Ms Mary Farrell:

That is very interesting. I will start with the management and one person taking responsibility for the co-ordination and management of the person's services or case. Interestingly, where our son lives, which is not where I live even though it is quite near, there is an ABI case manager, which is quite extraordinary. There is also a care manager. The ABI case manager is the stand-alone service and because it is around the ABI services that meet our son's needs it is difficult to see the role that the manager plays, but there is some connection there because there is some training with carers in acquired brain injury. There are online training sessions every month for a period of perhaps six weeks or something like that. That happens. It is like a little stand-alone piece.

The ABI case manager is involved in, and comes to, the case review, but the manager does not have an overall remit. Then there is a care manager. I will bring in the home support here because, as I said, we struggled doing this ourselves and we struggled with a little bit of support. Gradually, when we were no longer able to provide the level of support needed, our son was provided with a package of care after a long, tedious process. There is a care manager, a state registered nurse, SRN, who is responsible for the medical end and overseeing that area. There is that piece, yet there is no bringing this together in one place. The only time we get to discuss it in one place is if we have a review. As I said, we have had the online reviews, which are a little unsatisfactory. It is difficult for everyone and to get people to the table. I would prefer if a physiotherapist was out doing physiotherapy with a patient instead of spending time doing an hour-long meeting with our son. I understand that, but the physiotherapist might send in a report and so forth. However, it is difficult to get everyone together.

There is no single person. There are data protection issues and there is patient-client confidentiality, for example, liaising with Beaumont Hospital and then with the GP. There are all these pieces and they are all moving around, but there is no one person who can do that. It is not possible for a person, given the restrictions in all those areas, to get terribly involved and find out all the information the person needs to know. I often find myself back in the fray again because we have the legal responsibility in decision-making. Does the Deputy understand that? If it comes down to changing medications or epilepsy medications, for example, we would know because of our background. People working with our son now would not know all of what we know and the difficulties he has had with particular medications or issues in the past. The information we have sits there and one could not possibly put it on paper. Nobody would have the time to even read it. There is no way of managing that, whereby one person can do all of that given all those restrictions. That covers the home support and the area of the case manager, the case manager's role and how difficult it is.

The other question was about day services. There has never been, and I do not know when it will ever happen, a day service that is geared to people with acquired brain injury and the area of acquired disability. It is badly needed because it would provide structure and a centre of focus where people, perhaps the case managers, could meet and talk to other people. There could be an opportunity to do more and our son's life would be greatly improved. In a centre like that there could be physiotherapy and occupational therapy. There was an attempt to do that before 2008. There was a centre that had physical and sensory disability services. It was a wide range and not specifically for ABI, but it had physiotherapy and OT during the week. However, that was then brought back into clinical services in the HSE and the services went pear-shaped after 2008. That never recovered. It was never restored to what it had been previously. A day service could incorporate many of these, but it is just not there. I referred to the reports and the national rehabilitation strategy. Where on earth is it?