In the clamour for tax cuts and higher wages, social equity is normally forced to take a back seat. A similar pecking order operates within the health services where acute hospitals and clinicians absorb much of the funding, leaving community services and care packages starved of resources. As political parties and Independents consider policy issues and their possible participation in a future government, they should consider this and break with the inequities of the past.
The elimination of waste is a useful catch-cry, but it can wilt and die when confronted by powerful vested interests. That has been the pattern for decades within the health services where reforming programmes end up on life-support because governments have neither the determination nor the necessary support to change a two-tier, dysfunctional system. Publicity concerning waiting lists and overcrowded emergency wards are the usual weapons used to stifle reform and secure the bulk of available resources.
There is complete agreement among health professionals and economists that well-developed community services, rather than high-tech hospital care, is the best and most cost-effective way of dealing with an aging population. Most elderly people wish to live out their lives at home, rather than enter nursing homes or hospitals.
Allowing them to do so is both cheaper and more humane. And yet, government and local authority funding for home care packages and housing adaptation grants has been reduced while money has been diverted elsewhere.
People’s quality of life is important. The provision of a home care package can make the difference between quasi-independent living in the community or staring at a wall in a nursing home. In some cases, a home care package is only appropriate after a house has been modified. Both schemes are, however, extremely cost effective when considered in the light of hospital and nursing home charges. In spite of such obvious benefits, both psychological and financial, these community-based initiatives are losing ground.
A supplementary estimate of €665 million was made available to the Health Service Executive last year to cover cost overruns. Some of this money was used to fund free GP care for the under-6s and over-70s and to reduce the waiting time for Fair Deal nursing home care. At the same time, the number of home care hours funded by the HSE will fall by 50,000 hours this year.
This will exacerbate a situation whereby people who could otherwise go home to assisted living are required to remain in hospital. Professor Des O’Neill, geriatrician at Tallaght hospital, described the reduction in hours as “bonkers and self-defeating”. It was, he said, a deeply troubling development that would cause distress to frail older people who are being prevented from leaving hospital in a timely and supported manner.