Sinn Féin With Portfolio

I still remember the first time I visited a GP in the UK. He was a cheerful doctor, an Asian Arsenal fan, who spoke in glowing terms of David O’Leary as a defender, glad to big up an Irish player to an Irishman. After the consultation, I had to get some medicine and found myself bemused. No one had asked me to pay for the visit to the GP. Despite having grown up next door to the UK, when confronted with the reality of a health service, free at the point of use, my brain couldn’t quite process it. I mean, you have to pay the doctor, right?

Most people outwith Ireland now know the genuinely seismic results of last weekend’s votes are the result of long-standing concerns over health and housing. But the reality of those concerns are probably quite alien to non-Irish readers. As my own experience should make clear, Ireland’s healthcare service is a very different experience to the UK. Ireland is the only country in Europe that does not offer universal coverage of primary care, and hospital care is a complex mix of public and private options resulting in a two tier system of access to hospital care. Growing up in the 80s, the term VHI or Voluntary Health Insurance was a common one – if your folks could cover it, they would. In 2015, 46% of the population was purchasing private health insurance (Wren and Connolly, 2017). Ireland’s first attempt at something like the NHS only got cross party agreement when the Committee on the Future of Healthcare’s report on a proposed universal healthcare system, Slaintecare, was approved by the Dáil in 2017.

Our healthcare system is the legacy of a historical alliance between church and the medical profession who first opposed a programme for free healthcare when they worked together against Dr Noël Browne and the Department of Health’s Mother and Child Scheme in 1950. Browne was a socialist minister of health and he has been much on my mind lately, as a member of Ireland’s first coalition government which brought together Fine Gael and the more leftwing Clann na Poblachta. Opposition to Mother and Child scheme, combined with Browne’s legendarily abrasive nature, resulted in the collapse of the government and halted any serious reform of healthcare. It’s a warning from history for Sinn Féin who have taken advantage of the massive desperation and dissatisfaction with health and housing. Successfully turning the electorate’s frustration with Fianna Fáil (FF) and Fine Gael (FG) into 37 of the 160 Dáil seats is one thing – but to fail to achieve change in coalition would be quite another.

In splitting the votes that traditionally went to the big two of FF and FG, Mary Lou MacDonald and her party have won a great victory. The question for many of us is to whether Sinn Féin can hold onto their newly won voters. As one friend of my mothers’ noted, ‘It’s my first time voting for Sinn Féin, but I wasn’t voting for either of the other gobshites. Maybe they’ll do better’. For now, we’ll have to wait and see what comes of coalition talks. There’s 100 days to form a government, but it won’t happen quickly – in 2016, the FG minority administration took 70 days to agree on. As of the time of writing, the current talk is of a FF and FG coalition with the Green party, which would probably spell the death of the Greens and a further sharp fall in the FF vote as their republican anti-FG voters finally jump ship to the old enemy, Sinn Féin.

Whilst we wait, I wanted to highlight some aspects of the election that may not be as familiar to readers outside of Ireland. It’s tempting to read much of significance into the result about Scotland’s own independence conversations, or the UK and Brexit or a renewed growth of a nationalist left. But it’s probably best not to. As with any country, the easy narratives of observers from further afield are significantly less likely to be based on what is actually happening now, and as importantly, what has gone before.

The respected Irish historian Diarmaid Ferriter noted on RTÉ’s radio coverage last weekend that whilst the vote wasn’t expressing a wish for Irish unification, nonetheless many of the voters wouldn’t oppose a border poll. Although it was low down on the list of priorities on the exit poll, more than half those questioned wanted border polls in the north and south within the next five years (1). There has already been an extensive report done by FF Senator Mark Daly on the challenges facing any planning for a border poll (2), which was adopted universally by the all party Oireachtas Joint Committee on the Implementation of the Good Friday Agreement (3). The election result may move things along more quickly, but talk of unification has been in the air for a while now.

Another factor easily overlooked if you’re from outside Ireland is that parties on the broad left as a whole did well. The Greens (a centre left Green Party) jumped up 9 seats, and the Social Democrats (formed by former Labour TD Roisín Shortall and Democratic Left TD Catherine Murphy) tripled their seats to 6. Although Labour and the socialist Solidarity-People Before Profit party both lost one TD, they still hold a combined 11 seats. There were also wins for independent left TDs such as Thomas Pringle and Joan Collins. The phrase ‘vote left, transfer left’ became a social media hashtag in the run up to the election, and counts indicate that Sinn Féin’s votes frequently benefited the broader left. Ireland’s fractured left may seem a weakness, but in truth the smaller parties are happy to work together in technical groups within the Dáil to ensure they can propose debates, ask parliamentary questions and sit on committees. The Committee on the Future of Healthcare was set up by Shortall and Murphy and its work on Slaintecare (albeit flawed – its coverage of maternal health is conspicuously lacking) will have a huge impact on Ireland. With the steady decline in FF and FG vote share over the last three elections, and parties on the left the only ones offering reasonable solutions to health and housing, it doesn’t seem like their influence is waning anytime soon.

We’re big fans of transferring votes in Ireland and are frequently implored to number our voting preferences down to the bottom of the ballot paper. So it’s been gratifying to see Sinn Féin’s voting surpluses being transferred to the benefit of the broad left (4). A new study suggests that although the effect of transfers might not have been as decisive as fans of Single Transferable Vote would like, transfers in this election were more important than normal, with 13% of TDs gaining their seats due to transfers lower down the ballot paper compared to the average rate of 10%5. Again, it will be interesting to see whether this continues at the next election (which could be within the year).

It’s been gratifying to see the elections reflect the frustrations of the Irish voting public. But as noted at the beginning of this article, it presents a huge challenge for whoever forms a government (if we don’t go back to another election). All we can say for sure for now is that Ireland voted for health and homes. And heaven help the government that fails to deliver it. We don’t want to pay for GP visits anymore.

Wren, M and Connolly S (2019) ‘A European late starter: lessons from the history of reform in Irish health care’. Health Economics, Policy and Law 14 355-373



Comments (6)

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  1. Josef O Luain says:

    Bevin (Aneurin Beavan), had a mighty struggle with the predictable, vested interest groups in the UK before he could establish the NHS. There’s little doubt that SF, like Noel Brown et al, will be confronted with similar difficulties by the powerful and deeply entrenched Irish medical establishment.

  2. MBC says:

    You have to pay to visit a GP in Norway too.

    How much do you have to pay in Ireland?

  3. Alasdair Macdonald says:

    Given, the strength of unification and republican parties in the north, the north’s ‘Remain,’ vote and the fact that as things stand, NI will continue to be a member of the single market and customs union with the EU, it seems that many in the north and south would be amenable to a border poll. Whether this translates into an actual majority for reunification remains to be seen. I suspect that for many in the north, even supporters of unification, the benefits of the NHS are something which will give them pause.

    However, given that the electorate in the north will amount to around one-third of the entire Irish electorate, adding a fair chunk of them to the ‘left’ voters in the south, then, a United Ireland could have a pro Irish NHS majority.

    The travails of Aneurin Bevan in setting up the NHS are well known, as are the things which the health ‘professionals’ blackmailed/extorted from the public purse. In the light of scandals like priestly abuse and the Kincora Home in the north, the mistrust of financiers, etc, I think that there would be more public resistance to the bullying blackmail of the medical profession.

  4. florian albert says:

    ‘We don’t want to pay for GP visits any more.’

    I understand this but am doubtful that looking for an NHS style solution is the way forward. In Scotland, getting a GP appointment is difficult, especially if you are
    in work. GPs work, on average, a three and a half day week. Some people subvert the system by going straight to the A @ E, missing out the GP practice.
    At my local Health Centre, you phone and explain your condition to a receptionist. The receptionist arranges for the GP to phone you later. When the GP phones, they can arrange an appointment at the H. C. I do not like this system but, so far, this has worked OK for me. I am retired and can take any appointment on offer.

    Looking at the wider reasons for the success of Sinn Fein, the Republic has enthusiastically embraced global capitalism. This has led to a massive increase in GDP and –
    overall – big increases in living standards.
    Only now is the real downside becoming clear. It is an extremely unequal system and one which relies on low taxation. The ‘winners’ in the system can afford to buy property; not only that, they can afford to buy property to rent to the ‘losers’ in the system.
    The Republic appears to be lacked into this system.
    I am far from convinced that Sinn Fein – even if they get some political power – would be able to do much about this. Their record on health and housing in the Six Counties is very unimpressive.

    1. Jo says:

      Happy to say my experience of accessing medical appointments is not as yours is Florian. I have no trouble getting a same day appointment.

      There’s also NHS 24 but like you, I despair of those who turn up at A&E despite not having suffered an accident or experiencing an emergency. We really need to introduce more rigid processes there.

  5. SleepingDog says:

    In trying to understand the role of the Catholic church in Ireland, I read Dublin priest Joe McDonald’s book Why the Irish Church Deserves to Die (2017). I found it an odd book, not least for the way the author leads big then pulls his punches. Apparently death is not end, and resurrection of the Church is conceivable. Amongst many puzzles, I do not understand how the Church in Ireland affects internationalism. The Irish church may be a lot less of a target for criticism than the centralized power of the Vatican, and it is not clear to me how much international secular influence there is on Irish culture (in the UK, for example, there is enormous USAmerican influence, and an increasing Japanese one). My impression is that the Church is a fairly useless guide to the future, which is often sufficient reason for young people to abandon it. Yet I am not sure what occupies that vacuum in Ireland, if such generalities can be made.

    To illustrate what I mean, there is a melding of USAmerican, British and Japanese science fiction formats which incorporate influences from round the world to give a common vocabulary and set of tropes and lenses through which the future can be discussed by ordinary people in the UK. Someone has suggested that the Marvel heroes act as a kind of semi-secular pantheon for modern USA. What lens or lenses are commonly used in modern Irish culture that ordinary people use to view and discuss their futures?

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