The current debate on the Otago DHB's decisions to reduce some aspects of its aged care provision is in danger of becoming a single-issue one.
One side is apparently hellbent on cutting costs in aged care and the other side is adamant that old people will be put at risk and it must be stopped.
But is it really a single issue? I don't think so and we do our community a disservice if we don't look at the wider issues.
It's for precisely those reasons that I have supported the need to make reductions in some of our service delivery.
Let's start with some facts.
Otago has more elderly people than the national average and so we would expect to deliver more services than the national average.
However, you can adjust for this, and when you do, you discover that we are actually providing 28% more rest-home beds in the over 75 age group (and even more if you include the 64 to 75 age group).
This begs some questions, not the least of which is whether we are doing enough to keep people in their own homes.
We know that most people would prefer to stay at home as long as they can and we know that we are putting them in rest homes in Otago earlier than average.
The clear implication is that we may not be doing as much as we should to help people stay at home in Otago.
Well, yes, I hear you say, but at the same time you have announced that you are cutting out the very care that allows people to stay at home.
Really? I think we need some more information as it's clear that, generally, people do not understand the range of care services that are provided and the differences between them.
There are a whole pile of support services that operate, including meals on wheels, district nursing services, day services, domestic support and personal care.
It is clear that the distinction between the latter two is not well understood.
"Personal care" has as its primary target keeping someone in their home. This includes things like helping with showering, dressing and the like. It may be accompanied by "domestic support", which includes things like cleaning and vacuuming.
Almost all people at risk of rest-home care will be receiving personal care and there is no proposal to reduce this.
On the other hand, there are 2400 people who receive between one and two hours a week of "domestic support" but do not require "personal care" services. These are not, by and large, the group of people at risk of rest-home care.
It is this group (and, in fact, the subsection of this group that are classified as low-need) that are likely to have their support significantly reduced or removed.
It would be wrong to suggest that everyone in this category does not require the support and that is why it is important that a review process be available, and it is.
So that's some background for those who want to come back to the single-issue argument.
Because this is not one.
A DHB gets a finite sum of money and has to allocate that across its services. There is never enough to do all you want and so you rank what you will do in order of priority.
When we are spending approximately $9 million more than the national average on these services, we have a duty to look at that.
We also have to compare that spending against things we cannot afford to do at present.
We have a neo-natal intensive care unit that does not meet standards and puts babies at risk of infection.
We have a Dickensian mental health ward that we cannot afford to replace.
We have substandard facilities in the likes of paediatrics, intensive care, ED, and I could go on.
We have recently been taken to task for under-delivering on colonoscopy services because we do not have the resources to do them.
I could go on.
My responsibility as a board member is to ask myself the following:Is providing a disproportionately high proportion of our population with an hour a week of vacuuming a higher or lower priority than the above? An entire board, who really do give a damn, have decided that it is not.
I understand that most individuals affected will feel that their needs justify it, and I know that there must be sufficient flexibility to cater for those with exceptional circumstances.
But you cannot justify not addressing this spending when so many other people miss out on care or receive substandard care because there is not the money to fix it.
And there is more to be asked than even just this narrow question. I don't have the answers to them, but that doesn't make the questions any less legitimate.
What are we entitled to? If I am under 65 and want someone to do the vacuuming I have to pay them.
Yet there is an assumption in this debate that those having it provided by the DHB cannot or should not do likewise.
Accepting that there will be many who cannot, is it reasonable that people of sufficient means to pay for a cleaner should not have to do so?Where do families fit into all of this? I listened to someone on talkback complaining that he would have his vacuuming removed.
He said his son lived just round the corner, but why should he have to help? Accepting that there will be many people who do not have close family, is it reasonable that family members should expect others to pay to discharge them of that responsibility?Where does neighbourhood and community fit into all of this? More of us need to look over the fence and lend a helping hand.
That is something the community can do. It does not require 10 years of training. It requires some basic humanity.
Perhaps some of the energy going into this debate needs to be redirected into asking some basic questions of citizenship.
• Richard Thomson is the immediate past chairman of the Otago District Health Board and a current member of the board. This article represents his own personal views.
