Mr. John Dunne:

Families are not necessarily being given an option on hospital discharges. We have come across cases in which patients were bundled up with their suitcases packed and their families were told to collect them. People with dementia were told they would be going home without any discussion with their families. There is some pretty poor stuff happening in that regard. From a hospital's point of view, it must manage its budget. The patients represent a cost to the hospital and as soon as they leave they stop being the hospital's problem. The difficulty is that the existing structures do not include protocols stating that the State or the system has a responsibility for the individuals concerned. They may need to be moved out of the hospital but they also need to be moved somewhere else. That is the policy in theory but it simply is not working in practice.

In regard to the lack of clarity around criteria, one does not start with a blank sheet of paper. For historical reasons, the HSE employs thousands of people to provide home care services in certain parts of the country, whereas it does not directly employ anybody in other areas because it subcontracts these services. The latter model offers far more flexibility, even in terms of the point Mr. McGrath made on section 39 and home care packages. A coherent strategy has been put in place but the Croke Park and Haddington Road agreements create an enormous drag. This is not a party political point because the issue has existed for several years. The failure to address the legacy of staff structures and the commitment on staff costs has resulted in arbitrary situations. There is no difficulty accessing services in some parts of the country but it is virtually impossible to do so in others. That is not a criticism of managers in the HSE. They have been dealt an impossible hand of cards.