Mr. Gerry Martin:

I am from the Alzheimer Society of Ireland. I hope members have had the opportunity to review our submission. The title this year is, The Key to Cost Effective Dementia Care: Timely Diagnosis and Early Interventions. Our fundamental call is to make dementia a national priority. It is the single biggest health issue facing the country now and in the next ten or 20 years. Specifically, we are seeking three developments. First, we seek the publication of the national dementia strategy, as committed to. The working group is focusing on this issue. However, we are seeking more than just publication, we also desire an implementation plan in the strategy, with clearly defined leadership that will promote systemic change in the system and also lines of accountability and, importantly, a ring-fenced budget for implementation.

Second, as the title of our document suggests, we are seeking timely diagnosis and cost-effective post-diagnostic early interventions. International best practice has been outlined and the evidence is available. Timely diagnosis and cost-effective post-diagnostic early intervention need to constitute the core of the strategy. They have proved not only to be socially desirable but also to be cost-effective. The Alzheimer Society of Ireland believes a community-based response providing for a range of early interventions is an essential and critical component in moving towards cost-effective care. I will spend a moment outlining what early intervention is and what it will achieve. With timely diagnosis, early intervention can enable a person to live well and continue to have good quality of life. There is evidence for this and that early intervention will preserve function, reduce disability and delay cognitive decline. Obviously, it can sustain the carer in his or her role for much longer, which has a cost implication for the system. In this regard, it prevents crisis and unnecessary admission to acute care services. When this is the case, it can enable early discharge, which has a significant cost impact. These interventions, both medical and social, can prevent premature and unnecessary entry to long-term care services and the costs associated with it. These steps are not only right for the individual but also for the carer. They are also right in terms of the economics of dealing with dementia. For example, a person with dementia entering acute care services will spend, on average, 46 days in a hospital, which is double what a person without dementia will spend. If we could cut that number of 46 days in half, we would save €10 million per annum. There is a pure cost argument associated with our case. If we could reduce the number in long-term care by 10%, we would save €73 million per annum. There is a significant cost argument.

Third, I contend, without disrespect, that people accept that the health system is very difficult to navigate and find one’s way through. Sometimes even in the whole of one’s health, it is difficult to navigate. It is particularly difficult when there is dementia. There is an urgent need to co-ordinate the efficient delivery of all services in order that we can have greater access for patients and a continuum of care for individuals between community and hospital-based services. The Alzheimer Society of Ireland does not believe this is possible without a clinical care programme for patients with dementia within the HSE. It is critical that somebody in the system is responsible for dementia services and has the power to promote systemic change.