FUNDING THERAPEUTIC SERVICES

Michael McKeon argues that innovative solutions must be found if we are ever to reach an adequate level of multidisciplinary therapy services. Michael McKeon, Lecturer in Nursing, Dublin City University

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An acute shortage of therapists for people with intellectual disability has been a feature of the Irish healthcare services over many years. Irish society has not been prepared to foot the bill for one-to-one intellectual disability therapy services, and an insufficient number of people have been available to work in the therapy/social-care professions within intellectual disability services. The most important issue here is the inherent right of people with intellectual disability to have access to therapists and the resources to enable them to gain the most from their potential in life.

All agencies attempt to provide a multidisciplinary team—aiming to provide the services of a nurse (RNMH), a physiotherapist, an occupational therapist, a psychologist, a speech and language therapist and a social worker. The strength of the service may be judged by the breadth of professional representation, and services are weakened when any of the professions are not available to the team.

Long recognising the acute shortage of therapists, NAMHI’s Parents’ Seminar in early October set out to provide information and to encourage the exchange of ideas to deal with this problem. But there is no easy road to follow. Three factors work against the ability of service providers and families to source the best quality of therapeutic service.

The first area of difficulty is that service providers throughout the country have serious problems in filling therapy posts and in retaining both professional and non-professional personnel. Secondly, Dr Peter Bacon’s report has highlighted the inability of the existing education and training system to produce a sufficient number of qualified people—who then may or may not choose to work in the intellectual disability field. And funding constraints since the demise of the Celtic Tiger are an increasing factor in the restriction of health and educational services. Hopes are fading that those services in intellectual disability will retain high-priority funding levels for the near future.

By the end of this year, public service benchmarking may place an additional burden on resources for intellectual disability services. The annual salary costs of providing a full multidisciplinary team, including representatives of each of the professions (at top-of-the-scale, basic-grade salary levels), are in excess of €300,000 a year, as the table below indicates.

The cost of a full multidisciplinary team after benchmarking
Staff Nurse €35,828
Social worker €46,721
Speech and Language Therapist €41,015
Area Medical Officer /Psychologist €55,589
Teacher €48,776
Physiotherapist €36,620
Occupational Therapist €36,602
Total €301,151

The figures suggest that for many services, the cost of a full multidisciplinary team may be prohibitive, and that people with intellectual disability will continue to be deprived of the comprehensive service they need throughout their life span.

Although the table uses figures for top-of-the-scale, basic-grade professionals, intellectual disability services have, for many years, experienced severe difficulties in recruiting and retaining therapeutic professionals—and those who are hired may stay only for short periods, or are on short contracts, perhaps never reaching the top of the salary scale. Although resulting staff vacancies may actually keep services more in line with government budgetary restrictions, service users obviously lose out.

The above figures do not include dental, educational and complementary therapies which are also required by people with intellectual disability; additional costs of allowances, promotional opportunities and administrative supports associated with a full multidisciplinary team compound the difficulties still further-

Over the last few decades, people with intellectual disability, their parents and carers have faced radical changes, including a major shift from large residential centres to community-based services and the continuing fight for the right to appropriate educational provision. Funding, or the lack of it, has always lurked in the background, driving (and limiting) government policy in service provision. The availability of therapists is also an important factor in service planning; supply and demand are seriously out of equilibrium.

The increasing cost of providing therapists, and the other supply and demand factors, require another radical shift in thinking. Even if more professional training courses come onstream, and a greater number of therapists are trained—if they choose to work in other areas or to emigrate, intellectual disability services will still see little improvement. The ideal remains that the therapeutic needs of people with intellectual disability should be met on an individual basis throughout their full lifespan. But current service models appear incapable of reaching this ideal. What is required is radical and innovative thinking—to attract therapists willing to work with people with intellectual disability, to explore ways in which parents and carers can work with therapists, and to devise a role for therapy assistants. The full therapeutic needs of people with intellectual disabilities will be met only by the creation of an integrated and collaborative support system involving everyone.

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