"...The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped. " -  US politician Hubert H. Humphrey.

OK, it's a little lazy to start your article with moral guidance from some historical figure, but in this case it's relevant because it's true, and some crazy people would actually agree with what the former US Vice-President said.

And apologies that we are reduced to Googling for moral guidance these days. Because if you're setting out to look for for a moral template from the present Government, you'd be advised to take a heavy coat, some sandwiches and a torch, because it will be a long, cold, dark and lonely search.

Hubert Humphrey's words should be repeated ad nauseam by Mary Harney and her beleaguered colleagues. Because any illusion the present Government might have had about its commitment to looking after vulnerable people slithered down the moral plughole at around 10pm on Monday night last.

The old cliche is that a picture tells a thousand words. The Prime Time documentary film of a distressed elderly lady being force-fed by a home "care" worker from a private agency used with unsafeguarded alcacrity by the State provides a shocking but succinct summation of many aspects of the health policy of our current political leadership.

And in terms of serious fault-lines in our societal attitudes, the Prime Time horror story also echoed WB Yeats' references to those who who "fumble in the greasy till" and "add the halfpence to the pence". This greasy till- fumbling comes to you courtesy of our political and health service leaders.

Yes, and I'll bet you're thinking it right now, these are the same people who frequently lecture us about our moral, ethical and financial responsibilities.

And how are the "business" attitudes of the less ethical among us going to change if they know Governments will allow then to operate unhindered by guidelines or regulations?

In terms of looking after vulnerable older people, and indeed with pretty much anyone with illnesses or infirmities in our Godforsaken statelet, the tried and trusted policy can be summarised as follows:

Provide a bare-minimum and often inefficient State service and shunt aspects of the responsibility for this service elsewhere, for example the private sector. In fact, you can even go as far as to deny your legal responsibility to look after the elderly, as happened recently.

And don't, whatever you do, regulate any aspect of these services except, of course the bottom-line aspects. Because in our current system, the first rule is cash is king, and that was long before we started running out of it.

And the second rule is...there is no second rule.

If the Prime Time revelations have showed us nothing else , they have demonstrated the downside of unleashing market forces on healthcare provision.

The disturbing thing is some of these less palatable market forces could be force-feeding or neglecting one of your loved ones right now.

Wait a minute, I take back what I have just written about regulation. The current Government and the health authorities doing its bidding have been very diligent indeed about regulating the safety of services - after a particular scandal in which people have been misdiagnosed, mistreated or abused breaks in the media.

Cue TV picture of minister/health official. We all know the know the drill by now..."blah blah blah.. I'm glad you asked me that...this is unacceptable...no idea it was happening...take immediate steps...guidelines/regulation sometime in the next millennium...nothing to do with us...wait...OK, it does have everything to do with us...yes I know I'm still in New Zealand but...meanwhile here's details of a phone number you can ring if you're worried...operators are waiting to take your calls right now."

And then we usually see the headline in the newspaper the next day along the lines of "Minister/HSE knew about this particular scandal years ago."

It's the politics of the latest atrocity. Regulation by scandal, healthcare by helpline. It's so predictable it could have been choreographed. It's not good enough, but it has been good enough for the Government and HSE to masquerade it as a healthcare policy for more years than we care to remember.

Ask yourself how any recent improvements in healthcare safety and quality assurance came about.

Yes, breast cancer services have been improved...only after shocking misdiagnosis scandals. Prior to this, a report recommending a safer system was left gathering the proverbial dust.

Nursing homes are now regulated and regularly inspected...only after a major nursing home care scandal emerged.

Something will undoubtedly be done about the proper reporting of x-rays...thanks to the Tallaght scandal.

Here's a Trivial Pursuit question for after the Christmas dinner. Which healthcare agencies/services are the only ones that are properly licensed and regulated at present? Answer - nursing homes.

Surely public hospitals are. Well, no. Private Hospitals? Er, no. Home care providers? A very definite no. And there are other services too, for example in the disability area, that do not have proper regulation.

Now you may say, and you would probably be right, that the vast majority of private and public service providers operate to pretty high standards and get most things right most of the time. But in the absence of a licensing system we have no watertight guarantee of this.

But back to the Government's appalling record on care of the elderly. And remember, the current Government in one shape or form has been in power for most of the past quarter-century. Inevitably, there's a list:

* Illegally charging public nursing home patients for their care.

* Allowing an inequitable subsidy system for private nursing home care to effectively pauperise many elderly people and their families.

* Not only this, but denying the Government has a legal duty to provide State care for all elderly poeple and mounting vigoirous legal challenges to those who sought court confirmation of this duty of care.

* Frightening the life out of many older patients with limited incomes by threatening to take away their medical cards.

* Thanks to a then unregulated system, allowing neglect and abuse of elderly people in some nursing homes.

* Imposing prescription charges on many elderly medical card holders. The charge, however small, is still a tax on the poor and vulnerable, and could rise further.

This "list of shame" demonstrates nothing but contempt for older citizens, many of whom, and it's a cliche but again it's true, have contributed greatly to the welfare of the State over the years.

It is a policy that in many cases has propagated neglect and abuse, both physical and financial. But it's not a policy you'll be hearing much about on the doorsteps from Government TDs brave enough to show their faces in the coming election.

Let's just hope that the next Minister for Health in March, whether that be James Reilly, Gerry Adams, Jan O'Sullivan or whoever, can finally stamp a proper safety and quality guarantee on our health service.

And more importantly, let's hope they treat our older and vulnerable citizens with the respect they deserve.

See also 'Home care regulation urgently needed'




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