The Doctor Dr William Behan Local GP representative
As a representative of GPs in Drimnagh, dealing with the HSE for the last ten years, Dr Behan is well in tune with the needs of the community. He believes considerable investment – underscored by a complete rethinking of local healthcare provision through GP services – is required.
The budget, however unlikely, should steer a much larger overall proportion of health spending toward general practice. In the US, Dr Behan points out, for every million dollars invested, the overall cost of health spending is reduced by five million.
Following Tuesday’s announcements, he is disappointed the overall investment of 3.5 per cent in general practice is unlikely to change and remains entirely insufficient.
An extension of the free GP service to under 12s, he says, will only worsen the A&E crisis as patients won’t be able to get in to see their own doctors and be referred to hospital or simply attend themselves. The money is going the wrong way.
“For a budgetary measure you should stop funding buildings for administrators of healthcare; you can stop funding the corporatisation of primary care,” he says with a clear distaste for bureaucratic exorbitance.
“That’s not really what primary care is about. Primary care is about improving the quality of the services in a cost effective manner for patients.”
Drimnagh doctors tend to see an older demographic with chronic illnesses.
“For an older population, a more complex population, we do need a bit of time with these older people to greatly enhance the overall experience for them and reduce the unnecessary activity in the secondary services,” he argues.
“More GPs, more access to GPs; you will see a reduced A&E attendances. The evidence is incontrovertible.
“You will reduce unnecessary outpatient attendances, you will reduce unnecessary hospital admissions, and less mistakes being made in healthcare, you will see that. We do know that by providing extra GPs in any community, if you let them work away, we will reduce emergency department and outpatients in hospital activity. It’s well proven.”
This investment would also see Ireland retain many of the GPs who choose to emigrate.
But, he explains: “Healthcare isn’t a panacea for everything. When you step back and see what difference does health care make to people’s health, it only makes 20 per cent difference. Other issues need to be looked at: education, social circumstances, employment, income as well, you have to look at the whole big picture. You do want to raise the whole economy.”
In that regard, he says, increased spending on education and early childcare will help general health.
The Student
Cathy Kinnarney
Studying International Tourism and German at DIT
Every year the cost of third level educations seems to climb higher. Cathy Kinnarney has had enough of mounting expenses and believes budget 2016 needs to claw back some of the punitive measures introduced for accessing college education.
On Erasmus in Munich last year she paid less than €500 in registration fees but that jumped to €3,000 on her return to Ireland.
“To go from that level in Germany back to this was quite a leap,” she says, and the figures speak for themselves.
“Four years ago I think it was €2,250 and in my second year it was [about] €2,500. Every year it just jumps up. So students are hindered because you are forced to get a part-time job and the lecturers are not thinking about that. They think you have all the time to focus on studying.”
There are other reasons part time jobs are now an essential part of student life: rising rents in a property market with shrinking availability.
“We need more student accommodation,” she says, and a means to control rents, something she says the Unions of Students in Ireland (USI) has been very supportive on.
In its pre-budget submission the USI said there is 40 per cent less accommodation available than last year, in tandem with a national rise in rents of 8.2 per cent. Students, it said, are forced to “spend multiple nights sleeping on couches or in hostels”.
The budget could make an impact on the larger issue of accommodation, particularly in Dublin, but for now Cathy’s reality is working two or three days a week in a shop to help meet her costs.
“Some students I know have two jobs and I know they are struggling and it’s hard to see that,” she says.
Despite there being no major announcement on registration fees, Cathy was reasonably happy with the budget. “Overall it was quite positive,” she said. “I guess that was because they want to get people on their side to sweeten them up for the election.”
The Disability Recipient
Rosemary Holton
In receipt of disability benefit since 1994
Rosemary Holton would like to know if Enda Kenny could survive on €191 a week. She doubts it, and is angry about increasing bills and taxes eroding what little many of the country’s vulnerable have to survive on.
“I pay bin charges every week; I pay €25 off the electric and I pay €25 off me gas. Water charges: Jesus I feel like I only paid it when I get another bill,” she says.
“Wait until the budget comes out. We will pay even more. We will be paying €15 for a packet of cigarettes.
“It would be nice to have something aside for a rainy day or an emergency but I can’t do that by the time you pay your bills and have your food.”
Rosemary worked as a carer for 18 years, some of it voluntary, a service she feels is in decline. “I loved looking after old people and I just hope there is someone to look after me.” An operation in 1994 led to her retirement and receipt of disability support, and she had surgery for a brain tumour in 2011.
She is irreverent about her health but there is an anger at cutbacks in Government spending and an increasing cost of living faced by everyone.
“I spend more time in James’s [] than I do at home. I just had a CAT scan and now I have to have an ultra sound. I hate it because every time I go in I come out with something I didn’t go in with.”
She thinks those on disability should see some increase on budget day and the reinstatement of the Christmas bonus in payments.
Of the hike to 75 per cent in the latter, she said: “Fine, but the Government will get you in other ways. I wouldn’t trust them as far as I could throw them. It [the Christmas bonus] is back but they will get you in other ways.”
The Recently Unemployed
Martin Murray
Truck driver made redundant due to ill-health
Martin Murray and his wife both worked until a recent turn in their fortunes. “Now we are both unemployed and struggling,” he says, “I am bad of health and my wife Sheila is bad of health.”
Like many people his anger is focused on the Coalition which he says set about taking money away from people. He wants to see some of it given back next week.
Martin was a truck driver before he was made redundant due to his health. “I few years ago I could go on holiday, I had my money. Now I can’t,” he says, addressing the impact on his lifestyle.
He sees a Government that has stripped people’s benefits and, he says, at the very least it should be hands-off in budget 2016 for unemployment, disability allowance, medical cards and other core measures designed to help the vulnerable.
“I would like them to leave the benefits alone and give back some of the ones that they took away from us.”
He believes other reversals should apply to various work schemes which put limits on the amount of hours people can work, and increase the minimum wage to €10 an hour.
When it was announced that would reach €9.15 only, he said those earning it would probably come out with the same amount of money. “Those kids want to work and they should be given an incentive,” he said.
Martin has had his health issues and the treatment he has received has given him an insight into Irish healthcare and its lack of resources.
“Within three years I got heart trouble, liver trouble and diabetes. Sheila hurt her back in work and had been off for months and months and then the Government brought in this thing where if you are out sick you could be paid off,” he said.
“They they should be looking after the health services and looking after the nurses because at the moment there is talk about the nurses going on strike. We need more nurses to stay in the country.”
Even restoring health spending to the pre-crisis level wasn’t enough, he felt. “There should have been a lot more money put back into the health system. There are thousands of people on waiting lists.”
Martin also believes many of Tuesday’s measures were a pre-election “bribe”.
The Youth Centre Manager Brian Murphy Runs the St John Bosco Youth Centre
Community investment and its effects are often the unseen champion of social progress. Cuts to these kinds of services are often unseen too and those effects are difficult to quantify.
As with other sectors, Brian Murphy was hoping for at least a basic maintenance in the current level of support and this appears to have been the case.
Some sectoral spending increases – like children and education – may help them but it’s a little too early to tell.
“Over the last number of years the indirect impact of the budget on us would be reducing our funding. Earlier this year we had to make four staff redundant which would have been a quarter of our staff,” he says. Over the years funding at the centre has fallen by 30 per cent.
“Since 2008 successive budgets have reduced in general the voluntary and community sector with the youth club would be part of. All clubs have seen the money they received to deliver services reduced and all organisations are still expected to deliver the same services.”
Of Tuesday’s announcements, he says: “Over all it seems to be trying to give something for everybody. It’s definitely an election budget.”
The St John Bosco Youth Centre has been at the heart of Drimnagh for over 60 years. It opens 14 hours a day and offers numerous services like a Montessori, a drama group, sports facilities, martial arts and a youth café. About 150 to 200 people come and go every day.
“If you look at organisations like ourselves, the contributions that we make to our community are often in areas that aren’t measurable. It provides a focus for people. The test would be if you closed this place, and places like it, and see what you have lost,” says Brian.
There has also been an increase in the level of regulation and governance in the sector which, while often well intentioned, can have the unforeseen consequence of sucking up funding. “All of that takes time and time is money.”
They receive funding from myriad sources – typically the Department of Children and Youth Affairs, the HSE and the Local Drugs Task Force.
“In general last year there was no reduction and at the very minimum we would be happy to maintain that.”
Brian also warns about the less obvious “stealth reductions” though – increased spending on administration and other costs can take away from core services while exterior factors, like cuts to community employment schemes, impact on their ability to deliver. How these areas fare on Tuesday will also be keenly observed.
The Pensioner Paddy Wall
“There are people that are really down on their luck at the moment, old people,” says 70-year-old retired butcher Paddy Wall.
"They stopped my property tax out of my pension, €5.67. I wouldn't notice that but the water bills are coming in now." It all adds up, a common complaint in a community where "austerity" is a byword for "pain" and the common view here is that Budget 2016 must provide some anaesthetic.
“They should give pensioners a good deal. They have worked all their lives and they should be looked after in their old age,” he says.
“There should be a raise in the pension. They haven’t had one of those in a long time.”
The Government appeared to heed this concern, raising the pension by €3 a week for the first time since 2009. “I suppose it’s better than nothing,” he says.
Paddy lives in the same house he was born in and has seen the development of a working class part of Dublin over decades. Today, he receives a €230 weekly pension and, until April, a €20 fuel allowance. “It could be a bit more, an extra tenner. That wouldn’t break them would it?”
Water charges are also a thorny subject in the retirement community. "They mightn't be there if Fine Gael are put out of Government. Someone else might get in and do good, do away with water rates. They shouldn't be there in the first place, sure water is free."
Paddy is also exercised about the plight of the homeless and wants to see more done to provide housing.
“There is a big building down on South Circular Road that’s lying there empty and there are lots of buildings that are empty. There is people homeless not through their own fault, it’s because they owed on their mortgages,” he says.
Of the funding increase of €69 million announced to tackle those in need of accommodation, he reflected: “It seems to be better than they did the last time but they are only doing this because they are coming up to an election in the spring and next year they will probably fleece us again.”
It’s not just urban centres that need reprieve. “Everything is gone haywire,” he opines. “They closed down lots of police stations. I would like to see them open some around the country where people are getting mugged every week in their homes.”
