Refocusing healthcare resources – moving resources into primary care and general practice

I’m talking this morning at the National Health Summit in Dublin. I’m in a session on ‘fixing A/E services’ after Liam Doran from the INMO, talking about the ED crisis, and Mark Aiello from the NHS, talking about the role of pharmacists in A/E care.

The basic question I’m covering is this :-

Will Primary Care finally get the investment it needs to keep people out of hospital?

Every party has a piece on health in their manifestos. Many promise a lot of extra cash for the health services. I’m not sure this is either possible, or a good idea, and I doubt if the money is being spent in the right areas. We all know that he Irish health service has problems. Many of these have been widely reported in the media. Stories tend to focus on trolley counts, waiting lists, costs for drugs, excessive numbers of managers, and poor care. There is some coverage of rising levels of overweight and obesity, and our big problems with alcohol and drug use and abuse. There is much less coverage of some of the other causes of rising health care costs, notably new treatments for diseases, and the costs of care for people with chronic diseases, like diabetes, arthritis, chronic bronchitis, depression and heart failure.

The costs of the service itself are also a source of concern. The state spends about €13 billion, and the public spends about another €5.3 billion on health care costs, one way and another, each year. New figures from the CSO, which came out in December, show that we spend a higher proportion of our national income, 10.2% of GDP, and 12.4% of GNP (which is a better measure of the size of the Irish economy), than almost any other EU country. Over the last few years the proportion of care paid for ‘out of pocket’ has risen sharply, raising costs for individuals and families who need care. It would be very hard to argue that we get a correspondingly good health service for this very large investment. It will also be very hard to get additional money for it.

Why have we got the expensive service we have? Our services developed over a long period of time, and grew organically. After World War Two, when many EU countries restructured health services, we did not. The British got the NHS, we got little or nothing until the health act of 1970. This has left a system which is full of perverse incentives. We have, largely, free hospital care for outpatients, but quite expensive primary care.

Most health care, by far, is self-care, or care by family members. Most of the rest, the more visible piece, happens in general practice, where there are about 27 million visits a year. Unfortunately, the GP contract (the medical card) was designed to cover acute illness, and not the long-term care for people with chronic diseases. There is very good evidence that the long term relationship between the GP and their patient brings big benefits to the care of such chronic diseases, and especially to care for people with several such diseases. This group of patients is where most health care spending goes.

The problem in Ireland is resources. Irish general practice is seriously underfunded compared with similar countries. While GP’s have the ability to lead, coordinate and give care for people with long-term illness, They do not have the resources. There are too few GPs and not enough money, for GPs and their staff. GPs have also lost a lot of their state income n the last five years. Will resources be made available?

There’s an election on. I’ve gone over the manifestos of all the parties to find an answer to this question. There are a lot of common features in the manifestos. Most agree on two things :-

  1. The Irish health care system is unfair, and needs to move to universal care, equally accessible to all (except for Fianna Fáil).

  2. The system needs to focus more on primary care than at present.

There is also wide agreement on a number of more specific policies. Most parties intend to reduce or abolish prescription charges. This is good, because these charges discourage the use of essential medicines. Taxes on sugary drinks are popular, as are a range of public health measures, on alcohol, smoking, and promoting physical activity, especially in the young. Drug policy is more divisive, ranging from more Garda work to prevent the sale of drugs (FG) to a health based approach to drug policy (Green Party). However, every single party wants a wide range of public health policies and measures to tackle major health problems.

Free GP care is also popular, and most of the parties support the idea in some form. They are much hazier about what it means, how to do it, and how to pay for it.

What is missing? Several parties (FG, Sinn Féin, and People before Profit) want to abolish HSE. I understand why, but the price of abolition will be to halt change in healthcare for at least three years. The NHS -has suffered greatly from this over the years. Organization structure is secondary, what matters is changing what happens when the patient meets the clinician.

The parties, the media and the electorate remain obsessed with hospitals, and hospital beds. Hospitals do matter. In Ireland, I think the balance between care in hospitals, and care in general practice, is wrong. Too much is done in acute hospitals, and far too little in general practice. This is one part of the problem in the hospitals. We need some more investment in hospitals, but a lot more in general practice. GPs will benefit from more access to diagnostics, but there is almost no capacity to take on more work, be that free care for more people, or more care for chronic illness.

If action is not taken, as time goes by the services will be further and further stretched. The number of older people is rising steadily. While more are quite healthy, the need for healthcare will rise steadily over the next decade or so. Failure to meet this need, will cause much unnecessary suffering and death. We’ve tried building a hospital centred service, and it has not worked well. To meet rising demand I think we will need to move to community based services, and the heart of these is general practice.

What can be done? There are some very good models, backed by evidence, to support the further development of general practice. HSE are just beginning to move some chronic disease care ito GPs, starting with diabetes care, but more people will be needed to deal with this. More GPs are needed, both to increase capacity, and to cover for retirement, and more training places. Well trained nurses working with GPs, can provide good quality care. Bringing the clinical staff working for HSE in the community, public health nurses, physiotherapists, and others, much closer to the actual individual practices would be very desirable. The idea is achieve integrated care, led by general practice, but linking in to the hospitals, and the other community services.

This means moving resources from other parts of the service to general practice. Given the very high overall spend on health care here, I do not see that we can reasonably make a case for much more money. Between 1997 and 2008 the health care budget rocketed, but I do not believe that health care improved greatly. None of the political parties have acknowledged these problems in their manifesto, and several propose very large increases in health care budgets. Some increases will be needed, but we need more effective plans to ensure that the increased resources are not wasted.

My slides are here

Saving General Practice and Irish Healthcare

The IMO organized a meeting on Wednesday evening in Buswell’s Hotel in central Dublin, just across from the Dáil (the Irish parliament building) on the topic of ‘Solving the Chronic Disease Problem – through General Practice’. It was packed out, and there was a very good line up of speakers, starting with Leo Varadkar, who trained as a GP and is now the Minister for Health, and including three prominent GP’s Austin Byrne, William Behan, and Tadhg Crowley. We also had spokespeople from a selection of the political parties, Sinn Fein, the Social Democrats, Fianna Fail and Fine Gael there.

The problem

Ireland has a very young population by EU standards, with a low proportion of people aged over 65. However, that proportion has been growing rapidly since 2005, and is expected to continue to rise quite quickly, until 2040 or so. There are approximately 25,000 more people over the age of 65 every year, of whom approximately 5,000 will be over the age of 85.

This poses two challenges – first how do we pay for healthcare for the larger number of elderly people, and second how do we deliver it efficiently and fairly. (It’s worth pointing out that the panic about herds of older people roaming the streets in the future, demanding healthcare and pensions, is overstated. Most healthcare costs are incurred in the year or two before death anyway, and the usual measures of dependency ignore the quite large economic contributions of those over 65).

A rapid increase in the numbers of older people does pose a challenge – specifically the challenge of dealing with more cases of chronic disease, and more people with more than one chronic disease – people affected by ‘multimorbidity’. Unless this is met, and reasonably resourced, there will be severe problems.

The question

The question posed by the speakers last night was, fundamentally, can the Irish health service cope with these demands by business as usual, and the answer was an unequivocal no.

Too much care for people with chronic disease takes place in acute hospitals, or in private clinics, and that care is fragmented. Irish hospitals are at, or very very close to, capacity, with bed occupancy of 98% – far higher than they should be. They reviewed evidence showing that integrated care, led by GPs, can give a better quality of care, and can reduce the use of expensive health care, including hospital admissions, specialized investigations, and outpatient visits. For a small group of complex patients, a small group who account for upwards of half of total health expenditure, costs can be reduced by 10% to 20%.

The answer

They proposed a model of greater investment in general practice, with more care moving to the community, and much better access to hospital services, and special investigations, for GPs. This pattern of care would, very likely, improve patients’ experience of health care, improve the health of the population, and reduce costs.

Part of this would be a better GP contract. The current GMS contract forbids chronic disease management, and indeed 25 years ago, inspectors would go out to practices to make sure that GP’s were not managing high blood pressure in their GMS patients. However, a model where chronic disease care comes in piece by piece, over many years, will not work either. GP’s already know how to do chronic care, they just need to be resourced for it.

The politicians

The politicians sort of got it. Their biggest weakness was the failure to separate out general practice and primary care services. In Ireland primary care means HSE provided primary care, delivered by state employees. GP’s are private contractors. Their biggest threat was their universal view that the health care budget could not and would not rise much over the next few years.

Leo Varadkar, our current Minister for Health, said that health care had to focus away from hospitals and towards general practice. He would ring-fence cash every year to support the development of GP services and primary care. He spoke about the need for GP’s to lead in community care. He hoped that the large cuts experienced by general practice would be reversed from 2017, and that some allowances could be restored before then. He also indicated that expanded roles for pharmacists, community nurse, and others were on the way.

The Sinn Fein speaker, whose name I missed (apologies), urged free access to primary care, an increase in training places for general practice, and the introduction of some salaried GP posts.

Deputy Róisín Shortall spoke for the Social Democrats. She acknowledged that integrated care was vital, and that they aim for a single tier health system with much greater capacity in primary care and more innovation in care. She also felt that there would be little more money for health.

The FF spokesman, Senator Thomas Byrne had two good ideas, first that health care planning needed to run over many years; second, that the primary care budget should rise by €160m a year each year; and one very bad idea, that while they were happy to see free GP care extended, this should be on the basis of need, and not based on such factors as age. I advise them to read the Keane report, from September 2014 carefully, where the impossibility of this is carefully explained.

The FG spokesman, Senator Colm Burke, said that they would need to resource GP care properly, but felt that change would be hard, and that the health budget would not increase much over the next while. He also talked about primary care.


The solutions proposed by the GP’s and the IMO are straightforward enough. They can be delivered, and will, almost certainly, save money.

One big threat is the lack of capacity for change within HSE and the Department of Health. Although working models of community diabetes care have been evaluated in Ireland, and running for over 20 years, there is still no serious plan to implement and resource this most basic level of care, for one of the commonest chronic diseases, across the whole country. (There is a plan, but not a credible plan.) At the current rate of progress, chronic disease care in Ireland might be up to scratch in forty or fifty years. This is not acceptable.

The other threat is the lack of money. Overall, the Irish health care spend is quite reasonable. We spend a little below the OECD average per head, based on our GDP. Based on our GNP, which is a better measure for Ireland, we spend quite a bit above the OECD average. There are problems with these figures, but the overall conclusion stands. The problem is that we seem to get poor value for money, both from the public sector, and, especially, from the private hospital sector. To change how we deliver care, to move to a more efficient service, we will need to invest more, and quickly, in general practice. This will need an increased health care budget, rising by 6% to 8% a year.

If both of these cannot be delivered, then the most likely outcome is that the health service will continue to get worse, queues will continue to get longer, and preventable ill-health from chronic disease will continue to rise.

HSE Service plan 2016

HSE’s 2016 Service plan has just been published. I was on RTE’s Drivetime talking to Mary Wilson about it on Thursday night. It’s a long document, at 178 pages, with more detail and more useful information than previous plans. If you work in health, it’s worth looking at the pieces directly relevant to yourself and your patients.

The high level message is an 0.8% increase on the (expected) 2015 spend, or 6.7% on the 2015 budget. The good part is that talk from DPER about bringing the 2015 deficit forward into 2016, which would have led to a 5% cut in expenditure, has gone away. The bad news is that HSE probably needs a minimum of €300 million extra (that is above the 2015 spend, not the 2015 budget) in 2016, just to stand still, and it’s not getting it. The 2015 service plan took a similar approach to the budget, and 2015 was definitely easier than 2014. The acute hospital sector may have the greatest difficulty with a budget €83m less than they have spent in 2015. There is a lot of language about ‘significant financial challenges’ and ‘financial risk’, which is likely to be prophetic.

None of this was unexpected. HSE had suggested an extra €2 billion in budget, or about €1.4 billion in health service spend this year, which was never going to happen. The Irish budget is still very constrained by our commitments to the EU. These commitments may, or may not, be sensible (see a report from Brookings), but Ireland can do little to change them unilaterally.
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Governing quangos – not so Wild West anymore?

Ireland has several hundred agencies set up by Government departments to do various things. These range from the slightly inscrutable, for example the ‘Bookmakers Appeal Committee’, to whom your appeals on losing a bet should definitely not be directed, to the instantly recognizable, such as RTE or the National Museum. These bodies, sometimes dismissively known as quangos, make up a sizeable part of the Irish State, as of other modern states. They spend a lot of money, most of which comes from taxpayers and the public, and provide many services.

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MacGill Summer School

I’m just back from Glenties, in Donegal. I spent a few days at the MacGill Summer School. The School is an annual event, and has been running since 1981. If you wish, you can watch every session on the Donegal County Council website here. I saw most of the sessions form the Wednesday evening to the last session on Friday. MacGill drew a certain amount of criticism this year. One letter in the Examiner described it “nothing more than a ‘talking shop’ or junket for ‘has beens’ or ‘wannabes’. It offers nothing constructive to help solve problems of this country.” In a piece in the business section of the Irish Times Caroline Madden suggests that for the cynical it might be “a talking shop where navel-gazing represents the chief activity”. I don’t altogether agree.

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‘On Wednesday We Wear Pirate Hats’ The BT Young Scientist &Technology Exhibition and the state of younger people in Ireland

I was lucky enough to be one of the judges at the BT Young Scientist’s exhibition in Dublin in the first week of January. This gave me two rather different opportunities to see Irish school children. First, I got to meet the people who put in projects. These included the eventual winners, Ian O’Sullivan and Eimear Murphy from Cork, and about forty other people, all aged between 12 and 18, whose group projects, all entered into the Social and Behavioural Sciences section of the exhibition, I got to judge. (Every single project gets judged three times, independently, and those in the running for prizes are reviewed by further judges.)

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Have your Say in Ireland – Seanad Éireann

The next Seanad will be elected, most likely in June 2016, in the same unsatisfactory way as the current Seanad. Most of the senators will be elected by the votes of local authority members, and members of the Dail. The Taoiseach will appoint eleven senators. Six members will be elected, most likely as at present, three by graduates of TCD, and three by graduates of the NUI. There is a slim chance, if the bill on electoral reform is passed very quickly, that six candidates will be elected by graduates of all higher education institutions (HEIs) in the state. Unfortunately, given that the next election has to happen by the end of March 2016, at the latest, it looks as if even this modest reform may not happen in time.

What can we do to make the best of this bad lot? The only part of the Seanad that has any shred of democratic legitimacy are the two third level panels. This is far from perfect, with a very restricted franchise, but it is the best we are likely to have in time for the next election. It is also the only place where Irish citizens living outside Ireland can influence Irish elections, and it might form the seed for more effective Seanad reform after the next Oireachtas elections.

If this is to happen, I think we need to get as many people as possible voting, and that means encouraging people to register for their votes, and use them. The Seanad electoral register closes on February 26th, and will be used from June 2015. The only requirements are that you must be an Irish citizen, and you must have graduated from the NUI or TCD.

From today, November 2nd, there are 116 days to go. Please help me to get the word out. I’ve set up a Facebook page for this at

Trinity graduates

Full information about the Trinity Seanad election and the electoral register is here. Short version, you have to fill in this form, sign it, and post it to Student & Graduate Records, Academic Registry, University of Dublin, Trinity College, Dublin 2. It must be received by Thursday February 26th, 2015. You may not email it.

TCD degrees

Most eligible graduates attended Trinity, but there are also many DIT graduates who have TCD degrees. I’m not aware of any other such institutional links. Please let me know if I am missing any. Please note, you have to be an Irish citizen to vote, but you do not need to be Irish resident.

NUI graduates

Full information about the NUI Seanad election, and the electoral register is here. Short version, you have to fill in this form, sign it, and post it to National University of Ireland, Records Office, 49 Merrion Square, Dublin 2. It must be received by Thursday February 26th, 2015. You may not email it.

List of NUI colleges

The list of NUI colleges is longer than you might think. Besides the obvious, UCD/UCC/NUIG/NUIM, it includes RCSI, NCAD, the IPA, Milltown, and the Shannon College of Hotel Management. Some graduates of other institutions are also eligible, depending on exactly when you graduated – these include Mary I, St. Pat’s Drumcondra, NIHE Limerick (but not NIHE Dublin), Thomond College, and St. Angela’s. A full list is here. Please note, you have to be an Irish citizen to vote, but you do not need to be an Irish resident.

Funding universities – newish ideas from the IEA

There is an admirably bonkers new paper from Peter Ainsworth of the IEA with the title “Universities challenged: funding higher education through a free-market ‘graduate tax’”. I’m obsessed, amongst other things, with ways of funding higher education, so I read it cover to cover.

Some background first, as many people will not be familiar with the IEA. They describe themselves as a think-tank whose members, “all those associated with the Institute support free markets – though with different “schools” of free market economics being represented”. Their official history begins with a quote from John Blundell, their former director-general thus “Hayek advises Fisher; Fisher recruits Harris; Harris meets Seldon. In nine words, that is the start of the IEA.” This gives a pretty good idea of their perspective on the world. It isn’t mine.

The report itself, a concise 52 pages, has a good deal of useful material. There is a very good summary of how the UK got to their current situation, where a student loan scheme, intended to reduce Government payments to Higher Education, is now likely to cost more than the direct grant system it replaced. There is a very lucid analysis of the different economic perspectives of students, higher education providers, and the state. There is also a good description of the various perverse incentives in the current system in the UK. There is nothing on the perverse incentives on other countries, for example the US. There is less on the perspective of the families of students, but this is, I think, a relatively minor omission. There is a good review of the graduate premium to earnings, with useful data showing how it has varied over time, and between disciplines. There is particular emphasis on the variation between individuals in this premium, and the consequent uncertainty about investing in Higher Education.

Ainsworth’s key idea is this ” Universities should individually or collectively offer contracts to their students, who would agree to pay to the university they attended a given percentage of their [future] earnings. That percentage could vary by course and institution, though some agreement between universities could be helpful to achieve standardisation. Essentially, the university would be taking an equity interest in the graduate premium earned by the student, although any student who chose to do so could, alternatively, pay the full fees up-front prior to beginning their studies.”

He suggests that, based on a few models around the world, this might be between 4% and 10% of their income over a certain level, for a number of years, and that these payments should receive tax relief. This would be a private contract, and, as such, universities could securitize the earnings.

What’s right with this idea?

  • It could do a good job of aligning the economic interests of students and universities. Presumably institutions whose graduates were of very poor quality, as perceived by employers, would do badly. There would certainly be a strong incentive for universities to give students access to skills and competences, rather than information. Some of these would be specifically vocational, and others more generic.
  • Higher education would be free at the point of use, at least in the sense that there would be no upfront fees. These are, to say the least, a disincentive to poorer students. Ainsworth suggests that the state might choose to provide maintenance grants to support some students at university.
  • It would do a very good job of sharing the risk in choosing to do higher education between the students and the university, with the university taking all the downside risk – i.e. the student never gets a high enough salary to start paying.

What’s wrong with it? Ainsworth does try to address several challenges, for example, there would be an obvious incentive for universities to concentrate on subjects with a high graduate premium – putting less vocational course at risk. Such courses could instead be state supported, as a matter of public policy.

I see some further serious objections, which are not fully considered.

  • Incentives to select students – there would be a huge incentive to the university to cherry pick students, and I foresee a large premium on very low risk people, for example white male students from UK ‘public’ schools (i.e. private schools in other countries). Students with disabilities would be a significant risk to the university.
  • Incentives to select the courses provided – many universities, including all those I’ve worked in, provide courses which are actually uneconomic, or at best very very marginal. We also do a lot of experimentation, running course for a few years to see if they meet a need. These courses, and the associated innovation, provide a wider range of choices for our students, and support a wider range of voices and perspectives within higher education. I doubt that targeted government subsidies would, or could continue to support these.
  • Cost – the cost of collecting these funds is not discussed, apart from a suggestion that universities might get together to do it, or set up a common organization to collect the money. This is not unreasonable, but I suspect the costs would eventually eat up a sizable fraction of the money collected, perhaps 20% or more. The cost of collection is a critical part of any higher education funding system.
  • Risk – bringing in such a scheme is fraught with risk. There would be very large uncertainties, which would put at very serious risk any but the most well endowed (i.e. highly capitalized) of higher education providers. The education system requires fairly stable funding, if it is desired to provide a stable education. A reasonable estimate is that is takes 5 to 6 years from the start of development, to the first graduation of student from a new 4 year degree program. It might be another decade before the graduate premium from such a program could even be estimated. It would be very hard to make a business case for such an investment. The transition costs of any major shift in education funding are large, and are not considered by Ainsworth.
  • Feasibility – Ainsworth argues, on the basis of a number of examples, that such a scheme is feasible. The examples he gives are for small scale, highly targeted schemes. I’ve reviewed each of them, as best I can, and I remain very dubious of the ability to scale such ventures. One important example, CareerConcept AG seems to have had no media activity since 2011, which is surprising. Lumni looks much more promising, but has still only covered 5,000 students in four countries since 2002.

In short, I think the IEA report well worth reading, but I do not think that the proposals in it are feasible, desirable, or affordable. The UK desperately needs a better system of funding Higher Education. This isn’t it.

Gerry Haugh R.I.P.

I heard bad news today. I was up at the hostel in Knockree, collecting our daughter, and a few of her friends who had been away with the scouts. Gerry Haugh died at 11:35pm on Saturday March 19th. This will likely mean little to most of you.

When we first met I was 12, and he was 22, just starting as an English teacher in Belvedere. He was keen on, and knowledgeable about, the theatre, and I was in his first ever production in Belvedere. At a net cost of £57, generously provided by Fr. Noel Barber SJ, the then head master, he put on Robert Bolt’s play for children – ‘The Thwarting of Baron Bolligrew’, set in the AV room at the top of what was then the Science wing of the School.

This was the first of exactly 100 productions. Recently he did the ‘Pirates of Penzance’, in which my son played the 43rd pirate on the left. His last production, though we didn’t know it, was his adaptation of the ‘Pickwick Papers’ which opened on March 10th last. At that performance twelve of the original cast of Bolligrew, the 3 Syntax 1 Class of 1974, met up for a meal, the show, and a presentation to Gerry, who was in great form. Very unexpectedly he fell ill last Friday, was brought in to the Mater in a diabetic coma, and died on Saturday night.

What did I get from him? Many tangible things, a love of theatre, cinema, and stagecraft; the fun of long days hill walking in Wickow, and hostelling in Ballinskelligs; my first trips to London and Stratford to see plays; lots of great books, and great poetry; and even, (I think) an A in O-Level English. But I also got lots of intangibles. He was witty, sharp, and honest. He could be tough, when necessary, strict, when needed. He never fell in to the twin traps for young teachers of wanting to be one of the lads, or wanting to be God. He influenced many hundreds of young men for the better. He was a truly good man, an exceptional teacher, and we’ll all miss him.

Gerry Haugh, jacket open, tie askew, as usual, with some of the cast of Bolligrew, 100 productions later

Death Notice Irish times March 21st.
Haugh Gerard Martin (Gerry) (Glasnevin and Belvedere college S.J.) – March 19, 2011 (peacefully) after a very short illness at the Mater Misericordiae University Hospital. Only son of the late Desmond and Maire Haugh and sadly missed by his loving sister, Maureen, relatives, friends, past and present colleagues and students. May he rest in peace. Funeral arrangements later. Enquiries to Kirwan Funeral Directors, 0-8334444.

Funeral arrangements
Reposing in the Boy’s Chapel, Belvedere from 5pm Tuesday March 22nd, Removal at 7:30 pm to St. Francis Xavier’s Church, Gardiner St. Funeral Mass on Wed 23rd March at 11:30 am, in Gardiner St.

Gerry’s obituary from the Irish Times, Saturday April 9th 2011

Gerard Haugh: GERARD HAUGH, who has died aged 60, was a teacher of English and history at Belvedere College, Dublin, where over the course of four decades he made a lasting impression on successive generations of pupils.

Headmaster Gerry Foley said his sudden death shocked and saddened literally thousands of pupils, past and present, all of whom he encouraged to aspire to excellence.

“Generous and passionate in his belief in the principle ‘Mol an óige agus tiocfaidh sé’, Gerry’s legacy is that he inspired others to be generous, to live life to the full and that in giving, their life would be meaningful and rewarding.”

“A true educationalist” is how one parent described him. “His priority was on the developmental stages of boy to manhood and a wish to nurture a love of the arts, humanities and a philosophy of ‘being’ . . . I always experienced him as operating from a stance of an ‘ethic of care and love’ and a belief that he could get more out of the boys than they ever imagined.”

A former pupil wrote: “Gerry was much more than an English teacher to me, he was a man I could always look up to, and more importantly he was a friend to every student.”

Born in Dublin in 1950, he was one of two children of Desmond and Maire Haugh. At University College Dublin, he was an attentive student of English and history, and an entertaining records secretary of the Literary and Historical Society. He graduated in 1971. That year also he began teaching at Belvedere College, and completed his HDip Ed in 1972.

His interest in and knowledge of theatre led to his first school production, which was Robert Bolt’s play for children The Thwarting of Baron Bolligrew . It was staged in the science wing of the school for a net cost of £57.

Subsequent productions included Guys and Dolls, The History of Tom Jones and The Pirates of Penzance . He celebrated his 100th, and final, production last month. The author’s great-great-grandson, Gerald Dickens, attended his adaptation of The Pickwick Papers . And 12 members of the original cast of Bolligrew turned up at the opening night for a meal, the play and a presentation to the producer.

Gerard Haugh imparted a love of theatre, cinema and stagecraft to his pupils. He led them hill walking in Wicklow and hostelling in Ballinskelligs. He supervised their trips to see plays at Stratford-upon-Avon and London’s West End. Every year he organised the “Block Pull” from Dublin to Galway on behalf of Irish Guide Dogs for the Blind and Temple Street children’s hospital. And he also braved the elements to join pupils for the Christmas sleep-out in aid of Trócaire.

He is remembered as witty, sharp and honest. He could be tough when necessary and strict when required. He never fell into the twin traps of wanting to be “one of the lads”, or assuming to be God. He influenced many hundreds of young men for the better, one of whom now in middle age said: “He was a truly good man, an exceptional teacher and we’ll all miss him.”

He is survived by his sister Maureen, relatives and friends.

Gerard Martin (Gerry) Haugh: born April 13th, 1950; died March 19th, 2011