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The Cyclicality of Irish Fiscal Policy Ex-Ante and Ex-Post
Get PDFThe cyclicality of fiscal policy in Ireland in the budgetary plans put before parliament and expost is considered. Data in budgetary documents and particular econometric estimation procedures help address endogeneity issues and provide numerous variable-estimation procedure combinations for assessing cyclicality. Fiscal policy in Ireland is found to be pro-cyclical on both ex-ante and ex-post bases. The evidence is mixed between policy being more pro-cyclical ex-post than was intended at Budget time and there being no difference. With the preventive arm of the Stability and Growth Pact now applying to Ireland, a continuation of pro-cyclical fiscal policy would endanger its requirements being met
Cancer Pain Management at a Specialist Palliative Care Inpatient Unit: An Audit
Get PDFCancer pain is prevalent and burdensome in a palliative care setting and managed pharmacological and through non-pharmacological means. There is variance in how effectively cancer pain is managed, and to address this the ‘Pharmacological Management of Cancer Pain in Adults’ was published by the Department of Health in November 2015. To assess adherence to the standards defined by the ‘Pharmacological management of Cancer Pain in Adults’. Our study audited the implementation of these guidelines regarding recording pain, administering analgesics, dealing with side effects and opioid toxicity. Three researchers reviewed the charts of 100 consecutive cancer admissions between 01/09/17 and 31/12/17 in a Dublin hospice. This Information was used to assess adherence to 15 audit standards. Of the 15 audit standards examined, 9 met this goal of 100% compliance. 3 of the remaining 6 standards had a compliance equal or greater than 90%. There is a high degree of compliance in the assessment and management of cancer pain. Where compliance is not 100% clinical practice should be reviewed or feedback given on the audit tool. Future research should focus on completing the audit cycle, and further audit in a community or acute hospital setting
Lifting the Lid: the Private Financing of Motorway PPPs in Ireland
Get PDFThis paper addresses the complete absence of detailed information on, and analysis of, the financial aspects of Ireland’s road public–private partnership (PPP) programme to date. We focus on the eight hard toll roads in operation by 2010 and provide a financial analysis of their performance. Although privately financed we find that projects also received considerable public money. Whereas four projects are profitable, the other four have accumulated significant losses. The risk premia paid to profitable projects and the potential renegotiations that may be necessary for loss-making projects raise questions as to whether value for money can be achieved. We conclude with a number of policy recommendations
Assisted Dying? An Ethical Exploration of Some Concerns Around Legalisation: Swan Medal Essay Prize
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News: Repealed: What Next?
No full textLast Tuesday, TCD Obstetrics and Gynaecology Student Society (TOGSS), TCD Undergraduate Society of General Practice and Medical Students for Choice (MSFC) TCD welcomed a variety of prominent healthcare professionals to discuss the future of women’s healthcare in post-repeal Ireland. The societies, in their first ever collaboration, were joined by Dr. Marion Dyer, Dr. Pau Castell Montrull, Dr. Mary Short, Ms. Karen Canning and Senator Catherine Noone, an all-female panel ready to discuss the challenges that will be faced in the coming months as the legislation is passed and the new service rolled out.
The evening began as medical students and doctors gathered outside the Durkan theatre of St. James’s Hospital, having their own discussions over wine and cheese, before Brittany Telford, Co-Chair of TOGSS welcomed the audience with a short speech. Claudia O’Driscoll Greaney, Chair of the GP Society, then introduced and invited each panelist in turn to take to the stage and share their differing perspectives on the upcoming changes.
In her opening address, Telford reminded the audience what a memorable time in Irish history this is. Following a lengthy campaign, on May 25, 2018 the Irish people voted by 66.4% to remove the eighth amendment of the Constitution of Ireland, which since 1983 has recognized the life of the unborn fetus as equal to that of the mother, thus restricting termination of pregnancy. In September, the Bill to repeal this amendment was signed into law by President Michael D Higgins, meaning the Oireachtas is now free to legislate in regard to the provision of abortion care in Ireland.
“I would hope that it would get through before Christmas, but I don’t think we should rush it just to get it done and have a system that isn’t ready,” said Senator Noone, Deputy leader of the Seanad, who played a pivotal role in the referendum and chaired the Committee on the Eighth Amendment.
The plan for the new legislation is to allow a GP led abortion service, available for all women up to 12 weeks of pregnancy, and from 12-24 weeks only in certain circumstances. This month, the Select Oireachtas Committee on Health sat to discuss amendments to the legislation, many of which the Senator says she sees as “grounded in distrust of women”. Despite the challenges ahead, she maintained a positive outlook.
“The whole process is an excellent example of how deliberative democracy should work,” she said.
One of the issues coming up time and time again over the course of the evening was that of resources, in particular the need for ultrasound machines in primary care.
“Rapid and easy access to ultrasound is crucial”, said Dr Castell Montrull, a Dublin GP who is a member of GP POCUS (Point of Care Ultrasound).
“Why should women in the community get a lesser service than they’re going to get in the hospital? If they need a scan they should get it”, added Dr Mary Short, Director for Women’s Health at the Irish College of General Practitioners (ICGP).
Adding to this from the audience at the end of the discussion, Dr Brendan O’Shea, a GP and Professor in Primary Care and Public Health at TCD, put a motion to the floor ‘That this house strongly supports the availability of GP Point of Care Ultrasound as an integral part of providing a safe and convenient service for Women and their partners in this context’. This resulted in a unanimous yes vote and was strongly supported by fellow audience member Dr Tony O’Sullivan, ICGP Special Interest Group Lead for POCUS.
The funding for these resources, as well as the need for training of healthcare professionals, are some of the issues that need ironed out before the new legislation can be translated into a functional health care service. Ms. Karen Canning, outgoing Chair at The Irish Practice Nurses Association, highlighted that it is not just doctors affected by the upcoming changes, saying “the training for practice nurses is important, as we may be the first point of contact.”
Healthcare professionals with a conscientious objection to abortion are going to be another challenge for the new system to overcome in order to ensure that all women have access to appropriate care within the 12-week time frame allocated in the legislation. This controversial issue caused Dr. Marion Dyer, a Dublin GP and an Associate Professor in the School of Public Health to pose the audience with the question, “is it appropriate for a doctor, if a woman comes in distress, to say not only will I not prescribe, I will not give you any information as to where you can go?”
Dr. Short discussed some of the practicalities of the new service that aim to improve functionality and accessibility, saying “we need a 24-hour counselling phone line, and a preliminary triaging system”, also emphasizing the need for a high standard of post-abortion care and provision of contraception.
Dr. Dyer, an active member of Doctors for Choice Ireland, was also keen to disparage the notion that the number of Irish women having abortions is going to dramatically increase with the new law, putting it simply as “what is now secret will become visible.” She went on to quote the WHO figure of 94,000 deaths worldwide due to unsafe abortion between 2003 and 2012 and expressed her hope that women would find the new system more accessible than attempting to terminate pregnancy without medical support. Despite her impassioned views, the evening did not descend into the traditional debate on the ethical and moral views on abortion, but rather stayed focused on the logistics of the new service and meeting the needs of women in this new era in Irish healthcare. Ms. Canning left the audience with the fitting sentiment, “we must treat all our patients with dignity and respect, no matter what their issues are.”
Speaking afterwards to Allison Clark, secretary of MSFC TCD about the success of the event, she said “It was great to hear what has been done so far since the repeal, where we will be once the law is in place, and what to expect to change in terms of care given as medical professionals.” Telford concurred, saying that “the event was a great success! It was exciting to have such inter-societal collaboration and most importantly, our diverse panelists gave very interesting perspectives on how healthcare may be changing in the future. We are hopeful that this discussion continues the momentum for change.”
Photographs courtesy Emily Nguye
The Sacred and the Human: Dante and the crisis of the modern humanities
No full textAn essay exploring how the study of Dante can influence our thinking on the humanities today
Making the Worst of a Bad Situation: A Note on Irexit
Get PDFRelative to the rest of the EU, Ireland is especially vulnerable to the fallout from Brexit, both economically and politically. With increasing frustration over the reaction from Brussels, some are suggesting that an Irish exit from the EU would benefit the nation. A key argument for this is that it would allow for reintegration with the UK, thus reinstating close ties with one of its largest trading partners. Using a structurally estimated general equilibrium model, we estimate that such a move would substantially worsen the impacts of Brexit, with lower-skill and agricultural workers being disproportionately affected. This is due to the fact that while the UK is one of Ireland’s most important trading partners, trade with the rest of the EU is much more important
A Contingent Valuation Analysis of the Galway City Museum: Welfare Estimates for Attendance in the Absence of an Admission Fee
Get PDFThis paper provides empirical evidence about the demand for museum attendance in the absence of an admission fee based upon a survey of visitors to the Galway City Museum. The contingent valuation model results provide estimates of the total value (consumer surplus) of annual museum visits. Using these results it is possible to determine the welfare effects of predicted reductions in the number of visits at various levels for an admission fee. The results also provide insight about the impact of fees on the demand for subsequent versus initial museum visits, a focus of continuing interest within the cultural economics literature