Mr. John Dunne:

I will also deal with the funding question. It is a fact that many carers defer medical treatment and as soon as the person they are caring for dies or goes into long-term residential care they then begin to get their own health looked after. It is insane, if we think about it, that someone saving the State so much money is allowed to encourage their own health to deteriorate to a point where there are two charges on the health budget instead of one saving.

That is the fact, however, though the system does its best. I was approached recently on the subject of whether we could encourage carers to be more active in screening programmes. That would be a good thing as it would be preventative, but if they are screened and told there is a problem, there is no way the system can step in and do something about it. It would be a small example of joined-up thinking and a small part of what we see as the ethos of goal-directed primary care. We are 1,000% in favour of the retirement community model because it includes day respite and short respite breaks, which are part of the live-in community. Independent living in retirement communities is an excellent part of the total spectrum of care in the home.

If somebody provides intensive care at home and is about to go into hospital themselves, the only option is for somebody else to come into the home on a live-in basis, which is ideal but very difficult to achieve in practice, or to have short-term respite break beds. In recent years most such beds have been displaced. They might have been shut down because the facilities in which they were based were deemed inadequate or they have been converted into step-down beds for acute hospitals. There are large chunks of the country where one cannot get a respite bed anymore. In some places there is one building with maybe four beds. It is effectively rationed out and one week it is for adults, one week it is for children and one week it may be for the elderly.

I was asked about costs and the funding model. All community health care organisations are roughly the same size in population but CHO 9, Dublin north, accounts for between one quarter and one third of all home care packages in Ireland. If there are waiting lists in Dublin north, there are serious problems.