Mr. Liam Doran:

I will do it in reverse with regard to the frail elderly, the privatisation and the way back. In response to Deputy Harty, yes we have a very blunt view that what has happened in recent years regarding the care of the older person services is doomed to failure. The privatisation, the reliance on private nursing homes, the direct subvention to them and so forth will never be able to meet the growing demands that are placed on them. The sub-text of that is that the staffing levels in those nursing homes are not necessarily the best because one is managing, looking for profit and other issues come into it. The issue as well is that we must stop everybody being moved to the accident and emergency department the moment they have a temperature, respiration problem or the like. We must staff the units so they are capable of meeting those challenges, which are predictable challenges in many ways. They are very acute for the individual enduring them but they are predictable to the health professionals who know the area. That is the reason congress is calling for a complete reversal in that area to ensure there is a care of the older person service, whether it is in the home, a long-term facility, a transitional care facility or a rehabilitation facility, that is directly subvented and properly staffed, so the person is kept out of the acute hospital if at all possible. There is also the issue of how we will manage the quantum. It is anticipated that there will be 1.7 million people over the age of 65 years by 2045 in this country. Think about that. There are only 650,000 now. We have that huge statistic coming towards us. Privatisation of the older person service will not work in Ireland. It did not work in other jurisdictions. We must come back up that road.

Mr. Eamonn Donnelly mentioned work practices. There is no point in us appearing before this committee and saying that everybody else must change but we need not. Health professionals must change. We must have different models of care and we must liberate and complement one other. We do not, and cannot, survive on a medical model of care for our public health service. It must be one that is originated by the right person in the right place empowered to do it. That is the reason we are calling for regulation and independent inspection, so one can cross-check all of those things happening all of the time. Nobody has a divine right to walk away from public scrutiny when it comes to health. That is the reason we include regulation and inspection.

What is the one thing we could do now? Mr. Paul Bell touched on that. What we must do now is staff our health service properly to meet the demands being placed upon it. For example, we train 100 public health nurses per year. In the first six months of this year there were 41 fewer public health nurses in the public health service than there were in the service at the beginning of the year, because we cannot replace them. We require massive investment in a training programme for 200 public health nurses per year, at a minimum, and we must increase staff. Mr. Paul Bell is correct about health care assistants and home help personnel. It is not all about high-level consultants, multi-qualified nurses and so forth. It is about the whole team situation and one cannot achieve that, with respect, by paying the minimum wage to people providing home care. In many areas of this country, home care cannot be provided, even though there is the money, because the service cannot get the staff. The end product is that Mr. or Mrs. Murphy sooner or later ends up back in the emergency department because they could not get the support. The minimum wage will not cut it. The one thing we could do is invest in the one thing every health service needs - motivated staff. We are depleted in that regard at present.