Sir, – I refer to Paul Cullen's article on the funding crisis in the Fair Deal scheme ("Elderly to more for Fair Deal care", Front Page, February 13th).
The growing crisis has been a train coming down the track since the commencement of the Fair Deal scheme in 2009. The Department of Health instigated a review of the scheme in 2012 and yet three years later there is no sign of this report being published.
With the current resource cap on the Fair Deal funding scheme, this problem can only deteriorate as our over-65 population is growing by 20,000 per annum, of which 1,000 will require nursing home care. The supply of new nursing home beds is substantially lower than the demand requirement and this is as a direct result of the funding difficulties of the Fair Deal scheme.
If the Government is serious about addressing this problem, it needs to stimulate the private sector to build more nursing homes to meet the growing demand.
The current crisis situation in the nursing home sector will graduate progressively to a crisis in acute hospitals if the Government continues to sit on its hands. – Yours, etc,
Dr JONATHON ROTH,
Limerick.
Sir, – In 2009 I was appointed by the Royal College of Physicians of Ireland as joint lead to the HSE clinical programme for stroke following nomination by my colleagues in the Irish Society of Physicians in Geriatric Medicine.
The national programme has, it is generally agreed, been a success with substantial reductions in mortality, length of stay and improvements in care amongst stroke patients with increases in thrombolysis rate and discharge to the community and this has been thanks in large part to the hard work, effort and willingness to innovate amongst colleagues and clinicians across the health service.
Perhaps the most remarkable change associated with the programme has been the significant reduction in stroke patients being discharged to nursing homes.
At our last evaluation of the 2013 data, the number of discharges direct to nursing home from hospital had reduced by at least 23 per cent since 2009 and the savings associated with this have been estimated as around €40 million. The first six months of 2014 showed the lowest number of stroke patients admitted to Irish hospitals on record, so we would hope that this trend will have continued last year.
In one of his recent publications Don Berwick, health adviser to the Obama administration, held up the Irish stroke programme as an example of how to reorganise healthcare with very little resource, a fact that was recently mentioned by Minister of Health Leo Varadkar in an RTÉ radio interview.
On Thursday last, Minister of State for Older People Kathleen Lynch announced to the Oireachtas health committee that the so-called “Fair Deal” nursing home support scheme needed extra funding and that most of this would have to come from “new entrants”, ie patients.
While the fairness and justice of the “Fair Deal” has always been questionable, I think the injustice to stroke patients, for whom I have the responsibility to advocate in my current role, is particularly gross.
About a fifth to a quarter of people admitted to long-term care have suffered a stroke and for most of our patients such care represents a continuation of their medical therapy.
Put another way, it is primarily their need for continuing therapeutic input (nursing, therapy, nutritional and medical) as a consequence of brain injury that predicates their move to nursing homes not their need for new accommodation.
Few stroke patients want to be transferred to long-term care and the worst and most heart-breaking bad news I have to break as a physician is often not “you are dying” but “you cannot go home”.
The fact that stroke patients (and dementia patients, frail older patients, etc) but not, for example, cancer patients (or most recently patients requiring the drug Soliris) are forced to pay for their medical care to avoid excessive expense to the health service has always seemed inequitable.
The fact that these patients might now be expected to pay even more for their essential medical care is intolerable; indeed I wonder if it is even legal given previous established rights to such care.
In 2015 it is perhaps more intolerable and unjustified for stroke patients, given the acknowledged and lauded savings made from the long-term care budget since the creation of the national stroke programme, and without any substantial reinvestment in stroke care. The action would, in my opinion, be grossly discriminatory if implemented and would affect a large group of people often unable to protest or represent themselves.
At the same health committee meeting Tony O’Brien, chief executive of the HSE, described the “Fair Deal” as the “Achilles heel” of the health system.
Surely the existence such a weakness predicates a further discussion on how we provide long-term care, and indeed how we prioritise and fund health and social care in general, not a continuation of the same scheme in a more unfair and inequitable form. – Yours, etc,
Prof JOSEPH HARBISON.
Joint National Clinical
Lead in Stroke (Geriatrics);
Consultant Stroke Physician
and Geriatrician,
St James’s Hospital,
Dublin;
Associate Professor
of Medical Gerontology,
Trinity College Dublin,
Dublin 2.