Thirty-five years ago, tragedy struck our home in Strabane. In February, my 58-year-old father was diagnosed with terminal lung cancer, just before he retired from Dupont. Then in April, my youngest sister had a serious car accident which put her in a coma for six weeks and set her on a long road to recovery. Both received the exceptional care we expected from the health service, and for that we remain very grateful today. Cancer treatment had not yet reached the City Hospital Cancer Centre; at the time, I believe it was being carried out in Knockbreda. My sister was immediately transferred from Altnagalvin to the Royal Victoria’s intensive care unit due to the severity of her injuries. At the time, another sister and I were living in Belfast with young families so our parents could stay: for my father’s chemotherapy and to visit my sister.

We received excellent support from Dupont, who told us that my father had private health insurance as an employee, which would improve his care. They looked into benefits but found none. He had been a smoker and for other reasons his cancer treatment was not covered. My sister, who was living at home at the time and therefore covered by the health insurance, also had no insurance for a serious car accident.

This left me cynical about health insurance and, as a staunch supporter of the health service and the principles underlying it, I vowed never to take out private health insurance again.

Things have changed since the early 1990s. Even for those of us who provide services full-time, it is difficult enough to understand what has happened since about 2012. Not to mention the public who, as a result, have been slowly but surely deprived of a quality health service to which they have a right.

During the years of Conservative austerity and up until 2015, I had some insight into what was going on but was largely unable to do much. Of course, our local commissioning groups had passionate delegations from all interest groups, each thinking they were somehow special and exceptional. With a 6% annual health budget cut, despite the service needing at least 6% investment to stay up to date, the service was so decimated over a decade and up until the Covid pandemic that waiting lists across the service became, and remain, a major public health threat. There can only be so much salami tactics before the cuts tear the service apart.

The public reacted surprisingly complacently and accepted all this.

The solution offered was transformation; inefficiency, not lack of funding, was the problem, we were told. The Compton report was a first attempt at transformation, but it was largely ignored by our politicians, so we got a political version of transformation from our then Health Minister Michelle O’Neill, which was ignored by all other politicians before we got Bengoa. Transformation could improve efficiency, but lack of investment had ruined the service, and transformation was too slow, making efficiency largely irrelevant.

Our politicians have consistently failed to support transformation, exploiting and amplifying extreme public concerns about the lack of services in remote hospitals. So in all the wrangling, transformation has largely been wasted and we are now faced with a deteriorated service that is sadly no longer fit for purpose. I accept that transformation will still have a role to play, but it cannot now achieve what it could have achieved ten years ago.

The real agenda, the real goal in 2012 was the partial privatization of healthcare and its now almost complete form – a hybrid service. The only solution to not having to wait for a doctor’s appointment or hospital treatment is to look for a private solution. We all do that for the most part, and the private sector is growing exponentially year after year.

Politicians invariably claim to be bastions of the health service. That is what the public expects of them, but they are largely disingenuous in recognising that the public do not care about the health service, they only care about getting the medical care they or their family need in a time of crisis. And if they cannot get it, an appearance on the BBC will probably get it for them. Otherwise the health service will be ignored like water in a well.

I still have no health insurance and have just had hand surgery through the health service. I waited over 5 years and when I finally got a call it was from a private provider who could do the surgery the next day. The waiting list had been extended to get rid of it. The outpatient procedure and aftercare for this largely genetic condition which is certainly not life threatening was excellent. My brother who lives in Co Kildare has the same genetic disorder but as he is younger it is only now becoming a problem for him. He went to his GP, got a referral and had the surgery within 4 weeks. No waiting list. Yes he has health insurance but that is part of the national system which ensures equal coverage for those who cannot afford the health insurance premiums.

Over the last five years, as my right hand became less and less usable, I have been pressured by friends and family to seek private treatment. Go ahead, you can afford it, you miserable fool. It is perfectly understandable that they insist, which confirms to me that the agenda of partially privatizing our health care system – a hybrid system – is here to stay. I am unhappy about it. If we secretly change the principles of our health care system, we will increase health inequality and our health care system will look more and more American. Believe me, that is not a good picture.

My father died in October of the same year, despite great care. He suffered from stage 4 lung cancer and was unable to heal. My sister, who suffered terrible injuries, recovered more or less fully thanks to the skills of surgeons, nurses and physiotherapists, had three wonderful children and will soon celebrate her 30th birthday.^th Wedding anniversary.

I am a pharmacist in Belfast.