Professor Roy McConkey:

The Deputy made two important points. The first point was that housing and support need to be co-ordinated. The lack of co-ordination has been one of the biggest flaws in the British system, with which I am most familiar. In the North, it has also caused a lot of difficulty for us in trying to create alternative living arrangements for people. The Departments began liaising when the importance of co-operation was pointed out to them. One of the purposes of this joint committee is, I would think, to hold two Departments to account on this particular issue. I understand the committee operates cross-departmentally and it has the right to do that.

The second point related to families seeking assurances in regard to where the future lies, which brings me back to the point I made earlier that people not wait for a crisis to occur to ensure that the services are starting to think about the longer-term arrangements for their relative. Families can be reluctant to do that because it involves parents facing their own mortality. Professional staff are also wary of doing it because they think that creates an obligation on them to fulfil those plans. The family will not necessarily want the plans to be enacted straight away, but they will want some sense of the direction of travel they are going in. That provides an opportunity for people to be creative in the solutions and steps that might be taken along the way, some of which can be low-cost steps.

Deputy Tully spoke about cost effectiveness. We need to be more open in service provider land and spell out the spend of costs for individuals in, for example, nursing home care and look at how that could be translated into personalised support hours that spend would provide for an individual. In more general terms, I would caution that international experience shows there are risks in perpetuating congregated care, notwithstanding that are some good examples such as those outlined by Ms Fitzpatrick. History teaches us that in congregated settings there are three risks. First, there is a greater of abuse of people who live in congregated settings. Second, there is a greater risk of them getting infections and, therefore, having physical illnesses as well as emotional problems and, third, which we have documented for Ireland, people in congregated settings die at an earlier age than people living in other settings such as with family carers. Some of that might be due to the risk of infection. In the United Kingdom, the number of Covid deaths in congregated living arrangements has been much higher than it has been in other arrangements.

In terms of policymaking, we cannot ignore the risks of perpetuating a policy as well as denying people their opportunities for rights moving forward.