Mr. John O'Connor:

I would like to pick up on a few points. The question on assessments is a very important one because it is one of the things at the heart of the problem. It is also part of the solution to the problem. I was involved in Camphill in Northern Ireland for a number of years. We had a similar situation in the late 1980s and early 1990s. We dealt with the situation by finding a good robust assessment framework which we rolled out in the communities. An objective figure for individuals was found and their needs were able to be met on foot of those figures. We have been using the clinical indemnity scheme, CIS, assessment, which was introduced by the HSE in Kilkenny and is an effective assessment framework. It works quite well and can be verified externally by a clinical psychologist. It is a good mechanism for identifying the true costs of an individual's support needs.

There is no perfect assessment framework. Every body or group requires a different type of assessment framework, but this one works well for us. It is recognised nationally and can arrive at a very objective figure for support needs which can be verified. It is an available solution and one that we have been using. We have made some inroads in certain areas using it. In other HSE areas, it has been more difficult to make inroads using it. It is one thing that would be very good as part of the mechanism for addressing these problems. The assessment is there and we are very open to working with the HSE on it.

The other problem we have at the moment is that the face of social care has changed dramatically in the past seven to ten years. We have been working with what we in Camphill call a life-sharing model. We have vocational co-workers. Deputy Ó Caoláin referred to them, as did Deputy O'Connor and Deputy Healy. They have experienced that model through visiting the communities. It has worked very well and has served Camphill across the world, and in Ireland since the early 1970s, very well. However, the model is now changing for a number of reasons. The number of long-term co-workers is decreasing. Every year we have fewer long-term co-workers. When a long-term co-worker is living in a community it means there is not a complete shift system in place. There is an extended family situation in the residential setting. This works very well as there is continuity of relationships and familiarity grows over years. It is the closest thing to a home environment. This is changing because of the change to the face of social care and the pressures placed on the co-worker cohort over recent years. People are being asked to work an extraordinary amount of hours every week, which is not sustainable. People get burnt out. They realise it is not sustainable and that they cannot continue. These issues are eroding the co-worker cohort, which has been at the heart of Camphill. If we could do something in the very short term we would have some chance of addressing some of those issues, but the longer it continues the more people say this is something they cannot sign up to any longer.

Co-workers who are involved in Camphill are involved because they are interested in social care, but they also recognise that there is a richness of life available to those living in a Camphill community. It is a residential setting, but it is a home and not an institution. Anyone who visits a Camphill community recognises quickly that it is based on healthy relationships and recognising the humanity of the people who are living there. A culture develops and this is recognised by families. Families appreciate the culture and individuals who come to Camphill feel recognised and appreciated. Local HSE staff and administrators, social workers and liaison nurses notice the benefits of sending someone to Camphill. It ticks a lot of boxes.

It was mentioned earlier on that two or three of the communities are in serious jeopardy. If something is not done in the short term, we will see serious crisis situations in these communities. They are at crisis point already but they will be in serious crisis situations when the question of closure arises. It would make a huge difference if we could get an assessment mechanism in place and some kind of funding mechanism established that would address short-term issues in under-funding. Even hearing that it was in the pipeline would make a huge difference to morale in the communities.

We welcome HIQA's involvement in Camphill and that of other agencies, and we feel it is a positive thing. There is an increased amount of work and increased costs associated with this involvement but the standard of accommodation in Camphill is well above average. However, we are now required to meet nursing home standards on fire safety in what was a home environment. This sort of thing drives up costs. When a facility is underfunded, items such as maintenance are left on the long finger because we do not want to affect care. Care is the primary concern. We not want to erode the quality of care, so maintenance issues are left unattended. This includes vehicles. It can be sustained for a certain amount of time but after three to five years - this has been going on since 2007 - we get to the point where it becomes unsafe. This is one of the core problems at the heart of the issue.