Dr. Marita O'Brien:

I would like to speak about integrated care. The barriers to integration include the separate funding streams that exist at the moment. The HSE funding is divided into separate streams. Each section is very protective of its budget. For that reason, it is very hard to make changes in the social care system. We have never developed assisted living or anything like that because of the way the budgets are streamed within the wider Department and the HSE, which are very much focused on health. In other countries, there is more local authority involvement on the ground. The integrated care model envisages that health and social care should be integrated in a wider sense in communities. There tends to be a great deal of segregation in Ireland. The Department of the Environment, Community and Local Government has its budget and the Department of Health has its budget. At the moment, there are separate budgets. If a new funding system with moneys from each Department were to be developed, there could be more integration. That would allow people to develop. The suggestion at the moment is that having differentiated budgets is a barrier to integration. It would be preferable if the HSE could have more integration within its budgets. The acute care system uses up much of our funding. Primary care and social care tend to come further down the line. If there was a way of working to avoid the hierarchy that exists at present, that would help as well.