AT A RECENT event on The Human Right to Health, President Higgins supported a commitment to developing the use of human rights law within the field of healthcare in Ireland. This meeting of medical and legal minds, under the President’s Ethics Initiative in Galway on 6 February, aimed to discuss the benefits of using a human rights framework to ensure everyone has the right to the highest attainable standard of health.
The much-discussed government plan to introduce free GP care to all children under six was briefly debated also, in the context of who exactly is the ‘deserving’ and ‘undeserving’ in our current healthcare system.
Going on who is actually getting adequate healthcare, we would have to conclude that in our system, ‘undeserving’ means less well-off people - children and adults alike – who have no choice but to rely on an overburdened public health service. Lengthy waiting lists, chaos in Emergency Departments and the hotly-disputed reform of medical card allocation make it clear that Ireland’s two-tier healthcare system is unequal. Indeed, the medical card debacle – based around a government decision to review card-holders’ eligibility – has left some of the most medically needy in our society deprived of treatment.
Is this ‘adequate, affordable, quality healthcare for all’?
In the face of this situation, you might imagine that any new government proposals would be wholly focused on mitigating the worst effects and bringing order and balance to the system. Will giving free GP-care to all children under six – while wholly commendable as an idea – fix or even start to address existing inequalities of access to adequate, affordable, quality healthcare for all? The answer is not so clear and you can probably bet that the government isn’t sure either.
For example, there has been considerable criticism from General Practitioners of this proposed scheme. These doctors interact with patients on the ground on a daily basis and understand the health outcomes of patients based on all their life factors. So why are they – who will have to implement the scheme – so opposed to its introduction? A closer look at how the scheme was conceived and introduced will show how a different approach – one based on human rights standards – might help.
GPs were not part of the consultation process
Firstly, there were no consultations with GPs while this scheme was being conceptualised. Consultation with all affected groups is a pillar of the human rights approach to ensuring economic, social and cultural rights. Despite their prime position to highlight the potential weaknesses and challenges of this scheme for the wider operation of healthcare system – and that they will be at the frontline of its implementation – GPs do not seem to have been sounded out on it.
Secondly, the government has not carried out any obvious analysis of what impact re-routing €37 million from the general health budget to this specific scheme might have on other services – and more importantly, for the people who rely on them. We have to ask, where is the evidence that the best interest of all patients has been factored into Government decision-making here?
Lastly, the concept of a ‘minimum core’: under international law, the state must ensure that all segments of society are provided with a “baseline” level of healthcare regardless of age, socio-economic background, ethnicity, gender, or other variable. If all children under six are given universal health-care, how will this further the guarantee of the highest attainable standard of health for everyone in our society? That nobody will fall below an agreed minimum standard of healthcare?
Logical steps to better healthcare
The government needs to be shaping policies and schemes within a clear framework to safeguard equal access to quality, affordable healthcare. The human rights approach as outlined above at least ensures that all stakeholders have a chance to input into the policies that affect them and that will yield more realistic, workable results.
We are about to introduce a policy that will redirect considerable resources within an overstretched health system and while we are still living under the constraints of austerity. Surely we must be fully confident we have taken logical, informed steps to reach that vital decision – and that it is the best and fairest option available?
The framework is there – let’s use it.
Yvonne O’Sullivan is FLAC Advocacy and Policy Officer. Learn more about the civil society campaign to hold Government to account on Ireland’s economic, social and cultural rights obligations at www.ourvoiceourrights.ie
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