Hiqa service review: how much do we care?

The quality of State care for the elderly and for vulnerable children says a great deal about the values that inform a society. Deliberate neglect and under-funding for these services have been long-term features of government behaviour here. When it comes to allocating scarce resources, demands for tax cuts and public service pay increases take political precedence over the needs of marginalised and disadvantaged citizens. The latest report by the Health Information and Quality Authority (Hiqa) considers the ground that has to be made up.

Chief amongst Hiqa recommendations is the need for accountability at all levels of an organisation when things go wrong. Nursing homes and residential services for persons with disabilities, along with child-protection and foster-care services should, it suggests, be answerable to both service users and service funders. As in any business, good governance and management go hand-in-hand with the provision of services that respond to the needs of residents and support their rights.

In the disability sector, Hiqa found a significant number of people were experiencing “a quality of life that is well below that which would be expected for citizens in 21st century Ireland” while, in nursing homes, outdated buildings impacted on the privacy and dignity of residents and “their right to be safe while in long-term residential care”. Within children’s services, one-in-five young people with assessed needs had not been allocated a social worker last year.

Expressing outrage over predictable failures is pointless unless society is prepared to fund better services. The closure of 4,000 State-run nursing home beds, rather than refurbish the buildings, has been mooted. That bears an uncanny resemblance to the State’s abandonment of social housing provision and its unwise reliance on the private sector. Ireland ranks amongst the most socially unjust states in the developed world because of inadequate childhood services and generational inequality. A considerable increase in Exchequer funding will be required to change this.