Mr. John Dunne:

I endorse all that Mr. Dillon has said on behalf of Older and Bolder. As he pointed out, the Carers Association is part of that consortium. I will focus on two additional issues in my remarks.

To the extent that cuts are required, there has been insufficient creativity in considering how compensatory adjustments can be made to existing budgetary frameworks and commitments. We have made a number of proposals in our submission. Resources are being systematically shifted from home help to home care, which appears to fit the strategy of providing resources where need is greatest. There must be scope to backfill some of the services lost on the home help side by using labour market activation measures.

By and large we do a certain amount of this already, and people who have gone through training in home care have very high progression rates into employment because it is a growing area, not only in terms of State services but also commercial services.

We are giving a guarded signal that we support the extension of the fair deal model into community care, which is an alternative to cuts. However, there are problems with the current fair deal model which must be got right, and once the model is extended to community care it must be significantly tweaked because fundamental differences exist between the two. The Government has already signalled it wants to extend free GP care to everybody, and in delivering the next step we suggest extending it to full-time carers. There is a clear strategy to get people out of hospitals faster. Is it possible for this strategy to incorporate as part of the discharge process a transfer of carer protocol which would include helping carers and training them so when they take ill people home they are able to look after them?

We believe absolutely that community-based services should be on a statutory basis. With all the focus on cuts we are very concerned not enough attention is being paid to how the money that is being spent is being poorly spent. I would nearly go so far as to say that in some cases it is being misspent. It is not only about arguing about the margins. The absence of a statutory basis for community care means it is now routine that somebody looking for between €50 and €100 a week to support a carer for a person in the home cannot get it because the money is not there but they can obtain €750 a week to put someone into care because there is a statutory basis for this. Every time this happens the State loses €600 a week. The officials, doctors and patients do not want this. The only reason it is happening is because of the legislative framework. It is not a budgetary issue, it is a legislative issue.

Under the Croke Park agreement it is becoming quite routine to redeploy unqualified untrained staff into roles they simply cannot carry out. In the early stages, this had to do to some extent with work practices. As an example, somebody can be put to bed at 3 p.m. because that person needs help to go to bed but the home help deployed to do the work will not come any later. Leaving this aside there is an issue with regard to whether those being sent into homes to provide care are trained in moving and handling patients and are able to handle tasks such as dialysis or taking blood sugar tests, which they are not and they do not even pretend they are. Patients need these services and they cannot get them. This happens below the radar. People think it is okay because there are 5,000 extra home care packages but if these packages are inadequately delivered by unqualified staff it is a waste of money and not something from which to take satisfaction.

The lack of flexibility in responding to the needs on the margins means the State system takes the easy option, particularly under the Croke Park agreement. Where care is needed the voluntary sector is being asked to provide it at night and weekends because the State system will not do it. People in the State system get paid higher salaries to do the easy work while the voluntary sector is kicked off to do the hard work.

These are some thoughts for the committee to reflect on. In the current budgetary climate there is a danger of looking at cutbacks all the time. A vast amount of money is still being spent and it is not being spent as well as it could. This is a very important budgetary issue.