The government’s National Health Strategy, launched nearly a year ago, is to inform the long-term development of Irish healthcare. Paul Horan, Lecturer in Nursing Studies, School of Nursing and Midwifery, Trinity College Dublin offers his critique of the document, with specific reference to the provision of healthcare to people with intellectual disability.


The Health Care Strategy: Quality and Fairness (2001), launched by An Taoiseach Bertie Ahern last Novembe,r has been championed by many as the panacea to all the woes currently afflicting the Irish health care system. The strategy has received a mix of approval and disapproval across the broad spectrum of society who work in or receive services from our creaking health care system. The election manifestos which lauded or disapproved of the strategy are now being lorried to the shredders in their tonnes. So what of the health strategy for people with intellectual disabilities? What does the strategy promise—improvement or more of the same for the Cinderella sector of Irish health care?

Shamefully the health strategy offers very little by means of solace or hope for persons with intellectual disabilities, their families or carers. Much of what it has to say concerning people with intellectual disabilities reflects what has been achieved over the term of the coalition partners’ tenure in office between 1997–2001. Suggestions that respite services have achieved a 70% increase in recent years are highlighted. The fact that 1291 additional people with intellectual disability are in receipt of services compared with 1996 (when the Intellectual Disability Database was established) is mentioned. Increased funding over the past five years is crowed about—a figure of £256 million is suggested.

Increased demand for services

There is, however, the recognition that there will be an ongoing and ever-increasing demand for services.

The strategy suggests that four key issues are contributing to increased demand for services:

  • Improved medical technology in all treatment for people with intellectual disabilities
  • Changing and altering family structures
  • The increasing age profile of people with intellectual disabilities
  • An increase in the identified incidence of autism within Ireland.

So if these are the key issues contributing to increased demand for services—what will the new Fianna Fáil/PD coalition government do to address the issues identified?

‘Responsive and appropriate care delivery’

The slogan chosen by the strategy to address the needs of people with intellectual disabilities, their families and carers suggests that in future services will be more responsive and that the services provided will be aimed to deliver care in an appropriate manner. The strategy promises a programme of investment, but does not state how much money will be invested. More investment will take place, but quite how much investment will be entirely another matter.

Increased places

There is the aspiration that there will be an expansion in day, training, residential and respite places. It is also envisaged that support services will be expanded in schools.

End to care in psychiatric hospitals sector for people with intellectual disabilities

The strategy also takes cognisance of the inappropriate nature of service provision to people with learning disabilities in psychiatric hospital settings. A complete programme of transfer out of psychiatric hospitals settings to appropriate environments is promised for all persons with an intellectual disability, not later than 2006.

Autism to get more money and database

Additional investments will also be made in the area of autism, with particular emphasis on the development of adequate support services. The development of an information system (this presumably means a database) will be established to provide accurate information on the number of people with autism. It is hoped that such a database will also highlight the service needs of people with autism spectrum disorders as soon as possible. The strategy gives no date or deadline for the achievement of this particular objective.

Primary care issues

To some extent, in addressing the issue of primary care, the new health strategy misses the boat for people with intellectual disability. Despite the philosophical and services-provision leanings of stakeholders in the intellectual disability sector with regard to provision of services in a community context, the strategy fails to take the importance of developing an adequate primary healthcare initiative for people with intellectual disability seriously. It would appear that future government policy on primary care will be geared towards a more generalist approach to care delivery for all. The strategy also suggests that the newly developed primary care team can provide much of what is already being provided by specialist services. With an already underdeveloped community and primary care approach within an Irish context for people with intellectual disabilities, the primary care component of the health strategy needs to be viewed with caution and dismay.

While it is welcome to see that intellectual disability services are being viewed as part of the overall primary care network, the strategy needs to go further and develop community intellectual disability teams within the new primary framework.


Overall, the health strategy is an admirable document and is to be welcomed. However, more substance is required to what can only be seen as the aspirations of a government for the provision of health services in an Irish context for the next ten years. A number of major issues will dog the strategy moving forward

  • People who require services
  • Professionals who provide services
  • The ever-shifting political landscape
  • The implementation of health and social policy
  • The money to provide quality, responsive and appropriate services.
  • A real and meaningful commitment to primary care in that health and social care will focus and the maintenance of good health for all regardless of age, gender and disability.

For people with an intellectual disability, their families, carers and services providers, the strategy is disappointing and lacking in real vision. It is now twelve years since the publication of Needs and abilities. What is required now is a new and improved direction in the provision of quality, appropriate and responsive services for people with intellectual disabilities. Such a directive force might sit well within a primary care context; however the strategy is vague on what openings may exist for this to happen. One final and damming point in relation to the 272 pages dedicated to outline the government’s strategies on health for the next ten years—nowhere within the action plan which provides the framework for the strategy to be delivered is there a specific target or objective relating to the ongoing health needs for people with intellectual disabilities.


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