The Waterford TD - a leading candidate to be the next southern health minister - said a public health system free at the point of delivery is possible across 32 counties.
Sinn Féin’s health spokesman made the comments during a visit to Derry as part of a nationwide tour undertaken to ‘deepen his understanding of what is happening in health north and south’.
He acknowledged continued access to free public health services is something that comes up during any discussion of reunification.
Speaking to the ‘Journal’ he said his ambition is to align and integrate health services across the island, increase the sharing of resources and capacity, and to ensure the best of both systems becomes the norm across Ireland.
“My message for people in the north is that if we are in government we will build towards an Irish national health service in the south. My message to people who would have that concern - which is also a concern of ours - is that we will work to take the best of both health care systems and have an Irish national health service that we can all be proud of - whether you are from a unionist background in the north or someone living in Waterford or Kerry, Derry or Belfast.
“The type of health service we will have will be based on equality, on patient need and not on an ability to pay and not on the basis of private medicine.”
He insists this vision is both achievable and affordable and that is something the party is already preparing for.
“What does that mean? It means universal GP access. It means universal primary care access, looking at all of the elements of primary health care that need to be made universally available.
“We started to fund that in our alternative budget this year. We looked at a 10 year plan to transition to complete and full universal GP access and primary care access. The cost of it would be £550m. That seems a lot of money but over a ten year period it isn’t,” he said.
The Waterford T.D. said he wants to move away from the two-tier private health insurance model that has prevailed in the 26 counties until now.
“We want to remove private medicine from public hospitals by having public-only contracts for hospital consultants and then we want to build up the capacity in the system to allow that to happen. We want the type of health service that you have in the north but we want it to be better.”
While an admirer of the NHS model introduced by the British Labour government of Clement Attlee in the 1940s, Deputy Cullinane has learned from conversations with health care workers that the northern system is far from flawless. Staffing remains an issue and he sees the establishment of the Graduate Entry Medical School (GSEM) at Magee as an important step forward in addressing this.
“As ideal as the NHS is it doesn’t mean it is without its pressures in the north. There are people who are waiting too long for GP access. There aren’t enough GPs. “That’s why it is really important what is happening at Magee and that we train more medical professionals. We are looking at that in the south as well. A lot of the problems here in the north are also there in the south. We need to train more staff. We need more graduates coming through. We need to train more doctors, more nurses, more medical professionals. That’s why I think the new medical training advances at Magee are really important. That expansion is going to be massive in terms of recruiting more staff and we have to look at that in the south.”
The Sinn Féin frontbencher said delivering better health services for citizens across the island is not just about the political expediency of removing a potential impediment to a united Ireland.
“For me, it will be an important issue in relation to any border poll, so obviously there is a political imperative to be focused on it but we are focused on it anyway because we want to make sure that health care works.”
Reunification and the establishment of a 32 county Irish national health service may now be appearing over the horizon but it could yet be some time before it is actually delivered.
In the interim Deputy Cullinane believes practical steps can be taken to better integrate our health care services on a cross-border basis.
“Over the next five to ten years we want to see much more of a transition to align our health services to make sure we are creating efficiencies by sharing resources, sharing information, sharing data but also sharing services, aligning our health care services as best we can across the border and across the island.
“Looking at innovation in health care is an important part of that. If you look at new medicines, new drugs and new therapies coming through it makes sense if we are looking at all of that through an all-Ireland lens.”
He said the provision of radiotherapy services and primary percutaneous coronary intervention (PCI) [balloon and stent treatment) to patients from Donegal at Altnagelvin in Derry is an example of the kind of cross-border cooperation he wants to see accelerated in other areas of health care.
“We can see that with Altnagelvin where we have joined up services across the north west - cancer services for example. We need to see it in more areas.
“What I’m trying to do as someone who wants to be a future health minister in the south is to establish how can we create those synergies north and south. How can we make the health service north and south work better for everybody? Where are the areas that we can share capacity, share resources and how can we transition to what we want to see long term which is an Irish national health service? Using the long term lens we are looking at five or ten years down the road to having a national health service that is aligned obviously in a united ireland.”
Deputy Cullinane was in Derry and Letterkenny to garner an understanding of what’s happening within our frontline health care systems at this highly pressurised moment in time.
He said the same issues come up on both sides of the border as the COVID-19 pandemic continues to heap strain on our frontline systems.
“There are huge pressures on our emergency departments. We are seeing rising COVID presentations. We are also seeing a lot of unscheduled care. In the south because of the different waves of COVID we had the cancellation of elective surgeries. That has created huge pressures on GP services, on primary care and community care. Essentially a lot of people were not getting treated and were not getting hospital appointments because of cancellations and pressures on the hospitals through COVID. That is all beginning to catch up now so we are seeing unprecedented presentations to emergency departments. We are seeing the trolly count increase. We are seeing the numbers of people with COVID increase in the south with acute and ICU beds filling up so we have all of those challenges.”
The Executive, of course, have finally decided to proceed with vaccination certification for hospitality venues. Deputy Cullinane said it is a sensible move.
“What we have been calling for in the south is exactly what is now being put in place in the north. What we have had in the south is proof of vaccination-only. What we have been saying is a COVID cert is a COVID cert. What we were saying is that antigen testing, PCR testing and proof of recovery should also be part of it and that is what was agreed at the Executive.”
As someone who has been watching the progression of the COVID-19 emergency closely in the south Deputy Cullinane gives short shrift to those who claim vaccination certification has not stemmed the transmission of SARS-CoV-2 in that jurisdiction.
“What we are seeing in the hospital system in the south is a very disproportionate amount of people in ICU who are unvaccinated - 94% of the adult population are vaccinated. Only six per cent are not and yet the unvaccinated make up 50 per cent of patients in ICU. The vaccination programme works. We would obviously encourage people to get vaccinated. Nobody wants these restrictions to be in place.”
Deputy Cullinane is adamant that he wants to be health minister on one of his next visits to Derry and Donegal.
“Stating that we want the health ministry is a clear statement of intent because we want to make it better and we want to start looking at aligning our health care services and taking the best of both. We don’t see it as a poisoned chalice. We see it as something that if we can get it right we can transform people’s lives.”