If the scenario painted by Dr Muiris Houston in his Irish Times article on Monday comes to pass in hospitals this winter, it will bring the Government to the brink of collapse and probably cause a general election next spring.
Dr Houston warned of the impending arrival of a new strain of the influenza virus from Australia which is resistant to the current flu vaccine. This has resulted in twice as many people catching the virus, which most seriously affects the very young and the over 65s. If the virus strikes here with the same intensity, many of the people in these age cohorts who catch the flu will require hospitalisation.
“A significant percentage of these will require ventilation in intensive care units, as their hearts and lungs fail – some for a prolonged period,” he wrote. “Which is where our struggling health service will finally run out of rope.”
As the virus hits – and this is not a disaster movie, it’s just a worse-than-usual flu season – the emergency units will fill up. Those with respiratory and cardiac failure will have to move to intensive care – these units will quickly reach capacity – so patients will have to be ventilated elsewhere. This will lead to the cancellation of most elective procedures, even urgent ones.
This will all be translated into front page headlines describing “Chaos in our hospitals”, and RTÉ news bulletins outside hospitals, and so on.
If all this happens – and Dr Houston certainly presents a compelling case – then the Government would not survive.
Chaos in the hospitals would generate the sort of political forces that would probably pull the Government apart. The pressure would be internal, from the Independents, and external from Fianna Fáil. When pressure is applied, it finds cracks. And there are more than enough cracks in the internal Government relationships, and more in its alliance of convenience with Fianna Fáil.
Now it should be said that Dr Houston’s scenario is not inevitable. The Department of Health reckons that the strain in Australia at present is the same one that was prevalent in Ireland last year and so the Irish vaccine should be a good match, though even if so, it will only be effective in 50-60 per cent of cases.
Even without a bad flu season there will be an A&E crisis in the New Year. 'Half the consultants are off skiing. Nothing moves for a few weeks,' says one senior health figure
The HSE has been putting in place detailed preparations for a bad flu outbreak, with a national steering group in charge of the response.
Hospital groups and health organisations have prepared “flu plans”, junior minister Damien English told the Dáil on Thursday night. Nursing homes have been told how to prepare for, and deal with, an outbreak, and plans were reviewed at a national meeting earlier this week.
Senior figures in the Department of Health are concerned, but not unduly worried. But this is as much about politics as it is about the flu.
And even without a bad flu season, there will be an A&E crisis in January. “Everyone turns up at the hospitals in the first week of January. Half the consultants are off skiing. Nothing moves for a few weeks. But then we get on top of it,” says one senior health figure.
If the flu makes that situation even a little bit worse, the politics could escalate pretty quickly.
There is a sense around Leinster House that the relatively stately passage of the budget means that the Government is safe for at least another year. The Government’s new leader continues to settle comfortably into his new role; the Independents, who once treated power and responsibility as a scratchy blanket, now treat these twin aspects of office as a warm duvet in which to wrap themselves. Nobody, inside or outside Government took seriously their stentorian statements about the banks (“Send in the gardaí!”) during the week; they didn’t seem to mind in the slightest.
The expectation that the Government will proceed in a gentlemanly fashion to the next budget seems rather complacent. It ignores, for one thing, the fact that Fine Gael is making preparations to be ready for an election in the first half of next year if necessary. Two Cabinet Ministers acknowledged in recent days the pressing need for the party to be prepared for the eventuality.
It also ignores the growing election lobby in Fianna Fáil. Even those in that party who are in no hurry for an election now admit privately that it might have been better for Micheál Martin to cut and run over the Maurice McCabe controversy last February. This is now a view that seems to be almost general among the parliamentary party; it was heard everywhere at the ard fheis. Whatever its merits, its ubiquity means that the party is likely to take the next such opportunity. The leadership of Fianna Fáil is not spoiling for an election in the first half of next year; but it is expecting one.
Even if a health crisis does not collapse the Government, it would likely weaken it sufficiently that the next controversy, even a minor one, could topple it. “Could be anything, really,” says one senior Fianna Fáiler. “A breach of the ‘no surprises’ rule – and sure that happens all the time.” A senior official speculates that housing is a more likely cause.
A trigger would be required; but the trigger could be trivial. “If the appointment of Maire Whelan to the Court of Appeal happened now, we would pull out,” says another Fianna Fáiler, with certainty. All agree that a bad flu season creates the circumstances for the Government to fall.