A health system that supports and empowers you to achieve your full health potential - that's the vision of the new health strategy from the Department of Health. Fine words indeed but what do they mean to the fastest-growing group of health services users - older people?
Last week the Government published the strategy, a blueprint to guide policymakers and service providers in the health service for the next seven to 10 years.
It addressed a wide range of issues, from more effective preventative work to the development of major acute facilities.
Special provisions have been included in the strategy for four key population groups - children, people with disabilities, people with mental illness and older people.
In the area of community services for older people, a programme of investment is planned for the recruitment of a range of staff to support the development of primary-care services such as domiciliary care, day and respite services.
The strategy pledges an additional 7,000 day centre places and increased funding for aids and appliances in people's homes. A grant will be introduced to cover two weeks respite care per annum for dependent older persons.
A coordinated action plan to meet the needs of ageing and older people will be developed by the Department of Health and Children in conjunction with three other Government departments.
Community groups will be funded to facilitate volunteers in providing support services such as shopping, visiting and transport for older people.
An action plan for dementia, based on the recommendations of the National Council for Ageing and Older People (NCAOP) will be implemented, the document states.
NCAOP is an advisory agency on ageing and the welfare of older people.
Governments are never short of reports, recommendations, strategies and action plans. Such aims and initiatives are only worthwhile if the funding and structure follows to back them up.
So is there much cause to be optimistic with this wide-ranging piece of work? The NCAOP seems to think there is.
Mr Bob Carroll, director of the NCAOP, said the council is reasonably positive about the Health Strategy. "We feel our priorities have been addressed by and large and the aspirations of the strategy are to be commended. The promise is there but the delivery needs to be looked into."
Lack of integration of care between and even within some services has been identified as a problem in the existing services. Individual patients may have to access the system several times to have all their needs addressed. Mr Carroll is pleased to see provision in the strategy for a more holistic approach in planning and developing care.
"We need to see packages of care for groups with multiple needs and this is an encouraging development," he said.
One of the strategy's objectives is to take action to ensure the appropriate care is delivered in the appropriate setting, another favourite principle of the NCAOP.
The example is given in the existing system of older people being cared for in acute hospitals due to the unavailability of more appropriate extended care facilities or community supports.
"The emphasis on consultation with the clients is also very important. Having the central principle that patients should be at the centre of the delivery of care is definitely a step in the right direction," Mr Carroll said.
The Carers Association is less enthused about the content of the new strategy. Mr Eddie Collins-Hughes said the association was quite disappointed with several of its aspects.
"There is virtually no reference to family carers in the strategy and no recognition of the work they do in providing more than 90 per cent of all care in the community," Mr Collins-Hughes said.
Quite a number of measures relating to carers don't have implementation dates and are subject to budget provision, according to Mr Collins-Hughes. "We will be looking for further clarification on a number of issues but our members certainly can't wait for 10 years for gradual improvements."
There is a commitment to reviewing the Carers Allowance in the strategy and Mr Collins-Hughes firmly believes that the means test for the allowance should be scrapped.
Mr Maurice O'Connell, chief executive of the Alzheimer Society of Ireland, agrees. "The means test is an insult to people who are prepared to give up their work or earning power to take on care that would otherwise be the responsibility of the State," he said.
However, Mr O'Connell is encouraged to see that there has been a change of heart at the core of the health system. "We welcome the principles that are going to effect the change but are a bit worried that all of the money will be spent on the acute rather than the home environment," he said.
His organisation is keen to see the development of community services for people with dementia. Most of those diagnosed with the condition are still living at home.
"I think the whole integration of care between the different services in the system is where we will find the greatest benefit," Mr O'Connell said.
His organisation says it has been lobbying very hard for dementia-specific services. The society estimates around 30,000 people are living with some form of dementia in the Republic.
"We feel that, if the Government is serious about putting quality services into the community, it must be focused on the person, with specific services for specific groups."
Mr O'Connell said the delivery of services over the next few years was what really mattered.
On the issue of access and funding, the Nursing Home Subvention Scheme is up for review. The strategy notes that a large number of older people would like the option of receiving care in their home rather than in a nursing home.
A recent expenditure review of the subvention scheme showed that it does not effectively support home care - and that's putting it mildly.
The new strategy announces that the Government intends reforming the operation of existing schemes, including the Carers' Allowance, "in order to introduce an integrated care subvention scheme which maximises support for home care".
Mr Collins-Hughes claims only one in five carers or 18,000 people are currently receiving the allowance.
It clearly makes sense for people being cared for at home to be eligible for subvention, according to the NCAOP's Mr Carroll.
Older people should be free to stay at home as long as possible and return home as soon as possible, he said.
The NCAOP has researched what health means to older people and it found that pathways to care and information about services were critically important.
The council welcomes the strategy for tackling waiting lists.
"Anything that improves health services for the general population has a beneficial impact on older people who are important users of those services."
Mr Carroll believes the vision contained in the new health strategy will make a huge improvement in health care. The patients and clients of the system can vote on the result in 10 years time.
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