Dita De Boni: The question is: Who cares?

Illustration / Anna Crichton

The government needs to make sure public funding gets to those in need.

You can't just walk away from your funding obligations, said Peter Atkinson this week. And the government will no longer be allowed to shortchange families of people with disabilities who require respite care, thanks to Mr Atkinson and the fight he waged through multiple forums to bring the authorities to account.

The government hasn't so much been walking away from its obligation to give a break to family carers - what it seems to have been doing, to the tune of $250 million each year, is dispensing money for this service without, it would seem, any mind to ensuring it is used correctly.

This is amply clear in the Atkinson family case. Mr Atkinson's daughter had been allocated a carer, for two hours a day; reasonable enough. But, often, the carer didn't show up, leaving the family to step in. Meanwhile, the agency of so-called "carers" received the government cheque, thank you very much. To whom are they accountable?

This story would have been of only marginal interest to me, except earlier in the week I had a long conversation with a friend who has a relative who also needs daily care in her home. A reasonable amount of funding is attached to this "client" - something like $35 an hour - so care agencies are eager to get the work. Of that $35, they pay the princely sum of $15 to their carers, some of whom are excellent; others fail to show (common), or come and leave then come again at the end of the day (also common), and worse, as my friend has found to her horror.

Even the best agencies struggle to fulfil their care obligations to the clients on their books, she says - and she's used them all. They offer little in the way of apology for leaving defenceless people alone in their homes, if and when they are sprung, and offer bland reassurances it won't happen again - yet it does. These agencies continue to bank an obscene amount for a service so poor that thousands of families have cheered the Atkinson fight all the way to the Court of Appeal - and now, possibly, as far as the Supreme Court, such is the vehemence with which the Ministry of Health wants to overturn Mr Atkinson's three victories.

Some may say the problem is that private companies are obviously going to try to retain as much of that government-funded $35 an hour as they possibly can. That's the system we've got. The "care in the community" system that, in famous New Zealand style, saved us a few health bucks in the 1980s in order to ensure we'll pay through the nose for decades to come.

I would say there is no reason care could not be adequately provided by the private sector. But, in exchange for being able to make a buck off the taxpayer, they must verify they are providing the service they claim they are; that their carers actually turn up to work. Like those operating in aged care, it would probably help recruitment and retention no end to pay a decent wage, for a start.

Unfortunately, it's a "clientele" few care about, served by a workforce that even fewer care about, and this has become a situation in which the labour of love by many relatives has patched numerous holes in the system. Thanks to Peter Atkinson, the Ministry of Health will finally - hopefully - confront the huge disconnect between intention and reality.