Mr. John Dunne:

On the financial framework, we are calling for the establishment of statutory-based community care. I would go further and ask for a timeframe in this regard. It has not been a controversial issue in any government of the past ten years that community care should be provided on a statutory basis. To date, it has not happened. There are three civil servants in the Department of Health responsible for many things, including this potential legislation. I am not sure how granular the committee's inputs are but it might be worthwhile shoring this up a little. It is important this happens within a short timeframe. Until it happens, there will be no credibility for anybody in Government saying we cannot afford to do it if it can be said that it can afford to waste money in other ways. This is a really urgent issue.

In terms of push back into the community, in principle the push back is the only sustainable way to go. The problem again is how this would be done. Pushing back into the community and trying to abandon all responsibility for what happens is different from pushing back into the community in a supportive and constructive way. The reality is that we have been pushing for a while now. Large amounts of money are being spent by the special delivery unit in the Department of Health on getting people out of hospital.

We are not against that in principle. We are asking, however, why, if that is being done it is not recognised that as part of that process, somebody is going home in a more fragile state than they were before? There should be a protocol around a transfer of care situation and some induction training.

I referred earlier to patient moving and handling. We have had situations where the HSE comes into a house to assess a situation. They look at a large man sick in bed and his wife, who is small in stature, standing beside him. They say it would take two people to move that person safely, but we cannot spare two people. They leave the wife to cope with moving that person, not even having been trained in the basics of how she might go about it. If one is going to talk about moving back into the community, that is the kind of thing to consider.

The provision of respite care is critical because if people are going to take on full-time care they have to be given a break. If they were working for the State, or anyone else, they would be entitled by law to holidays, and health and safety legislation would apply to them. However, because it is being informally dumped onto them in the community, none of that applies. Traditionally and historically, there has been a move informally to develop those kind of services. In the current climate, because of the absence of a statutory basis, those supports are being withdrawn at exactly the same time that the pushback into the community is being accelerated.

The third thing we are seeing within those services is that there is a growing abuse of voluntary organisations, such as ours, which are being told that while HSE staff will provide low quality care between the hours of 9 o'clock and 5 o'clock or 9 o'clock and 3 o'clock during the day, if anything is needed at night, say at midnight, or on a Sunday, we are asked to do it. That is not a sustainable basis for pushing back into the community. I am providing examples here but one cannot argue against the aspiration. That is where the difficulty lies. We can all sit here and have a wonderful discussion and agree we are going in the right direction. We are doing so but we are going about it the wrong way. As Mr. Dolan said, it comes back to the question of reform. We are not getting reform.

I had a rather heated discussion with the Minister for Public Expenditure and Reform, Deputy Howlin, recently. With a degree of justification, he said that nobody is acknowledging the great things that are being done. Great things are being done but, in terms of public sector reform, they are being done primarily in the back room. They are being done around the consolidation of support services and even there flaws are apparent. There has been a centralisation of the delivery of incontinence pads or adult nappies. In some respects the service is much better. One now gets a quantity delivered to one's house, which is great. Unfortunately, in certain cases, the quality of what is being delivered is seriously deficient. People are being delivered material that is the wrong size. Hopefully, not many of those present will have to deal with this. Imagine giving a child a nappy that does not fit. What would happen? That is happening consistently around the country, yet the system that has been set up is completely inflexible so it takes months to sort that out. Backroom efficiencies are being achieved but there is not the same kind of efficiency on the front interface in terms of grassroots services.

I was having a conversation recently about unqualified staff delivering services. The HSE response was to acknowledge the problem and express the hope to have it sorted out in a year or 18 months. I acknowledge its difficulties and I am not trying to make cheap shots here. If I said I will sort out my taxes in a year or 18 months, however, what sort of change would I get? If I said I would comply with some legislative measure in a year or 18 months, I would not be given the time of day. I do not understand how the Government assumes it can get away with saying that the rules apply to everyone except itself because its heart is in the right place. That is not good enough. What is happening on the ground is unacceptable.