What more can one ignorant retired journalist add to the trillions of words written about the Corona virus? Not much, except perhaps two points that readers will have seen before from me ad nauseam on a range of topics: 1) the importance of North-South cooperation in Ireland (in this case for disease prevention); and 2) the necessity for a strong social democratic state to play a central role in any civilised modern society.
It is often said that the Chinese word for ‘crisis’ is made up of two characters signifying ‘danger’ and ‘opportunity’, which is taken to mean that every crisis is also an opportunity. In Ireland today, I believe the Covid-19 crisis is a great opportunity for people on this island to come together to combat a common external danger. I don’t have any illusions that the toxic two century old sectarian divisions will disappear in a few months because of the need to fight a disease. But history does tell us that when divided peoples have to combine to fight a common external enemy (military or medical), ancient divisions start to appear less important. To take just one example: the way the people of the Netherlands, historically divided between Protestants and Catholics, united against the Nazi occupiers in the Second World War, led to a much more harmonious postwar society there.
More practically, I believe a systematic overhaul of our inadequate health services, North and South, to make them more integrated and eventually islandwide, would make sense in terms of improving those services to patients everywhere. This would particularly benefit people in the Republic, who have long suffered from the inequity and inefficiency of a two-tier system: a superior insurance-based tier for the minority who can pay, an inferior public tier for those who can’t. Now that the Irish government has moved to bring the 19 private hospitals under public control for the duration of the present crisis, we effectively have two public systems on the island for the first time. This, rather than the proposed Sláintecare scheme (to which all the South’s parties play lip service, but is so far stillborn), should be the first step in setting up a National Health Service, first for the Republic and then – let’s be really daring – for the whole island.
Because frankly, Northern Ireland’s NHS-based public system – however reduced by Tory cuts in recent years – is still far better than the Republic’s odd conflation. Firstly the North, in common with the rest of the UK, has free universal access to health care. It has a common waiting list for treatment in public hospitals. Nine years ago I wrote an article comparing the 82% of Northern patients either treated, discharged, or admitted to a ward within four hours of their arrival in Accident and Emergency, with the large numbers of patients in the Republic (up to 45% in Cork) who had to wait 12-24 hours for admittance through A&E.¹ I wonder if that has changed significantly in the interim – I doubt it.
Secondly, primary care is better organised and funded in the North, with the provision of teams of GPs and allied health professionals (nurses, physiotherapists, chiropodists etc.) who offer free and lifelong care to people in local areas. In the South the nearly 70% of people who don’t have medical cards have to pay €50-75 before they even darken their local GP’s door.
Similarly, public health is a much higher priority in the North. The all-island Institute of Public Health used to consistently show in its reports that there was a greater understanding of the relationship between social inequality and health in the Northern system. This was particularly so under former Ulster Unionist health minister Michael McGimpsey, who made overcoming health inequalities a top priority.
I know much of this goes against the received wisdom in the Republic, which likes to think everything is done better here, a belief that has only been reinforced by an incoherent British government’s stop-go response to the looming Covid-19 catastrophe. Wise and careful crisis leadership in Dublin has seen everybody from Taoiseach Leo Varadkar through health minister Simon Harris to the Chief Medical Officer, Dr Tony Holohan, singing off the same World Health Organisation hymn sheet of handwashing, social isolation and physical distancing. We have one of the highest testing and tracing rates in Europe. Schools, non-essential shops and other public facilities were closed down quickly and comprehensively. But these crisis steps (we always seem to perform well in crises) are tending to paper over the deep faults that continue to exist in the system. An early danger sign is this week’s report from the European Centre for Disease Control that Ireland has the lowest level of intensive care facilities in the EU, and thus our hospitals could be the quickest to be overwhelmed if there is a major surge in the virus.
The long-term political point here is that a successful joint tackling of Covid-19 could start to convince Northerners – and Unionists in particular – that the two jurisdictions growing closer together through sharing essential services such as health is not some Trojan horse leading inevitably to political unity, but a sensible way of greatly improving people’s lives on this small island.
The cross-border health network, Cooperation and Working Together (CAWT), now nearly 30 years old, has shown what can be achieved by health professionals coming together in the border region: better joint services and reduced waiting times in cardiology, radiotherapy and ear, nose and throat (ENT). But the lessons of CAWT have not been learned elsewhere. A senior Northern civil servant told me in 2015: “Neither health system is in good shape but some rationalisation could have been done together. The cross-border justification could have been used: ‘this has to happen on a cross-border basis – otherwise it won’t happen’. 60 per cent of people on the island live in the Dublin-Belfast corridor, yet there is no sense of coordinated services or activities.” A few years earlier a study for the two Departments of Health had concluded: “Through working together to address major health issues, significant additional benefits to the population of each jurisdiction can be achieved, which could not be achieved by each system working in isolation.”
It is good to see Arlene Foster and Michelle O’Neill at last working closely together to combat this crisis. According to Newton Emerson, the former “appears truly changed and chastened by the events of the past three years”, while the latter “has shown herself to be non-confrontational in her dealings with the DUP and to have a genuine,likeable personal style.” I don’t so far see any equivalent major coming together of the two governments on the island, although we are told the two Chief Medical Officers are in touch on a daily basis. Let us hope that cooperation deepens over the coming weeks. It makes enormous sense to work as one island to keep the effects of this death-dealing plague to an absolute minimum.
My second point is a more general and international one about the post-Corona virus realisation that a powerful social democratic state, despite its many right-wing detractors in Europe and the Americas, is as vital an underpinning to a civilised society as it ever was. Can anyone imagine what chaos would ensue if dealing with a mega-crisis like this was left to the tender capitalist mercies and ‘bottom line’ priorities of the private sector?
Calls to galvanise nations as if to fight a war are heard from right and left these days. From the sensible right, Financial Times columnist Robert Shrimsley says: “Wartime mobilisation and central planning smoothed the path to nationalisation and the Welfare State, a fact not lost on some on today’s left who see the scope to recharge some of their policy positions. Narratives will be built around this crisis and few will be about over-funded services or an overactive state.”
He goes on: “What will not be easily shifted will be the sense of the state as a force for good. Free market liberals seeking to cut government and bureaucracy will face a fight to hold onto the gains of recent decades…The crisis strengthens those who want policy to think of the less fortunate.”²
Or as the editor of the French left-wing newspaper Liberation, Laurent Joffrin, puts it: “This will perhaps be the great lesson of this unforeseen crisis, comparable to the shock of the last war, when European societies mobilised by conflict experienced the importance of solidarity and collective strength, and decided, once peace was won, to create the Welfare State, democratically charged with the protection of ordinary people against the hazards of solitary lives of intolerable harshness. On the rise will be the values of sharing, good citizenship, cooperation and collective action. On the decline will be the ‘everyone for himself’ philosophy of materialist societies.”³
Let me leave the last word to the much-maligned Jeremy Corbyn, in his last speech to the House of Commons as leader of the Labour Party: “We’ll only come through this as a society through a huge collective effort. At a time of crisis, no one is an island, no one is self-made. The well-being of the wealthiest corporate chief executive officer depends on the outsourced worker cleaning their office. At times like this, we have to recognise the value of each other and the strength of a society that cares for each other and cares for all.”
PS: I loved the tweet from BBC Northern Ireland journalist Mark Simpson after Leo Varadkar’s powerful St Patrick’s Day message to the Irish people: “Bumped into a Unionist today. Not a fan of the Irish government. Never has been. But said, through gritted teeth: “I watched the Taoiseach speak last night. Afterwards, I must admit…I felt like he was my Taoiseach.”
² ‘Boris Johnston’s agenda is over – a new politics will emerge’, 23 March
³ ‘L’enfer, c’est les autres?’ 17 March