Angela Flynn

Dr Angela Flynn is a lecturer in the School of Nursing and Midwifery in UCC. Having worked as a nurse in the NHS in London, she returned to Ireland in 1999. She was shocked at just how unfair and inequitable the Irish health system was and was taken aback by the stark two-tiered system.

Over half the population of Ireland pay for private health insurance because they know that should they need to see a consultant or have scheduled surgery they will languish on waiting lists if they stay as public patients.

Angela decided to examine the history of the Irish health care system that led to this inequity for her PhD, and she used Noel Browne’s Mother and Child Scheme as one of the case studies. She has published a number of papers from this research. Now in 2022, on the 25th anniversary of the death of Noel Browne, Angela will discuss an imagined world where his scheme had been successful and explore the potential health system we could have had.

Background.

Noël Browne was born in Waterford on 20th December 1915. He died in Connemara on the 21st May 1997.

A quarter of a century has passed since the death of Noël Browne, the most controversial Minister for Health in Ireland’s history. His courageous account of early life and a political career of over 40 years can be found in his autobiography ‘Against The Tide’ published in 1986. Written with a rare honesty and integrity, it portrays an often heartbreaking account of the ‘precarious survival’ of early family life against the backdrop of the deathly poverty, illness and the sheer awfulness of daily experience for many poor people in the new Irish State. His earliest memories of witnessing the savagery of the Irish Civil war ensured his abhorrence of violence.

Both parents, Joseph (1923) and Mary Therese (1929) died of tuberculosis (TB) and many of his seven siblings contracted the killer disease, Noel who also had TB was one of three to survive, while his sisters Annie, Eileen, Una and Jody, his brother all eventually succumbed.  

Official figures show that from 1921 to 1950, 114,000 Irish people died of the disease. Scarcely an Irish family remained untouched and many families were completely wiped out.

Browne was fortunate to be “adopted” by the Dublin surgeon Neville Chance and his family who ensured Noel gained entry to Trinity College and eventually became a doctor.

He realised quickly that the only way to change Ireland’s disastrous health system was to become directly involved in political action. Browne, by now a committed socialist was elected to Dail Eireann in 1948 as a Clann na Poblachta TD. The Clann, led by Sean McBride with ten TDs joined a Coalition government. To the surprise of many he was appointed Minister for Health on his first day in the Irish parliament.

The Tuberculosis (TB) Scheme was based on a 1946 White Paper produced by Dr James Deeny the Chief Medical Officer of the Department of Health while Dr Jim Ryan’s Health Act of 1947 and the Health (Financial Provisions) Act 1947 gave a legal and financial basis for a no means test principle for the health care of Mothers and Children. Dr Noel Browne to his everlasting credit ensured the treatment of TB was fully implemented. He also acknowledged that his authority for the Mother and Child Scheme arose from that Health Act of 1947. 

He commenced a massive hospital construction project, free X-ray screening for tuberculosis patients and set in motion systems to eliminate tuberculosis with the aid of Streptomycin. The blood transfusion service was set up.

Browne set a frenetic pace within the department, he was indeed a man in a hurry witnessing the immediate and positive impact of the National Health Service (NHS) introduced by the UK Health Minister Aneurin Bevan in July 1948.

Unprecedently and uniquely for a politician, he decided to actually implement the health reforms contained in the Irish 1947 Health Act, fully aware that he would “only have one crack at it”. However his proposal to introduce free medical care for children under 16 and their mothers in order to reduce child mortality which became known as the Mother and Child Scheme was vigorously opposed by the Catholic Hierarchy which it described as ‘the free-for-all Mother And Child Scheme’ and Irish Medical Association (I.M.A) which condemned it as ‘the socialisation of medicine’.  

Browne refused to concede to the concessions demanded by the Church and the establishment and once he lost the support of his leader in Clann na Poblachta, Sean MacBride who requested his resignation he was eventually forced to resign on 11th April 1951.

Now a political outsider, he never regained access to political power again to drive positive structural change in the health system.

Later many of the changes Browne had helped to introduce made a real difference to ordinary people and the arrival of vaccines and new drug treatments helped to reduce significantly the death rate. This fell by half within a few years and was down to 15% of the 1940 levels by 1960. The death sentence of  a TB diagnosis was no more.  

While aspects of his health scheme were eventually put in place, his initial opportunity to construct a NHS type universal health care system for Ireland was lost and the two tier private and public health system remains in place.

Noel Browne remained in politics, moving in and out of various political parties, marginalised by those in the political power, ignored by others, always controversial, passionate from the back benches, sometimes caught up in roundabout arguments of the Left yet adored by many radicals as an uncompromising advocate for the social justice and a universal free health system.

John Horgan’s book Noël Browne, Passionate Outsider portrays this complex man in a warts and all analysis with empathy, understanding and some criticism.

Browne’s love story with Phyllis Harrison, was told by Phyllis in her publication Thanks For The Tea, Mrs. Browne – My life with Noel.

Written with love and affection, sadness and struggle, courage and quiet passion, Phyllis describes their life together as “a stormy passage” and the difficulties they faced through over fifty years of married life. The couple even tried farming, an episode described with some humour in an Amateur Farmer’s Journal. Browne was originally informed that he had six months to live when they married back in 1944, he again suffered a relapse after his appointment as Minister and occasionally ran his department from his sick bed.   

Noël Browne retired from politics in the early 80s, daughters Ruth and Sue raised,  he and Phyllis moved to an isolated cottage in Connemara on the west coast of Ireland where he wrote his memoirs Against The Tide, which became a best seller. Some former political colleagues received blunt assessments of their actions and when coupled with a gripping narrative, the book remains a very rare and raw account of Irish life and politics.

Former Labour Party Minister for Health, Barry Desmond in his memoir “Finally and In Conclusion” discussed Noel Browne in a chapter “An icon Revisited”. He acknowledged that Browne emerged with “considerable credit” but strongly criticised “Against the Tide” for some aspects of its personal criticisms of some individual politicians on the left in Ireland, especially in the chapter The Left in Ireland.

Historian Joe Lee in Ireland 1912-1985 Politics and Society has described Noel Browne’s career as among “the personal tragedies of recent Irish politics”. 

While admitting that he brought “idealism, energy and ability to his task” and accepting that “his vision was generous” and decent which would have argued well for his ideal health service, he added that “his talents were largely squandered as the rest of his public career was to be passed in growing frustration and rancorous recrimination”.

Did Noel Browne indeed underestimate those in the political game “protecting their privileges, their pockets and their power”? JJ Lee suggests he did but that Browne exacted sweet revenge in “Against the Tide” as he became the first former Minister to publish detailed memoirs with portraits of his colleagues “etched in vitriol” which consigned that Costello government to the opprobrium of many observers.    

However did Noel Browne really underestimate the extent of Church opposition to his scheme to provide free assistance to mothers and their children?. Many of the Cabinet were members of the secretive right wing Catholic Knights of St. Columbanus. These included Richard Mulcahy, (Minister for Education) Sean Mac Eoin,(Minister for Justice) Joe Blowick (Minister for Lands) and William Norton (Minister for Social Welfare and leader of the Labour Party 1932-1960). Even Taoiseach John A. Costello had been a Knight. Brendan Corish, Labour party leader from 1960-1977, was appointed Secretary of the Department of Local Government, was also a Knight.

Browne was criticised by several commentators for destroying records on his departure from his Department relating to the Mother and Child Scheme however his actions were more understandable if one considers that the conservative Knights were also well represented both across the higher echelons of key Civil Service departments where they controlled general policy and promotion networks within their departments, and in the medical professions, where they controlled medical appointments to hospitals. Did Noel Browne ever really stand a chance?  

Yet if Bill Norton’s planned Social Welfare Bill and Sean Mac Eoin’s effort to legislate to solve adoption issues both failed to pass the McQuaid veto on legislation, then Browne must have realised that his chances of legislating for the Mother and Child scheme without a means test passing the “commandos” of the Knight of St Columbanus were also negligible.  

Browne also strongly opposed the violent activities of various Republican groups and challenged their basis for espousing socialism or social democracy. His views on contraception, censorship, abortion and homosexuality and his savage attacks on the Catholic Church, while prescient of later social battles, alienated many potential allies in the Labour Party and the Left generally.    

His successful efforts to end the scourge of TB and his exposure to a new generation of Church control of the State remain his major achievements.

But his passionate dream of providing access to a decent health service for all citizens of the Republic of Ireland based on need remains to be achieved.

‘He lies in the clean sandy soil by the Atlantic shore, where he liked to sit every afternoon, seagulls and screaming curlews flying above him’

Phyllis Browne.

On Saturday afternoon 30^th July at 2.30 Angela Flynn will discuss the Mother & Child Scheme, imagine if it had been successful and explore the potential health system we could have had.

Venue is the Maldron Hotel Shandon. All Welcome.