Professor Cillian Twomey:

I thank the Deputy. On the previous point, Sage Advocacy has been involved in the case to which the Deputy referred and has provided independent oversight, which is very helpful. There are departmental advocacy plans. However, to come back to the Deputy's main point, there is a possibility - through Sage Advocacy - to do things more speedily.

The issue of complaints is complicated. Dementia is more common as people get older but there is a more fundamental point. In this society, we are, with few exceptions, either living at home and well - this is the case for the vast majority, young and old - or we get sick and go to hospital. Hopefully, we get treated and get better or we get treated and need ongoing supervision and care but get better and get home. However, there is a subset of people who have been completely healthy for 60, 70 or 80 years and who suddenly get a devastating illness such as a stroke. The system in place in present means they will either go home, if somebody can look after them, or they will go to a nursing home. It is my view that we have failed, with few exceptions, to develop the alternatives.

People with significant dependencies, including dementia, will do better in smaller congregated settings than in the institutional environment that any residential care facility inevitably is. We know from work done in other European countries, and there are some examples in Ireland as well, that people living in smaller settings, with maybe six or so residents, do infinitely better than those living in the larger ones. We have facilities in this country for residential care nursing homes that range in number from perhaps 30 to 180. I refer to the Years Ahead report of 1988, which the committee might like to have a look at because they will see resonances with what we are saying here. It was never envisaged that we would create large multi-occupancy residences like we now have. What we need, in my view, is a single integrated system of care for older people which allows the person to choose where they avail of that support and care. There should be a single source of funding which should allow them to be supported at home, if that is their wish, to be supported in one of an adequate number of smaller congregated settings - these are yet to be developed - or, if required, to be supported in long-term residential care.

We hear regularly: "This is their home." It is their home in the literal sense but not like your home or my home and we have to recognise that the needs of people with significant disabilities, including dementia, require an alternative system of support to being congregated in large numbers. I am glad that, in the context of the commission on care referred to in the programme for Government, this is instanced as an important development.

I hope that we can introduce financial incentives now to develop these alternative, smaller congregated settings of support which are more locally-based and close to where people live, just as we did with the development of the private nursing homes sector 20 years ago.