lockdown because we can’t do anything else. Photograph: Paul Faith
John McManus's picture
John McManus
Mon Oct 26 2020 - 01:39

Playing to your strengths is always a good idea. Ours seems to be the ability to endure suffering. I am not talking about the 700 years of oppression, although it was without doubt a useful formative experience for what was to come.

I was thinking more of the 2007 financial crisis and the economic catastrophe that followed. Ireland emerged from that bleak episode as the poster child for austerity; we demonstrated an enthusiasm for cutbacks that bordered on the masochistic.

We did it because we did not have a choice. It was that or national bankruptcy. But at least we made a virtue of it. It earned us the somewhat ironic sorbriquet of Best Small Country in the World for Austerity; a play on the then taoiseach Enda Kenny’s avowed goal of making Ireland the best small country in the world in which to do business.

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And here we are again. As every day goes by, it becomes clearer and clearer that the Government has opted for a second lockdown because we can’t do anything else. It’s obvious now that we simply did not have the institutional wherewithal to establish a tracking and tracing system that could cope with the inevitable second wave. There are also ominous signs that we also lacked the capacity to put some sort of system in place to protect and support nursing homes once infection numbers started to rise again, as we knew they would. Likewise it seems to have been beyond us to increase the number ICU beds to a level that they would not be a critical factor in determining the fate of the nation.

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We had six months to do it and we didn't. Democratic states are pretty bad at this sort of thing

We had six months to do it and we didn’t. It’s not that we are bad, incompetent or lazy. It’s just that democratic states are pretty bad at this sort of thing and our particular system – which has many strengths – seems to be particularly ill-suited.

Crisis vs catastrophe

It is a bandwidth thing. The system can only manage a limited number of problems at anyone time. Today’s crisis takes precedence over tomorrow’s looming catastrophe.

It’s an error to focus blame on the Health Service Executive for the failure to prepare for the second wave. If ever there was an organisation set up to fail it was the HSE. It’s never been much more than a scaffold built around a profoundly dysfunctional health system which is forever hamstrung by the incestuous links between public and private medicine.

We all know this. And just in case we didn’t, we have the Sláintecare report. Why on earth would anyone who has even a passing knowledge of the report’s contents expect the HSE to be able to step up to meet all the multiple challenges it faces as a result of a once-in-a-century pandemic? Its initial response drew deserved praise but the limitations of the system have come back to bite it now. It’s equally daft to think that much will change over the next six weeks.

Money, long considered the solution to all of the health system’s ills, is not the problem. It is the ability of the health service to rapidly adapt that has brought us to this juncture. The reasons are myriad. Some are common to any large bureaucracy. Others are unique to the way medicine is structured in this country and how power is wielded by vested interests in the public and private sphere.

Lives vs economics

Much has been written – a lot of it unfair – about the National Public Health Emergency Team (Nphet) running the country. It is just the latest quango to which the Government has farmed out its key job of making policy. The simple fact is that if you put 40 health professionals in a room and ask them how to minimise the number of people that will die in a pandemic they are not going to come up with a modern-day equivalent of TK Whitaker’s First Programme for Economic Expansion.

Nphet is not in the big-economic-picture business. They are in the saving-lives business

They are not in the big economic picture business. They are in the saving lives business. And they know better than pretty much anyone else in the country what the health service can and can’t achieve in the short term. Twelve of its members work in the Department of Health, another 10 work in the HSE and most of the rest work in related bodies such as the Health Information and Quality Authority.

You would have to imagine they are pretty clear-eyed about the prospects of an effective tracking and tracing system being put in place, or the likelihood that ICU capacity can be significantly increased in the short term. They know how difficult it is to keep care homes free of infection. They know the chances of quickly implementing any of the “silver bullets” being promoted by various academics and medics as the key to keeping the economy open.

Perhaps it is time to accept our fate. Time to knuckle down and be the best little country in the world for lockdowns until the vaccine arrives.