Ireland was the first country to agree an international bail-out with the ‘Troika’ of the European Commission, International Monetary Fund (IMF) and European Central Bank (ECB). The successive agreements between the Irish government(s) and the Troika have included quite severe wage and pension decreases in the public sector, besides a major on-going reform of welfare spending to introduce synergies with employment activation. Specialist social work and care services have however remained largely outside the scope of the agreements between Ireland and the Troika.
In the past few years Ireland has implemented a series of ‘austerity’ budgets and is perceived as making such good progress that it may no longer face such regular Troika visits after 2013. However, economic indicators remain problematic: unemployment rose from 6% to 14% from 2008 to 2012; the country’s gross debt increased from 44.5% to 117.6% of GDP; the number of people at risk of poverty and social exclusion rose from 23.6% to 29.9% in the same period. (Source: European Commission)
Public sector employment cuts
ESN members from Ireland point to the ‘employment control framework’ as the most significant impact on social services.This moratorium on recruitment and promotions in the public sector was first put in place by central government in 2009 to help stabilise health (and social care) spending, which had been expanding rapidly. It follows an earlier pause in recruitment in 2007 at the initiative of the Health Service Executive (HSE), which funds or provides most social work and care services, next to its focus on health care services.
Staff spending accounts for around 85% of the HSE’s annual expenditure. Its 2013 budget is set at €13,404.1 million, a reduction of €3,300 million (22%) compared to 2008. Currently the HSE is required to lose 500 posts per month by the end of 2013 in order to reach the government’s target of 98,955 staff on top of a reduction of 11,000 posts since 2007.The Irish Examiner highlighted that Ireland was liable to pay a €30million EU fine if it spent an “unsustainable” €217million on agency workers again this year, as it had in 2012. It comments that the employment control framework makes it almost impossible to recruit permanent staff, leading – ironically – to a reliance on agency workers.
Impact on health and social care
The most direct impact of the Troika came in mid-2012 when they became aware of a potential overspend of €500 million by the HSE by the year-end. A scramble to identify some €135 million of “cost containment measures” then followed. An HSE press release at the time claimed that “every effort” had been taken to target areas that do not impact on direct patient services, but it was “inevitable that some impact on service delivery will be experienced” as a result. Besides various savings in administration, a €10 million reduction in the budget for personal assistance to disabled people was announced. It was later retracted in the face of demonstrations by disability interest groups and providers outside Parliament, causing a public outcry.The savings would instead be found through further administrative measures under headings, such as travel, training and catering. Other reductions in home-help hours and home-care packages went ahead.
ESN members also reported that HSE managers had an agreement with the government to introduce early intervention teams for children with developmental disabilities, but this has been virtually impossible to implement because of the inability to recruit staff. There may not be adequate day-care places for next year’s disabled school-leavers, so even access to traditional services is at risk. To deliver real personalisation and support for independent living, HSE would need to be permitted to recruit more social workers, personal assistants and other support staff.
There is a difficult balancing act in the area of elderly care between residential and home-care provision. The Irish Examiner reported that the “HSE’s 2013 service plan foresaw the closure of between 555 and 898 public nursing home beds as a result of agency and overtime cuts, retirements, and facility failures to meet new infrastructure standards. The HSE claims the move will focus care on those in most need, with some elderly people receiving cheaper home help packages.” A cut of 0.5 million hours (from 10.8 to 10.3 million hours) of home help in 2013 is among the measures that allow for a cut of 2.3% in older people’s services compared to 2012. Meanwhile, public funding of residential nursing home places rises €4million to €998million, following an increase of €55million in 2012.
This signals the long-term challenge that Ireland and many countries face in coping with rising numbers of older people with chronic diseases and basic care needs. Ireland is renowned in Europe for its high General Practitioner (GP) visit charges (€60) and in a column last May for the Irish Times, Fintan O’Toole commented on the government’s failure so far to deliver its election promise to eliminate GP charges. He lamented the inaction, citing an expert report on health finances commissioned by the government: “High pay-as-you-go GP charges are known to deter use of care, increasing the risk of later detection of medical problems, with the likelihood of higher costs in terms of healthcare in the longer term.” At the same time, the HSE is working to introduce a Single Assessment Tool (SAT) for social and health care for people with complex care needs to help them stay at home longer.
Another area of reform is in children services. A new Child and Family Agency is in the process of being established. It will bring together the functions of three State agencies in the wake of a series of reports on child abuse and child deaths, which all point to “the fragmentation and silos that exist in services is the systemic cause of the failure to meet children’s needs”, according to a government taskforce. The Irish Association of Social Workers (IASW) warned in a letter to the Irish Times that “social work staff numbers in Ireland were at 30% of the numbers in England or Northern Ireland” even before the crisis and “due to more recent cutbacks and embargoes, those numbers have fallen further.” The IASW believes that there has to be a substantial recruitment of social workers if the new agency is to deliver its obligations.
The latest Troika review mission identified unemployment as a “key challenge” and sees the ‘Pathways to Work’ programme as a move “in the right direction”. According to Joan Burton TD, Ireland’s Minister for Social Protection, the programme is “about making services more integrated [...] through merging our unemployment payment systems with the job-activation services.” The Troika stated that “significantly more resources are needed to ensure meaningful engagement with job-seekers, especially the long-term unemployed.”
Ireland seems set to exit the Troika programme in early 2014, but the reverberations of the crisis and the ensuing austerity policy will surely be felt long afterward by people receiving health and social care and those working in the caring professions in Ireland. There are positive reforms and strategies in several areas, but the principal challenge will be having the right staffing mix and volume to deliver change and meet the needs of the people.