THE UNSEEMLY rush by the Department of Health to minimise its involvement in public nursing home care should be reassessed. There is broad acceptance that current financial constraints will impact on services. But the bean-counting approach taken by Minister for Health James Reilly, when he warned that all public nursing homes with fewer than 50 beds are at risk of closure, should be challenged.
As Ombudsman Emily O’Reilly observed: “the provision of health services requires some genuine engagement with ordinary citizens”. Such an approach has been singularly lacking in the behaviour of health authorities. Nowhere has this been more evident than in a unilateral decision by the Health Service Executive (HSE) to close the community nursing home unit at Abbeyleix hospital. Public protests and a High Court challenge by three elderly residents caused the HSE to suspend that decision and to offer a three-month “meaningful consultation process” during which all relevant matters, financial, medical and the concerns of residents would be considered. That response is at odds with the approach taken by Dr Reilly and the chief executive of the HSE Cathal McGee at an Oireachtas committee last week. Where they were concerned, the issues appeared to boil down to economies of scale and cost per resident.
Nobody is arguing against a need to ensure value for money. But when comparisons are made between the cost of keeping an older person in a public or a private nursing home, then like should be compared with like. The HSE and Dr Reilly quote an average difference of €500 a week between the cost of private and public care, more where small nursing units are concerned. That differential appears to offer a compelling case for public bed closures. What the figures do not show, however, is that public facilities tend to cater for acute patients and may offer better quality nursing care and a broader range of services. In addition, the cost of tax breaks for the construction of private homes is ignored.
There is a worrying tendency to farm out healthcare to the most competitive bidder. It has been most pronounced in relation to nursing homes. That should not surprise, given the past shabby treatment of older patients by State agencies. Excuses offered for the closure of most remaining public beds range from the quality of accommodation, to staff costs and economies of scale. Nowhere are the wishes of those in care, their families or their communities addressed. That approach to the provision of public health services must change.