Speech by Kathleen Lynch T.D., Minister for Disability, Equality, Mental Health and Older People At the Public Health Policy Consultation Day, 13th June 2011
I want to join Minister Reilly in welcoming you all here today for what I hope will be a lively, interesting and informative discussion on the development of a comprehensive public health policy in an Ireland which faces many challenges, both within the health sector itself and obviously on the broader economic front.
Given those challenges, it is particularly apt that we should draw on the good work that is already being done across many strands within the health services, and place these within a more specific high-level public health policy framework.
I want to keep my remarks brief and make a few relevant points insofar as my areas of responsibility, disability, mental health and older people, are concerned.
Firstly I should say that, without trying to generalise too much, there is recognition that poverty is associated with ill health. It is also true to say that people with a disability and or with mental health issues are more vulnerable to health conditions that are additional to their disability and or mental health issue. This is an area that I would particularly like to see examined further as discussions on overall public health policy develop in the coming months..
On the disability side, the focus in recent years has already been on trying to view this sector not just in a wider public health context but indeed, in a wider societal context. The Disability Act introduced in 2005, for example, sought to mainstream services previously delivered for people with disabilities within a health related environment. This, I believe, was an important first step in seeing disability not as a limiting condition for individuals but as something that required a broader and more inclusive support system from the State to enable such people to exercise their rights to participate, to the fullest extent possible, in economic, social and cultural life.
More recently, a public consultation with key stakeholders on the efficiency and effectiveness of disability services was undertaken which shows that people with disabilities want more choice and control over the services on offer to them and how they are delivered. This view is also emerging from the Expert Reference Group which has now delivered its Report on a review of Disability Policy to my Department.
The Report proposes what would be a very significant reframing of disability services with the introduction of an individualised budget for people with disabilities in order to put more choice and control directly in their hands. What is envisaged is that all public services, insofar as is possible, would be delivered by the relevant State providers. Individualised funding would then be allocated based on an independent assessment of each person’s needs which would result in individual support plans being drawn up from which the supports and services needed would be purchased.
A number of mechanisms are proposed to achieve this, including direct payments, where the person manages the budget and purchases the supports themselves, or a broker system, where the person still has the choice and control, but the broker administers the budget and contracts for supports and services on their behalf.
While this Report is now complete and has been the subject of internal consultation within my Department, the next step will be to consult with my Ministerial colleagues as the delivery of services for people with disabilities is more than just about what the Department of Health has to offer. The Report will also be the subject of a public consultation when individuals as well as advocacy groups can have their say about how future policy in this important area is shaped in the period ahead. This emerging policy, which takes into account an individual’s health as well as personal social needs, is consistent with an overall public health policy approach.
Of course no examination of issues or policies in the area of public health would be complete without also, and at the same time, giving equal attention to the whole area of mental well-being.
It is something that a lot of people can take for granted. However, I believe that when the State is considering a major initiative on public health, it must within that exercise give a priority of attention to the public’s overall health incorporating our mental wellness. We, as a State, should always seek to ensure that the systems, services and supports we put in place facilitate solutions across the entire area of the nation’s health.
In the area of mental wellbeing, we are fortunate to have progressive evidence based and realistic strategy documents on Mental Health and Suicide Prevention – A Vision for Change and Reach Out. A Vision for Change proposed a new model of service delivery which would be patient-centred, flexible and community based, with a special emphasis on recovery. The fundamental objective of Reach Out is to prevent suicidal behaviour, including deliberate self-harm, and to increase awareness of the importance of good mental health among the general population.
Despite disappointment at the slow rate of progress on implementation, it is also important to recognise and acknowledge that in many parts of the country, services are pressing ahead with the implementation of A Vision for Change and Reach Out
Mental health and suicide prevention is a priority for this Government. We are committed to:
- reforming our mental health service, in line with A Vision for Change and Reach Out, to provide more and better quality care in the community;
- ring fencing €35m annually from within the health budget to develop community mental health teams and services and to implement Reach Out;
- developing closer links between mental health services and primary care, a key recommendation in ‘A Vision for Change’.
It is also the Government’s intention to review the Mental Health Act 2001, which will be informed by human rights standards.
Initial work in terms of scoping out the review and drafting the terms of reference has commenced. The review will consider the extent to which the recommendations of ‘A Vision for Change’ could, or should, be underpinned by legislation as well as the provisions of the UN Convention on the Rights of People with Disabilities.
I intend to engage with the service providers, services users, voluntary organisations and stakeholders to develop our community mental health services and to implement Reach Out to ensure early access to more appropriate services for both adults and children.
All that said, I would like this review on Public Health to look long and hard at the mental health initiatives that would be helpful in addressing the real pressing needs of people in our Society who are struggling with their mental well-being, but do not, and probably don’t need to, engage with our organised psychiatric services. Many are dealt with at GP level and perhaps how this can best be developed and focused is the way to travel.
I would also like you to consider the wider role of the community and how it can support people in their daily lives. A combination of local effort, coupled with State backing through supports for the development of a vibrant community and voluntary sector may well represent a greater contribution to solutions than health services in many cases. Let’s have an open discussion on these issues. This is, I suppose, more relevant today than ever before in these times of recession that are proving very difficult for a lot of people in Society.
As Minister with responsibility for older people, I am tasked with bringing coherence to Government planning, policy and service delivery for older people. In this, I am supported by the Office for Older People. I believe that we are currently at a very important juncture in the lives of older people in Ireland. In common with most EU Member States and with other countries across the globe, our population will age quite rapidly from this point onwards, with all demographic projections pointing to substantially greater numbers of older people in the population in the years ahead. This will bring significant challenges and also opportunities. I believe that these challenges can be successfully met and the opportunities fully exploited by planning ahead now. As the World Health Organisation has pointed out, ‘societies that are willing to plan can afford to grow old’. If we are willing to be innovative, if we promote the co-operation of all sectors of Irish society, and if we set out to plan for the ‘greying’ of our population by developing sound, evidence-based policy choices, we will successfully manage the economics of an ageing population.
The current Programme for Government contains a commitment to complete a National Positive Ageing Strategy. An overarching plan that will set the strategic direction for future policies, programmes and services for older people. The Strategy is being developed within the constraints posed by the present fiscal situation. It cannot propose new service developments; rather it will set strategic direction for future policies, programmes and services for older people..
The new Strategy takes account of the fact that a range of factors impact on an a person’s health and quality of life as he or she grows older. Factors such as socio-economic status, housing, transport, education, employment and his/her wider social interactions. The promotion of well-being in later life demands a much broader perspective and will demand responses from all sectors of Irish society – public, private, community and voluntary.
However, not only is it vitally important to have joined-up thinking on older people’s issues across the public policy process, it is crucial that we also have hard evidence in relation to these issues, evidence on which sound policy choices can be based. In that regard, we are most fortunate in having the TILDA, the 10 year longitudinal study of the health, social and economic circumstances of a large, statistically representative sample of 8,000 people aged 50 years and over. The first of its kind in Ireland, TILDA will provide detailed information on all aspects of the participants lives, including health, economic and social dimensions.
This Government through its agreed Programme for Government will support older people to live at home and in their communities for as long as possible. We will achieve this through providing a wide ranging and flexible services such as Home-Help, Home Care Packages and Day Services and Respite care. Our other task is to ensure that these are quality services which have at their heart the safety of the older person.
Another area for which I have responsibility and which has been the subject of recent public debate is the Nursing Homes Support Scheme. The processing of approvals under the Scheme has re-commenced today. Approvals will be issued to those applicants processed to final stage in the chronological order in which they were received in the Central Office in Tullamore.
The Minister for Health has also identified savings, from other non-service related spending, which will be used to facilitate the payment of financial support to a net additional 1,700 people between now and year end.
I commend and support this venture to develop and progress a high-level policy framework which will support and bring to life the provisions as set out in the Programme for Government with regard to the future health and wellbeing of the Irish population.
Increased consultation and collaboration between Government Departments, health providers, voluntary organisations and the user of public services is the way forward. This will ensure that Ireland has a solid and fit-for-purpose public health policy for the future, particularly in light of the current economic realities.