Mr. John Dunne:

Our approach to the budget is less to do with coming in and looking for vast amounts of extra money - let us be honest, it is not there - and more with highlighting where money is being wasted or where the policy is operating in principle but not in practice. First, we have seen an increase this year in the trend in which a family carer can receive income from the Department of Social Protection or service support from the Department of Health but not both. That matter, which is completely contrary to Government policy, is arising on the HSE side. The two systems were designed to reinforce each other, so what is happening is crazy.

Second, I made the point to the committee last year that fair deal wastes money in an avoidable way. It is a statutory right to put people into residential care. However, there is no equivalent right to put them into community care, so when the budget runs out, the only available option is to put them into residential care, even if that is not what they need or want.

The employment control framework is underpinned by the Haddington Road agreement. For example, if a person living in Carlow or Kilkenny has a child between six and 18 with mental disability, that child would probably never be able to access psychological or operational therapy services on the State system because the limited resources available are concentrated on those aged under six. We have no argument about the concentration on those under six, rather we have an argument with the fact that how the framework is operated leaves that gap. We have no argument with the principle of a framework. It is how it is operating that is at issue.

Respite beds are empty in certain parts of the country. Last year, a charge was introduced for those who avail of more than 30 respite days a year in a State residential centre. The scheme and the charge seems to be slightly troubling in principle but, when it is looked at carefully, the scheme is relatively fair. The problem appears to be about how the scheme is communicated and the fact that people are more scared than they should be of how the arrangement works. Furthermore, it results in empty beds. That does not represent a saving as the costs associated with the beds are still there. It is a lost opportunity. The situation is occurring because there is no proper audit of resources and there is no way to move those resources effectively around the country were we to identify waste in any part of it.

We also flag up a concern about the effect of the recent Labour Court recommendation. Although we are not criticising the court, its recommendation on the terms and conditions of 10,000 home help workers directly employed by the HSE is significant. We have little doubt that it will have an adverse impact on patients, carers and other home help workers employed by voluntary organisation such as the Carers Association or even the commercial organisations because it will cause scarce resources in the HSE to be diverted to directly employed staff for no visible increase in services.

On the Government's phased roll-out of medical cards, we point out that every healthy family carer is saving the State not one but two health bills, because were the family carer to get sick, the person they are caring for must also be looked after by the system. Consequently, family carers should be a priority in the pecking order in the roll-out. In addition, the prescription charge for card holders was introduced last year. Although we have no problem with the principle behind that charge, it could be restructured on a revenue neutral basis so that the old and chronically ill are not penalised.

The proposals to replace the mobility allowance scheme have not emerged. We understand that the problem is a difficult one, but we assume that the ad hoc arrangement by which the old scheme will continue until October will be extended until the new scheme is introduced.