Holly Cairns (Cork South West, Social Democrats) | Oireachtas source

The overlap between disability, mental health and old age is complicated. It is important for the committee to take time to discuss this theme. I thank the Minister of State for attending today. Mental health falls under the Convention on the Rights of Persons with Disabilities, CRPD, which gives people with mental health conditions additional protections and rights. As people age, they can develop disabilities which present different challenges. The CRPD gives people the right to live independently in their communities, while the programme for Government commits to introducing a statutory scheme to support people to live in their homes. The reality is very different, with more than 6,000 people on waiting lists for home care this year alone. There have been more than 1,000 delayed discharges from hospitals directly linked to home care shortages. Part of the staff shortage problem is that massive responsibility is placed on home support workers, who are often the lowest-paid workers. As part of plans to improve the provision of home care, and the Minister of State mentioned the funding allocated, what is being done specifically to support the support workers in that allocation? There is a creeping privatisation of the sector. What is the Minister of State doing to stem that? An issue of concern is the continuing lack of regulatory framework or independent regulator for this sector. The Minister of State mentioned the development of regulation for home support services. Will she give the committee an idea of what that will look like? Will it involve an independent regulator's office or something to that effect?

The committee recently heard how interaction between community healthcare organisations, CHOs, and mental health services can negatively impact the quality of life and increase rights restrictions placed on disabled people in the community, such as, for example, individuals having to stay in mental health acute units, sometimes over long periods of time, because appropriate supports are not in place. Core to this issue is the structure of the HSE, with the disability services and mental health services operating off different budgets and systems with a lack of co-operation. Teams are then arguing about who should take responsibility for an individual. The committee has received examples of these cases. The Minister of State must also be aware of them. Will she share her response?

Currently, under the Assisted Decision-Making (Capacity) (Amendment) Bill 2022, treatment decisions are being removed from enduring power of attorneys. This means that people will now be forced to go through two processes at a potentially difficult time. For example, members of the Irish dementia working group have pointed out that shortly after receiving a diagnosis of dementia, individuals will have to draft two separate instruments with different requirements for supporting evidence and witnessing etc. This is especially burdensome if the relevant person wishes to authorise the same person who holds the enduring power of attorney as their designated healthcare representative. Given her responsibility for older people, what are the Minister of State's thoughts on that issue?

The next question is for Department of Health officials on the national policy on access to services. Will they provide details on how integrated it is? For example, in west Cork there is a situation where young people are at risk of not being able to access day services because there is no suitable public transport. It is all well and good to have the models of care, but how well integrated are they? The ADHD app has been mentioned a lot. What is it called? People watching may want more information about it.