Professor Cillian Twomey:

I thank Deputy Browne for the question. If consultant manpower levels are inadequate for consultants in old age psychiatry, as they are, there is a deficit in the service provision. It is unequally distributed. This applies to care of older people in general and care of people with chronic illnesses of all ages. What is required is a multidisciplinary package. The straight answer to the question is there should be more consultants in old age psychiatry.

I was appointed as a geriatrician in 1979 and I was the sixth geriatrician appointed in the country at the time. There are now approximately 110 geriatricians in Ireland. At a time when everyone is going berserk about how awful things are, it is fair and right one should acknowledge there have been some improvements. There is an endless demand for health care, and no matter what the committee comes up with at the end of its deliberations it will still not satisfy most people because this is the nature of the service, but there is a fundamental inequity in what is done to people with chronic illness vis-à-visthose who are acutely ill. If I get a stroke, go to hospital, get thrombolysis, then get a complication with my heart, go into heart failure, get kidney failure, need dialysis and ultimately need a transplant, I will get all of this fantastically well serviced in the country, and we need to remind ourselves of this. No matter what my age is, this is what I will get. However, if I survive until 75 and get a stroke, having never once cost the State anything in terms of health care, and I am incapacitated by the stroke, the first questions I will be asked is when I will go home or what home I will go to, what property I own and about my money. This is completely and utterly fundamentally flawed. There is a basic fundamental inequity in the way we approach illnesses in people with chronic disease as opposed to acute illness, and the committee cannot avoid addressing this question.

The question how this can be dealt with was asked and it is a fair question. All of us have a responsibility to provide for the needs of all people. It is a combination of general taxation and social insurance. This is what it should be. If a 20 year old betting man was asked to pay more tax to look after Johnny McGuirk or Cillian Twomey if they get a stroke in 100 years time, his answer would be no. That man would not believe he would be affected because 90% of people who reach the age of 80 are healthy, but this is not the point. A civil society in my view has a responsibility. We do not say this sufficiently and we give lip service to choice. People are sent into nursing homes because there is nowhere else to go. Why is it they are either independent at home or in long-term care? The village-type idea promoted in this morning's presentation has much to commend it. We have given huge financial incentives to build nursing homes. Why do we not incentivise more humane alternative supports in the community for people, which would include, as Dr. Browne said, such facilities as a shop and a betting shop so it becomes an integral part?

The Years Ahead report in 1988 prescribed all of this. The committee will write a report which will tell us what we should do in 2016 and onwards. I invite committee members to read The Years Ahead. It speaks about integration and linking housing with health, transport and social supports. It states it is not just about illness and medical issues but about social issues. It is all there. An implementation plan was put with it and it was priced. Dr. Ruth Barrington was its lead author. We are honours graduates in this country at reports. We are the greatest on earth at reports. I would like to see one or two of them implemented. The Years Ahead contains an awful lot of what would be good for chronic illness in our society.