Bishops’ Council for Justice and Peace launches Caring for Health in Ireland
“Health policy needs to be more specific about the improvements in public health it seeks to achieve” – see scripts below
Caring for Health in Ireland was launched today in the Mater Misericordiae University Hospital in Dublin by the Council for Justice and Peace of the Irish Catholic Bishops’ Conference. The document is a response to the health care reform outlined in the current Programme for Government and was inspired by key principles from Catholic social teaching: human dignity, the common good, participation, solidarity and subsidiarity.
Caring for Health in Ireland analyses the current public health consultation, the proposed Universal Health Insurance scheme and related changes to the structure of the hospital system; mental health services; disability; older people; and palliative care.
According to the Bishop Raymond Field, chairman of the Council for Justice and Peace of the Irish Catholic Bishops’ Conference, “The issue of health care and justice has been a long-standing concern of the Council for Justice and Peace. Lead author Professor Tony Fahey has brought valuable insights to this paper and was the driving force behind this response to the proposals for reform outlined in the Programme for Government.
“Caring for Health in Ireland was developed following a consultation with religious congregations involved in health care provision. Today we offer our thanks to the religious congregations involved in health care provision, some of whom are represented here. In producing this document we wanted not only to draw on your experience, but also to honour your selfless contribution to the care of some of the most vulnerable people in our society. That example has created an important legacy which needs to be remembered and valued.”
Bishop Field continued, “A message that we want to convey strongly today is that our understanding of health has to be wider than health care and health services. A multi-dimensional approach is needed: for instance, one of the things we have highlighted in our document is the impact of education on the choices people make in relation to their health.”
Speaking at the launch Professor Tony Fahey said, “We have a massively inequitable and inefficient health services system. The plans for reform contained in the Programme for Government make a welcome attempt to tackle many of the worst features of the system. We support the general thrust of these plans, though their real merit will become evident only as the details of how the plans will be implemented are worked out.”
“However, the Council for Justice and Peace is concerned that the Government’s thinking pays too little attention to the social factors which affect health and focuses instead on a narrow health services view of health policy. Medical services are only one of the factors that will help improve the health of our population in the years ahead. We need a balanced approach that will give due attention to medical services but will also give proper weight to other factors such as educational disadvantage that also influence health. What we need, therefore, is a health policy, not just a health services policy,” Professor Fahey said.
Notes for Editors
• Bishop Raymond Field is an Auxiliary bishop of the Archdiocese of Dublin and chair of the Council for Justice and Peace of the Irish Catholic Bishops’ Conference. The role of the Council is to support and promote the social teaching of the Church and to advise on issues of social concern, both nationally and internationally.
• Professor Tony Fahey is Head of Social Policy in the School of Applied Social Studies in University College Dublin.
• Recent publications of the Council for Justice and Peace include: Palestine/Israel: Principles for a Just Peace, January 2007; Violence in Irish Society: Towards an Ecology of Peace, June 2008; In the Wake of the Celtic Tiger: Poverty in Contemporary Ireland, January 2009; From Crisis to Hope: Working to achieve the Common Good, February 2011; A Call to Action in Times of Crisis, December 2011.
• The Mater Misericordiae University Hospital, Dublin, celebrated 150 years of caring for the nation in 2011. On the 24 September 1861 the then Archbishop of Dublin Paul Cullen opened the Mater Hospital. The Sisters of Mercy, who were founded in Dublin by Venerable Catherine McAuley in 1831 to care for the sick and poor, built the hospital. At the time, Dublin was noted for its level of poverty and city tenement buildings. Most of the poor had no access to hospitals and it was Catherine McAuley’s dream to build a large hospital in Dublin where the only admission criterion was that the person was sick and in need of medical treatment. Unfortunately she did not live long enough to see this dream realised, she died in 1841. However, ‘the seed did not die’. Encouraged by Archbishop Daniel Murray, the Sisters of Mercy set about the task of building the hospital to provide the sick with care and a sense of dignity in 1848. The Mission statement of the Mater Hospital is: “We pledge ourselves to respect the dignity of human life; to care for the sick with compassion and professionalism; to promote excellence and equity, quality and accountability”.
Catholic Communications Office Maynooth: Martin Long 00353 (0) 86 172 7678
Comments by Bishop Ray Field
Good morning everyone. I am delighted to welcome you all to the launch of our position paper Caring for Health in Ireland. All of us here today are involved, in some way, in caring for and promoting health in Ireland, whether at the level of service provision, education, advocacy or the spiritual and pastoral care provided by chaplains. This really is an issue that affects every single member of our society and at this critical time of reform it is vital that we make our voice heard.
I’d like to start by thanking our hosts here in the Mater Hospital and – although I know she’ll be embarrassed – I have to give special mention to Sr Margherita Rock, Director of Mission Effectiveness. Not only has she been very supportive of this project, but her tireless efforts on behalf of those who are suffering as a result of ill-health are an example to us all.
One of the core themes of the paper we are launching today is that our understanding of health should not be focused entirely on health services, but nevertheless there can be no doubt that hospitals are at the centre of our health care system. The Mater Hospital last year marked 150 years of dedicated service to the people of Dublin and further afield. Much has changed in that 150 years, but those of us who have experienced the care provided here will know that the underlying values and ethos have not changed – what is offered is a person-centred approach, rooted in a firm conviction of the equal dignity of all human beings, created in the image and likeness of God. As indicated in the title of our paper, ‘Care’ and ‘Caring’ need to be at the heart of the decisions we make in relation to health.
Particular thanks are also due to the religious congregations involved in health care provision, some of whom are represented here today. In producing this document we wanted not only to draw on your experience, but also to honour your selfless contribution to the care of some of the most vulnerable people in our society. That example has created an important legacy which needs to be remembered and valued.
As we begin our launch, can I invite you all to take a moment to reflect on what it means to care for the sick. The following reflection, from the prayer book for the 20th Year of World Day of the Sick (celebrated last Saturday) from the Archdiocese in Dublin, is significant to all of us, because we are all, in some way, called to be carers:
For each person in my care,
O loving and mysterious God,
Open my heart to their healing need.
Give me wisdom as you guide me
in my care for the sick.
Help me to see the presence of the
suffering and risen Jesus
in each person and to know always
that you look at me, O Lord, through
the eyes of the sick
and that you love each of us as we
give and receive care from each other.
I now invite Professor Tony Fahey to give a presentation of our paper. Tony is Head of Social Policy in the School of Applied Social Sciences in UCD and has been a member of the Council for Justice and Peace since last year. The issue of health care and justice has been a long-standing concern of the Council for Justice and Peace and its predecessor the Irish Commission for Justice and Social Affairs. Tony has brought valuable insights to this work and was the driving force behind this response to the proposals for reform outlined in the Programme for Government, which was developed following a consultation with religious congregations involved in health care provision. (A list of participating congregations is provided in the Appendix to the document.)
As I now formally launch this document I want the key message of this event to be one of hope. It is easy to feel overwhelmed at the challenges that confront us as we attempt to reform our health care system. And the task of health care reform will never be complete, because there will always be new challenges and new developments to respond to.
But if we stay true to our core values – protection of human dignity, solidarity, subsidiarity – we will ensure that our approach to these issues is always person-centred. Economic considerations will always be important – we need to ensure that the financing of our health service is sustainable and promotes quality and efficiency – but we must never allow health care to be reduced to a commodity. We are dealing with people… at their most vulnerable.
Recognition of the right of every member of our society to the means and services necessary for the protection of health is of primary importance, because health has such a significant impact on our ability to avail of other rights and make our contribution to society. That is another message that we want to convey strongly today – that our understanding of health has to be wider than health care and health services. A multi-dimensional approach is needed – for instance, one of the things we have highlighted in our document is the impact of education on the choices people make in relation to their health.
As everyone here knows it is the poorest in our society who are most likely to suffer from ill-health. In a society where we allow wealth to be taken as a measure of a person’s worth, the poor are doubly disadvantaged – often with devastating consequences. Speaking in 1987, Pope John Paul II in his Encyclical Letter Sollicitudo Rei Socialis reminded us of the obligation to show preference for the poor. He stated that to ignore “the immense multitudes of the hungry, the needy, the homeless, those without medical care and, above all, those without hope of a better future” would be to become “like the ‘rich man’ who pretended not to know the beggar Lazarus lying at his gate (cf. Lk 16: 19-31)”.
Many people in our society today are faced with difficult choices when it comes to protecting their health. For those on low incomes but just above the threshold to qualify for a medical card there is very little incentive to seek early intervention for health problems. Many parents feel they cannot justify spending a large portion of their weekly budget on a visit to the GP for themselves and so wait until a problem has become serious or chronic before seeking medical help, by which time the intervention required is more serious – and more costly! Older people are forced to stay longer than they need to in hospital because they don’t have access to the facilities they need in their local community. People with disabilities face huge obstacles in trying to live independent lives because of the difficulty in getting services tailored to their individual needs. All of this is happening in spite of the best efforts of health care professionals.
Government targets for healthcare are frequently expressed in numerical terms: reduction of the number of weeks people spend on the waiting list for operations, reduction of the numbers of people without beds in our hospitals. While this setting of goals, targets and benchmarks is important, we must not forget that behind the figures and statistics lie people who are in pain and suffering and those working to provide them with care. In seeking to reform our health service we must be motivated primarily by solidarity with all these people. This is an important and challenging message because, as Pope John Paul II wrote: “Solidarity is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say, to the good of all and of each individual, because we are all really responsible for all.”
We cannot afford to forget that health is central to the common good. Today’s event may have raised more questions than answers, but what we have set out to do here is make a contribution to dialogue. This is not the last word on health care reform. Far from it. But we hope that it represents an important contribution to this debate from a Christian perspective. We greatly appreciate the contribution of the religious congregations who contributed to this document and wish them every success in their ongoing work. Once again I thank Sr. Margherita and the staff and management of the Mater Hospital for their support for our event today. I would like to thank Prof. Tony Fahey and the members of the Council for Justice and Peace and the Irish Commission for Justice and Social Affairs for their contribution to this research. We are particularly grateful to the Minister for Health, Dr. James Reilly, for taking time out of his busy schedule to contribute to this event.
Finally, on behalf of the Council for Justice and Peace, I would like to thank all of you for being here. We would be very glad to receive your responses to this document as part of our ongoing engagement in this area.
And now, in the interests of promoting good health, we are pleased to be able to offer you some refreshments.
Comments by Professor Tony Fahey at the launch of Caring for health in Ireland
As Bishop Field said, our aim in this document was to comment on the plans for health set out in the Programme for Government (PfG) from the perspective of Catholic social teaching. Catholic social teaching is based on the principles of the dignity of the person, the common good, social solidarity, social participation and subsidiarity. In view of the large role played by Catholic health service providers in the health services and in the mission of the Catholic Church in Ireland, we also sought to take account of their views and integrate them into our commentary. We consulted with ten Catholic congregations in preparing the document, and we thank them for engaging so willingly with us as we did so.
Here I will pick out four main points from the document:
1. The Council welcomes and supports the general thrust of the plans for health service reform set out in the PfG. It particularly welcomes the commitment to introduce a single-tier health service which guarantees access to medical care based on need, not income, and a funding system based on the principle of social solidarity.
2. The Council is concerned that the PfG focuses entirely on health services and does not spell out the public health goals which the health services are intended to serve. At times in the past, Irish health policy has pursued clear health goals such as the reduction of infant mortality and the conquest of tuberculosis. No health goals of that kind are set out in the PfG. Since coming into office, the Minister has set about developing a public health strategy to cover the period 2012-2020 and has conducted a public consultation to inform that strategy. A recent report on that consultation encouraged health policy to focus first on health as an end and then consider the means best suited to achieve that end. It points to the many social and lifestyle factors, ranging from poor education and low incomes to smoking and lack of exercise, that influence health and create inequalities in health. It highlights the social as well as medical interventions needed to promote health. Of these factors, the Council would point in particular to educational disadvantage as a contributor to health inequalities and poor health outcomes. The Council hopes that the new strategy, when it appears, will follow through on this analysis and set out health objectives and a view of what works best to promote those objectives. This would help create an integrated, evidence-informed approach to medical and social interventions in health policy and thus overcome the present excessive focus on medical services and on the inputs side of the health system. It would also provide a rational framework within which difficult decisions about resource allocation in the health field that now face government can be made.
3. The PfG proposes a radical over-haul of funding and governance in the hospital sector in order to overcome the unfairness and inefficiency of the present system. The Council welcomes these proposals in general but recognises that their real merit can be judged only as the technical details of how they will be implemented are developed and debated. The Council does not adopt a position on whether the proposed schemes of universal health insurance and tax-financed universal primary care are the correct ways to achieve the goals of a single-tier, affordable system of access to health services. But it strongly supports those goals and welcomes the general pledge in the PfG that solutions will be founded on the European principle of social solidarity. The Council also welcomes the plans to make the present system more efficient by converting existing public hospitals into not-for-profit trusts and to replace existing block-grant funding by a system of payment for services in which ‘money follows the patient’. It should be noted that Catholic congregations who provide hospital services also welcome these proposals. They have long been unhappy with the present two-tier system and the block-grant method of funding. Among other things, present arrangements force them to rely on private patients as a way of supplementing inadequate public funding, a situation they dislike for both practical and ethical reasons.
4. While welcoming the proposed reforms of the hospital sector, the Council also warns of the risks of new inequities in health services which they entail and which will have to be guarded against. In a system of independent hospitals funded on a payment-by-activity basis, some hospitals could pull ahead of others and become the provider of choice for better-resourced users. This would leave the weaker hospitals as the preserve of the more vulnerable sections of the population. Something like this happens in other single-tier universal services such as primary schooling and has to be combated in various ways (such as funding for disadvantaged schools). There is plenty of international experience on how to counter such tendencies and this experience as it applies to the health sector has been well reviewed by specialists in this field in Ireland. The Council urges the government to pay close attention to this issue as it designs the details of a new hospital funding scheme.
Catholic Communications Office Maynooth: Martin Long 00353 (0) 86 172 7678