The scandal of the day in Ireland is the matter of so-called ‘top-up’ payments to senior executives at the Central Remedial Clinic. The Central Remedial Clinic describes itself as ‘a non-residential national centre for the care, treatment and development of children and adults with physical disabilities.’
If you read the word ‘national’ in that description the way I normally do, you might be inclined to conclude that the Central Remedial Clinic belongs to the nation, that is, it is a public institution, owned by everyone. But it isn’t. In fact, the Central Remedial Clinic is…. well, I’m not that sure what it is. Is it a business? Is it a charity?
According to its website, the Central Remedial Clinic was ‘set up in April 1951 by Lady Valerie Goulding and Kathleen O’Rourke’.
This is a bit strange, because I thought Ireland did away with aristocratic honorifics when it declared itself a republic. Article 40 of the Irish Constitution says that ‘Titles of nobility shall not be conferred by the State.’ You can’t miss it, it’s there a few lines up from the bit where the State ‘acknowledges the right to life of the unborn’.
So you’d think a self-declared national centre would conform to national norms on fundamental rights, by keeping its website free of feudal vestiges. Wouldn’t you? I don’t know, maybe you wouldn’t. Maybe you think there’s nothing wrong with the use of aristocratic titles in public service provision, in the same way as you think there’s nothing wrong with a health service run by a Minister for Health who lives in a stately home.
Anyway. The Central Remedial Clinic is a Section 38 body. This means the Health Services Executive contracts it to provide services that the HSE itself is statutorily bound to provide. So one solid description of the Central Remedial Clinic is… ‘outsourcing firm’.
How does that work, then? People who use the Central Remedial Clinic have a statutory right to the services it provides. But if you go to the Central Remedial Clinic website, there’s nothing about rights, or -given that it calls itself a national centre- citizens. It does say that the Clinic works ‘in a spirit of partnership’ ‘with the people we seek to serve’. Personally I don’t understand how public services can be delivered in a spirit of partnership. I get on the bus, the bus takes me from A to B. I do not work in a spirit of partnership with the bus. I go to hospital, I get an appendix out. My appendix is not removed in a spirit of partnership.
Now obviously people receiving treatment from therapists need to receive that treatment through a personal relationship that recognises them as equals to the therapist, not subordinates. Fine. What I don’t get is how me or you getting occupational therapy from a Clinic on the one hand, and, on the other, a board member getting a ‘top-up’ allowance of tens of thousands of euro every year, amounts to a ‘spirit of partnership’. I’m bullshitting here, of course I can: ‘spirit of partnership’ is one of those superficially attractive and egalitarian expressions intended to mask unequal relations and the icy cold material concerns of hard cash.
Just what is the scandal here, exactly? From what I can glean from the papers, senior board members were using the proceeds from charity fundraising to feather their own nests. People were getting involved in all kinds of charitable fundraising, thinking their efforts were going to provide people with essential services, when in fact they were lining the pockets of the Clinic chiefs. Just what made the Clinic chiefs worth such amounts of money isn’t all that clear. But then again, employment law contains few references to use value.
You could argue that the scandal here is the fact that people went out and worked their assess off thinking they were funding basic services for people who needed them when in fact they were comforting the really rather comfortable. And you could argue that the trickery involved here will hit the revenues of a whole range of institutions that need charitable funding in order to deliver vital services, with the effect felt most by those who need the services the most. That is how Fianna Fáil finance spokesperson Michael McGrath criticised the scandal.
Well, that all is true, but it isn’t the scandal. The consensus across Ireland’s political and media establishment is: public bad, private good. Rights bad, charity good. Public servants: conniving, self-seeking lazy bureaucrats. Private sector bosses: dynamic innovative go-getters who deserve your cash and admiration. It’s hardly a surprise if the Clinic chiefs expressed this consensus in their own remuneration arrangements.
What is scandalous is the way this event has come to light without even the slightest questioning of whether it’s appropriate for public health services to be outsourced to private firms or charities. Nor has there been any questioning of the role played, by private firms and charitable institutions, in helping to bury the notion that vital services including health ought to be provided on the basis of equality and social solidarity, and not on the basis of access to economic resources and the discretion of moneyed benefactors.
And this scandalous silence should come as no surprise, because the burial of social rights and access to public resources and their replacement with charitable discretion is both longstanding government policy, as is the outsourcing of public service functions.
Ireland’s ruling elites -economic, religious, political- have always hated the idea of universal public services because it smacks of socialism. Charity, on the other hand, bestows a saintly glow on the filthy rich, and consigns all that talk about rights to the domain of what Fine Gael strategist and Forum on Philanthropy Chairman Frank Flannery calls ‘ideological bullshit’.
Safely insulated from ideological bullshit, it doesn’t matter if the person providing you with the service is an aristocratic Lady, or, in the case of Crumlin Hospital for Sick Children’s parental accommodation unit, a clown called Ronald McDonald who makes his money from selling junk food to working class people: sure aren’t you lucky you’re getting it at all? Don’t be complaining, now.