Our citizens are not charity cases - they have a right to care services

I’M still seething, nearly a week later.

Last Monday’s Primetime Investigates programme showed the desperate situation facing a number of families facing terrible consequences as a result of the failure of our health and care services to provide adequately for their needs.

Some of the stories told would move any Irish citizen to tears of anger and shame. (You’d be much more impressed, as the week went on, to discover that our Taoiseach had been emotionally affected by the programme, rather than discovering that he cried every time he watched Riverdance.)

Immediately after the Primetime programme, Pat Kenny’s Frontline came on. Now, I have the utmost respect for Pat Kenny, as a person and as a broadcaster, but I watched in disbelief as his programme tried to set up a choice between Irish overseas aid — the support we give to the poorest people in the world — and the plight of Irish families facing cutbacks in services.

The programme brought on a self-appointed expert in foreign affairs to argue that our development aid — which has already been cut by a third — should be cut further, and some of the money spent on, as he put it, “special needs teachers or citizens”. The overall message of the programme was — and it was repeated several times — that charity begins at home.

To their eternal credit, the audience, which included a large number of the very families directly affected by cutbacks, didn’t buy it. They applauded Justin Kilcullen of Trocaire when he pointed out the invidiousness of pitting families in desperate hardship in Ireland against families dying in their thousands in sub-Saharan Africa. With one or two exceptions, it was clear that the people in that studio understood the moral argument far better than the so-called expert. And they were right. God knows we’ve spent hundreds of millions here on wasted effort and on vanity projects over the years. We’ve supported the wealthiest in the country with tax break after tax break, from everything to the racehorses they own to the luxury hotels they’ve built.

We’ve poured massive amounts of money down the drain on wrong, and frequently arrogant, policy choices. From decentralisation to Anglo-Irish, the waste has been phenomenal. If we had made better choices over the years, there is almost nothing we couldn’t afford still.

And even today, it’s not entirely about money. When you watch the Primetime programme one thing is clear. The money is still there to provide the services that are desperately needed — and to which those families are entitled. But the structure we have built to run and manage the health system is so huge and damaged and fragmented that it is incapable of making anything but bloodless, bureaucratic choices. It cannot respond to need with urgency and flexibility.

Change the structures and we won’t have to spend an extra penny. We certainly won’t have to listen to deeply offensive and frankly immoral arguments about how we could protect people who are vulnerable by screwing people who are deeply and utterly vulnerable.

But you know what the most offensive thing about the programme, and the discussion, was? It was the repeated use of the word “charity”.

Our overseas aid programme may have been based on a patronising notion of charity at one time — most of us of a certain age can remember putting small change into tin cups for the black babies. But now it’s based on principles of justice. We try to help the poorest countries of the world to be more self-sustaining, and we invest in healthcare and education in those countries.

And as a matter of principle we don’t tie that aid to anything in return, unlike some other countries — including those admired for providing “effective” aid by the Frontline panellist. That’s because we recognise — and why wouldn’t we? — that countries that have been colonised and exploited by the west for most of their histories need investment that is designed only to be of assistance.

The relationship between the developing world and the first world has been based for far too long on exploitation; from the era of slavery to the pillage of generations of natural resources, we exploited them. Overseas development aid, coming from a country that has its own experience of exploitation, is one small way of seeking to redress the balance. It’s a fraction of a percent of our wealth, and it’s never going to break us.

But the point never made by anyone on the Frontline is the most fundamental point of all. Even if there were any moral justification in arguing that less charity abroad could mean more charity at home, it is simply outrageous to argue that the people in that audience, or whose lives featured in the Primetime documentary, should be the beneficiaries of charity at all.

When did a decent health service become a matter of charity? People who depend on the health service are citizens with rights, and their rights are being ignored. That’s the real scandal, not whether charity should begin at home. Rights should be honoured at home. There was a time in Ireland, of course, when a charity model of care was the norm. Back then — and it’s not so long ago — people with disabilities, people with mental health problems, and often people with dementia, were locked up in large wards in awful institutions. There was a stigma attached to their conditions. If they misbehaved, they were medicated into submission, or treated with electric shocks. Many of the institutions had padded cells.

Of course, no one is arguing that we should go back to that. But you know something? The minute we start accepting that some people have a right to care, and others have a right to charity, that’s the sort of slippery slope we’re on. It might sound odd coming from me, who works full-time for a charity, but charity exists to supplement rights, never to replace them.

And we are on a slippery slope already, by the way. The revelation that the Fair Deal Scheme has effectively run out of money already means that a right to decent residential care when it is needed is now, once again, under threat.

How is the system going to choose between one elderly person and another when resources are scarce? Will it be done according to the severity of their need? Or the size of their bank balance? The ease with which their behaviour can be managed? When the money runs out, can it really be the case that we are going to compel frail elderly people to form a queue while we decide which of them deserves care and which of them doesn’t?

And if the care of elderly people is going to be made subject to the availability of money, what will we do when the resources run dry for autism? For stroke victims? For deaf people? For people with acute depression or schizophrenia? For teenagers who are self-harming or are causing trouble because of an addiction?

Will we have a hierarchy of deserving issues? Because that’s what happens when we start treating people as charity cases. We learn very quickly who deserves help. And who should be allowed to suffer.