Belfast Telegraph

Wednesday 24 September 2014

DebateNI home of Northern Ireland politics

Can Northern Ireland learn from Cuba in how to care for the elderly?

If Edwin Poots is content to preside over a Third World healthcare system, can it at least look like Havana's, asks Don Anderson

Health divide: Pensioner Mary Anne Hood (98) in Ulster Hospital
Medical students receive first-class training in a clinic in Havana, Cuba

I read the diary of Rosemary Craig, daughter of 98-year-old Mary Anne Hood, with something close to despair. It outlined what she said happened to her mother and what she experienced over days in the Ulster Hospital, Dundonald.

It was frightening. How on earth has our society reached the position where bits of our health service are being compared unfavourably with that of some very poor countries?

The signs of crisis are now too loud and too persistent to ignore.

What should be ignored are the public assertions from health managers that all is well and that the wretched treatment meted out to an old lady in one of our top hospitals was an aberration.

It should be recognised that these managers – many of whom may be privately despondent – must make reassuring public statements; it's part of their job.

The party line is that all will be well in our healthcare, if not tomorrow, then some time soon. It just needs the Transforming Your Care (TYC) proposals enacted – which requires money.

I tend to trust the Royal College of Nursing when it says that at the root of the problem is a lack of staff, insufficient priority given to patient care and underfunding, which is probably the basic debilitating malaise.

But it is also structures.

One of the key recommendations in Transforming Your Care was the introduction of Integrated Care Partnerships (ICPs). To quote Health Minister Edwin Poots: "ICPs will enable local health and social care professionals and the voluntary and community sector organisations to work more closely together on a collaborative basis to improve efficient and effective service delivery.

"These multi-sector collaborative networks will include statutory, independent and voluntary and community practitioners and organisations in their membership ..."

I'm beginning to shudder on reading jargon containing words such as "partnership", or "collaborative", or "multi-sector" in policy documents, because of the assumption that this is the best, or only, way to do things.

One of the most obvious disadvantages of partnership and collaboration is the danger of disagreements between partners. People are likely to have different ideas about who should be doing what, when and how.

A partnership makes it necessary for all the partners to agree and this can take time and it can fail. When it fails, every partner can point accusingly at another.

For political strategists, partnership can never fail, because, when it fails, it can be explained as a lack of partnership. And, in the meantime, something like what happened to Mary Anne Hood goes on and on. But partnership and collaboration are fashionable buzzwords and few dare say that it can hide bureaucratic hernia.

Don't get me wrong. Many of our greatest achievements involved partnership and collaboration to some degree, but often real achievement has been due more to a unified structure driven by a supremo.

Take Eddie Haughey, who tragically died in a helicopter crash last week. He was the founder of the low-profile, but extremely rich, Norbrook Laboratories, now one of the major world pharmaceutical companies.

A self-made man, he achieved success by single-mindedly going for his target. The late Steve Jobs did much the same at high-profile Apple, inventing a string of devices which made a huge impact and a bigger fortune.

The triumph by those two men is, in the main, not down to partnership. They dictated what was to happen and forged ahead with few consultations, partnerships, or multi-sector obfuscation. So did Napoleon and Caesar.

I would like our health service to mirror that of one Third World dictatorship: Cuba. According to a United Nations human development report, Cuba has the same life expectancy as the United States and a lower maternal mortality rate.

A paper published in the International Journal of Epidemiology found Cuba has eliminated several common diseases, including diphtheria, measles, rubella and mumps. Unquestionably, Cuba has created a healthcare miracle relative to the small resources available.

The New England Journal of Medicine praised the Cuban health system: "Everything is free, totally free ... It is tightly organised and the first priority is prevention. Although Cuba has limited economic resources, its healthcare system has solved some problems that ours has not yet managed to address. Family physicians, along with their nurses and other health workers, are responsible for delivering primary care and preventive services to their panel of patients – about 1,000 patients per physician in urban areas.

"All care delivery is organised at the local level and the patients and their care-givers generally live in the same community. The medical records in cardboard folders are simple and handwritten, not unlike those we used in the United States 50 years ago. But the system is surprisingly information-rich and focused on population health."

Not everything in the Cuban health garden is rosy, or translatable to here – their doctors scarcely earn a living wage and modern equipment is scarce, but they have got more right than wrong.

Cuba now exports expertise in medical care. Please talk to them, Mr Poots, because we need help.

Do remember one-third of our population is aged over 50, a group who disproportionately attend polling stations.

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