Mr. Peter Tyndall:

I want to reflect on a couple of the issues that have been raised in the first two questions. One of the things we have to ask ourselves when we have a problem is how did we get into it in the first place. The report sets out a number of issues which I think are important and touch upon the questions that have been asked. The first is that we do not have proper mechanisms for arranging for the discharge of people from hospitals who will need support other than, as we have seen all too often, placing them into nursing homes. The second is that we have a funding system which is heavily biased towards nursing home care. There is a statutory scheme to support people in nursing homes. There is no statutory scheme to support people in the community. The consequence of that is fairly inevitable. To be fair, the Government has committed to introducing a statutory home care scheme, which is to be welcomed.

The other point that was raised relates to assisted decision-making. People we talk to have full capacity. For the most part, they are people who are more than capable of expressing their own preferences and do not need access to that scheme. However, many other people in this context will need that access. Many people said to us that they did not realise what they were letting themselves in for. Quite a few of them thought they were going in for short stays. It is important that there is great clarity when people are being admitted to nursing homes so that they understand the consequences for them, particularly the consequences of accepting funding.

Deputy Tully asked why there is no data. Once people are admitted, they are, essentially, off the books. They do not have link workers and there is nobody within the system whose responsibility they are. That is why there is no data about them and that is why one of the first recommendations in the report is to create a database so we can at least have a full understanding of the problem. It may well be the case that some of the people concerned are perfectly happy in their nursing homes. I am not sure for how many that is the case, but it may be so, in which case, there is no problem. However, it is likely that a majority of people, or a significant minority at the very least, will want to move out. Until we ask them, we will not know. That is why this is so important.

I will make a final point in response to those particular issues. We looked at people under 65 in nursing homes but those issues I have mentioned about capacity, informed consent and biased funding platforms are also likely to have affected other residents of nursing homes. In all likelihood, there are older people in nursing homes who would not have chosen to go there and would prefer to remain in their communities. I want to be clear that is not to say that only people under 65 have been affected by some of the issues we have identified because clearly other people will also have been affected.