Mr. Bernard O'Regan:

I will comment on the first point made on the role of national and local and on what is support and what is an obstacle. The very clear intention of the CEO regarding the redesign of the HSE and its structures is absolutely about making sure that local decision-making, local structures in the context of the health region, is the way forward, that the national roles are there to support the health regions in the delivery of services, and that the decision-making will be increasingly located in the health regions. That is welcome. Decisions made as close as possible to the citizen are always going to be better.

Regarding the nursing home numbers, it is right to say they have remained static and while that is better than them increasing, it is certainly not anything that anybody is celebrating. There are a couple factors to the reason the number remains static and these are areas on which we are actively working at the moment. Part of the difficulty is that we are not able to make a policy decision at this point, to say no more admissions of people inappropriately into nursing homes because we do not have the alternatives in place. We need to support people to move from places like the National Rehabilitation Hospital when they are ready for discharge because there are others who need to access those services. We are working to develop some models around step-down facilities and then developing the community services that people need with the level of support they need and to be able to do that safely. We are talking sometimes about people with quite complex needs and we need to do it safely. Having available housing and support is certainly part of it but in terms of some of the models of service we have between let us say the National Rehabilitation Hospital and a supported community placement that people might need, we are using nursing homes to bridge the absence of appropriate other services. Until we can develop some of those models, we are not going to see a dramatic reduction in the number we should be working towards. Once we have those step-down facilities in place, we will see much more appropriate stepping stones for people and less use and reliance on nursing homes as part of the model. It is good that number is not increasing. It will be better when we can get the point of making no more inappropriate admissions to nursing homes and we are confidently able to do that because we are able to provide an alternative.