Dr. Michael Browne:

I will return to the Chairman's question on funding and make two comments, one of which is that we must look at the issue in a general way, but it is also something that should not be landed on people at a stage when they require high level of support and care. It is something that must be thought about and planned for as a society. On that basis, we must revisit the Mercer 2002 report on the financing of long-term care, in which a number of aspects were examined and considered and some proposals were made. We do not have time to discuss them today, but it would be worthwhile for the committee to consider the report. In other words, everybody knows from an early stage that there will be the question of the funding of their long-term care and there should be a system in place that is fair and equitable to do this. My point is that it is an issue for society.

The second point made was related to the housing-health interface. It is very tricky. It is tricky primarily because of the type of administrative system in place in Ireland, under which there is silo funding from the top Department down to local government or the HSE. One way to deal with this is in the context of local government reform, an we have mentioned regularly and we have been asked by the OECD and various other bodies to examine it. Some type of administrative structure to enable the pooling of resources at local administrative level, within which housing and health services would be integrated, is the only way by which we will be able to deal with it. It is tricky and a challenge, but we can do it.

I refer to the community care service and the dearth of supports and services. Obviously, it is evident that this dearth of services creates problems, but I wish to refer to simple things such as easier access to physiotherapy, occupational therapy and house adaptations. These adaptations might be relatively minor; they might involve the provision of grab rails, accessible ramps, toilets and so forth. At that level there is great potential for more interventions at relatively low cost. In that regard, there must be somebody in the community - I am not sure whether it would be the role of the social worker or perhaps some other person - to pull these aspects together at what I term the lowest level of complexity.

A couple of points were raised by Deputy Josepha Madigan. One concerned initiatives to combat social isolation. The fundamental and crucial issue is that there is premature disengagement of people from society. Why, as a society, do we communicate the message, at a very subtle level, that somebody no longer has a contribution to make either to the workforce or the community? We must deal with that issue at a fundamental level because people have a significant and enormous contribution to make on an ongoing basis. Many make it, but some do not.

On the question of retirement, I am a little concerned about the notion of segregation. While I see the potential, we used to have a lovely concept - I am speaking about the ideal - which I believe was mentioned in a report some years ago from the Department with responsibility for the environment. It was a report on building sustainable communities. We should hold in so far as possible to the concept of sustainable communities, inclusive of everybody, within which we can have the concept of the multi-purpose unit. Three aspects of that vision are important. We must make provision for what might colloquially be termed people who are a "go go", people who are a "slow go" and people who are "no go" in terms of mobility. That is where we need to be and the type of concept we should move towards.

There is the question of leadership in the system which was raised by a few members. We probably need innovative and inspirational leadership, but I have no idea from where it will come. It can come from either a political level or an innovation level from a charismatic individual, but we need it. We must change the narrative and the discourse. We need to regard older people, even those with dementia or other chronic conditions, as essential and integral parts of communities.