Lectures – Page 2 – Alice Leahy Trust

April 16, 2012September 26, 2020 Alice Leahy Trust Lectures, News and Press

Human contact challenges us as Nurses to speak out

Athlone Institute of Technology
Department of Nursing & Health Sciences
Monday 16th April 2012

TRUST was founded in 1975 – see our website www.trust-ireland.ie for more information. Our work would not be possible without the enormous generosity and support of people from all walks of life, rich and poor, and even very poor. We have always said that in an ideal world there would be no need for TRUST – but of course this is not an ideal world.

“To be without a home is to be suspect. The homeless are easy targets. Their bodily integrity is constantly at risk. Their lives are an offence against the sacred canons of private property and consumerism. Their privacy is regularly intruded on as part of the price of being statistics in the poverty industry; their painful experiences are reduced to sociological research data. The true test of a civilised community is how people at the margins are treated. Not only must individual liberties be defended, but society should be educated and sensitised towards a broader vision of life and living. In an area dominated by the culture of individual acquisition, homelessness may have important lessons for us all.” – Dan Sullivan, then President of the Irish Council for Civil Liberties, describing what it means to be homeless in Ireland in a piece I asked him to write in 1995 for a book I co-authored with Ann Dempsey “Not Just a Bed for the Night” published by Marino Books in 1995.

The service we set up was the first of its type, and has been used as a model for services here and overseas. We are sandwiched between St. Patrick’s Cathedral and Christchurch Cathedral in the Liberties area of Dublin. We work in the basement of the Iveagh Hostel and are grateful to the Iveagh Trust who only charge us a nominal rent.

The philosophy of TRUST is based on two central principles:
The recognition of every individual’s right to be treated as an autonomous and unique human being.
The need to restore the dignity of individuals whom society has labelled deviant and undesirable.
Everyday we meet up to 60 men and women who sleep rough. We meet with people as they present themselves to us – all outsiders in our Capital City. Many come from outside the city, some from the remotest parts of rural Ireland, some returning to the land of their birth to be buried in the “old sod” and many from outside this jurisdiction. In February this year we had 15 different nationalities through our door. They came from Ireland, Romania, Latvia, Poland Czech Republic, Lithuania, Slovakia, Hungary, Estonia, Spain, Iran, Russia, Moldova, Slovenia and Canada. However, the numbers are decreasing – in February 2011 people from 25 different countries used the services of TRUST.

Many people we meet we have grown older with. Sometimes our place looks like a casualty department, as many people we work with will not go to A&E, and if they do go they will not wait, which obviously poses huge problems for hospital staff.
As part of a holistic service we provide bath and shower facilities. We have lobbied Dublin City Council to provide public shower facilities. Ironically, one of the best-known public baths in Ireland was sold by Dublin City Council and is now home to a very expensive gym, which is located just across the road from where we are based.
We seek to treat people as people recognising that they need help and have rights, especially the right to privacy and a right to be heard.

Hospitality is important. We provide tea and coffee, as we would welcome visitors to our own home and, most importantly, provide a listening ear. We frequently receive phone calls from members of the public about their entitlements and on behalf of people in prison and other institutions we know, with no one else to call. A lot of the calls we receive from members of the public are due to the frustration of having to deal with machines rather than an actual person. Many people we meet have no family contact, and often family members contact us about loved ones who have disappeared.
The people we meet are perceived by the wider society as being different and difficult; and indeed many are difficult. They suffer from the effects of isolation, neglect and health problems, exacerbated by what are often described as chaotic lifestyles. Accessing mainstream services – often basic accommodation is a major problem. We meet increasing numbers of people who were ‘re-settled’ in totally unsuitable accommodation, and then find themselves homeless again, an experience that often makes them feel even greater failures and more isolated.

People present to us with a wide range of medical problems including bodies that are ravaged by disease and violence. Some have pressure sores from sleeping out in all weathers, sometimes in urine soaked clothes for weeks; infected and untreated minor skin conditions and major skin problems e.g. leg ulcers and gangrene; as well as lice infected heads and scabies. In addition we often meet people who are suffering from malnutrition and all of the medical conditions common to the general public but exacerbated by their living conditions. We are now coming across conditions long disappeared since the advent of good food e.g. trench foot and impetigo (wild fire). These are conditions clearly associated with extreme poverty and many of the people who suffer in this way are our new neighbours from Eastern Europe, who like our own Irish who emigrated in the past. In addition we witness the consequences of racism, a new and worrying phenomenon in Ireland.

Some people we meet cope with very serious addiction problems, including drugs, alcohol and gambling. They suffer from despair and the pain of loneliness. They are pushed from service to service, often unable to get relief for minds at breaking point. These people are seen just as statistics in our increasingly bureaucratic world. Some people we meet have literacy and numeracy problems of which they are so often ashamed.

Many people we meet struggle to create a sense of normality after years locked away in institutions and others who have been relocated from one institution to another eg. psychiatric hospitals to hostels, much cheaper to run but often as institutionalised without the expertise available to them. Some people who are locked in prisons they have created for themselves, often out of the frustration of not being understood or ignored. Many people who were known to us have died on the streets and many more will. The true number is impossible to gauge because very often families feel ashamed that their loved ones ended up on the streets – some didn’t even know. The lifestyle of many who died would have been a contributing factor to their demise. A number of people we knew ended their own lives tragically and others have attempted to.
We meet some people who are so cut off from everything around them that they at times appear to be beyond reach. Others however challenge and inspire us every day to look at the way we all live our lives.

My last book was entitled “Wasting Time with People?” This title I chose having read a piece in British Medical Journal by Simon Challand, a former Medical Adviser from the UK in Uganda about the advice he had received from “an African Bishop with a smile –“ “Waste time with people”… You Europeans are always concerned about projects and budgets. The African does not worry about them–just waste time with people”. He gave me this advice in 1996 shortly before I came out to work in Uganda. Since then his words have kept coming back to me, and I reflect on their truth and wisdom and how difficult it has been for me, as someone with European values and attitudes, to apply them.” A contributor to the book suggested the question mark in the title. I am sure there must be times if you were honest with yourselves when all of you or at least some of you must ask yourself that question too.

The following description of nursing was used to promote nursing as a career which I noticed a few years ago – “Nursing is inextricably linked with life. What other career permits practitioners to be present at birth, death and every life enhancing moment in between? Equally while few careers offer such opportunities to share in and care for the lives of others, nursing is about self-development too”.

This perhaps captures what nursing is about – or do you think so? Nursing challenges us too to look at our own humanity and vulnerability especially when working with vulnerable human beings and the current changing climate.

All contact with human beings moves us and when it doesn’t it is time to question why we are nursing.

Has it become all too easy to just become technicians and report compilers than listen to or touch fellow human beings. Have we lost ourselves to bureaucracy in the name of progress and are we afraid to even speak simple language to express human needs, not just that of those we provide services for but our own needs and those of our colleagues?

After one year working with TRUST, which we founded in 1975 we decided to compile a report. This document now makes depressing reading because it illustrates how little has changed for people apart from closure of small hospitals, changing landscape of the city and of course technology. From what we see on a daily basis it would appear that the most difficult people were ironically better cared for then.

However, while we may have made a valuable contribution to the development of services in that our approach has been used as a model for the delivery of care we find ourselves increasingly isolated because we insist on highlighting how nothing has changed for many of the people we meet everyday. More “experts” with little or no “hands on experience”, new legislation, more bureaucracy and a very intrusive approach through research into peoples lives with little regards for their rights.

I attended a conference on Health Reform just a few weeks ago and must admit I found its focus so narrow as to be depressing. There was little reference to nursing apart from referring to the changed model of nursing, no mention of carers, home helps or rural transport etc. and a lot of reference to research and figures. Of course good quality supervised research is crucial to good planning however it is worth reflecting on the following:-

“He uses statistics as a drunken man uses lampposts – for support rather than illumination”.
Quote by Andrew Lang, over 100 years ago.

I will give you just a few statistics from recent monthly figures and last year’s.
Sometimes the only hearing the people we meet ever get is when they are being researched – an issue we have grave reservations about because of the amount and quality of research being undertaken today. In that context nothing has changed in the last thirty years as a quote from a report we wrote in 1976 which could be published in its entirety today: “If we are to push for fundamental change in the whole area of homelessness, then a certain amount of constructive research is necessary. We feel strongly however that it must be pursued with the greatest caution. It is clear to us that the ‘research industry’ uses that section of our society, which is the most vulnerable and the least able to battle for its rights as its’ source of material. We must never forget that we are working with human beings, who for the most part have been battered by our society and who for so long have been pushed about as just another number in a cold inhuman bureaucracy”.

Until those in positions of power or influence are prepared to sit with people in their misery and poverty, feel their pain, smell the smell of human misery and waste, feel the trembling body and listen to the cries of frustration rather than looking at statistics in neat boxes with grandiose titles nothing will change. If they cannot do it they should listen to those who can otherwise the vulnerable patients will continue to suffer and those of us working with them will only be adding to their misery through our silence. To speak out can mean exclusion, no promotion and a lonely existence – a situation that a philosophy of caring would simply prohibit and make impossible. I am reminded of the words of our esteemed former President Mary Robinson who in 2001 said “Each time you speak out with a critical voice you pay a price”.

An interesting observation worth reflecting on made by Judith Chavasse, former Director the Department of Nursing, University College, Dublin who contributed to my first book “Not Just a Bed for the Night”, which I co-authored with Anne Dempsey (1995), published by Marino Books:

“Nurses are the only professional group trained exclusively within the health service. Most student nurses enter straight from school into a hierarchical training system. To survive, they rapidly learn to conform. Hospital research in the 1980s found that student nurses’ experiences encouraged adaptation to the system, an adaptation seldom reflected on and usually internalised by the end of training. Most nurses are women. It has been argued that, out of mistaken loyalty, women often support structures and practices which are oppressive to others. Alternatively, the internalisation may have been refined to the extent that nurses have ceased to see injustice and have identified with the oppressive system. Anyone who demonstrates against this may provoke a storm of protest, as happened when research showed that some patients are treated differently if they are unpopular with nurses. Rebels, whether patients or staff, have a hard time in hospitals. Many nurses who maintain a rebellious streak leave the hospital system and exercise their caring role to great effect in a different environment”.

What has changed? Yes, we now have degree courses but is this creating a two-tier system? We do need to support each other and recognise each others skills and experience. We also now have more males in nursing but I recall we had a male student working with us a few years ago who left nursing because of bullying.

We should not allow human contact and frontline care to be devalued, it is not easily measured as you know. A philosophy of caring is good for people but is also the most economic in the long-term. The current management philosophy which is supposed to expose inefficiency has done little to highlight its own inadequacies.

The language of the current management philosophy is about performance indicators, benchmarks, outcomes and best practice etc. and is widely used, and goes unchallenged. Where does this leave the most vulnerable of people most in need of understanding, care and time and unable to speak for themselves. You are not “wasting time with people”, an essential part of a caring culture so often perceived as being uneconomic, to my mind it is the managers who are wasting time by not listening to you and the system therefore ironically becomes more uneconomic.

I am extremely conscious of the role we have as nurses within the system where we can – if aware – use our knowledge based on hands-on experience to ensure a culture of caring exists to ensure people are treated as people, not mere statistics and indeed to my mind we have an obligation to do so.

You nurses are highly educated academically, you should not be instrumental in creating a two-tier nursing service where the hands on work of those not academically trained is undervalued and so easily dismissed. It is by working together and challenging if necessary that’s required to make our health service a service we should be proud of – not something we can say with any conviction currently.

We should never forget the words of Eleanor Roosevelt:
“Where, after all, do universal human rights begin? In small places close to home – so close and so small that they cannot be seen on any map of the world. They are the world of the individual person: the neighbourhood he lives in; the school or college he attends; the factory, farm or office where he works”.
Eleanor Roosevelt

We of course have no real definition of ‘nurse’, and much time now perhaps is spent trying to distance ourselves from the vocation image of Florence Nightingale. However, the nurse intuitively comforts and cares – this quality is hard to quantify at a time when, to quote Oscar Wilde, ‘we know the price of everything and the value of nothing.’
In writing this I looked back at a paper I presented in 2005 when speaking in Cork at the presentation of the Miller Trust Scholarships organised by the Institute of Community Health Nursing. In a press release at that time I stated:
“We constantly hear complaints that health services are insensitive to people’s needs and allegations that unfeeling bureaucracy is out of touch. In most cases this is true but only because those in the frontline with the knowledge and experience are not consulted.”

I would add to that now – because we don’t speak out.
You nurses of the future will hopefully not be lost to our nation – we need you now more than ever before.
A Christmas morning a few years ago I happened to catch Eurovision Mass from Circus Pinter Top in Paris. Apart from the charm and artistry of Parisians I was struck by a few quotes from the Pastor and find myself reflecting on them regularly: “Encounters with people move us” he further said “It is the blind application of the law which makes us inhuman”.

Let this be your thought for the day.

ALICE LEAHY
Director & Co-Founder
TRUST
A befriending social & health service
for people who are homeless
Founded in 1975
Bride Road
Dublin 8
Tel: 01 454 3799 (w)
Email: www.trust-ireland.ie
16th April 2012

March 24, 2012September 26, 2020 Alice Leahy Trust Lectures, News and Press

Wasting Time with People?

Samaritans Regional Conference 2012, Newbridge, Co. Kildare.

It is indeed an honour to address you at a time in our country where the work of the Samaritans is more important and in demand than ever before. In the early days of TRUST I remember having a lot of contact with the Samaritans, less so in recent years. Let me tell you first a little about the work of TRUST.

“To be without a home is to be suspect. The homeless are easy targets. Their bodily integrity is constantly at risk. Their lives are an offence against the sacred canons of private property and consumerism. Their privacy is regularly intruded on as part of the price of being statistics in the poverty industry; their painful experiences are reduced to sociological research data. The true test of a civilised community is how people at the margins are treated. Not only must individual liberties be defended, but society should be educated and sensitised towards a broader vision of life and living. In an area dominated by the culture of individual acquisition, homelessness may have important lessons for us all.” – Dan Sullivan, then President of the Irish Council for Civil Liberties, describing what it means to be homeless in Ireland in a piece I asked him to write in 1995 for a book I co-authored with Ann Dempsey “Not Just a Bed for the Night” published by Marino Books in 1995.

The philosophy of TRUST is based on two central principles:

The recognition of every individual’s right to be treated as an autonomous and unique human being.
The need to restore the dignity of individuals whom society has labelled deviant and undesirable.

Everyday we meet up to 60 men and women who sleep rough. We meet with people as they present themselves to us – all outsiders in our Capital City. Many come from outside the city, some from the remotest parts of rural Ireland, some returning to the land of their birth to be buried in the “old sod” and many from outside this jurisdiction. In February this year we had 15 different nationalities through our door. They came from Ireland, Romania, Latvia, Poland Czech Republic, Lithuania, Slovakia, Hungary, Estonia, Spain, Iran, Russia, Moldova, Slovenia and Canada. However, the numbers are decreasing – in February 2011 people from 25 different countries used the services of TRUST.

As part of a holistic service we provide bath and shower facilities. We have lobbied Dublin City Council to provide public shower facilities. Ironically, one of the best-known public baths in Ireland was sold by Dublin City Council and is now home to a very expensive gym, which is located just across the road from where we are based.

We seek to treat people as people recognising that they need help and have rights, especially the right to privacy and a right to be heard.

The people we meet are perceived by the wider society as being different and difficult; and indeed many are difficult. They suffer from the effects of isolation, neglect and health problems, exacerbated by what are often described as chaotic lifestyles. Accessing mainstream services – often basic accommodation is a major problem. We meet increasing numbers of people who were ‘re-settled’ in totally unsuitable accommodation, and then find themselves homeless again, an experience that often makes them feel even greater failures and more isolated.
People present to us with a wide range of medical problems including bodies that are ravaged by disease and violence. Some have pressure sores from sleeping out in all weathers, sometimes in urine soaked clothes for weeks; infected and untreated minor skin conditions and major skin problems e.g. leg ulcers and gangrene; as well as lice infected heads and scabies. In addition we often meet people who are suffering from malnutrition and all of the medical conditions common to the general public but exacerbated by their living conditions. We are now coming across conditions long disappeared since the advent of good food e.g. trench foot and impetigo (wild fire). These are conditions clearly associated with extreme poverty and many of the people who suffer in this way are our new neighbours from Eastern Europe, who like our own Irish who emigrated in the past. In addition we witness the consequences of racism, a new and worrying phenomenon in Ireland.

We meet some people who are so cut off from everything around them that they at times appear to be beyond reach. Others however challenge and inspire us every day to look at the way we all live our lives.

Sometimes the only hearing the people we meet ever get is when they are being researched – an issue we have grave reservations about because of the amount and quality of research being undertaken today. In that context nothing has changed in the last thirty years as a quote from a report we wrote in 1976 which could be published in its entirety today: “If we are to push for fundamental change in the whole area of homelessness, then a certain amount of constructive research is necessary. We feel strongly however that it must be pursued with the greatest caution. It is clear to us that the ‘research industry’ uses that section of our society, which is the most vulnerable and the least able to battle for its rights as its’ source of material. We must never forget that we are working with human beings, who for the most part have been battered by our society and who for so long have been pushed about as just another number in a cold inhuman bureaucracy”.

The title of my paper sounds odd perhaps, but let me explain. My last book was entitled “Wasting Time with People?” This title I chose having read a piece in British Medical Journal by Simon Challand, a former Medical Adviser from the UK in Uganda about the advice he had received from “an African Bishop with a smile –“ “Waste time with people”… You Europeans are always concerned about projects and budgets. The African does not worry about them–just waste time with people”. He gave me this advice in 1996 shortly before I came out to work in Uganda. Since then his words have kept coming back to me, and I reflect on their truth and wisdom and how difficult it has been for me, as someone with European values and attitudes, to apply them.” A contributor to the book suggested the question mark in the title. I am sure there must be times if you were honest with yourselves when all of you or at least some of you must ask yourself that question too.

When the Rev. Dr. Chad Varah founded The Samaritans in 1953 little did he foresee the world we now live in and particularly his neighbouring country – ours, now attempting to recover from the after effects of The Celtic Tiger and struggle through the mine field that has been created. He ensured from the outset that the voluntary principle would flourish and thanks to the dedication of so many it has.

Reading in the Irish Times in December last a report on the Report of The Samaritans “Recession leads to rise in calls to Samaritans….. loneliness, depression and anxiety also feature strongly”. Today anyone reading the papers or listening to the radio can add flesh to these comments. Listening to the sound-bites and spin from those in a position of power and responsibility I suggest can add to the isolation of many in need rather than offering hope and also to those who daily deal with the complexities on the frontline.

“Today I spoke to no one,
and no-one spoke to me.
Am I dead?”

This is taken from a book of poems by Tony Gill Street Poet, they were edited by Thomas Crilly after his death. He was well known to us in TRUST and is buried in our plot in Glasnevin. These lines capture what many people experience. I stand open to criticism by suggesting that for example in rural Ireland where elderly men particularly found comfort in a local hostelry, maybe a mug of tea shared, a pint, a chat in a warm space to discuss maybe the land, the state we now find ourselves in, the hurling, football or rugby match is now off limits.

Last Christmas I got a lovely card from The Most Revd Walton Empey who presided at the funeral of Rev. Billy Wynne who died in 2000 and who founded the Irish Samaritans in 1970. Rev. Billy was known to me and I attended his funeral in St. Patrick’s Cathedral. St. Anne’s in Dawson Street, home to Rev. Billy Wynne is well known to us too – they include TRUST in Black Santa. Interesting to note how many very important voluntary bodies came to be in that decade. Interesting to check 1970 in Ireland from Wikipedia – nothing about voluntary bodies who then and now provide services that in many instances should have been provided by the State

Rev. Billy Wynne was never afraid to say it as it is. He had a great energy, hating hypocrisy and I am sure the health zealots would frown on his pipe smoking, however he lived to the great age of 81 and look at his legacy.

I refer to above because I think it is important to reflect on the founding principles that guide your work, particularly in these challenging times with pressure to probe into the personal details of lives of those hurting and many requiring professional help but more importantly a listening ear, often the first step to getting it.

In the area of work I am involved in it is shocking to see how debate around the issues of confidentiality is non existent. Resistance to compiling reams of data, storing and sharing it to fit into case management agendas, designed all too often by faceless bureaucrats has led to people being dismissed as “not being progressive enough”. I can vouch for that as we have ongoing contact with the Office of The Data Protection Commissioner about our concerns.
I see a huge challenge facing your agency at a time when more agencies are coming on stream, many are massively grant-aided and find themselves under enormous pressure to compile personal data, to meet targets, measure outcomes all to meet grant aid requirements when one phone call that may save a life may be undervalued in time. We may also think at times when we see other agencies on the television or in the media in general that we should be out there too – it comes to mind particularly at Christmas time. Don’t waste your energy dwelling too much on not being in the limelight because the importance of your work is surely that which is done quietly and you are aware of the sensitivities of the people needing your help. Of course there are times when you would like to know what happened to some of the people you meet but you must let that go too. The fact the people make contact in the first place is what is important.
Suicide has reached crises point and I am sure the numbers may be more than that reported. It is not surprising that huge numbers of people feel life is worthless looking at the situation they find themselves in, in these recessionary times. We can all remember the attitude to suicide a generation ago – I do wonder have we now reached a space where yes we can discuss it more openly but is there a danger that the importance of a listening ear and that often provided by a dedicated volunteer will be devalued in the rush to collect information. I think you in The Samaritans must be careful not to get into the trap of prying into peoples lives just to meet grant aid requirements. The way charities are being grant aided to deliver services is changing. The trend is now towards contracts where grant aid is based on outcomes achieved. Yes, surely this does make a lot of sense, particularly to those who are giving the money, but so often far removed from the frontline. Being paid on outcomes achieved poses particular difficulties for groups like The Samaritans who may be under pressure to change their structures and more importantly their core mission. It also is possible that outcome based contracts, particularly in the area of healthcare will go to large for profit organisations with huge balance sheets and they in turn could end up sub-contracting to the charities. The Samaritans particularly based on their mission will have to look at where they are in today’s world being aware of the increasing numbers of people likely to need the services you provide – that is the main challenge facing you into the future. Now with ever increasing demands on services, agencies must ensure they too can speak out – prophetic voices have been silenced by grant aid and will continue to be well into the future. It is possible that structures now being put in place can be more important than the humanity of those suffering or those attempting to alleviate their misery. Giving time to people is not easy. I know from our daily work sometimes meeting people who never had a listening ear and now we are meeting people some months from 26 different countries – their body language, dead eyes and solace found in alcohol and other drugs, the symptoms of pain, isolation all too obvious and hard to penetrate.

We regularly refer people to The Samaritans and we can only hope that they use the service. We have known many people who died by suicide and I am sure more will – a terrible indictment of all of us and reflection on the world we share. It may be suggested to you that you should refer people on to other agencies – too often referring people on can give the impression that others may have the solution to the problem. It could also mean pressure would be put on them to give very personal details they are not ready for. Worse still it could give the impression you are anxious to get rid of them. You could however signpost appropriate services, it’s really a question of how you do it and I would suggest that dropping the idea gently is possible. For example there are useful freefone numbers like that for people who find themselves homeless 1800 707 707 for accommodation and 1800 724 724 for social welfare that might be suggested to people and they can decide for themselves without pressure. This is something you could look at guided by those of you with experience and also have a list of appropriate services.
There are a number of issues I would like to draw your attention to:-

Who cares for the carer comes to mind when I was compiling this paper. Listening to someone hurting isn’t easy. We are all but human, while you have a strong support network it could be all too easy to be overwhelmed – it’s not a sign of failure to say its not for me and walk away. In my experience when one door closes another opens. The reverse side of the coin is that maybe we think we are too important and that we are the only one who can solve someone’s problem. If so, we need to pose the question – are we just satisfying our own needs without being aware of the dependency we may be creating, leading to an even greater problem down the road for the person requiring help and colleagues providing the listening ear.
Rev. Chad. Varah and Rev. Billy Wynne got great sustenance from their religious beliefs but they also appeared to have a great capacity to live life as presented to them and spared no energy in ensuring that those for whom life was difficult and at times too painful to live were supported. We owe it to them getting support from their vision to ensure the work of The Samaritans continues and that it is possible for all of us to “Waste Time With People” to great effect.

May 26, 2009September 26, 2020 Alice Leahy Trust Lectures

Submission – Proposed tender for the provision of support services and housing for people who are homeless

26 May, 2009

Mr. Michael Finneran TD
Minister for Housing, Urban Renewal & Developing Areas
Department of the Environment, Heritage & Local Government
Customs House
Dublin 1

Re: Submission – Proposed tender for the provision of support services and housing for people who are homeless.

Dear Minister

Thank you for meeting me and my colleagues on Wednesday, 20 May, 2009, and for giving us the opportunity to share with you our concerns in relation to people who are homeless, and the way in which services are provided in seeking to meet their needs.

As requested, we also provide this submission in relation to your intention to seek tenders for the provision of support services and housing for people who are homeless. However, I must point out that while we are in principle opposed to the outsourcing of services in the manner that you propose, we do make specific recommendations as to how the interests of very vulnerable people might be better protected, while at the same time outlining our reasons for questioning your approach.

TRUST’s Philosophy and Experience

We have, based on our experience, come to believe that outsourcing or privatizing public services, especially for vulnerable people like those we work with everyday will not succeed, and more seriously, puts their rights in jeopardy as it is much easier to make the state accountable than a private sector enterprise or a voluntary service provider.
Indeed, as I draft this submission, there is widespread public outrage at the way in which children were abused in horrific ways in the various centers in which they were held by the religious orders. We are forced to ask could a similar mistake be made by the state again by subcontracting its responsibilities to the private or voluntary sector, as it did in the past, and at great cost to those affected, most of whom have been forced to carry that pain through their entire lives. Indeed, we are fully aware of the human cost of the state failing children. We help many of the victims who ended up homeless on our streets and we know all too well the consequences for individuals when the state gets it wrong. For that reason we are convinced, based on our direct experience that this is a very retrograde move, and the state should accept its responsibilities to people who are homeless and put the necessary services in place under the direct management of your department and through the relevant local authorities.

While some might consider the comparison above unfair, it is worth reflecting on the image and standing of the religious orders at the time they were entrusted by the state with so many of the nation’s children. The voluntary bodies today, like the religious orders in the past, are in the main often manned by well meaning and dedicated people. However, they do not have the resources the state can command, and most importantly, and the reason for our main concern, cannot be subjected to the same level and degree of accountability that can be demanded from state institutions. This is not just a philosophical point, but a critical issue if we are serious about ensuring that the rights of the most vulnerable in our society are properly protected. The state failed children in the past, and it is worth underlining that these were the most vulnerable children, from extremely poor backgrounds, like many of the people your proposed outsourcing of service provision is meant to help.

Our recent success in having our complaint upheld against the Homeless Agency (see below), and the way in which it was using the voluntary sector to harvest information in an unwarranted and in a potentially illegal way from people who are homeless, is a clear illustration of just how vulnerable they can be in having their rights infringed. Indeed, it is worth underlining that point. Imagine some one who has serious mental health problems, possibly as a result of serious abuse during childhood, being subjected to an in depth cross examination about the most intimate details of his or her entire life – with an extensive forty page questionnaire – by a very young and untrained person. Surely the risk of inflicting such damage to a very vulnerable person is the kind of approach that never should be even countenanced? However, unless the state is directly involved in the management and provision of services the risk to vulnerable people will increase, especially at a time when resources are cut back. We do of course acknowledge that some research is necessary to plan services but it must be managed in a highly sensitive, responsible, transparent and accountable way.

Accountability and Transparency

The nature of homelessness requires a high degree of accountability and transparency on the part of service providers. During our meeting we very much welcomed the opportunity to share with you how we define this issue. We also were impressed by your understanding of the problem, and for that reason, we are confident you will equally understand the great emphasis we place on putting mechanisms in place to guarantee a very high level of accountability and transparency. Homelessness is not the same as not having a house. Most of the people we meet everyday are living the way they do because they cannot fit in. In some instances, addiction problems of all kinds from drugs to gambling as well as alcohol are to blame. In other instances, mental health problems, family breakdown or an inability to cope explain why a person is on the street. It is clear, that if someone with any of these problems is to survive in settled accommodation of any kind they will need a high level of support. If the services fail, the person will quickly end up back on the street and considerable resources will have been wasted. Worse still, if the wrong approach is adopted with any individual, they could be left worse off, and end up costing the state much more in the long term.

The critical resource most people who find themselves outsiders in Irish society need is time, if they are to have any chance of re-integrating back into society. And against the background of cuts in services that is a costly and scarce commodity today. We have often been told by those like ourselves in the state services who try to help people that if they try to give them the time they need, they are made to feel like they are “wasting time with people.” That issue inspired our very successful project and book of the same name, a copy of which I gave you at our meeting. Indeed, the reason for the success of that initiative, and especially the book, which made into the Irish Times best sellers list for a non fiction book, is because it resonated with so many people. In other words, if we are to help people we must give time. Against that background, we believe that outsourcing state support services to voluntary bodies, highly stretched financially, even with well meaning people, cannot succeed in replacing the state, especially when such initiatives maybe undertaken by the state to save money. This raises the question is the state relinquishing its responsibility because it is not prepared to undertake these services on the cheap, because it must operate to a much higher standard, which voluntary or commercial bodies do not?

We fully respect, and I emphasize this point, that you are trying to do the best you can with the available budget at your disposal. However, it is our responsibility to point out to you that if the state cannot afford to meet the standards that are expected, voluntary bodies will not be able to do so either.

The Homeless Agency

We do not want to single out the Homeless Agency for particular criticism as we have no doubt that like many organizations in the field it is staffed by people who want to make a difference. Nonetheless, our complaint against the Agency (see attached letter dated 25/07/2007) was upheld by the Data Protection Commissioner (see attached his reply dated 11/07/2008). It is also worth noting that many envisaged that the Homeless Agency would act as the guarantor or protector of the interests of people who are homeless. But as you will also see from the attached letter, the Data Protection Commissioner discovered that in a legal sense the Agency does not exist! It has no legal personality and is not properly constituted, and therefore is in no legal position to protect anyone. More seriously, it presented itself as an independent body when it is merely an appendage of Dublin City Council. In other words, it cannot provide any proper protection, or properly advance the interests of people who are homeless the way it is constituted.

Protecting the Rights of the Most Vulnerable

We recommend the following specific safeguards which must be put in place if support services for people who are homeless are outsourced. We offer these recommendations as a constrictive contribution, although we are opposed in principle to outsourcing for the reasons outlined above. Against that background, we must stress in the strongest terms that these measures be put in place or vulnerable people will be put at risk:

Human rights based management practices must be adopted by all service providers contracted to operate these services. This will require training, which is not unduly onerous, but will help to ensure that a self critical management style is adopted, this is especially vital given that many become homeless because they are not able to cope or speak up for themselves, and end up having to accept what they are given.

An independent ‘advocate’ must be appointed to work with each service provider who will work actively in an independent way in demanding that the necessary high levels of care are provided for the people the service is set up to help. This person can be thought of as a kind of independent ‘quality control’ operative who will seek out failures or deficiencies in the service and ensure that at all times the relevant staff are working optimally in meeting the needs of the people they are meant to serve.

The independent ‘advocates’ will report to an independent monitoring committee which will have the sole function of ensuring that ‘quality control’ will be maintained at the highest possible level in the delivery of services. The committee will set and review standards and provide leadership and real back up for the ‘advocates’ on the ground. In other words, this committee will give the ‘advocates’ added impact at local level as they can seek the assistance of the committee to intervene when they do not get action at local level when deficiencies are found.

In conclusion, the state should not abdicate its responsibility to the most vulnerable to save money. We fully accept that for the best of motives to seek optimum return out of existing budgets there is a temptation to engage voluntary bodies to provide state services. However, as we have again been reminded in recent days, when short cuts are taken for any reason, there will be a price to be paid. Indeed, we also do not want to give the impression that we are totally happy with state service providers in preference to voluntary service providers. The only difference is that state service providers are easier to make fully accountable and transparent in their operations. Therefore, if you do proceed with the outsourcing of services it is absolutely imperative that the recommendations above are fully implemented or there is a real risk that vulnerable people will suffer.

Thank you for meeting with us recently and for affording us the opportunity to brief you directly about our concerns. We also look forward to welcoming you when you get the chance to visit us shortly.

With very best regards

Yours sincerely

ALICE LEAHY
Director and Co-Founder
TRUST
Member of Irish Human Rights Commission

Encl. Trust Letter to Data Protection Commissioner dated 25/07/2007
Reply from Data Protection Commissioner dated 11/07/2008

cc. Ms. Claire Gavin, Assistant Principal Officer, Social Inclusion Unit

and Mr. Tom Gallagher, Private Secretary to Mr. Michael Finneran, TD
Minister for Housing, Urban Renewal & Developing Areas

May 28, 2008September 26, 2020 Alice Leahy Trust Lectures

“Peculiar Places – more important than ever”- Lecture delivered by Alice Leahy at the AGM of the Adelaide Hospital Society

The Adelaide Hospital Society’s Annual General Meeting

Good evening everyone. I am really honoured to be invited to address you this evening and indeed humbled, mindful of the long history of the Adelaide Hospital and the work of the Adelaide Hospital Society.

When I now walk past the old Adelaide Hospital in the morning and indeed the other small voluntary hospitals frequently, I cannot but reflect on what we literally have thrown away in the name of progress – and no amount of research could quantify the contribution of these hospitals to the life of their communities and the City of Dublin.

I first heard of the Adelaide as a very young child growing up in the shadow of Slievnamon on the estate of the late Olivia Hughes, one of the great Irish women of the last century. We picked wild flowers, especially primroses, wrapped them up surrounded by green leaves and sent then by rail to the Adelaide Hospital.

Of her many friends who visited our family I always remember Mrs. Beatrice Sommerville-Large, a great friend of the Adelaide Hospital, her daughter Faith is here tonight, she is a very special supporter and friend of ours in Trust, visiting regularly with her friend Vi. The late Dr. Becher Sommerville-Large encouraged and inspired me when nursing. I sometimes look at a reference he wrote for me to seek employment in Cunard Lines (I cannot swim and sometimes suffer sea sickness). At one stage I had considered going to the famous Moorfields Eye Hospital – but as I often quote the words of Bob Dylan “we are all prisoners in the mystery of the world”.

Let me talk to you about our work in Trust – daily on my way to work each morning I see people sleeping in sleeping bags all over the place, and then when I read some media reports on our health service and statements saying there is enough accommodation, I could be forgiven for thinking it is all a figment of my imagination.

Trust founded in 1975, grew out of work I carried out in night shelters and with people sleeping rough with a group of doctors, all working in a voluntary capacity. That work, and the generosity of the late Ann Rush, led to the foundation of TRUST – a private charitable trust and our aims are:

“to serve homeless people in need by promoting human services which would meet their immediate and long-term needs and by these means to encourage their development and give their lives a dignity which is their birthright.” (…from the Deeds of TRUST.)

The service we set up was first of its type, and has been used as a model for services here and overseas. We are sandwiched between St. Patrick’s Cathedral and Christchurch Cathedral in the Liberties area of Dublin. We work in the basement of the Iveagh Hostel for which we pay a nominal rent, a reminder daily that people have gone before us and I sometimes ask myself what would Dean Swift do today.

The philosophy of TRUST is based on two central principles:

The recognition of every individual’s right to be treated as an autonomous and unique human being.

The need to restore the dignity of individuals whom society has labelled deviant and undesirable.

Our work would not be possible without the enormous generosity and support of people from all walks of life, rich and poor. Incidentally I should mention the friendship, support and encouragement we get from the Protestant community all over Dublin and beyond, in fact without it I doubt if we could continue to work as we do. Please God that will continue for as long as it is required.

Everyday we meet over 50 men and women who sleep rough and meet with people as they present themselves to us – all outsiders in a city of plenty. Many come from outside the city, some from the remotest parts of rural Ireland, some returning to the land of their birth to be buried in the “old sod” and many from outside the jurisdiction, with increasing numbers from the EU Accession States and other countries. This is evident from the 2006 Census highlighting the demographic changes. Between 2002 and 2006, non Irish Nationals increased from 224,000 to 420,000 (+87%). EU Nationals make up the greatest numbers, particularly from Eastern Europe. Polish Nationals were the biggest group – 63,000 people and not all have become successful. However this week I note 35,000 Polish people have returned home but we have seen no decrease in numbers calling to Trust.

Some people we meet we have grown older with. We provide a health service, advice and dressings and much, much more, but most important is the human contact – sometimes Trust looks like a casualty department as many people we work with will not go to A&E, and if they do go they will not wait. As part of a holistic service we provide bath and shower facilities, a complete set of clothes and information on rights and entitlements. You may be interested to note that in April we had 677 consultations, 329 of those were non Irish Nationals, 22 new people called, 8 were non Irish Nationals, 407 people had showers and 375 people had clothes. I am sure you have seen our proposal for Public Showers and we were grateful to the Irish Times for the publicity given to it – it even led to voting on their website, 51% Yes 49% No. Our shower submission can be seen on our website www.trust-ireland.ie

We seek to treat people as people recognising that they need help and have rights, especially their right to privacy and a right to be heard. Coming to TRUST we hope people can feel secure and are hopefully able to trust us. Hospitality is important – we provide tea and coffee as we would welcome visitors to our own home and provide a listening ear – now daily phone calls from prison from people we know with no one else to call. Many people we meet have no family contact, and often family members contact us about loved ones who have disappeared.

The people we meet are perceived by the wider society as being different and difficult and indeed many are difficult. They suffer from the effects of isolation, neglect and health problems, exacerbated by what are often described as chaotic lifestyles. Accessing mainstream services – particularly basic accommodation is a major problem. We meet increasing numbers of people who were ‘re-settled’ in totally unsuitable accommodation, and then find themselves homeless again.

I meet people homeless in Dublin whose heartbeat I listened to while working as a midwife in the Rotunda and consider it a sad reflection on our society that we are now meeting 2nd and 3rd generation homeless.

The people we meet everyday present with a wide range of medical problems including bodies that are ravaged by disease and violence, some with pressure sores from sleeping out in all weathers, sometimes sleeping in urine soaked clothes for weeks; infected and untreated minor skin conditions and major skin problems e.g. leg ulcers and gangrene; as well as lice infected heads and scabies. In addition we often meet people who are suffering from malnutrition and all of the medical conditions common to the general public but exacerbated by their living conditions. We are now coming across conditions long disappeared since the advent of good food e.g. trench foot and impetigo (wild fire) – conditions clearly associated with extreme poverty and many of these people are our new neighbours from Eastern Europe, like our own Irish who immigrated in the past. [Racism is a new challenge].

Some people we meet cope with very serious addiction problems, including drugs, alcohol and gambling, suffering from despair, the pain of loneliness, and spirits broken. Pushed from service to service, often unable to get relief for minds at breaking point and the only solution offered is a brown envelope of medication and often unable to read the directions – seen just as statistics in our increasingly bureaucratic world.

Many people we meet struggle to create a sense of normality after years locked away in institutions and others who have been relocated from one institution to another. Some people who are locked in prisons they have created for themselves, often out of the frustration of not being understood or ignored. Many people we know have attempted suicide, and many have died on the streets. Now almost weekly we hear of someone known to us has died. Often families are ashamed to talk about it and others are grateful that someone cared for their loved ones and we can tell them something about the missing pieces of the jigsaw. When preparing this a long time friend of Trust who slept rough for years since coming to Dublin was being buried in Strabane. He came from a poor family, we made contact with them some years ago and remained in contact. A nursing colleague and friend of Trust in Queens University attended his funeral on Friday last and met his family. Rev. Ian Gallagher from Foxrock who will be known to many of you also came from the Northern part of our island, he often sat with him in Trust on Christmas Eve as they shared a cup of tea and a cigarette, one of the very few nice things that happened to him in his sad life.

Increasingly we get calls from members of the public seeking help in accessing services and dealing with bureaucracy, dealing with machines, seeking help when at their most vulnerable.

Sometimes the only hearing the people we meet ever get is when they are being researched – an issue we have grave reservations about because of the quality and quantity of research taking place today as well as the time and money spent on “evaluating outcomes and cost effectiveness” while ultimately making no difference to the lives of those who have been examined in the course of these expensive research exercises.

Some people feel pressurised to take part in research into homelessness in case they lose their hostel bed or their entitlements. We in Trust only become involved in research, when we believe the research design is sound, ethical and likely to provide useful information and would be concerned about the sharing and storage of confidential information without due regard to the rights of our fellow human beings.

Of course research is essential to plan services. “If we are to push for fundamental change in the whole area of homelessness, then a certain amount of constructive research is necessary. We feel strongly however that it must be pursued with the greatest caution. It is clear to us that the ‘research industry’ uses that section of our society, which is the most vulnerable and the least able to battle for its rights as its’ source of material. We must never forget that we are working with human beings, who for the most part have been battered by our society and who for so long have been pushed about as just another number in a cold inhuman bureaucracy”.

This last quote is from Leahy and Magee – Report on Broad Medical Services for Single Homeless People in the City of Dublin – March 7th 1976 – 30 years later, in a new millennium -what has changed?

We have met with the Data Commissioner about our concerns regarding the recent Assessment Forms people are now required to fill in – 40 pages. We point out to people that we should not allow ourselves to be blinded by statistics and jargon – we should be prepared to question what is happening, rather than facilitating reports to further distance people from people, or just support entrenched ideas. Homelessness is not just about housing alone, it is much more about not fitting in, being different, being an outsider.

“To be without a home is to be suspect. The homeless are easy targets. Their bodily integrity is constantly at risk. Their lives are an offence against the sacred canons of private property and consumerism. Their privacy is regularly intruded on as part of the price of being statistics in the poverty industry; their painful experiences are reduced to sociological research data. The true test of a civilised community is how people at the margins are treated. Not only must individual liberties be defended, but society should be educated and sensitised towards a broader vision of life and living.” – Dan Sullivan, then President of the Irish Council for Civil Liberties, describing what it means to be homeless in Ireland in a piece I asked him to write in 1995 for a book I co-authored.

The words of Emerson “The use of history is to give value to the present hour” used by the late Dr. David Mitchell to set the tone for his book “A Peculiar Place” on the history of the Adelaide Hospital now over 20 years ago comes to mind when preparing this paper as we often find ourselves describing Trust as “A Peculiar Place” and no doubt some people say that too about Trust. Two lovely chairs of the late Dr. Mitchell were given to us by his daughter Geraldine, one I sit on daily and one we gave Eddie, a dear friend of ours – perhaps the only comfortable seat he ever had in his humble room with his beloved dogs as he watched the old black and white films on a second hand television set until he died.

In some ways I draw comparison between Trust and the Adelaide as we face daily challenges. We are a small agency with charitable status and a Board of Trustees, not in receipt of grants from the Health Service Executive. The now highly bureaucratic HSE and indeed the same in the area of poverty has created a huge gap between planners, front line workers and ultimately the people needing services. No philosophical debate takes place at any level around care, quality of life and lack of choice, and more important the State’s responsibility to care for its most vulnerable people. This is an area extremely neglected now in Irish life, apart from the Adelaide Hospital Society.

The Adelaide too relied on donations, but I feel also on the enormous commitment, expertise and goodwill, together with a strong Christian commitment of all involved. A commitment that ensured a quality of care hard to find today. We value the enormous commitment, generosity of time and spirit of my colleagues at work, our Trustees and those who make our work possible.

I still visualise the cleanliness of the Adelaide, the freshness of the place when going up the stairs and the pride the nurses took in their special navy uniform with white spots. And how could I ever forget Margaret Horne in her tiny busy office, a reminder of the Adelaide Hospital’s staffs commitment to caring for people in the local community.

For over thirty years TRUST has been involved in advocacy work – trying to be a voice for the voiceless – as well as providing health and social services and have had a number of Education & Awareness projects, our Art & Essay competitions were supported by the Irish Times.

I should mention our latest book “Wasting Time with People?” just published. This book is dedicated to two very special friends of Trust, one of whom you would have known, the late Professor James McCormick. You would also know many of the contributors including Dr. Fergus O’Ferrall, Prof. Davis Coakley, Prof. Patrick Plunkett, Bishop Walton Empey and Rev. Olive Donohoe.

As part of our commitment to education and sharing our experience stressing at all times dignity of every individual should be at the very centre of everything we do, we take student Gardai on social placement and this has proved enormously useful. The last group of nursing students from the Adelaide on placement with us before you moved to Tallaght were surprised when I asked them to visit The District Court – all of human life is in there – everyone should spend a morning there, especially those involved in social work, medicine and nursing.

Human rights is about treating people with respect and dignity and sometimes we are afraid to use the language of human rights, a much more challenging concept, that we often think should be left to the lawyers. I should emphasise that when I speak about human rights, and human rights based approaches, I am talking about a philosophy of caring for people as people. The good thing about a rights based approach is that it constantly reminds us we are providing charity, or advocating charitable giving, we are demanding that we live up to the principles of justice and fair play outlined in our constitution which we all subscribe to.

Article 1 of the Universal Declaration of Human Rights states that “all human beings are born free and equal in dignity and rights”. However, by looking at the conditions and the way in which those who are marginalised in our society are treated from those who are homeless on the street to people unable to care for themselves and those living lives of isolation in urban and rural Ireland – we really have to debate with and challenge those responsible.

Some years ago I met in the RCSI Phil Barker, former Professor of Psychiatric Nursing, who runs workshops on the premise that “Knowledge can only be gained through experience”. I once wrote to him for permission to use a quote and he replied: “Alice, people don’t remember what you say or what you do. They will remember how you made them feel” – this excellent advice comes to mind daily and is a quote from a well known Afro American female poet.

Today through the development of human rights based approaches – which should be developed into a potential management philosophy in the health and social services, including all statutory and voluntary services – we have the potential to transform the way the most vulnerable are treated and in this I include all of us.

Some time ago a Welfare Officer, decided that a man who lives in a park and doesn’t use services should have his meagre €165.00 a week (try living on it) stopped because he refused to move into a hostel. His medical card had run out and his doctor hadn’t signed a disability form even though he was not disabled! The Welfare Officer told me it was a ministerial order and that was that! Is this about playing about with numbers, not her fault perhaps – people need to be trained and informed about the complexities of homelessness and indeed the human condition as well as people’s rights.

A Christmas morning a few years ago I happened to catch Eurovision Mass from Circus Pinter Top in Paris. Apart from the charm and artistry of Parisians I was struck by a few quotes from the Pastor: “Encounters with people move us” he further said “It is the blind application of the law which makes us inhuman”.

The collapse of the Public Private Partnerships, which were supposed to lead to the provision of social and affordable housing in Dublin, and regenerate some of the most deprived areas in the city, illustrates in a compelling and powerful way where we have been going wrong in recent years as a society. We cannot expect the private sector, which is solely concerned with making profits, to protect peoples rights to basic services. The shattering blow this has dealt to the people waiting for the redevelopment of their areas, and families on waiting lists for housing, can only be imagined.

I would appeal to everyone in the voluntary sector to become much more forceful, in speaking out as advocates, in defending those in society who have no voice, instead of becoming involved in providing services that should be provided by the State. We risk becoming complicit, in letting the State avoid having to provide decent quality public services, unless we speak with one voice in demanding justice for the most deprived.

We have argued against this trend because we have seen the serious consequences for the people we work with. Many well meaning people in the voluntary sector let the government off the hook, when they accept apparently large amounts of money to take over the role of the State in providing services. This represents a form of privatisation that has enabled the State to obtain services on the cheap, with the shortfall in service quality falling on the most vulnerable. In other words, goodwill and generosity has been exploited, often with low wages and poor conditions, and worse still, has then impeded the ability of once authentic voices to speak out, because they are in receipt of State funds.

PPPs and the privatisation of services are not about caring for people, they represent opportunities for the private sector to maximise profits in areas where the State should be in the driving seat protecting peoples’ rights. If we are serious about caring for people as people, everyone in the voluntary sector must reject the encroachment of privatisation in all its form in the health and social services, and increasingly in the provision of accommodation for people who are homeless.

Now more than ever before we should have confidence to debate at all levels the concerns of our time. It is indeed something the Adelaide Hospital Society continue to do – your fearless highlighting of issues is required more than ever I think in the history of the State when “Peculiar Places” instead of being valued and included in the vision of where are, are dismissed. At a time when the biggest challenge for public service providers is to ensure that services are responsible for inclusion of all, regardless of race, class, creed, gender and age.

Caring for people does require us to speak out if we feel people are being denied their rights. If anyone is not being treated with dignity or worse still being excluded from society or our world we do have a big responsibility.

We must be prepared to discuss and highlight these issues and support those who speak out. I am mindful of the words of Mary Robinson, our esteemed former President of our country, when she said in 2001 “Each time you speak out with a critical voice you pay a price”.

All of you no doubt have read “A Peculiar Place” over and over again. However it is worth noting the words of John Healy written in the Irish Times May 1987 – looking back to 1970 wrote ” Fianna Fail created the health boards; they were going to effect great savings; they were going to give Ireland a very modern and efficient heath service… Mr. Erskine Childers was a very earnest Minister for Health, and when his Fianna Fail backbenchers warned him that he was creating bureaucratic monsters, he argued long and passionately against them. He would not hear any criticism that the boards would become petty kingdoms which could not be touched by a national government and that such a bureaucratic stratum would be laid down that there could be no way in which the health service would become “patient-centred”.

Also in 1972 Comhairle na nOspideal (The Hospital’s Council) was established, it had advisory functions and published reports – its worth noting that in its “4th report, 1982 – 1985, expressed the view that the assumption in the document that community care was a cheaper alternative to hospital in-patient care was not proven and that there were indications that it was incorrect”.

In 1987 “any computer screen in the Department of Finance must have shown that education and health were the two big spenders, which had to be cut back – the cuts began” – sounds familiar today.

So where now does the Adelaide fit in? I think more important today than ever before, the Adelaide Hospital continues to be a powerful, sometimes lone voice in raising important issues.

I agree with Dr. Fergus O’Ferrall when addressing the Old Dublin Society earlier this year said “There are great dangers that the precious intangibles which produce quality personal patient care which so typified the Adelaide at its best will be eroded by centralised control and micro-management by bureaucrats who have the power but little responsibility for patients at the point of care. The Adelaide Hospital Society continues to seek to preserve such intangible values and to ‘inoculate’ them into our health system”.

If care and compassion never make the agenda, those delivering our services and our country will be the poorer – the onus is on all of us to ensure this is not allowed to happen.