The Irish Times are doing a series of articles on Ageing Ireland and the first one this weekend has highlighted the significant change happening in our society’s demographic make-up and asking if we are ready for an ageing Ireland?

Certainly the present indications are that we aren’t and that sufficient thought or discussion hasn’t gone into how to address these changes. This lack of preparation is illustrated by rising waiting lists for operations, increased delayed discharges from hospitals, lengthening waiting lists for nursing home care and care in the community, as well as health budgets under pressure causing a rationing of services.

While there is no magic solution to our health sectors woes, I do feel that our overall approach has to move away from one of control and command, with service users being asked to fit into existing systems and configuration of services, to an approach based on outcomes and the Local, with decisions made at the lowest level possible including service users themselves.

This change of emphasis will necessitate the empowering and enabling of communities to help themselves. The State will need to move from managing by dictate to managing through fostering self help and innovation.

I feel in this day and age of increased dissemination of information, better informed people and general technological advances, we need to build more trust into our systems and shift responsibility back to the local and service users themselves. I think our present systems and structures assume too much responsibility for the State and treat citizens as children, unable to make their own decisions.

Inherent to more trust and devolved responsibility are choice and the welcoming of managed risk. The availability of choice is as I see it, a great driver of quality and efficiency. When choice is stifled, poor practices, inefficiencies and declining quality can become embedded and institutionalised in existing structures.

One of the main reasons for limited choice is risk avoidance by existing structures and systems. This in turn means a lack of innovation and change. Our health sector can’t be immune to the changes going on in our world through technology and increased communication, which are having profound effects on many other sectors.

If we are to properly manage the changing demographics in our society and ensure our health system is fit for purpose, the blind adherence to how things have always been done just wont cut it.