Mr. Tony O'Brien:

Deputy O'Reilly sought long and detailed answers to three questions. She will get those answers in writing, if that is okay.

Senator Dolan raised the specific issue of the current way in which highly intensive clinical care needs are being addressed. It is evident that there is a difficulty in providing for such needs in environments which are designed around the needs of older people. The Senator described eloquently the nature of the establishments in question. The answer that was given to the Senator sought to make it clear that certain patients, or people who need care, have clinically assessed complex medical and social care needs which mean they cannot be cared for in their own homes and require care in other settings. The answer in question referred to such cases. The numbers involved are relatively small. The challenge we face is to determine how we can provide care in settings that are more specific to the needs of this particular subset of patients. Factors like geographic distribution have to be considered in this context. By and large, this is currently done on an undifferentiated basis in mixed use facilities, the primary purpose of which is to provide for the care of the elderly. Clearly, we need to find a different solution. The particular needs of these people unfortunately mean that the solution in question cannot involve providing care to individuals located in their own homes. The nature of the resources that are required means that a number of patients need to be in receipt of this care. I acknowledge that we do not yet have the right answer. Our social care division is focusing on this issue.

I do not doubt that in a small number of cases, decisions on participation in and co-operation with the fair deal application process are influenced by particular family dynamics and issues of long-term economic interest. No evidence is currently available to us to suggest that this is a widespread issue. It is reported in very few cases that those experiencing delayed discharges are not co-operating with the fair deal application process. I do not suggest that such cases are not important because any case in which a hospital bed is delayed or inappropriately used for a number of days denies more appropriate care to a patient who is probably on a trolley in the accident and emergency department of the hospital in question. I do not think this is a very widespread issue. The number of cases is quite small, but it often seems that it is much greater because these stories grow legs in the telling. The evidence does not appear to exist to support the idea that there are many such cases.