Fair Deal: fudging a political hot potato

Government can’t risk the wrath of the ‘grey lobby’ by increasing charges, but it needs to do something to address the root cause of the hospital trolley crisis

 Minister of State Kathleen Lynch: on a damage-limitation exercise.  Photograph: Alan Betson

Minister of State Kathleen Lynch: on a damage-limitation exercise. Photograph: Alan Betson

 

Quick to deny that older people will be asked to fork out more for Fair Deal nursing home packages, Minister of State Kathleen Lynch has been less clear about where the extra funding for the scheme can be raised. Despite the financial pressures on Fair Deal, Lynch says the existing contribution levels will not be changed.

It wasn’t hard to detect the influence of political handlers when she appeared on radio attempting to clarify remarks made to the Oireachtas health committee a day earlier, when she bluntly told TDs the scheme was unsustainable.

“The notion that you would pay €260-€290 for a service costing anything up to €1,200 is unsustainable,” she said. She added that the State would pick up only “some” of the extra cost of the scheme.

With politically embarrassing front-page headlines reporting the only reasonable inference from her remarks – that extra charges would be levied on the users of the scheme – Lynch went on a damage-limitation exercise.

 

No explanation

 

The problem with her remarks is that no explanation was forthcoming as to where the extra money – at least €30 million, then another €30 million in a second year, and so on – is to come from.

Lynch kicked to touch, saying she did not want to pre-empt the findings of a review of the scheme. This is the review promised in the programme for government and promised with predictable regularity since.

Now, nearly four years on, the Minister is saying the report will be ready next week. This is welcome but, given the urgency of the situation, it’s astonishing it has taken so long. People are waiting months to get on the scheme and the budget is running out two-thirds of the way through the year.

Lynch says she wants a “demand-led” scheme, which seems to involve the removal of the existing budget cap. If agreed, the funding tap could then be turned on to reduce waiting lists when required.

Even if other Ministers agree to it, extra State funding for Fair Deal would have to come at the expense of other badly needed health services.

 

Restructuring

 

Another possible solution is a restructuring of the scheme so it funds both nursing home placements and home care. One of the faults of Fair Deal is that it effectively forces some older people into a nursing home prematurely, because this care route enjoys stable funding vis a vis patchy home care provision.

The point has been illustrated by Age Action Ireland, which gave the example of a man in his 80s who is incontinent and living at home. He has been told by the Health Service Executive he can have three incontinence pads a day at most. Such petty restrictions serve to drive older people into residential care.

Making Fair Deal money available for home care makes sense, but it would require a change in funding arrangements. It is feasible at present to require people to contribute 80 per cent of income to the cost of a nursing home place. Where a person stays at home, they will need more of their pension to pay for heat, light, food, etc.

Fair Deal is a political hot potato for the Government. In the run-up to an election, it can’t risk the wrath of the “grey power” lobby, as did the previous government, by imposing extra charges. But it has to do something, because Fair Deal delays are the root of the hospital trolley crisis.

In these circumstances, expect a fudge that will avoid the imposition of politically embarrassing charges and yet keep the system barely ticking over until after the election.