John Gilroy (Labour)

I welcome the Minister of State, Deputy Lynch, to the Chamber. It is great to see my constituency and party colleague, friend and neighbour in the House. We could perhaps sort out this matter over a cup of coffee in Blackpool shopping centre.

I welcome the opportunity to discuss the fair deal scheme, which since its introduction in 2009 has been portrayed and widely viewed as the solution to an ongoing problem of securing certainty of delivery of services in residential care for older people. It was warmly welcomed at the time by all sides that the HSE would provide a level of funding for the scheme each year, which it was hoped would be sufficient to support all those wishing to avail of it. However, reports in the media, which I accept the Minister has addressed today, that the fair deal has run out of money, while disturbing, are not entirely unpredictable. The crisis in the fair deal scheme represents the latest in a series of crises that has bedevilled the HSE since its inception. At the core of the problem is a contradictory set of public policy assumptions. Policy decisions on health care provision are often contradictory and seldom coherent.

Deliberate political policy decision making has led us to where we are now. We have a highly disordered health service, not because the previous Health Minister's policies have failed but because they have succeeded, leaving us with the mess we are now in. The model favoured by the previous Government was flawed in that no serious attempt was made to properly restructure the service when the HSE was established. Policy goals were not identified nor were they communicated within the structure or to the general public. We see examples of this throughout the entire service. For example, in mental health services, there is a contradiction in the Department's stated goal to deliver services in the community. One objective, outlined in a plan drawn up 27 years ago, Planning for the Future, has still not been implemented. We can see coherent policy outcomes emerging in the cancer services area, but this seems to be the exception more than the rule. While in the 1980s and 1990s we might have been able to blame a lack of resources for this failure, this argument fails when we consider the economic success enjoyed by this country in the early years of this decade.

Services for older people are a good example of policy confusion. We often hear the population of older people referred to as a single homogenous group. However, we know, or at least we should know, that older people bring with them all the advantages and disadvantages built up over the course of their lives. Therefore, a one size fits all solution is not appropriate. Older people are often seen as a group to whom things need to be done. Again, there is a failure to see the diversity in value that older people represent. It is unfortunate that in some public comment there appears to be the underlying thought that older people are a burden. We need to consider our own views of older people and must come to recognise older people as valuable and a valued part of our community.

My colleague, Senator John Kelly, reminded me yesterday evening that many older people in residential care would prefer not to be there. The stated objective of the HSE service plan is to maintain older people in their homes for as long as possible. However, the incoherence at the heart of health policy makes this almost impossible to achieve. Funding arrangements for social care in Ireland have the effect of skewing demand for long term care in the direction of the residential option. The services available to older people are dispersed across a wide range of often unlinked schemes, including the fair deal scheme, home care packages, home help services, day care services, residential services and carers, a group much under-appreciated by the system. It might be thought odd to talk about restructuring the services at a time when the country is facing economic challenges but a coherent and new policy direction cannot just deliver a better service for our older people but would be economically more efficient.

As Labour Party spokesperson on health, I have much more to say on this issue but, perhaps, not today. The Seanad has an important role to play in discussing medium to long term policy and health policy is a good place to start. I have only barely scratched the surface of this issue and this House could usefully devote more time to discuss it.