Opinion

Denis Bradley: Health likely to be a key issue in any border poll

Denis Bradley

Denis Bradley

Denis Bradley is a columnist for The Irish News and former vice-chairman of the Northern Ireland Policing Board.

Many unionists are convinced that the health service in the south is inferior and outlandishly expensive. Many nationalists are of a similar mind 
Many unionists are convinced that the health service in the south is inferior and outlandishly expensive. Many nationalists are of a similar mind  Many unionists are convinced that the health service in the south is inferior and outlandishly expensive. Many nationalists are of a similar mind 

Health is your wealth, but it is also the arbiter of political wellbeing. Covid, now, but long before and long after, health is a vital key in unlocking the door into new political possibilities.

Public perception is at its strongest when it comes to health. Most of us want to live as long as our bodies can support our spirit.

The NHS in the north is the one with the powerful reputation for delivering that aspiration – free at the point of delivery, the best care in the world etc., but becoming more and more tarnished with the stories of waiting lists as long as your arm.

The HSE in the south has a reputation of having some fine hospitals that the northern authorities sometimes call upon; but who wants a health service where everyone has to pay a fortune to see their GP and a double fortune for every prescription.

Where the perceptions of everyone, north and south, merge is the belief that treatment will be quicker and better if you have private insurance or the money to pay the private clinic – even though it will be the same doctor who would have treated you in the local hospital.

Reality, of course, is more layered and complex. For ten years or more I have been treated like a king for a kidney condition; better than any millionaire could buy. I have seen my siblings across the border in Donegal receive excellent and free treatment in hospital for very serious medical and prolonged conditions. But there is something distasteful about paying to attend your GP or, for those of us who have become accustomed to free prescriptions, paying across the counter for ointments or tablets.

Many unionists are convinced that the health service in the south is inferior and outlandishly expensive. Many nationalists are of a similar mind. The reality is that a fortune of money is being spent on the health services, both north and south.

Despite the amount being pumped in, both are creaking. The waiting lists in the north have reached crisis stage – a friend of mine is waiting two years for a critical operation and I learned this week of a woman who has had life threatening cancer for eighteen months and has yet to see a consultant.

The south cannot decide between an insurance- based model or a single free at delivery model. It falls between the two stools. If you have money to pay for the highest insurance, you will get the best access to the best hospitals. If you haven’t that type of money, you will be hoping to qualify for a green card which provides free medical care for most but not all services. It is a hotchpotch of models which, admittedly, has benefits for many people but which creates an unfortunate hierarchy within the public and private sectors.

Despite reluctance in the north and apathy in the south, economic reality and a shortness of medical expertise has forced joint ventures between the two services. The Altnagelvin cancer centre and the children’s heart centre in Crumlin, Dublin, have the highest profile. More of that type of pooling will happen but, of itself, will not answer the more fundamental issue.

And so, to politics. Realistically, a border poll will not take place in the next few years. There is too much on people’s minds and too much on the political agenda. Brexit will have to settle and Covid will have to be got under control.

When the border poll becomes real, the item on the agenda that will cause the greatest difficulty for those who are promoting a change to the constitutional position of the north will be the question of health. If, by then, the perception still exists that the northern health service is good and the southern bad, it will be more difficult to convince a majority to vote for change.