Professor Eamon O'Shea:

There are several really good elements and it is important to say what they are. A strong sense of intergenerational solidarity exists in the country. We are not starting from a base where we do not have willingness or a commitment of support. Whether this is through care, through families caring, through contributions or through our social insurance system, there is a strong element of solidarity. In recent years, we have had really good examples of where personalised care is working. There have been a number of innovations, particularly for people with dementia, throughout the country. There are programmes in Mayo, south Tipperary, south Dublin and Kinsale in Cork. There are many interesting projects. We are not starting from a zero base with regard to personalised care. We know older people and their families like this. There are good models in terms of what we want to do.

I will give an example of the demographic changes that will happen. At present, 55,000 people have dementia and they require various levels of care on a continuum. We know this will increase to approximately 100,000 by 2026 and up to 150,000 over the next 15 years. We know it will double and treble in the foreseeable future. This is not decades away. This is a good example of how numbers should concentrate minds.

It is difficult to know for sure how many carers we have looking after older people and the number of hours they do. From the limited surveys we have done, we estimate there are approximately 60,000 carers of people with dementia, ranging from cognitive impairment to advanced dementia. Many of these carers provide hours of care in terms of work we would shy away from in the formal paid labour market. Very often it is alone and debilitating, and very often shocks happen in the system of care to which there is not an immediate response and people are left even more vulnerable. These numbers have meaning. They are not just numbers or estimates, they have real meaning. What does this mean for a personalised, person-centred base in terms of the provision of supports and where do older people fit in? Whether they are physically or cognitively dependent, the voices of older people must be central. We cannot run a system where it is supply-side driven and provider-driven with an "I know best" approach. We will not get the connectivity or the social model of production where people are integrated and visible and we have an equitable provision throughout the country.

A question was asked as to how we get this voice. There are good things happening in this regard. We have the Irish dementia working group, associated with the Alzheimer's Society of Ireland, and we hear directly from people with dementia. We need to hear the direct voice in various fora and the policymakers need to hear it. We need champions, and that refers to this building and this group. We need champions, and not just the advocacy groups who are champions in their own right. We need political champions. If we look at countries where there has been political championing of older people's issues there has been an impact in the policy-making process. Over the coming years, it would be very helpful if there was direct championing of these issues in the political process.