Dr. Emer Begley:

To follow up on Dr. Foley's point on nursing homes, work is under way in the HSE to address this. There is a national group and a reference group which Dr. Foley is on. The numbers are static but involve slightly different people. Small numbers of people are moving out of nursing homes but people continuously move into nursing homes. The reason for that is that they may be in an acute hospital, then when they try to move out of the acute hospital, they are presented with a nursing home place as a short-term option and end up there for longer because there is no place for them to move on to. The Disability Federation of Ireland is concerned about the slow progress of work on this. One key thing is getting accurate figures about the number of people under 65 in nursing homes. The figure of 1,300 is based on those signed up to the fair deal scheme but many people in nursing homes are not on the fair deal scheme. There is a national survey of nursing homes to get accurate figures but there are delays with it and progress is extremely slow. While attention has been given to this, progress is slow and people under 65 are still going into nursing homes, which is crucial.

The other issue the Senator raised was about the lack of integration across services. We have spoken at the committee about the lack of integration across housing, disability, health and advocacy in local authorities. There is an issue with integration across the different divisions in the health services. The Senator mentioned the progressing disability services, PDS, programme for children and the child and adolescent mental health services, CAMHS. We have seen in parts of the country that children can be on one care pathway, involving PDS, and may need CAMHS, but the services are not talking to each other. It depends on the pathway on which people end up but there is no integration across the different care divisions, which means that families and individuals have to navigate an extremely complex system. To echo what Ms Condon and Ms Byrne have said, advocacy and case management, which ABII has mentioned, support people to navigate a complex system. Without that, people can get lost.