John Dolan (Independent) | Oireachtas source

We should not go back that far. Mr. Breslin must have read that in a history book.

Naming the condition does not cure it and naming the possibilities does not make it necessarily happen. The Minister's presence was spoken about. There is also the presence of other members of the Government, whether here or in addressing this issue.

Poverty is a massive issue. Unemployment is a massive issue. There is also poor nutrition, isolation and poor living conditions. There is a real place in all of this, if one wants to get to prevention and early implementation, for other members who sit around the Cabinet table, which must happen more often. That is the axis around which the implementation of this report will hinge in the medium and long term.

Earlier the Minister mentioned he was frustrated with the pace of the report's implementation and that it was a ten-year report. The Secretary General mentioned 1987 and I mentioned 1994. We had the Health Act in 1970 that resulted in eight health boards being created. There was a change in 2000 that reduced the number of board members to seven plus the Eastern Regional Health Authority that had four subsets. Four years later we got the Health Service Executive. I have lost track of all of the reforms and changes of structure in the HSE. We had a governance structure and we lost a board. There were supposed to be other changes but they have not happened and now we are going back to a board. We must move beyond simply changing the governance charter because there is more to reform than that. Part of it is drawing in other members of the Cabinet. We must also analyse the things that happen outside of the Department of Health that have a huge impact on people's lives. As I have said before, children have got through school, graduated from college and face the hurdle of finding employment. That is a tipping point for them in terms of their health and well-being. If they can move on their health and well-being will be in a way better space. If they cannot then they are back in some day place. What does that do for someone who is in their mid-20s, 30s or, indeed, 40s?

I wish to refer to three aspects of the implementation mechanism. One can get the right man or woman but the system that he or she works in will help or hinder.

In terms of legislation, the Minister has mentioned putting administrative programmes on a statutory basis and gave a commitment to do so. However, there is a dysfunction between the fair deal scheme and the plethora of instruments that are required to keep a person in his or her home and community. The requirements range from personal assistants, home supports and access to other services. Resources are an issue in the health services and beyond.

Another aspect is the organisational and cultural change. Cultural change must include a whole of government approach but it must also be about the public understanding of what our health services are trying to do. We have a way to go with that because we tend to think of our health services as being there to fix us. We need the fixing bit but we also need health services and supports to live well.

In conclusion, I shall mention the empowerment of people with disabilities. The mobility allowance was abolished almost five years ago and the anniversary will be at the end of next February. Ironically, the allowance was abolished due to equality issues and replaced with the motorised transport grant. The mobility allowance was introduced in 1979. People now use new language about empowerment and claim money follows the person. What was the mobility allowance? It was an outstanding example of putting a few bob in someone's pocket to help him or her with his or her mobility. It was money follows person and it was the person maximising his or her choice. Therefore, we must rethink the current initiative. Thirty years later people talk about the principle of money follows the person. The mobility allowance was a simple programme that gave a few bob to people in west Clare, Donegal, Tipperary and wherever. I am not having a go at the Minister but simply making a point. As I have pointed out before, young people with disabilities have been put into nursing homes without consideration being given to other options while at the same time we are trying to move disabled people out of institutions. Having the correct mindset, and dealing with the soft stuff and cultural aspects are very critical to making Sláintecare work.

Finally, like others, I welcome Deputy Róisín Shortall who is chair of the Sláintecare group.