Ms Yvonne O'Neill:

We are in full agreement with the Deputy on the points about the variation and better co-ordination. In fact, that is why we are motivated and had hoped to have already started this work in 2019. The variation will be minimised when we have the model of care, which brings some standardised practice to what are currently CHOs and the future regional health organisations. The better co-ordination piece is essential to the model of care and the database is also key. Unfortunately, I am at these types of forums too often, talking about our lack of information systems in the community, but we have progressed significantly this year. We got approval from the Department of Public Expenditure, National Development Plan Delivery and Reform for our integrated community management system. Understanding from the point of referral through assessment and the type of allocation of hours and review will be critical.

Over-65s will be an important part of the future model of care. If somebody who is in receipt of hours turns 65, in practice, at local level, the hours are not taken away based on the age. There are a range of reviews, depending on the change of circumstance of the individual. This does not undermine the point the Deputy is making, which is right, in that a person over 65 starting the process will be disadvantaged. We should address that in the model of care.

Ms Hanley may wish to answer on some of the other issues with regard to night-time hours and flexibility. Employment is of equal concern to us. Some of our experience in the feedback we are getting, both with regard to personalised budgets and personal assistants, is often around having the right skilled people. This has also come up, rightly so, with regard to skilled and trained staff. I ask Ms Hanley to speak about this. She is also the head of service in the Deputy's area.