Maman Poulet | Clucking away crookedly through media, politics and life

The health of the 25 % and the nation

July 20th, 2015 · HSE, Irish Politics, Personal, Social Policy

Wrote most of this recently in hospital on my iPhone where I had the time as nothing else to do but observe the health system at work and participate in it!

I am one of the 25% of the population who has neither a medical card nor private health insurance.

I don’t believe in private health care or paying insurance for it. I never have. I have been chronically ill for many years and had a medical card until 9 years ago. I have written before regarding the extra costs of having a disability and health is one of them. I am not interested in having some private company manage my care and tell me what I can and can’t have. I want equal access for all to health, no postcode (ahem Eircode!) lotteries, am in favour of  of centres of excellence and no discrimination against people with disabilities in accessing acute health care. (Not Dead yet!)   I already pay for health care through my taxes and additional charges and and I realise and am grateful to others who pay for my access through their taxes, direct and indirect. I am able to pay the hospital charge for this stay in hospital and know that for others in the 25% it would be a difficult expense to deal with.  The same with my monthly medication expenses which even if I was privately insured would not be covered by a premium but there is a limit through the Drug Payment Scheme on what I pay – unless the medications are not covered by that scheme which I know is becoming an issue for many.

Often the commentariat on this 25% is that we can’t afford insurance rather than we won’t pay for it or that indeed we already pay for the system and expect to receive care.  Consumer and financial journalists (many seen as campaigning advocates) only see us as the ‘uninsured’ which is not accurate at all given everyone is legally entitled to access to the health service (though not primary or community care). Their pieces on health insurance create notions of panic if prices rise or people opt out of the system rather than campaign for a better system for everyone. The belief is also created that those using the system for the uninsured are not receiving or entitled to good care.

My experience of public health care (hospital based) is really positive – once you are in the system that is. In my recent admission I was fortunate to have the support of doctors who made decisions, communicated information clearly and it was clear that anyone no matter their income or social status would have received the same service.

I’ve been treated according to my need and matters are usually expedited should I require it.  Granted I attend one of the major teaching hospitals in the state but despite the crowds and the fact many outside Dublin attend also I’ve had generally a very positive experience with multiple specialities as both an in and out patient.  Unfortunately if it is not an emergency one has to wait – and it might become an emergency in the mean time.  And I have had to chase things up as an outpatient and am lucky that I am able to do so.

I’m prepared to pay more for access for all to an equitable well run health service. I earn a good wage and can afford to do so. However I don’t want to pay for health insurance to a private company who will only want me if I have an added premium either paid by me or the state. And for whom I might quickly become a liability. If I was to join a private health scheme at present I would have to wait five years before I could access treatment due to my pre existing conditions.  We need to talk about universal health care vs universal health insurance and we have to clearly define what that is.  It must include community health and social care and allied care including physiotherapy, dietetics and occupational therapy and mental health supports.

Recently whilst waiting for a public  outpatients appointment I observed a couple arrive. They indicated to the receptionist that the consultant who they had been seeing privately had asked them to attend the clinic at short notice. The receptionist didn’t know who they were and was not expecting them. After obtaining their details she asked them to take a seat. The woman looked at the rest of us (yes it was ‘a look’) and asked if it was there that they should sit and she was told yes. Fifteen minutes later the woman returned to the desk to ask if the receptionist knew they were private patients of Mr X. Again the receptionist retained her composure and said yes and she indicated that this made no difference here and it was a public clinic.  The woman said that she just wanted to check and said that they had found a quieter spot to sit around the corner and hoped they would not be forgotten about. At this stage others around me who had been waiting for their appointments for some time were copping on that she was 1) trying to jump the queue 2) laying it on thick that she and her husband were different to ‘us’.  By the implacable courtesy of the receptionist it was clear that this was not the first time she had dealt with such attitudes.

While I understand going to see a consultant can often be stressful, especially if unplanned surgery is involved, the two tier health system provides attitudes like these where some patients believe that they should have easier access than others because they pay extra for it.

But some say that private healthcare is about choice and also alleviating pressure on ‘the system’.  That’s bullshit really – it’s about an expense many can’t afford for a system we should all be able to access without prejudice and without profit.

We ALL pay for healthcare in one form or another. And We ALL should have the expectation that our health needs should be met in the same way as everyone else’s.

Minister Varadkar’s recent piece on the state of the health service has depressed many and I fear it will extend further the notion  that healthcare in Ireland can never be fixed and that privatisation is the only way to go.

Primary care and community supports in the areas of chronic conditions, disability and mental health should be as good as the hospital based care I and others have received. Sadly I know that not to be the case. Rather than campaigning to keep the ailing local hospital open and providing all services perhaps politicians and other campaigners and indeed the general public should change their focus to a holistic vision of a healthy society and how it can be organised and achieved.

My final point for the moment is in praise of those working in healthcare and the much maligned HSE.  As both an out and inpatient I was frequently moved by the kindness of all involved from physios, nurses, catering staff, doctors and radiographers.  Many think the compassion has gone out of much of Irish life but I constantly experienced caring and reassurance from almost everyone I met in the past months.  I also saw a system where people worked together to improve outcomes, afford choice and maintain dignity for those involved. And I also observed advocacy and kindness from other patients for those in the beds next to them which as someone wisely pointed out  are the forgotten pieces in the care jigsaw.  There is much wrong with the health system in this country but we don’t talk enough about what is right and what should be expected and received.  I can speak up for myself and my recent experiences have made me think about those who cannot speak up for themselves as I detailed here.

I’m off to send to send a thank you card or two to people who cared for me recently and to continue to work on coping with an extended period of leave for recovery and indeed finding my voice and learning to breathe again.  I hope that we do have conversations and questioning of healthcare in Ireland that extends beyond trolley watches and hospital closures and election manifestos – everyone deserves better than that.


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Dear Nervous Nellies

January 21st, 2015 · Homophobia, Irish Politics, Marriage Equality, Queer, Same Sex Partnerships, Uncategorized

Yes you … stop looking over your shoulder… you who watched Claire Byrne Live and began to panic about the Marriage Referendum and started worrying about what was going on, who was doing what and the sky was going to fall in and and and…

1) Chill the feck out.

2) There are 4 months to go to the day of the vote which is yet to be announced.  This is a marathon and not a sprint. There is a piece of legislation to go through the Oireachtas on Children and Families and relationships which will mean that the referendum will be about marriage as it should be.

3) Yes campaigners are not going to win this referendum on their own – there are not enough LGBT’s able to vote. People who believe in equality are, by voting in favour of it, going to win this referendum because you have asked them to do so and because they think it is the right thing to do. These are your grannies, your neighbours, your workmates and generally sound people you don’t know (yet) who believe in fairness and equality.

4) Because this is a marathon and not a sprint there are groups strategising and getting ready for the campaign with different campaign events, plans and posters and the like. Some of them need your money and others want your time. Think about helping them out. They won’t tell you what the plan is 4 months from the vote, but there is a plan. Trust them.

5) This is a democracy. People are going to oppose this referendum. They are in the minority but they have the right to express their opinions and try and get people to vote No or not vote at all. Don’t spend too much time focusing on them, don’t vilify them. Implacable courtesy all the way or ignore them. Mind your mental health, look out for others who might find the negativity and homophobia depressing and difficult to deal with. Mind each other.

6) There are other things you can do to ensure people vote Yes in May.

– Ask people you know to vote and tell them why it’s important to you.
– Make sure you are registered to vote yourself. Check the register – if you are not on the 2015 version you can go on the supplemental register.
– Read information on campaign groups websites (people can leave comments on this post with info on local and regional groups) Join mailing lists – Sign up as a volunteer, go to the training, if you (or you mother, granny or doting great uncle) are prepared to speak to the media tell these groups also.

– There are Facebook groups for constituency campaigns being set up at the moment. Closer to the date find out if there is door to door campaigning in your area from political parties or other campaign groups. Or on street leafleting in the month before the vote etc.
– Bring information into your workplace or college or sports club etc. See if a hustings can be organised where someone might be invited to speak on the issue.
– Call into radio debates and give your opinions (if only to make sure that Brendan Conroy – Breda O’Brien’s husband – is not the only person texting in!) Again be polite and to the point and explain your side of the story.

I write all the above as someone who was involved in the decriminalisation campaign which was not a referendum but was as important and often threatening and could make you ill with the stress and the mudslinging. It was not a sprint but a carefully planned marathon. A marathon where non lgbt people did the running along side lesbians and gay men and helped with the lifting. We have to ask our straight allies to run this marathon with us again.

I also write this as someone who isn’t particularly into marrying (though there are friends and family members looking for their day out) and I don’t see marriage as the most important issue for lgbts and find much of the narrative extremely conservative and restrictive and that’s on the Yes side.

But I will support the choice of people to marry. And I’ll come back to all later for discussions on why it’s ok not to marry, why single lesbian mothers rock and gay men who are serial monogamists or otherwise are to be treasured.  And why we still will need to keep Civil Partnership.

So chill the feck out, put on your safety belts and plan for a bumpy but important ride.


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What do you call a Former Taoiseach?

October 10th, 2014 · Uncategorized

Regarding that matter of His Excellency and how one might refer to a former Taoiseach.

I asked the Government Press Office

Former Taoisigh don’t have titles and are not referred to as “your excellency”.  On printed matter and by way of introduction they are referred to as Former Taoiseach.

Grand so we are now clear on the matter.  Over to you Bertie.  Sorry I mean Former Taoiseach.


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His Excellency on Water and other issues

October 10th, 2014 · Irish Politics

Later this month in Cardiff a group calling itself the Interaction Council will launch a book of papers by former world leaders offering  ‘authoritative insights into topics from the Middle East and denuclearization of Korea to the water crisis and the future of energy.’

The InterAction Council (IAC) is a 30 year old association pooling the expertise of world leaders and speaking out on issues of vital importance to the world community and the community of world leaders alike.

The launch will be moderated by the ‘Rt. Hon. the Baroness Margaret Jay of Paddington, former leader, UK House of Lords and joined by H.E. Mr. Bertie Ahern, former Prime Minister of Ireland.’

Yes H.E.

Wonder what his chapter is about.  Wouldn’t be Water would it?  Probably achieving peace in Northern Ireland though as it’s one of those subjects he used to get up to $40k a time speaking about when he was on that Speakers Bureau before he didn’t speak for them anymore. Otherwise known as before the Mahon report.

If you would like to refresh your memory on Bertie Earners… click away.


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Taking the hit and being clobbered

October 14th, 2013 · Disability, Equality, Social Policy

Claire is a woman I met socially a few months ago.  She has had a significant physical disability since birth and following leaving school undertook a period of study in a further education college.  She lives in local authority housing having moved there some years ago despite the concerns of her family.  She was desperate for her own space and when in college over 10 years ago she thought maybe she could get some part time work in the public sector under the 3% recruitment quota for people with disabilities.  However there is an embargo on public sector recruitment for the past 6 years including the recruitment of people with disabilities.

Claire and I began talking about the impact of austerity and budgets on the lives of people with disabilities and I soon realised she had begun to keep a list in her head of all the ways she had been affected.  I asked her to write a post for the blog or another publication if she wanted but she said she would prefer if I wrote out the list as she talked and added explanations to it.

Claire would not be able to work full time due to her disability and is limited in the tasks she can undertake due to literacy and communication difficulties.  She did try supported employment and job coaching but a job in the private sector could not be found despite many attempts – Claire said she just couldn’t keep up or could not find a job that she was able for and that an employer would be willing to make allowances for her.  Claire did take part in a CE scheme but the costs of getting to and from work which were covered by keeping her Disability Allowance payment would now prevent her doing such work again as that payment has been removed for those on CE schemes.

Claire also mentioned the loss of a medical card if she ever did get a job – it’s a worry as a medical card covers more than medicines for people with disabilities and doctors fees.  Claire needs help from Public Health Nurses for dressings sometimes, she also needs Occupational Therapy services and new aids and appliances including wheelchairs – both of these services are only available to medical card holders.

She has a few Personal Assistance hours each week and some daily home help hours.  However there are days where she does not get a freshly cooked meal because there is not enough time and she might trade the time taken in cooking if instead she needs help getting to a clinic appointment or needs bills paid. So she reheats leftovers or goes out for a meal if she can afford transport.  She says that eating out alone is a change of scenery never mind a break from the same food cooked again and again. She has three showers a week but not if there is a bank holiday in the week.  Most nights she says she goes to bed earlier than she would want to because that is when her assistance is available to her and it is warmer there.

Claire can’t use public transport without assistance.  So if she does not have someone to help her get on and off a bus safely she uses a taxi.  She has a mobility allowance which was removed by the government earlier this year but then reintroduced pending the introduction of a new scheme.  She wonders if she will still qualify for the new scheme.

Claire listed the cuts she has experienced under this government.

  • A 25% cut in home help hours.  Refusal to transfer home help hours into Personal Assistance hours which would have meant the PA’s could have helped her go out into her community. (Home helps can only assist with personal care within the home, sometimes the person who helps Claire cannot cook or does not know how to cook – Claire buys food which is more expensive to cover those times to ensure that she will eat. She also mentioned this being more of an issue when her home help hours were cut and getting up out of bed, washed and laundry done competed with time spent preparing food.) Claire’s home helps are called carers – Claire doesn’t like the word much. She would prefer assistants as she thinks having a carer means she should be grateful for it and just let herself be cared for and have no say in things.
  • A cut to Electricity and Telephone allowances (Claire has to have a landline for her emergency response unit – a pendant operated call system if she needs help – her line rental is no longer free.)  Her electricity Bill is up due to the cuts in allowances and also the big increases levied by the power company in recent years.
  • A cut to the number of fuel allowance payments each year from 32 to 26 weeks.  Claire noted that she feels the cold more due to her health and also the fact that she is at home more that people who are able to work she has additional costs.
  • A €1.50 per month charge for her 5 prescription items received on the medical card.  Cost to Claire – €7.50 per month.
  • The removal of 3 items from the medical card scheme which means she has to pay for them over the counter – cost to Claire €19 per month.
  • Claire’s disability allowance has been cut in 2008/9.  Meanwhile everything has increased including VAT on many items she purchases.  Claire also mentioned the extra costs she faces in laundry, cleaning and other purchases which make life more accessible for her. She also has to provide items to homehelps and PA’s to protect them in their work. These are not covered by their employers (latex gloves/aprons etc.) and the HSE have cut the amount that they provide.  Claire says she can’t stand it when this government says that the primary payments have not been affected – everything else costs so much now.
  • Claire’s rent has increased – waste and property tax charges have been levied on her.  There is no waiver scheme for waste charges.
  • Claire needed adaptations done to her bathroom but the local authority refused to fund them last year despite reports indicating that they needed to be done.  She has been told she might get the work done this year.  Also her front door opener stopped working and a replacement order took months to be approved – this restricted Claire’s freedom of movement and happened at the same time her home help hours were cut.
  • Claire’s wheelchair has broken a number of times in the last 18 months. She has had her chair for nearly 5 years and hopes an application will be made for a new chair.  However there have been huge cuts to the aids and appliances budgets in the HSE.  The manual chair (which Claire got without asking for it – as a health and safety measure) is no use to Claire as she cannot propel herself in it.
  • Claire also mentioned the constant reapplying and reviewing for everything.  Her Disability Allowance reviewed, her medical card, each time something new is needed or needs fixing.  New reports are needed, new letters from her doctor, forms need filling.  Her disability is life long and permanent but the ‘systems’ don’t seem to understand this.
  • Finally Claire and I have had a few conversations about mental health and the effect of all of this and the increasing isolation on her sense of worth and wellbeing.  She notes that family members have pointed to the cuts as an excuse to say she should not be living alone or independently.  When a big bill comes in she does not feel she can ask her siblings for help to pay it or to buy something she really needs now instead of waiting for it.  Also she says she feels when going out and about she is less a part of society, not just that she goes out less often, but when she does that people don’t talk to her or ignore her more than they did before.

So when Minister Noonan, Burton, Howlin et al say yet again that ‘we all have to take the hit’ in the coming days as they explain away the budget , Claire and many other people with disabilities will again be reflected on being clobbered (Claire’s words) again and again and again and how it appears that the government says that the fiscal violence is deserved.

*Claire asked for her name to be changed and picked this name for herself after we had finished making the list.


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