We aren’t good at joined up socio-economic thinking in this state. As we move from the depression to the recovery, now would be the time to put in place some of the elements to solve longstanding issues. All the evidence is that the state wont, as it seems to be immune to evidence based policy .
Take the perennial health crisis. Right now the epicentre of concern is around the disgrace that is the trolly system. Anyone who has spent some time on a hospital trolly knows that they are not suited for anything other than the shortest stay. People spending hours or days on trollys or chairs is simply unacceptable. They are there because they cant be accommodated in wards. They cant be accommodated in wards for two reasons. One is the effect of the cuts. We have 2.9 beds per 100 persons, versus the OECD average of 4.2. In real, purchasing power adjusted terms, we spend 6% less per capita than the OECD average on health. Above that however we have a dysfunctional pipeline. People end up staying in acute hospital beds because there is nowhere to which they can be safely discharged. Having cut back on home help, and having outsourced (as with so much else) nursing home provision to the private sector, elderly and ill persons who could be in situations other than acute beds remain there. And then they system clogs up. The obvious solution, of opening wards and restoring home care packages seems not to be on the table. There is little evidence of joined up thinking
A second and third set of issues are in the education area. There is overwhelming evidence that structured, professional early childhood education and care pays enormous dividends later on in life. These are social, economic, educational, emotional and health benefits. An oireachtas report in 2012 lays out these in very clear terms. A return of 16 fold over expenditure is not unusual. It also lays out the components of excellence. Again, despite the evidence, we are not carrying through. The total public spend is less than 2/3 the average OECD spend on child and pre-primary education and care. Thus the burden, again, is outsourced. Irish Childcare costs are eyewateringly high. As a % of average wages Irish childcare cost is typically twice that of the EU or OECD average and is the second highest as a % of family net income, 2.5 times the OECD or EU average. The burden is disproportionally higher for lone parents. As a consequence Irish children are less likely to be in formal childcare than the OECD or EU average, and to spend less time there. Irish grandparents are more likely to be informal childcarers than others in the OECD. There is nothing wrong with informal childcare – but it should be a choice and the evidence is that it is usefully complemented with formal structures. A further element of excellence is that childcare and early childhood education workers be professionals, and paid as such. Yet the evidence is that they are not, with many earning barely over minimum wage. So, in sum we have a sector that pays enormous dividends, where we as a state will not invest, and which we have structured as to be inaccessible or enormously expensive for families to access. Where is the logic in this?
Children grow up, however they are educated. And many of them go to university. Irish universities have had enormous cuts in spending over the last half decade, while increasing output. Despite the evidence that we spend less as a percentage of national income than the average OECD nation, and have not increased the share of spending since 2000 (in contrast to the OECD average), there is an unwillingness to face up to the looming educational crisis. The boom in children now emerging in primary schools will translate, inevitably, into increased demands for third level places in a dozen years or so. Every single independent examination of the finances of the sector conclude a need for both greater sustainability and a greater certainty in funding. Some form of student contribution will inevitably be part of this, yet successive governments have kicked to touch. Much is made of a commitment to increasing educational attainment at this level by not excluding persons on foot of a fee requirement. This is in contrast to the evidence that there was little sustained increase in access consequent to the removal of fees. Again, evidence is ignored when it is politically inconvenient.
We are poor at evidence based joined up government. And yet we keep electing the parties and individuals who deliver this dysfunction, while saying we want a properly functioning system. Our actions and our words are in conflict.
A column published in the Irish Examiner 14 March 2015.