Mr. John Dunne:

Respite is a big broad area. Centres that provide residential respite, by and large, suit carers of younger people. Carers of older people often do not like residential respite. They would prefer in-home respite in order to stay at home. I make that as a starting distinction.

Another distinction can be made between regular respite, whereby everybody should be able to take a break every so often, and emergency respite, when carers need cover such as for a family occasion or going into hospital for an operation. In the past 18 months, the HSE began to acknowledge emergency respite as a concept in its own right. We do a lot of work in trying to deliver such respite. We are successful in about 50%, maybe 60% of cases. In other words, we cannot find suitable respite in 40% of cases, either because it is for someone who needs residential space with clear criteria that is not available, or because workers are not available in a particular area. I believe 50% or 60% is better than nothing. Historically, there was no emergency respite. There was a service called emergency respite that could be availed of if it was booked a year in advance. That is a strange sort of emergency service.

I totally agree with the point raised about the idea of home help. It was an extraordinary move by the HSE to effectively get out of the business of home help and get into the space of personal home care. In trying to backfill this, I would suggest that in looking at overall labour force planning for the home care sector in Ireland, an interesting training model could be provided that involves trainees who are not yet in a position to do one-to-one caring, but would certainly be able to provide home help. As part of a graduated ladder of levels of care, the basic level could be home help, which includes company keeping and doing small tasks to some extent, such as going to the shops. Professor Lynch is right; at the moment the focus is on cleanliness and some medication care, although that is quite low.

Mental health was mentioned, and I might have misunderstood the point, but the mental health of carers has been a big issue in recent years. We have developed a counselling service that is proving very effective. Our whole model of counselling is around how caring is a good and rewarding thing but it is also challenging. People cope, have routines and go along at a certain level. Periodically, the caring arrangement changes and something happens, such as the person has an extra illness or falls or whatever, that causes a strain on the system. Carers periodically go into crisis. Our focus is on trying to bring them back to a sustainable model. Our counselling has been very effective in that regard. Counselling that is just talk is not much bloody use if someone is stressed and needs counselling because they cannot afford to pay the bills or they have to carry their adult son upstairs because they do not have a downstairs toilet. There is no point in talking about that; something practical has to be done as well. Our holistic intervention around carer well-being includes counselling, of which we can measure its effectiveness, but if we did not have the practical responses to go with it, it would not be half as effective. The mental health of carers is definitely a big part of it.

I am obviously one for weird references. Dumbo thought he could fly because he held a feather in his trunk, but then he dropped the feather and discovered what happened. We live by having confidence in ourselves. If carers lose confidence in their ability to cope, that is it, they are gone and cannot keep it up.