Government 2016: Split responsibilities – free up resources

Jerome Corby argues that the disability sector in Ireland needs a strong voice at the government table, in order to ensure people with disabilities are adequately supported and resourced as the Irish economy emerges from recession.

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  • Jerome takes a look at the outgoing government
  • He thinks Kathleen Lynch has done a good job overall
  • We need to make sure that the next government Health ministers have disability as one of their priorities
  • There is talk of the Ministry for Health being split in two. This might be a good thing for the disability sector

As we approach the possibility of a government being formed, it’s worth reflecting on what is required of a new Health ministry with responsibility for improving the lives of people with disability and their families.

After what can likely be termed an admirable performance by the outgoing Minister of State with special responsibility for Primary Care, Social Care (Disabilities & Older People) and Mental Health, Kathleen Lynch, it has to be recognised that the greatest problem during that time was that she and Ministers Reilly & Varadkar had way too many strings to pull to be able to bring improvement to them all. Resources which were deemed to be scarce in the early days of this administration are difficult to free up now we seem to be seeing some economic recovery. Fine Gael are historically good at keeping the reins pulled tight, even as the perceived need for austerity subsides.

When the general consensus would seem to be that recovery is not happening for all citizens, perhaps that situation can be helped if a minister is appointed in the next government with sole responsibility for disabilities?

Let’s see where we would appear to be at after 5 years of the Fine Gael / Labour coalition. Ms. Lynch lists among her government’s achievements the implementation of free GP care for under-6s and over-70s, and raising awareness of mental health issues; for advances, she has pointed to improvements in (among others) perinatal mental health, and dual diagnosis – all of these are potentially beneficial for the lives of people whose care may be served by multiple areas of the healthcare system.

Regarding free GP care, it would appear that extending it to all citizens is not on the cards, given that the outgoing government believed us to be light on GPs anyway – everyone knows that keeping newly-qualified GPs in Ireland is a concern. But in a government where Lynch’s voice was being heard, we might have expected free GP care to spread to a broader age range at least. At any rate, that whole area is set to occupy a large part of any new healthcare administration’s time over the coming 5 years.

The modern world gives us more than enough reason for close attention to the issue of mental health – the challenges are greater, and coming from a wider range of contributory factors now than ever before.  The outgoing government did make efforts to increase independence for people with disabilities, and those with mental health problems, and at least propounded the idea of strengthening primary care services by consolidation of GP practices into primary care centres.

Inclusion Ireland have expressed concern at the lack of attention to disability in various organisations’ short-term plans (see http://www.inclusionireland.ie/content/media-releases). Examples, among others, are the Irish Human Rights and Equality Commission IHREC Strategy 2016-2018, the delay in implementing a volunteer advocacy programme in residential centres as advised by HSE following the Áras Attracta events, and the poor state of respite care services. During the early days of the last administration, http://IrishHealth.com observed that Minister Reilly needed to kick-start hygiene inspections by HIQA in healthcare settings. Add to these the concerns raised by various groups with the intrusive nature of those highly valuable HIQA inspections, and there would seem to be enough material to occupy a minister exclusively for a significant part of the next government’s tenure.

The Assisted Decision-Making (Capacity) Act 2015 has served to repeal the Victorian-era Lunacy Regulation (Ireland) Act 1871 and the Marriage of Lunatics Act 1811. The arrival of this legislation means persons with intellectual disabilities can make decisions for themselves in law. The new Act also removes a significant barrier to ratification of the UN Convention on the Rights of Persons with Disabilities (UNCRPD). This is surely a game-changer that will require some focus from the incumbent minister(s), senior or junior.

However, the focus of government to date, on simply smoothing the way for business, to the exclusion of other concerns, (“best little country to do business in” etc.), has meant increased disillusionment among the people who depend on government to provide adequate care and basic services. Moves towards the privatisation of water and public transport, the placement of private consultant services above public treatment in publicly-funded hospitals (which many believe to be the genesis and growth of the trolley problem), all are contributing to the national sense that profit is the purpose of good government, not the provision of a workable social and healthcare system for the people as a whole.

The obvious effort to “remove public housing from the nation’s balance-sheet”, which amounted to the dismantling of county-council-based building and maintenance services, is patently aimed at giving over this public concern to private interests. This has resulted in the building of little or no public housing in the period of the past government, which means homelessness for a considerable section of the population, and it is a major cause for concern throughout the country. Add to this the alarming situation where existing houses in the public system get boarded up for months on end with no repair or maintenance, and you have a population raising a serious eyebrow.

Simply put, the political tenet that economy wins over everything else is fuelling discontent. Most people in a sophisticated, educated society acknowledge that modern market-based economic conditions demand countries to be financially viable, but governments appear to be stumbling into electoral failure by working to that belief and ignoring the necessity for public services to remain public.

Fiscal function and the profit motive together can serve to change the focus of organisations or companies away from the provision of services, and swamp efforts to make a thriving economy serve all of its people equally. Compassion is easily relegated to the sidelines in this scenario, and history has shown time and again that there is much to be lost socially when we let that happen.

The last government spoke of the possibility of splitting the Senior Health ministry into two, one for urgent care/hospitals, and one for social services and primary care – this sounds interesting. One likelihood for people with disabilities and their families is that they will have greater need of more of the services typically provided by a healthcare system, than people without disabilities.

The provision of a junior ministry at least with sole responsibility for disability would seem to make sense, given that resources would appear to go to those that make most noise at budget time? We all know that one of the keys to unlocking budgetary resources is accountability – surely this separation of health functions would go some way to easing the job of reporting cost and expenditure information. The question there is, does government want financial information easily available to the public?

And of course, if you are more concerned on a national basis with profitability than care for those of us less fortunate, then carry on as before. Perhaps though, it is something for such a minister to bring to future discussions with government – to separate resourcing from finance generation and allow the principle of adequate service provision at least a competitive voice in the fight for resources in this more affluent modern world? If that voice was as strong and interested as that of Kathleen Lynch in the previous Dáil, it would be no bad thing.

Jerome CorbyJerome Corby is copy-editor for Frontline Magazine, and an interested citizen.

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