Jerry Buttimer (Cork South Central, Fine Gael)
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I remind witnesses, members and those in the Visitors Gallery that mobile telephones should be switched off or set to aeroplane mode as they interfere with the broadcasting of our proceedings and particularly affect members of staff, which is quite unfair.

Today's meeting is dealing with pre-budget submissions from various voluntary organisations working in the health and children sector. I extend a céad míle fáilte roimh gach éinne. I thank the witnesses for being here in such large numbers. This meeting is divided into three sessions of one hour. Not wanting to sound too much like a schoolteacher, I remind our witnesses that they will have three minutes per presentation, after which there will be an opportunity for questions and answers. I ask members to be precise and tight in their questioning.

As part of our preparations for the budget, the committee decided it was important for it not just to engage, but to be able to listen to and participate, with witnesses as part of the pre-budget submission period. The committee felt in its role in the Houses of the Oireachtas that it was important to have witnesses appear before it as part of our pre-budget preparations. Even though they have their own pre-budget hearings in different parts of the city, it is important for us to engage with them. They are most welcome and I again thank them for coming.

By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of the evidence they are to give this committee. If witnesses are directed by the committee to cease giving evidence in relation to a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, witnesses should not criticise or make charges against any persons or entity by name or in such a way as to make him, her or it identifiable. Members are reminded of a long-standing parliamentary practice or ruling of the Chair to the effect that Members should not comment on, criticise or make charges against a person outside the House, or any official by name in such a way as to make him or her identifiable.

Apologies have been received from Deputy Robert Troy, Deputy Regina Doherty and Senator Imelda Henry. I call on Mr. Chris Macey from the Irish Heart Foundation to make his opening remarks. I again remind everybody to keep to three minutes.

Mr. Chris Macey:

I will be discussing fiscal measures to reduce overweightedness and obesity. We also developed a joint submission on tobacco control with the Irish Cancer Society and fully endorse the points it will make today.

Members of the committee are well aware of the facts behind Ireland’s obesity crisis. One in four three year olds, one in four primary school children, one in five teenagers and 61% of adults are obese or overweight, and these rates are rising. Despite this, the State continues to fail in its duty of care, particularly to protect the health of children from a multinational processed food and beverage industry whose sole remit is to maximise profit for its shareholders and accepts no responsibility for the impact of its marketing tactics on public health.

We believe the resulting excessive consumption of energy dense processed foods and sugary drinks must be tackled through action on many fronts, including the following fiscal measures: taxation to increase sugar-sweetened drink prices by at least 20%; unhealthy foods and beverages currently subject to zero or reduced VAT to be charged at the standard rate of 23%; and a regulatory impact assessment of healthy food subsidies and taxes on unhealthy foods.

Sugar-sweetened drinks are a key driver of our obesity epidemic. Although they have no nutritional value, they are packed full of calories. Children who consume these drinks receive around 20% of their recommended daily sugar intake from them. It is estimated that each extra glass consumed daily increases by 60% their risk of becoming obese. In addition, one in five one year olds, more than half of four year olds and 82% of 13 to 17 year olds consume a sugary drink daily. While the overall number consuming carbonated drinks has fallen since 2001, the daily intake has increased by more than one third among those who drink them.

A health impact assessment and modelling exercise by the Institute of Public Health and Oxford University for the Department of Health estimates that a 10% additional tax on sugar-sweetened drinks would reduce the number of obese adults by approximately 10,000. A 20% tax would have an even bigger health impact and generate extra tax receipts of around €60 million which could fund subsidies for healthy food and drinks and thereby counteract claims that such taxation would be regressive.

Industry groups claim taxation would not work, but in 1992, the removal of a special tax on soft drinks drove consumption up, suggesting the public is sensitive to their price. The industry also claims that taxation would cost jobs. However, reduced spending on sugar-sweetened drinks would result in higher expenditure in other areas and incentivise the industry to reformulate unhealthy products, thus being exempt from additional tax, opening up new markets and positively influencing public health. Research has shown the employment effects of a sugary drinks tax combined with a subsidy on fruit and vegetables would be neutral at worst.

Unhealthy food is generally subject to the standard 23% VAT rate, but products like croissants, banoffi pie, chocolate chip biscuits and jam doughnuts are charged at a reduced rate. Sugar, icing sugar, chocolate spread and pizza have a zero VAT rating. These anomalies make no sense whatsoever and we urge their removal.

Ms Kathleen O'Meara:

I thank the Chairman and members of the committee for the opportunity to address them on the joint submission being made to the Government by the Irish Cancer Society and the Irish Heart Foundation to this year's budget. I will speak on behalf of both organisations, and Mr. Chris Macey of the Irish Heart Foundation and I will take members' questions afterwards.

Our submission concerns tobacco and we have four recommendations: the regulation of the tobacco industry in Ireland, ensuring tobacco tax increases benefit the Exchequer and not the tobacco industry, a price escalator for tobacco taxes, and a comprehensive tobacco smuggling strategy. Why do health charities concern themselves so much with tobacco? Our objective is to continue to cut the smoking rate in Ireland, and it cannot be achieved unless the tobacco industry is controlled here, specifically in how it operates in the market and the profit it makes.

Three big international tobacco companies dominate the market in Ireland: British American Tobacco, Japan Tobacco International, and Imperial Tobacco.

Dr. Robert Branston, an economist at the University of Bath in the UK, has conducted research which shows that these tobacco firms enjoy profits of 55% after duties on sales in Ireland. He estimated that their combined profits in Ireland in 2011 were €104 million after tax, which is about three times the profits enjoyed by the food and alcohol industries. Those are super-normal profits.

We propose that the State intervenes in the tobacco market by appointing a tobacco regulator with the purpose of curbing the excessive profits of the industry. This could yield up to €65 million to the Exchequer. In 2011, total tax receipts for tobacco were €1.42 billion while the cost of smoking related illness to the Exchequer is estimated to have been around €2 billion, so the tax collected from the industry does not meet the cost of caring for those people whose health has been ravaged by their addiction to tobacco.

Our second proposal is to adjust the structure of tobacco tax to ensure that when tobacco tax is increased, it benefits the Exchequer, not the tobacco industry. We seek an increase in the specific tax on cigarettes, with a corresponding decrease in the ad valoremtax. Specific tax is levied on the volume of cigarettes sold, while ad valoremtax is calculated on the price of the packet of cigarettes. That would mean tobacco profits are squeezed, with more revenue to the Government.

Third, we are calling for an annual tobacco tax escalator of at least 5% above inflation in tandem with a national anti-smuggling strategy. This would bring a 60 cent tax increase this year. We stress that the smuggling rate is not the 30% plus claimed by the tobacco industry and the groups it funds. The real rate is provided through IPSOS MRBI research for the Revenue Commissioners, and last year smuggling fell to 13% from 15% in 2011. That is still unacceptable, but if high tax fuels smuggling as some people claim, that has not been the UK experience where the smuggling rate has fallen from 21% to 9% in the past ten years, while tax increased by 77%, making UK cigarettes dearer than here.

Committee members may have heard that tobacco companies and their front groups criticise tax increases, but over the past decade the rate of industry increases has been higher. Therefore, while the Government has made small increases, the industry has in fact made its own, and in some cases higher, increases.

We want increased resources to tackle smuggling. It is important to know that Revenue estimates that 87% of smuggled tobacco is the product of the legal industry getting into the supply chain and just 6% is counterfeit, so supply chain control is a key issue. In the past, cheap tobacco jurisdictions have been knowingly flooded with cigarettes which are then smuggled into other European countries. We need extra detection equipment, such as scanners in our ports, in addition to more supply chain controls. In addition to tackling supply, we must address demand, and our proposals include the introduction of legislation to make buying illicit tobacco a criminal offence. We need to be aware that industry-sponsored lobbying on tobacco tax is aimed solely at maintaining its extraordinary profit levels at the expense of the public purse and, of course, public health.

Jerry Buttimer (Cork South Central, Fine Gael)
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I welcome Mr. John Dunne from the Carers Association, and invite him to speak.

Mr. John Dunne:

Thank you, Chairman. Is it okay to highlight the main points in my presentation and leave the script for the record?

Jerry Buttimer (Cork South Central, Fine Gael)
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Okay.

Mr. John Dunne:

Our approach to the budget is less to do with coming in and looking for vast amounts of extra money - let us be honest, it is not there - and more with highlighting where money is being wasted or where the policy is operating in principle but not in practice. First, we have seen an increase this year in the trend in which a family carer can receive income from the Department of Social Protection or service support from the Department of Health but not both. That matter, which is completely contrary to Government policy, is arising on the HSE side. The two systems were designed to reinforce each other, so what is happening is crazy.

Second, I made the point to the committee last year that fair deal wastes money in an avoidable way. It is a statutory right to put people into residential care. However, there is no equivalent right to put them into community care, so when the budget runs out, the only available option is to put them into residential care, even if that is not what they need or want.

The employment control framework is underpinned by the Haddington Road agreement. For example, if a person living in Carlow or Kilkenny has a child between six and 18 with mental disability, that child would probably never be able to access psychological or operational therapy services on the State system because the limited resources available are concentrated on those aged under six. We have no argument about the concentration on those under six, rather we have an argument with the fact that how the framework is operated leaves that gap. We have no argument with the principle of a framework. It is how it is operating that is at issue.

Respite beds are empty in certain parts of the country. Last year, a charge was introduced for those who avail of more than 30 respite days a year in a State residential centre. The scheme and the charge seems to be slightly troubling in principle but, when it is looked at carefully, the scheme is relatively fair. The problem appears to be about how the scheme is communicated and the fact that people are more scared than they should be of how the arrangement works. Furthermore, it results in empty beds. That does not represent a saving as the costs associated with the beds are still there. It is a lost opportunity. The situation is occurring because there is no proper audit of resources and there is no way to move those resources effectively around the country were we to identify waste in any part of it.

We also flag up a concern about the effect of the recent Labour Court recommendation. Although we are not criticising the court, its recommendation on the terms and conditions of 10,000 home help workers directly employed by the HSE is significant. We have little doubt that it will have an adverse impact on patients, carers and other home help workers employed by voluntary organisation such as the Carers Association or even the commercial organisations because it will cause scarce resources in the HSE to be diverted to directly employed staff for no visible increase in services.

On the Government's phased roll-out of medical cards, we point out that every healthy family carer is saving the State not one but two health bills, because were the family carer to get sick, the person they are caring for must also be looked after by the system. Consequently, family carers should be a priority in the pecking order in the roll-out. In addition, the prescription charge for card holders was introduced last year. Although we have no problem with the principle behind that charge, it could be restructured on a revenue neutral basis so that the old and chronically ill are not penalised.

The proposals to replace the mobility allowance scheme have not emerged. We understand that the problem is a difficult one, but we assume that the ad hoc arrangement by which the old scheme will continue until October will be extended until the new scheme is introduced.

Jerry Buttimer (Cork South Central, Fine Gael)
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Go raibh maith agat. I welcome Mr. Martin Naughton, from the Disability Federation of Ireland, and - I am sorry if I am not pronouncing this name correctly - Mr. Seng Duc Ngeuyn.

Mr. Martin Naughton:

I thank the committee for inviting us here. I am not going to stick to my script, but I ask Members to read it. I am someone who normally talks off the cuff; that is why I end up in so much trouble a lot of the time. I could spend all day talking to members about there not being enough personal assistance, PA, hours. I agree with all that Chris Macey said and I could elaborate on his points. However, what I want to say to members more than anything else is that it is not the money that we do not have but the money that we have that is most important. I do not know whether the figure for disability services is €1.3 billion or €1.4 billion or some other amount in that order. I have 60 years experience of living with disability and working in all aspects of it, through which I earn a reasonable living. The difficulty I have is that although the support to people with disabilities is provided for, when the services are provided, usually what happens is that people and families are made even more dependent. The reality is that people can never have enough and the State cannot continue to provide the services. How do I know that? The same situation is arising in every other state across Europe.

I am sure that members are familiar with the UNCRPD, the United Nations Convention on the Rights of Persons with Disabilities. There is much debate about that and we are waiting on one more piece of the jigsaw to come together.

All that says a number of different things. Services must be provided in a form of support. That form of support must be a form of empowerment, choice and building and developing people with disabilities to understand their rights and responsibilities. If we do not do that, we will continue to have funding and more funding, so I urge many of those here to stand back. The policies within the Department are nearly right but there is a lot more to be done.

We need to look at how we fund people with disabilities. If we move to Australia, we have the national disability insurance scheme. We should be discussing at European level and should be in search of a Commissioner for disability. We should be getting European-wide support. Disability occurs right across Europe. We may think it is a subsidiary point but it is not. I urge members to step back and think about how we spend such valuable money. I am very mindful of the figure today, which I understand is €77 billion on the wrong side of the equation.

Jerry Buttimer (Cork South Central, Fine Gael)
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I welcome Mr. Eamon Timmins from Age Action Ireland.

Mr. Eamon Timmins:

On behalf of Age Action, I thank the Chairman and the committee members for this invitation to be here. The cumulative impact of a succession of austerity budgets is taking a very heavy toll on older people who are being forced to make drastic decisions to make ends meet. We carried out a nationwide consultation between February and April 2013 when we were preparing our pre-budget submission. It involved asking people whether austerity affected them and the actions they are taking to deal with it. We were shocked by the results. Although we work with older people every day, we were genuinely taken aback by some of the things that came back in the questionnaires. They ranged from people going to bed at 7 p.m. to remain warm, to people sitting with hot water bottles and turning off the heat, to people choosing between food and fuel, to people who could no longer afford to keep their pet. Our pre-budget submission highlights how older people on fixed or falling incomes are being hit on four sides as a result of austerity. They are being hit with new taxes and charges, cuts to their income supports, rising prices for essential goods and services and cuts to publicly funded services on which they depend to remain living independently in their homes. Faced with growing pressure from all sides, many older people are being faced with very tough decisions as to what to pay for and what to do without.

Our submission smashes the myth that older people have not been affected by austerity. That myth is out there and is being perpetuated time and again. If we do nothing else, we would like to say that the poorest of older people who are dependent on the State for their basic needs are among those who have been hit hardest by austerity. If we get no other point across, it will be a very good day's work for me. On the income side, fixed pensions are expected to pay a series of new taxes and charges. Property tax is equivalent to two or three weeks' pension for many older people. The prescription charge was trebled in the last budget. It only affects the sickest and poorest. The carbon tax has been extended this year and will be doubled in the forthcoming budget. The increased charge on a person’s home under the nursing homes support scheme will increase from 15% to 22.5%. At the same time, key supports for older people are being cut. The means-tested winter fuel allowance was cut by six weeks, the gas, electricity and phone allowance under the household benefits package has been cut, there have been cuts in the respite care grant and funding for the home adaptation grant, and there has been the loss of waivers for bin charges. The list goes on and on.

Meanwhile, prices for essential goods and services are soaring. This pre-budget submission was compiled in April and we looked at key prices going back to 2008 and 2009, which was the last time the State pension increased. We are particularly worried about the cost of energy. Electricity prices have jumped by 32%, gas prices have increased by 26% and home heating oil has increased by 25%. These energy figures do not include the latest increases, which were approved by the Commission for Energy Regulation in recent weeks.

The other element of austerity is that key services on which older people depend have also been cut. An example would be home help hours. In 2007, the HSE provided two million more home help hours compared with today. Austerity is also taking a psychological toll on older people. It was very clear from the submissions and questionnaires that older people are uncertain about what the future holds. Many of them feel guilty and that they are a burden on society.

Our pre-budget submission features 32 recommendations. I will not go into them all but what we are asking the Government to do in this forthcoming budget is to ensure it poverty-proofs all measures and not just those related to older people in order that the most vulnerable in society are not penalised further. We need to protect the State pension because it is the bulwark against poverty in later life for the majority of PAYE pensioners. We need to reverse the cuts to the household benefits package. If we reverse no other cut, we must reverse the cut to the means-tested fuel allowance for the poorest of older people. We need to ring-fence the carbon tax in order that it goes into home insulation programmes. The original intention of carbon tax was to protect people. We are also looking for a property tax exemption for households with an income of under €12,000 per annum and the scrapping of the 4% interest charge. We have not received figures back from the Revenue Commissioners. Our experience is that very few older people are taking that up but are going without to pay their property tax. A copy of the full submission has been sent to the committee and is available on our website.

Jerry Buttimer (Cork South Central, Fine Gael)
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I welcome Ms Magdalen Rogers from Neurological Alliance of Ireland.

Ms Magdalen Rogers:

I thank members for this opportunity to reflect the needs of more than 700,000 people who live with a neurological condition. In May of this year, the Irish Government hosted European month of the brain as part of events for its EU Presidency. The irony is that Ireland is among the most challenging countries in which to live with a neurological condition. In the year in which our country was the focal point for neurological conditions, we are calling on the Government to halt the effects of years of successive cutbacks to health and disability services which have had a devastating impact on people with neurological conditions and their families.

I am aware of time constraints this morning and refer members to our full pre-budget submission. I will group some of our most important themes under the following headings. Overall, living with a neurological condition in Ireland is becoming increasingly difficult because of the range of cuts to health, education and disability services which have taken place over recent years. Neurological conditions are among the commonest causes of significant disability so, proportionately, these people are the most vulnerable to these cuts. The examples outlined in our pre-budget submission include increases in the cost of medical care represented by prescription and other charges, cuts to transport services which effectively deny access to health services for those who need them, and cuts to personal assistance services.

We are critically reliant in Ireland on the not-for-profit sector to provide neurological care. The strength of this sector has been steadily eroded because of successive funding cuts of up 15% in recent years resulting in the curtailing and withdrawal of vital helpline, respite and support services to people with neurological conditions and their families.

By cutting community-based home support, transport and other services, we are choosing the most expensive option for caring for the growing numbers of Irish people with neurological conditions. Cutting community supports places greater reliance on hospital and nursing home care. While cutting community-based supports does not have the same optics as removing beds and closing wards, its effect is no less devastating on our health services and those who need care.

What is the Neurological Alliance of Ireland calling for? We are calling for the Government to take actions in line with its policy of keeping people in their homes for as long as possible by halting and reversing key cuts in community-based supports such as personal assistance, home help, home care supports and home adaptation grants. We call for it to recognise that not-for-profit neurological organisations cannot sustain further cuts without them having a devastating impact on vital services and supports for people with neurological conditions. We call for a halt to funding cuts to disability organisations and for the Department of the Environment, Community and Local Government to renew the scheme for national voluntary organisations.

Jerry Buttimer (Cork South Central, Fine Gael)
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We will now hand over to members. I remind members that they have two minutes each because this session will finish at 10.45 a.m.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I join in welcoming all our guests here this morning. They will appreciate that two minutes will not allow me to go into all of this in any great depth. I noted a number of points in the Irish Heart Foundation submission. The Department of Public Health at the University of Oxford estimates that a 10% additional tax on sugar-sweetened drinks would reduce the number of obese adults by approximately 10,000. I support the case and the point. People will challenge it in discussion and debate.

How do they do that and what methodology is employed? It is a difficult thing to quantify. The only supportive evidence for it was the information that suggests the public is sensitive to price. In terms of winning the case, those of us who are open to making the argument need to have more information so that we can be of help. It is not enough for us to be supportive in broad commentary. It would be helpful if we had an idea of how the impacts were assessed.

Mr. Macey drew an important link between the additional drink tax and the flip side of the coin, that is, the subsidy. We want people to think about subsidising fruit and vegetables in order to make them more affordable and attractive, and to encourage parents to explore the variety of good food options. That is a welcome idea which I would endorse.

The committee recently discussed the issue of the tobacco market. I acknowledged on that last occasion that to the best of my knowledge there are no differences among the members of this committee, across all parties and none, in our intentions regarding the impact of the tobacco industry on the health of the citizenry. Ms O'Meara referred to the appointment of a tobacco regulator with the purpose of curbing the excessive profits of the industry in Ireland and suggested that such an approach could yield up to €65 million for the Exchequer. I am interested in the details of her proposal. We are given a figure of €65 million but we need to be able to make an argument in support of it. She also proposed an adjustment of the structure of the tobacco tax to ensure that when it is increased it benefits the Exchequer rather than the tobacco industry. I ask her to explain how the tobacco tax has benefited the industry.

Her submission contained a staggering fact on tobacco smuggling which merits the attention of the media at large. The submission claims that 87% of smuggled tobacco products come from the legal industry. I am not challenging her to substantiate the claim because I am buying it straight off and I can only deduce that the tobacco industry is in some way complicit in utilising certain countries and markets in order to enter supply chains in Ireland, Europe and elsewhere via the back door. That issue needs to be highlighted and addressed because it is a serious charge. I do not doubt that it is the case. The industry has a serious case to answer.

I apologise to other speakers that I cannot respond to all of their contributions. I have made note of their points and questions and I thank them most sincerely for their time. What they have given us in written format is very important and welcome.

Jerry Buttimer (Cork South Central, Fine Gael)
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Deputy Ó Caoláin will be glad to learn that I gave him the Fianna Fáil members' time in addition to his own.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I would take it all off.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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I welcome the witnesses and thank them for their presentations. I may get more than two minutes but I am aware that time is limited and I will not be able to cover all the areas they discussed. I particularly empathise with the presentation by the Irish Heart Foundation and the Irish Cancer Society because I have personal and family experience in both of these areas of health.

I draw attention to a thread that runs across the submissions, namely, that all the organisations want people to be able to remain in their own homes and communities. That is critical for all the clients of the various organisations before us. A number of issues arise, of which fuel poverty and medical cards are of particular importance.

A shocking study on fuel poverty has been prepared under the direction Professor Goodman of Dublin Institute of Technology. The study, which was peer reviewed and publicly funded, was launched last year by the Minister for Communications, Energy and Natural Resources, Deputy Rabbitte. The research indicates that in excess of 1,281 winter deaths occur over summer deaths in Ireland. That figure is one of the highest in Europe and is even higher than the rate in Scandinavian countries, which experience much colder winters than Ireland. In the context of the cuts introduced since the Government came to power in the free fuel schemes, the reduction of the scheme from 32 weeks to 26 weeks and the cuts to the household benefits package for electricity and gas heating units, it is essential for these cuts to be reversed if people are to be able live in their own homes. I hope this will be taken on board by the Government in the coming budget.

I have referred on numerous occasions to the issue of medical cards and the fear that exists among sick, elderly and disabled people that they may lose their cards. Medical cards are being reviewed in instances where they are not due for review. A considerable number of elderly people who have valid cards which were assessed, approved and issued by the HSE with expiry dates up to 2020 are being subjected to review. That practice must stop and I hope the Minister for Health will instruct the HSE to desist.

In regard to the question of discretionary medical cards for persons with serious and ongoing illnesses, such as cancer and motor neuron disease, these people are not qualifying for cards. That is something which will have to change and I hope the committee puts that argument strongly and clearly to the Government.

Colm Burke (Fine Gael)
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I thank the witnesses for meeting us this morning and for the contributions they make on a daily basis to the members of their organisations. In regard to the comparison of home care packages with the fair deal scheme, we will face a serious problem in this country over the next 17 years as the number of people aged over 65 years increases from 500,000 to 900,000. We need to start long-term planning for this demographic change. I am not sure we are doing sufficient planning.

Mr. Timmins talked about the fair deal scheme and the 7.5%. Some 34,000 people have entered the fair deal scheme since 2009. Some 12,000 of those have died and the total refund to the fair deal scheme has been only €7.5 million in real terms, so the 5% or 7.5% will not make a huge difference in real terms. It causes anxiety with families and is an issue I come across regularly when I am acting in my legal capacity. I am not sure we are giving enough support to families in how to manage the problems they face or will face. I am not necessarily talking about financial assistance. We have tended to get the message out there that everything is State dependent. I wonder if we need to be more proactive. We have been very proactive on health issues such as smoking but we have done no education programme with the general public on how we can all make a contribution to elder care. What is the view of the witnesses, who have made very good submissions here?

Peter Fitzpatrick (Louth, Fine Gael)
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I welcome the witnesses. My first question is for Mr. Chris Macey of the Irish Heart Foundation. We are all aware of the obesity crisis in Ireland. As he stated, 61% of adults are obese or overweight. He believes the over-consumption of processed foods and sugar-sweetened drinks are the main contributors. If tax on sugar-sweetened drinks were increased by 20%, he maintains it would generate €60 million. We charge the standard VAT rate of 23% for the unhealthy food. What is the best way to spend this money to combat obesity and overweight? I am working on the committee's report on obesity, which we will present to the Dáil in the next couple of weeks.

My second question is to Ms Kathleen O'Meara of the Irish Cancer Society. I do not smoke, and the main reason is because of my father. I lived at home for 25 years and all I can remember of my father is the constant cough every morning. I agree that smoking-related illness costs an estimated €2 billion per year and the tax revenue from that industry does not meet the care of these people. My main concern is the damage cancer can do. How can we stop young people and pregnant women from smoking? What suggestions does Ms O'Meara have if finance were made available to combat the effects of tobacco addiction?

Jillian van Turnhout (Independent)
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I thank the witnesses. I agree with my colleagues that the presentations were very clear. Deputy Healy picked up the point on community care. It is a strand that runs through all, as does the concept of rights and not charity. The fair deal scheme, respite care, the carer's allowance and even the policy decision Mr. Dunne talked about in Kilkenny all come together. When we try to raise these issues, for example about the fact that people are being pushed from community care into the system, we are told that is only a one-off, anecdotal case. All the budget submissions here are saying the same thing. Can the witnesses provide the evidence that this is systematic and not accidental or one-off? That would be really useful. It is very welcome to see some revenue generating measures being promoted but we all know that cost-wise it makes no sense, and it also goes against the individual's right to be cared for in their own community and home. If that is what they choose we should support that decision.

Mr. John Dunne:

On anecdotal evidence, we are not equipped to do a detailed audit of the HSE. After last year's committee there was a witch hunt in the HSE for three days, and the case I referred to of somebody who was being put to bed at 3:00 p.m. was addressed. I specifically did not give the details because that was not the point. I wanted to highlight a different issue, which is that within the labour and management systems this is the sort of dysfunction that happens. We regularly meet Ministers and senior officials. We give them cases; they say it is shocking; the case is reversed. We are wasting so much time and effort within the Oireachtas system doing that sort of nonsense. We do not have the resources or the access to the information, so all we can offer is anecdotal evidence. As legislators if the members are hearing a very diverse group of organisations coming in with the same message, that points at something needing to happen.

On Senator Colm Burke's questions about the community-based approach, there are increasing efforts to develop volunteer initiatives but there is a limit to how appropriate they are within the system. I refer to the age-friendly counties initiative as a positive initiative. It is outside the health area and that is a conscious point around ageing and dependency. Within the HSE the social care agenda is being squeezed out by everything else. It is due to pressure on resources. I am not trying to malign any individual.

Mr. Eamon Timmins:

I agree with Senator Colm Burke's point. With an ageing population, the State needs to prepare in terms of pension and health care. Families need to prepare. We all need to prepare. We will all grow old if we are lucky, and the decisions we are making now about where and how we live will have an impact. Communities also need to prepare. We run a program called care and repair. We will have a major conference tomorrow in Croke Park to examine the future of that program and how we can continue to fund it, because our sponsorship is running out. We will also examine the community groups who are working with us to see how we can grow it on the ground. This is a programme where volunteers come in to do small DIY and visitation. Many of the people we deal with are not receiving social care but might need the grass cut or a light bulb changed. They are the vulnerable side of older people who are hugely affected by emigration. Many of their families would have done these jobs. We have seen a marked rise. We need funding for that, whether it is from the corporate sector, the State or both. They are the kind of programmes we need to examine.

I agree with Deputy Healy on fuel poverty. Fuel poverty is affected by a person's income, fuel prices and insulation. Two of those three issues have been markedly hit by the State. People's incomes and income supports are falling, while the price of energy, over which the State has no control, is soaring. This issue must be addressed and there is huge dependence on the State to address that. The Minister for Communications, Energy and Natural Resources, Deputy Rabbitte, has a fuel poverty strategy in place and there is a home insulation programme working. We need more funding to go into that. If I am freezing this winter there is no point in knowing there is a home insulation programme which will get to me at some stage. That will not keep me warm. We need more money to go into the scheme so that more homes can be insulated.

Ms. Magdalen Rogers:

Senator van Turnhout commented on the importance of an evidence base for the impact of cuts on the community. I agree that we need that evidence base. On neurological conditions, one of the key indices we could have is the direct knock-on impact on acute hospital services of the lack of community services for people with neurological conditions. A report came out in the UK last week which identified the number of unscheduled care admissions of people with neurological conditions to acute hospitals as one of the clearest indices of the lack of community services for people with neurological conditions. The report showed that the number of emergency admissions for people with neurological conditions is very high and that is a direct reflection of the lack of community based supports. We need to collate that information.

Mr. Martin Naughton:

We describe the win-win situation. People want to live in the community and it is more cost-effective for a number of reasons. If people wanted, and it was more cost-effective, to live in institutions we would all live in them. Why are we asking to make a different rule for people with disabilities or others who have, very often, been forced into dependency by the system? I am not disabled because I choose to be. That is my condition. It presents an extra few barriers a lot of the time.

I do not want anybody fencing me in. I want somebody to help me over the barriers. That is all we all want and, therefore, that is the evidence. I am reminded of the "why do they not commit suicide?" approach. One has to pick that up right now. Members may recall a famous politician who said that because he could not see the warning lights or he did not want to see them. We are wasting good money on doing bad things. It does not matter what evidence we bring to the committee. Members are the people in power. How many times do we have tell them? How many different ways do we have to dress it up? This is their society. Members are the protectors of the taxpayer's money. The deaf soldiers, the Magdalen laundries and other abuse survivors have nothing compared to what we have coming. We will have an extra court after next week.

Jerry Buttimer (Cork South Central, Fine Gael)
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Mr. Naughton should not pre-judge the referendum.

Mr. Martin Naughton:

I do not mean to be disrespectful. It does not matter. If there is not an extra court, we will get it quicker. We will have one fewer court to go to. The reality is my disability is making certain people very rich. I am one of the hottest cash cows in this country. I have lived a long time and people are making a huge profit. Members should wake up and smell the roses. I am sorry if I raised my voice.

Jerry Buttimer (Cork South Central, Fine Gael)
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Mr. Naughton is fine. He made a strong and articulate point, which is more than welcome.

Mr. Chris Macey:

Deputy Ó Caoláin asked how we can estimate a 10% increase in tax will reduce obesity by 10,000 people. This is generally recognised to be the most comprehensive study of its kind to have ever been carried out in Ireland. Data on purchasing activity was used to assess the impact on consumption and then nutritional data was used to assess the impact that would have on reducing weight. Clearly, it is an estimate and the only way we will ever find out how effective this tax would be is to impose it. The industry argues there is no evidence but the only evidence one can have is to bring it into effect. The study also examined what has happened in other countries and it found that a tax below 10% raised revenue but did not affect behaviour whereas a tax of more than 10% affected behaviour and reduced obesity rates. I can get a much more detailed answer on that to the Deputy if he wishes.

Deputy Fitzpatrick asked how we can solve the obesity crisis. There is no short answer to that but the first thing we have to do is make healthy food cheaper and unhealthy food more expensive. We have a man who had a heart attack last year who said he used to eat fast food five times a week. He has cut this down to three times a week because it is cheaper to get a pizza from a takeaway than to cook a pork chop and boiled potatoes for his family of an evening. That is an issue. The other factors are not necessarily about spending money. We have to restrict the power of the multinational marketing industry. Some of the best brains in the world are targeting children. One estimate is that for every healthy food advertisement a child sees, he or she sees 99 unhealthy food and drinks advertisements. People then comment on personal responsibility and ask why children and adults cannot see beyond all this marketing but it is impossible. They are bombarded by it and there is no way out.

The third factor is information. Half our teenage girls have been on a diet, which is an incredible statistic. That is terrible in its own way but they are not even allowed to see front of pack labelling that will show them the amount of calories they are taking in. The State is protecting the multinational processed food industry from the public rather than the other way round. That has to be wrong and we have to challenge that. We are back before the committee asking for the same measures as last year. Another year has gone by and nothing has been done.

Jerry Buttimer (Cork South Central, Fine Gael)
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Has Mr. Macey been asked to meet the members of the special action group on obesity?

Mr. Chris Macey:

We liaise and talk to them and make submissions to them.

Physical activity is another issue. Our schools may reduce physical activity time in the junior cycle at a time the physical education rate in our schools is among the lowest in the EU. It is a disaster at whatever point one looks at it. We are doing nothing to tackle this and we are being hoodwinked by industry into doing nothing and putting it down to an issue of people's personal responsibility.

Ms Kathleen O'Meara:

Deputy Ó Caoláin asked about the tobacco regulator, how tax increases benefit the industry and smuggling. With regard to a tobacco regulator, we have models of regulation in other sectors such as the energy, aviation and taxi regulators. There is market failure in the tobacco market and there are excessive profits. Three companies sell 90% of all legal products. It must be recognised that there is market failure and excessive profits. An office of tobacco regulation should be created, which would intervene, cap the price, take the excessive profit and give it to the State. This is set out in great detail in our submission. This basically amounts to an intervention by a regulator in a market that is failing to curb profits and return them to the Exchequer against a background of recognising that those excessive profits are generated by an industry, half of whose consumers die as a result of using the product. From a public health perspective, that is the model we propose.

With regard to tobacco tax increases, one must examine the tobacco tax structure, which is set out in graphics in our submission. In 2010 the European Court of Justice ruled that minimum pricing was illegal. We have minimum pricing here. Since then there has been a trend of introducing lower end tobacco into the market at €6 or €7 a pack and then there is the high end of €9 a packet or 32 cigarettes in a pack of Benson & Hedges for €10. In view of the current tobacco structure, the tobacco industry is allowed to make increases on premium cigarettes and well known brands while keeping low end cigarettes cheap. We have a nice graphic on page 10 of our submission. This means that the industry benefits as a result because the tax is levied on the volume of cigarettes sold and the ad valorem tax is levied on the price. Companies are using that structure to increase their profits. Cigarettes are cheap to produce and profits are high. A small increase, therefore, will produce a major profit but it will not affect consumption.

The Government introduces a small increase in the budget in response probably to lobbying by ourselves and so on. Every year for the past ten years, the industry has also introduced a small increase, which means their profits have increased. Consumers do not notice because all they hear is there has been a budget increase and at midnight the price of cigarettes will go up. They might see a 10 cent or 15 cent increase on television but they do not realise they are paying 20 cent or 25 cent more. The tax increase is absorbed and because it is not a high increase, consumption is not affected. The WHO agrees with our argument that high increases will hit consumption.

The smuggling figure of 87% comes from Revenue; it is not ours. The example we quote is 3.1 billion packets of cigarettes were supplied to Andorra in a single year.

That would be equivalent to every Andorran citizen smoking seven packets a day. So many of these cigarettes ended up in Ireland. I think members of the committee have got it in one. I do not need to say anything more about that.

Regarding young people-----

Jerry Buttimer (Cork South Central, Fine Gael)
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Briefly.

Ms Kathleen O'Meara:

----- I say two things. We support what the Minister is considering regarding standardised packaging. That would greatly protect young people from the marketing tactics of the tobacco industry. We believe it would have a major impact. The second thing is price. We have carried out some focused research and the Irish Heart Foundation has done some focused-group research with young people. They are particularly price sensitive. I remind members that consumption has dropped in Ireland. We are at just under 22%, down from 29% and price is certainly having an impact. We urge members to back our proposal for a tax escalator of inflation plus 5%, which would be 60 cent this year. I thank the Chairman for his indulgence.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The carers have recommended protecting income support for family carers. In order to address the needs of carers, we have emphasised the restoration of the respite care grant to €1,700, which we believe is essential. I have personal knowledge of the impact of that in real cases and I do not need to be convinced. I am somewhat concerned that I am arguing for slightly more than what is mentioned in the opening paragraph which states that all income supports for family carers must be protected at current levels. I wonder about the language because after the significant reductions in recent years, that is not enough. We all get beaten up by the barrage of where we are at and everything. We almost succumb to the weight of guilt placed on us and that we cannot be looking for anything more - never mind what Mr. Naughton said earlier. Is that the correct language to use?

Colm Burke (Fine Gael)
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I have a question for Mr. Macey on the obesity issue. I recently spoke to somebody who had addressed a meeting of GP and practice nurses and raised the issue about the importance of GPs giving advice to families on the obesity issue especially regarding young children. The reaction from the audience was not positive. Their attitude was that if GPs raise the issue in their surgeries they lose patients - entire families have left surgeries. How should we deal with such reluctance by the front-line carers to raise the issue when there are clear signs of unhealthy eating and obesity in families?

Peter Fitzpatrick (Louth, Fine Gael)
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I agree with Mr. Macey on obesity. For the past 12 months I have been working on obesity. I have looked at reports for the past five, ten and 15 years. Every approach was continually requested. At this stage of the game something needs to be done to tackle obesity. I will take into account what he said this morning and will send a copy of my report in two weeks. I would be interested to hear what he thinks of it.

Mr. John Dunne:

In our pre-budget submission we called on the Government to reverse this cut. We have never previously called for a cut to be reversed, but we seek the restoration of the respite care grant or alternative ways of making it up. We acknowledge that if the Government wants to be creative there are other possibilities.

Mr. Eamon Timmins:

I support Deputy Ó Caoláin. The respite-care grant has had a huge impact on family carers, who are the forgotten heroes in Irish society.

In response to an earlier comment from Senator Colm Burke, the national positive-aging strategy deals with how the State is preparing for an aging population. In April, the Minister of State, Deputy Kathleen Lynch, published a national positive-aging strategy. It does not have an implementation plan yet, but we were told it would come within six months. That six-month period expired yesterday. We need to see the State start to implement a national positive-aging strategy and start to plan for an aging population. We cannot continue to put our head in the sand; the issue will not go away.

Mr. Chris Macey:

I have not heard of what Senator Burke mentioned and it is cause for concern. It has been shown that GPs have a major role in areas such as this. For example, when GPs get involved in smoking cessation, it has a major effect. Obesity is similar and I would be concerned if health-care professionals on the front line do not feel it is something they can discuss. There are sensitive issues here, but these are professional people who are well used to dealing with such sensitive issues. I am somewhat surprised. I will carry out some investigations and come back to the Senator on it.

Mr. Martin Naughton:

In case Deputy Ó Caoláin might think we forget, we do not. Many people with disabilities are on permanent allowance etc. Disability allowance in particular of the three major allowances there, is the lowest paid. Yet they are not entitled to go on the unemployment register so we are trapped. If there is 200% employment in the country, we cannot get on to that employment register because we are locked into a kind of thing. Of course if we manage to break through that, like some of us have, we are okay, but most people are trapped there - 105,000 at the moment. They cannot get onto any of these schemes or anything like that. In terms of housing, the 3% quota and all of those, they have cut in the first year alone the lowest people.

I could go on forever talking about the cut in PA services, less housing and education. The Deputy knows them all and could rehearse them all. That does not mean the pain is less this year. Actually the pain is greater this year because now depression has replaced hope in many of these families.

If we talk about alcoholism, obesity, drugs, etc., they come about through the absence of education. We have parents today who need much more support and time than ever before because they have no extended families to support them, educate them and bring them through. I am talking about parents. They do not realise it until it is too late and obesity has already set in. They do not realise they have often been facilitating it. The bottom line of that is that community does not care anymore. Community is very much what the British introduced in the 1970s when they had community care but no care in the community. That is the problem we have and we had better wake up. It is all ahead of Deputy Regina Doherty.

Jerry Buttimer (Cork South Central, Fine Gael)
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I thank all of our witnesses and guests for their very challenging and thought-provoking presentations. We thank them for the great work their organisations do on behalf of thousands of people across the country. We will suspend until 11 o'clock.

Mr. Martin Naughton:

We do not need thanks; we need powerful representation.

Jerry Buttimer (Cork South Central, Fine Gael)
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I welcome the guests, witnesses, members and those in the Visitors Gallery to the second session of our pre-budgetary submission hearings. Some members have left due to various commitments but I hope they will be back in due course. This committee decided it is important to hear from the witnesses at these hearings rather than have external briefings, all organised in witnesses' own sectors and spheres. Each group has three minutes. I will be strict on time because we want to engage in questions and answers.

Witnesses are protected by absolute privilege in respect of the evidence they are to give to the committee. However, if they are directed by the committee to cease giving evidence in respect of a particular matter and continue to do so, they are entitled, thereafter, only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that where possible they should not criticise or make charges against any person or persons or entity by name or in such a way as to make him or her identifiable.

I remind members of the long-standing parliamentary practice or long-standing rule of the Chair to the effect that they should not comment on, criticise or make charges against either a person outside the Houses or an official by name or in such a way as to make him or her identifiable.

I invite Ms Angela Edghill from the Irish Hospice Foundation to make her contribution.

Ms Angela Edghill:

I am thankful for the invitation to make a presentation to the committee. I feel I am preaching to the converted because, having met many of the members on a one-to-one basis, I noted they have read our full pre-budget submission. In the interest of brevity, I will concentrate on three issues that we refer to in the submission. The first is the specialist palliative care budget, €72 million for 2013. That sum pays for home care nurses in each of the 26 counties and nine hospices throughout the country. We know there are three areas in the country that do not have a hospice. This is a vital service because the mortality rate will remain 100%. The needs of people are increasing and the budget has decreased by 14% over the past five years, and by 3% in each of the past two years. Despite that, the hospices and home care teams have managed to increase their services. We are the perfect pupil doing what the Government says, namely, doing more with less. Everybody present today will see we deal with the most vulnerable people in society but they should note death is a uniquely vulnerable and lonely experience for most people.
The hospices do an amazing amount of work. We are not asking for an increase in the budget but that the budget be maintained. The chairperson of the voluntary hospices CEO group said it has trimmed away every item of excess expenditure it could find. It has cut to the bone and managed not only to maintain services but also to increase them. If the budget is cut again this year, the services will be fragmented and suffer. Everybody says that but it is true in this case.

Around the country, the voluntary and community sector supports the hospice services. In Waterford, for instance, the Waterford Hospice Movement pays €400,000 per year to support the home care services. The south east has no inpatient unit. This cannot be sustained so it is very important that the service be maintained. Members will have received my statement so they will know all the figures.

Let me announce some good news on children's palliative care. We now have the consultant in children's palliative medicine and the eight nurses my colleague spoke to the committee about last year. Five of the nurses and a consultant are currently funded by the Irish Hospice Foundation through public subscription or fund-raising. The public is providing the funding. We would really like it if the HSE started to think about sustainable funding.

We do not have hospices in three areas of the country. There are unopened hospice beds provided by the voluntary sector in St. Francis in Blanchardstown and Marymount in Cork and we are delighted HSE says it will build the hospices in Waterford and Kerry. We would like it to happen as soon as possible.

Jerry Buttimer (Cork South Central, Fine Gael)
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Our next speaker, whom I welcome, is Mr. John Hannigan, vice chairman of the National Federation of Voluntary Bodies.

Mr. John Hannigan:

I thank the Deputies and Senators for inviting me. I represent an organisation that has 61 voluntary members. It provides 80% of the services for intellectual disabilities across the country. Most of the services have been founded by parents and families. Most still have family and parents involved in their governance. Effectively, we support nearly 22,000 people across the country. I am the managing director of Sunbeam House Services, a Wicklow-based adult service providing supports for 360 people in the Wicklow area. We provide 410 jobs and support 350 families with what they believe are very necessary and critical supports.

Unfortunately, over recent years, the demand for our services has outstripped the supply. We are constantly looking for ways to innovate but, over recent years, we have seen more than 17.5% taken from the budgets of the various organisations providing the supports. It may not sound like a very big figure but when already operating on a not-for-profit basis, it becomes very difficult to sustain the cuts. Up to 20 September, 831 school leavers have been provided with some level of support, but nothing like what they need. Unfortunately, quite a number of them have very complex needs. They probably need very significant supports but are not getting them. They are now on a waiting list.

We spent the past two years implementing the value-for-money report, considering the policy review and ensuring that the sector as a whole has made progress in that regard. We can demonstrate very clearly that is what we have been doing. We potentially face a considerable number of cuts this year. If they occur, everybody, including Ms Angela Edghill, will say he or she deals with the most vulnerable people. Organisations supporting affected people are now facing growing deficits that are very significant. Services cannot continue where growing deficits occur.

My organisation has had to implement very significant cuts regarding what we consider to be substantial services for 44 people. We operate across an urban-rural divide and there is not very good rural transport, unfortunately, at this point. Owing to the Haddington Road agreement and all the cuts imposed over the past 12 months, we now have to reduce that, which has an impact on the lives, jobs and finances of families.

Next year, we know there will be at least another 800 school leavers affected. This year, a sum of €12 million was required to provide the relevant services. Some €4 million was provided, yet most of the affected individuals received some level of support.

I am not here just to speak about the organisations as it is very important that cuts to DA, carer support and respite care be reconsidered, as advocated by other witnesses. Increases are required because the cost of living among the people who are being supported has been very much eroded over the past five or six years. The people of whom I speak are among the most vulnerable. That is not a cliché but I acknowledge it is a statement that members will hear for the rest of the day.

Jerry Buttimer (Cork South Central, Fine Gael)
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I welcome Mr. Michael Harty, chairman of Home and Community Care Ireland.

Mr. Michael Harty:

I thank the Chairman and members for the invitation. Home and Community Care Ireland, HCCI, is the representative body of private home care providers throughout the country. It employs roughly 6,000 staff and cares for approximately 8,500 clients. It contributes approximately €36 million to the economy each year.

In putting together our budget submission we have been very cognisant of our current economic difficulties and the imperative to ensure our limited resources are put to best use; the historical overspend in the health budget, in particular, which has led in the past to cuts to front-line services rather than structural reform; and an increasingly ageing demographic profile which means any issues or difficulties we now face will only be magnified in the years to come.

Our budget recommendations call on the Government to make better use of existing resources, which would incur no extra cost to the Exchequer, would follow the Government’s stated policy of money following the patient and would enable older people to remain at home for as long as possible. We make five principal proposals and I will focus on two recommendations in particular, which are immediately achievable and could deliver immediate savings to the Government in 2014.

In line with the Minister’s often stated aim of getting the money to follow the patient, we question the wisdom of ring-fencing €1 billion of the total €1.4 billion budget for older people for residential care through the fair deal scheme. We call on the Government to amalgamate the budgets to allocate funding in accordance with patient need and wishes, which could potentially save approximately €69 million in 2014. In an effort to ensure we provide the best quality care to the maximum number of older people we call on the Government to ensure all home care provision which falls outside that provided directly by the HSE is allocated or commissioned in an open and transparent manner, with quality being the key basis for approval. This would entail stopping the use of section 39 funding for home care provision and instead redirecting those funds to the home care package scheme where we feel there is more accountability and transparency. Several HSE reports have shown the gross inefficiencies of using section 39 funding for home care provision and redirection could potentially save a further €48 million in 2014 alone. I look forward to answering any questions in the question and answer session to follow.

Jerry Buttimer (Cork South Central, Fine Gael)
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Our next speaker is Mr. Tadhg Daly, chief executive of Nursing Homes Ireland. He is very welcome.

Mr. Tadhg Daly:

Committee members have our statement and I do not propose to read it all. It is important to point out that 22,000 people reside in a home from home with our members nationwide. We provide in excess of 23,000 jobs in local communities throughout Ireland. Having high quality residential care is an essential part of the continuum of care for older people. Notwithstanding the point made by the previous speaker, rather than focus on only one area of care or state one service is better than another, we need to look at the continuum of care for older people to ensure the appropriate care is given at the appropriate time.

The fair deal scheme has been very successful from the point of view of older people themselves. As the former Minister stated, it is affordable, accessible and anxiety-free. However significant issues arise which must be addressed. With regard to the upcoming budget we agree with the Minister of State, Deputy Lynch, who addressed the committee on 25 July and stated the scheme should remain ring-fenced and should follow the principles of money following the patient. Under the fair deal scheme, a person chooses to apply for the scheme based on his or her medical and social care needs. Those in nursing home care now are much more highly dependent and have much more complex care needs, which means there is a requirement for the scheme to remain protected on this basis.

An issue for our society with its ageing population is how we develop and fund the range of services we need for our ageing population. Residential care is but one element of this. One of our concerns is the significant pressure with regard to public units complying with physical environment and HIQA standards, but there has been little development. Our members will also be under some pressure in this regard. Given our ageing population there is a requirement on us, and committee members as policymakers, to examine how we will develop a range of services for older people.

In our pre-budget submission, we state the narrow definition of goods and services under the fair deal scheme should be reviewed. The definition of long-term residential care services includes bed and board, basic aids and appliances and nursing care, but does not consider the holistic care needs of the resident. Items such as physiotherapy, occupational therapy and activities are excluded from the scheme, and from our point of view this beggars belief. We strongly argue the scheme should remain ring-fenced and should be adequately resourced to deal with waiting lists. On 9 July, the Minister told the committee that 777 people had been assessed as requiring nursing home care but were awaiting funding. We could speak about statistics all day, such as the number of delayed discharges.

Our submission includes proposals on developing new services in the immediate term. Our key point is on how we should work in partnership. It should not be about public versus private versus voluntary but about ensuring our society has the appropriate services for older people. We strongly argue there should be a forum on long-term residential care involving all players to ensure we address the growing needs of our older population.

Jerry Buttimer (Cork South Central, Fine Gael)
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Our next speaker is Dr. Shari McDaid, director of Mental Health Reform. She is very welcome.

Dr. Shari McDaid:

I thank the Chairman and the committee for inviting Mental Health Reform to appear before it. Mental Health Reform is a national coalition of 39 non-governmental organisations promoting improved mental health services and implementation of the Government’s mental health policy, A Vision for Change. I wish to share some of the concerns expressed to us in public meetings this year.

Shortfalls in staffing still have a negative impact on people seeking support. One person was on a list to see a psychologist but lost access because the psychologist went on maternity leave and was not replaced. Another person told us that because there are not enough professionals to provide support, people on a waiting list are seen by a student trainee. We also know that waiting times for child and adolescent mental health services had increased at the end of 2012 and were 17% higher than in 2011. At our public meetings, people told us of their difficulty accessing services when they are in a crisis, resulting in long waits in accident and emergency units, which are inappropriate and stressful places for someone in mental and emotional distress.

As committee members know, central to the Vision for Change policy is the development of holistic, multidisciplinary, community-based services. We welcomed the commitment in the previous two budgets to invest €35 million in community mental health services, including a commitment to appoint 891 staff in total between 2012 and 2013. However, there continues to be a challenge in translating this commitment into reality. The Minister, Deputy Reilly, reported in a Topical Issues debate on 19 September that a total of 803 of these posts were at some stage in the recruitment process, with almost 400 of last year’s posts either filled or awaiting clearance and 220 of this year’s posts having been accepted. However, the HSE's staffing report for the end of July showed a net increase of just 192 posts, which represents an increase of approximately 2% in staffing. We are concerned the pressure on the HSE to lose 2,400 whole-time equivalents throughout the health service is undermining efforts to resource mental health services as the Government intended. Our recommendation to the Government ahead of the budget for 2014 is that the €35 million be allocated for community mental health services as promised in the programme for Government.

This year, as we did last year, we highlight the need for a national information system for mental health services. Under HSE structures, it is not possible to tell how many mental health service users await psychological therapies, how many have an individual care and recovery plan, how many service users are satisfied with the service or how many are using community-based services. We call for an allocation towards this in 2014 and that the Department of Health ensures the new director for mental health, Mr. Stephen Mulvany, makes real progress in 2014.

Mental Health Reform recognises the Government faces difficult choices in this year's budget to maintain control over the country’s finances. The recommendations we make in our pre-budget submission are based on cost-effective solutions which would help Government services for people with a mental health condition be more efficient and, at the same time, fulfil the Government’s policy commitments on mental health.

Jerry Buttimer (Cork South Central, Fine Gael)
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Finally, but not least, I welcome the president of the Irish Medical Organisation, Dr. Matthew Sadlier. He is very welcome.

Dr. Matthew Sadlier:

The Irish Medical Organisation, IMO, thanks the committee for the invitation to today’s hearing. In our budget submission, we wish to highlight the negative effects of the economic downturn on the health service as well as the opportunities the recession can create to improve health and health care. Our submission covers four main areas that I will try to go through as briefly as possible.

Regarding health system reform and investment in health services, a recession offers opportunity for reform and the Government is embarking on a major reorganisation of our health services in order that the majority of an individual's health care needs are met in primary care. Since 2009, however, Government expenditure has decreased by 10% and there are 11,000 fewer people employed in the health service. While some efficiencies have been made, there have been signs in the past year or so that the health system is under significant financial strain.

In terms of hospital services, the IMO recommends that capital funding be provided to support the proposed reconfiguration. Under the principle of money following the patient, the Government must ensure adequate financial and human resources are provided. To ensure primary care patients are treated in the appropriate setting, money must follow the patient out of secondary care and into primary care. Chronic disease management and prevention must be adequately costed and resources must be forthcoming from this important programme. The Government must also ensure adequate investment in facilities and resources to support primary care teams.

The IMO is concerned about growing health inequalities and inequalities in access to care due to the recession. It is important that budgetary measures do not widen these gaps further.

The IMO welcomes the publication of "Healthy Ireland" and is calling for the development of a detailed implementation plan. We emphasise the importance of a health impact assessment. All public policy, including budgetary measures, should be subject to health impact assessments.

Regarding access to care, there should be no further increases in out-of-pocket payments for all public patients. The Government must identify and prioritise resources for universal access to primary care.

The third pillar in our submission regards suicide prevention. There is a link between recession and suicide. There is a need, therefore, to ensure adequate resources are available for a suicide prevention programme. We recommend the full implementation of the recommendations outlined in Reach Out, the national strategy for suicide prevention. We also call for the availability of suicide intervention teams in all hospitals on a 24 hour, seven day per week basis, and for the piloting of community-based, 24-hour crisis mental health care provision throughout Ireland.

Our submission's final pillar of minimum alcohol pricing is fitting, given the day that is in it. Despite an increase in excise duties last year, alcohol remains cheap to purchase relative to the societal costs of the problem. There is room to introduce a minimum alcohol pricing structure to reduce the burden of excessive alcohol consumption. There is evidence from Scotland, which is pressing ahead with minimum pricing, that difficulties arising from EU competition law do not apply to this issue. The IMO calls on the Department of Health to continue working with counterparts in Northern Ireland and Scotland on introducing a minimum price structure for alcohol, based on grams of alcohol as opposed to units. We also published a paper recently on young people and alcohol that we would be happy to distribute to the committee.

Jerry Buttimer (Cork South Central, Fine Gael)
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We have that paper. I thank Dr. Sadlier. As we have concluded our presentations, I express my hope that this day does not become a festival of alcohol consumption. I regret, and I hope that many of those present agree with me, that this supposed celebration of Arthur's Day is wrong. It sends the wrong message. Perhaps the committee should consider the issue again, given the vested interests of the alcohol industry. I do not mean to take over the meeting, but it is a sad day when a drinks company can manipulate a market of young people in particular on the basis of celebrating culture and music.

I call Deputy Ó Caoláin, who may be able to join the coalition of two minutes plus two minutes again.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I endorse the Chairman's comments. He most certainly speaks for me. I have no doubt he is echoing the views of everyone present.

I ask for the Chairman's patience, as we have agreed to raise a couple of additional items in the course of this engagement. I will not be abusive of the time. I will not be able to direct questions to each of our guests, so I thank them all for their oral and written contributions.

I wish to ask about the most distressing of all situations, which Ms Edghill referenced, namely, palliative care for children. The Irish Hospice Foundation highlighted a recommendation. What can the system do to improve? Ms Edghill told us about the advances made in the past year, but that was done at the foundation's cost and through the generosity of the citizenry. The foundation highlighted a reasonable proposition in the second of its two recommendations under the heading of children's palliative care, namely, to facilitate staff releases for training and the progressive roll-out of children's palliative care education and training programmes. Will Ms Edghill expand on that recommendation?

Ms Angela Edghill:

Sure.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Not yet. The Chairman will ask Ms Edghill to respond later. What is the current system? I understand how stretched front-line service staff are within the HSE system, but is there any facilitation currently? To what extent is the need? Let us all join the foundation in trying to have that particular matter addressed. It is a common-sense measure that needs to be done appropriately and adequately.

I welcome Mr. Hannigan's affirmation of the need, not only to restore, but also to improve support for carers. I appreciate his remarks that reflected on the committee's engagement with the previous panel.

The submission from Home and Community Care Ireland, HCCI, contains two points that might merit expansion. Both are interesting. I endorse the first, namely, incentivising people to take on work in the home care sector. Unquestionably, this is important. There may be a range of measures involved, not only monetary. Where that need presents, people are really challenged. They are challenged by what they want to do as well as all the other factors that make more difficult the obstacles that can present. This relates to the HCCI's third recommendation.

It is also necessary to consider the entire issue. Sometimes, we can say societally that people are able to provide for themselves, but this is not always the case. There can be false notions of people who have lived through particular income streams. I am referring specifically to recommendation No. 5 on the extension of the definition under IT47 so as to include for tax relief entitlements the provision of these supports for those who may, on the face of it, appear to be in a position to provide for themselves. This may not always be the case. Mr. Harty instanced cases of people who were being forced to consider residential institutions for care. Will he expand on that point?

I apologise to Mr. Daly and Nursing Homes Ireland, NHI, as I am not able to focus on specifics. Our overall experience, and my experience personally, is that the overwhelming number of nursing home providers in the private and voluntary sectors are providing an excellent service. We would be lost without them. There tends to be a focus on specific reports that can have a challenging impact on many of those who are adhering to the highest standards. It is only fair that a balance be struck.

Regarding mental health reform, I wish to ask Dr. McDaid about two points.

Jerry Buttimer (Cork South Central, Fine Gael)
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Time please, Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I beg the Chairman's pardon, but it is important that I reflect on the mental health reform recommendations. The Chairman will be pleased to know that the cross-party group on mental health launched our pre-budget submission, the second that we have had, in the past week. We fell down last year, but we made one the year before. We are back in business and have been able to strike a concord across all of the political views in these Houses. We have reflected on the €35 million allocation. It must be spent in its entirety, for its purpose and within the current year. It is a continuum and is provided in respect of needs in 2014 and ongoing.

I have only one question arising from this point.

I note the opening commentary reflects that the inspector of mental health services is pointing again to the need for a national programme of reform, driven by the director designate of mental health services. We have addressed the matter before and I have no specific issue with the individual, whom I know and have met in his previous work life within the HSE. In his presence I nevertheless raised concerns regarding the appointment and the process. What is the position of Mental Health Reform Ireland and is there any indication that what the inspector of mental health services has argued for is under way?

Jerry Buttimer (Cork South Central, Fine Gael)
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The Deputy's time is up.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I remind the Chairman we hoped to address two issues with the Irish Medical Organisation, IMO.

Jerry Buttimer (Cork South Central, Fine Gael)
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The Deputy has already used six minutes.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will you come back and allow me question the IMO?

Jerry Buttimer (Cork South Central, Fine Gael)
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The Deputy can have a minute now and I can bring him in again.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Fair play. I thank Dr. Sadlier for his contribution. We are very concerned, as a committee, about two critical areas, and only one has been reflected in the presentation this morning. That is the impact on GP practices and primary care of the financial emergency measures in the public interest legislation. There has been a significant reduction in the money directed to GP services and the IMO has referred to a reduction in overheads and staffing costs. It has also mentioned the impact on phlebotomy services, warfarin and blood pressure monitoring. I know from engagement with GP services that there is also an impact on ancillary services that have been brought together in a collective centre of doctors. The witnesses mentioned specialist nursing provision and there are other elements. The consequence of the impact is displacing people from primary care into accident and emergency hospital scenarios, which already cannot cope with the load. I ask the IMO to take the opportunity to elaborate on the impact as it is a concern.

What is the position of the junior hospital doctors and the ongoing engagement over the threatened industrial action? How will that manifest itself and will the witnesses give an update on that issue? There is a shared concern in that regard.

Marie Louise O'Donnell (Independent)
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It is very good to be here this morning and I am very informed by what I have just heard. I will address my questions to Ms Angela Edghill of the Irish Hospice Foundation. I am afraid of dying so having the group here is interesting; we cannot choose when we are born but all must die so it is a major part of our living lives, particularly if we can die well. The submission concerned holding on to the €72 million already available to the organisation but can the witness tell me two major negatives that will arise if the €72 million is not maintained? She spoke about voluntary community service amounting to €400,000 and unopened beds.

Regina Doherty (Meath East, Fine Gael)
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I thank everybody for coming in this morning. I will not address questions to everybody as we could be here all day, as Deputy Ó Caoláin noted, because the topics are so interesting. I thank everybody for their presentations and we will take them all on board.

Ms Edghill and the Irish Hospice Foundation do fantastic work and it is incumbent on us as a committee to try to ensure, in whatever way we can, that the €72 million is ring-fenced and untouched. We must also ensure there is a transition path from the voluntary funding servicing child palliative care services to sustainable funding, and each of us must take that on board.

I have specific questions for Mr. Harty and Mr. Daly. Although a "battle" may not be the right word, there is a struggle going on with regard to the care of more mature elderly people and those who suffer from disabilities. The merits of what is offered by the witnesses' organisations are unquestionable and second to none but if there was an amalgamation of budgets, could they describe how it could look? The organisations are competing for the right reasons, and there are good services offered that we need, although the vast majority of families would prefer to keep mothers, fathers, nannies and grandads at home for as long as possible. The two elements should not compete but rather be working in harmony. How would best practice look in an amalgamated world?

Colm Burke (Fine Gael)
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I welcome all the organisations and thank them for the work being done. What is the current position of doctors, not only junior doctors but also general practitioners? I have heard of a number of cases where a GP who is not a partner in a practice is having hours cut, with days employed reducing from five to two or three. As a result these doctors are giving notice and emigrating. Has the IMO come across such events on a large scale?

With regard to junior doctors in hospitals, we are educating quite a large number of people through the university system every year, turning out over 600 people, with a cost of €90 million per annum. We have done nothing to keep them in Ireland. Even if we agree to take on many more junior doctors in the hospital system, would the numbers be there to be employed? What do we need to do to keep such people in the country?

With regard to the hospice budget, the Marymount Hospice's number of beds is increasing from 24 to 44, with 36 extra staff to be employed. If the budget is to stay the same, somewhere will suffer. The employment of extra staff will absorb a share of the €72 million, along with the beds, although it is great to see the increase in Marymount and I welcome it. Nevertheless, the last thing we need to hear is that somewhere else will suffer. What additional funding is required to ensure nobody else suffers?

I have a further point relating to home care. Could we offer a tax package - as we have done in other areas - where the first €15,000 earned in providing home care assistance would be tax-exempt? Would that be of benefit in getting more people into assisting in the area?

Jillian van Turnhout (Independent)
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The witnesses are doing great work and I will try not to duplicate the questions. With regard to the Irish Hospice Foundation and children's palliative care, I was at a launch a few years ago and the HSE was very positive about how it would make the process sustainable. Will Ms Edghill clarify when the wheels came off that commitment? I thought sustainability was on track so where is the gap in funding? The public has supported these essential nurses through the Irish Hospice Foundation but where is the gap?

With regard to the National Federation of Voluntary Bodies, there was mention of school-leavers and I have not been aware of that issue. Why are these people falling into limbo on leaving school and how long does that limbo last? With regard to nursing homes and the continuum of care in the home, there was mention of becoming "anxiety-free". In the previous session we heard that the system is being structured to push people into a system with schemes and support, rather than necessarily allowing a person to be cared for in their home. I welcome any thoughts on how to achieve a continuum of care, although it is not a competing model. We should be considering the person and individual, and where they can be best cared for.

I am concerned about the €70 million promised with regard to Mental Health Reform Ireland. The IMO raised the alcohol issue and I fully endorse the comments. Any time the matter is discussed in these Houses, it should be done as a public health issue and it should not be dealt with by other committees.

For me it is a public health issue.

Peter Fitzpatrick (Louth, Fine Gael)
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I thank the witnesses for attending this morning. The presentations were excellent. Each witness made a good case for their budget and I wish them the best in the future.

The Minister, Deputy Reilly, is a firm believer in the policy that money follows the patient. I fully support that. As Deputy Regina Doherty said, it is important that older people stay at home for as long as possible. My question is for Nursing Homes Ireland, NHI. Representatives from the Health Information and Quality Authority, HIQA, appeared before the committee a couple of weeks ago. It is currently organising regulations and inspectors for nursing homes. I was very impressed. They realise a nursing home is a different situation because for the people in a nursing home the nursing home is their home, and it is important that they are looked after and that everything is done correctly. There are currently 22,000 people in nursing homes under the fair deal nursing home system. Are there any vacancies at present? People are always looking for vacancies but they cannot seem to find a place.

Second, I understand there are 23,000 staff employed directly in nursing homes. However, every time I visit a nursing home there are always different staff. Is there a problem retaining staff? People get used to certain staff caring for them but then they disappear. Is there a big turnover of staff?

Jerry Buttimer (Cork South Central, Fine Gael)
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I ask Dr. Sadlier to start. There are about 18 minutes left.

Dr. Matthew Sadlier:

I will be as brief as possible. There were three basic issues so I will compact my replies rather than address them individually.

Regarding the question on primary care, since 2008 and FEMPI there are over 0.5 million extra GMS patients with medical cards than there were previously. General practitioner income has dropped by 23% under FEMPI. What we wish to emphasise is that GP income is not a personal income for the general practitioner. They are a sole practitioner running an infrastructure with overheads and premises. The difficulty is that, since I qualified ten years ago, we are in an era where patients have a higher level of expectation of chronic disease management and health screening, rather than the concept that one waits until one has a problem before first going to see the doctor. General practitioners are finding it increasingly difficult to make ends meet and to be able to provide proper chronic health screening and proper management for chronic illnesses. This is leading to services having to fall by the wayside if one cannot economically maintain them. As part of my presidency, we conducted a tour of the country and met practitioners in the different areas. They say they are obliged to let their primary care nurse or their practice nurse go or use the receptionist or drop the ability of the services they can provide to the community.

Second, there were two questions regarding the junior hospital doctors or the NCHDs. It is a very frustrating situation. I was a junior doctor or NCHD in Ireland for 13 years and during every one of those years the issue of hours was discussed. The fact that the NCHDs in Ireland, as a group of workers, had to resort to industrial action to have the legislation which was passed by the Oireachtas implemented for them is just bizarre in any shape or form. Yes, there is an ongoing process. I understand they are before the Labour Court today. The planned industrial action for yesterday was suspended. It is an ongoing process and talks are ongoing, so I cannot say any more than that.

Recruitment and retention is another significant issue. For one year post graduation medical graduates must remain as interns and the Medical Council said last year that less than 50% of interns had maintained their registration within Ireland after internship. The Irish health service has always depended on junior doctors or NCHDs to provide a vast amount of services. Since before I graduated we have campaigned to increase the number of specialists in the country so there can be a consultant provided service.

Jerry Buttimer (Cork South Central, Fine Gael)
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There is a vote in the Seanad.

Dr. Matthew Sadlier:

Second, with regard to proper working conditions and motivation, the working balance, motivation and quality of life in hospital for a junior doctor working in Ireland are particularly poor. On pay issues, Ireland is now the lowest paying country in the English speaking medical world, which is where we compete for doctors. Ultimately, doctors do not choose whether to work in Ireland or Finland but whether to work in Ireland or the UK, Canada or Australia. Of those areas, at specialist levels we are significantly lower paid than is the case in the UK and this has been a huge problem in recruiting from overseas. If one is coming from a very long distance away, one does not necessarily see a huge difference between a small town in Ireland and a small town in England.

The last question was about alcohol. We have published our paper on alcohol. I will conclude with that.

Dr. Shari McDaid:

I thank the Senators and Deputies for expressing their support, particularly Senator van Turnhout and Deputy Ó Caoláin. As of today, more than 17,000 people in Ireland have signed a petition supporting investment in mental health services, which is an indication that there is widespread recognition of the need for support. In addition, people want to have good quality mental health services available.

Deputy Ó Caoláin asked about the director for mental health. We have consistently advocated for the appointment of a director for mental health and we are pleased to see somebody taking up that role. We have met with him and are impressed with his commitment to continue the reform agenda. However, we are concerned. Anybody in that role must have control of the budget, adequate resourcing and an information system that can enable them to manage the system effectively. It is very difficult for somebody in that role at present to be able to manage effectively when they do not know how many people use the services, how many staff there are in the services and where they are, and what the waiting lists are for adult mental health services. We have none of that information, so that is a real priority.

We also seek an implementation plan that would assist with transparency. We used to have an independent monitoring group for the mental health policy, A Vision for Change. There is no longer an independent monitoring group and no annual report to tell us how well the HSE and other Departments are doing on delivering the policy. The child and adolescent mental health services already have an annual report and it would be helpful to have something similar for the other mental health services and the policy as a whole.

Mr. Tadhg Daly:

To refer to the points raised by Deputies Doherty and Fitzpatrick, they will note from the submission that I spoke of that concept of a continuum of care. It is important to realise that 4.6% of the population over 65 years, a relatively small number given the total, reside in long-term residential care. Over 65 years is something of a misnomer. In fact, if one visits any nursing home, one will mainly see people who are over 80 and 85 years because of the dependency and the complexity of care.

With regard to the debate about home care versus nursing home care, I do not see it that way. What we need is to have that continuum to ensure that at a particular point in a person's life the appropriate services are available for them. The Deputies are not comparing like with like. Senator van Turnhout mentioned the concept of people being directed towards residential care. That is a myth. People are medically assessed by a multidisciplinary team before they are approved for nursing home care. In fact, I draw the committee's attention to the report of the Ombudsman yesterday. One of the cases she took up was that of an applicant who was refused support under the nursing home support scheme even though the medical team had directed that the person was more suitable for nursing home care. It is not a case of either-or and, in my book, it should not be. My mother is 83 years of age and is living happily on her own in west Cork, and when my time comes I would like to live in my own home as well. However, when the time comes that one is unable to maintain oneself in one's own home because of the dependency or complexity, it is important to have the high standard, high quality nursing home care that is required.

On 9 July the Minister, before this committee, mentioned the fact that, at that time, 777 people had been assessed as requiring nursing home care but were not in a position to access it because the funding is not available. Add to that the figure for August of 693 people in delayed discharges in hospitals. If they could be maintained in their own homes, they would be discharged to them.

The vast majority of those are people with complex needs so they need nursing home care.

The fair deal scheme is under review and we have proposed in our submission to the review that there should be a parallel scheme for home care mirroring the fair deal scheme. Our fear is that, if the fund is amalgamated, it will remain at its current financial amount and more people will draw from it. This would create more problems in terms of people trying to access appropriate funding.

With regard to Deputy Fitzpatrick's point about vacancies, the HSE's service plan for 2013 alludes to the undersupply of residential care beds in north Dublin and other urban areas. It is difficult to get a nursing home in some areas. Our fear is that, if we do not act now to develop appropriate services for the older population, it will get worse.

With regard to staffing, Dr. Sadlier referred to recruitment and retention. It is very important for the nursing home sector. We must engage with stakeholders in what we term workforce planning to ensure we have the appropriate skills for residential and community care. As an organisation, we are active in continuous professional development and training of staff in order that they can upskill and have a career path within a nursing home. Someone who is a carer today may decide to become a nurse in five or six years time and become one of the people in charge. There are more opportunities in the private sector for people to develop their career paths.

Mr. Michael Harty:

I thank the members for their interesting questions. I wish to address the two points made by Deputy Ó Caoláin concerning carers. One of the most difficult jobs is the job of the carer. It takes a special kind of person to take it on. One of the advantages of the recession is that there are currently more carers available than were available at the height of the Celtic tiger. As the economy improves, that will not be the case. We must also take into account the fact that demand and resources will increase all the time. One of the major issues is the question of sourcing quality carers. We must move towards a situation where caring is looked on as a career rather than as job. In the short term, we find ourselves competing with the social welfare system for people who want to take on work. Initially, we cannot offer them enough hours and they are not willing to forgo social welfare payments. That must be examined.

With regard to the extension of the IT47 definition, it does not make any sense to have barriers in front of people in respect of their care choice. Not extending the definition and not allowing tax relief is pushing people towards residential care or other care that they do not necessarily want.

I will reply to Deputy Regina Doherty and Senator van Turnhout together. I agree with Mr. Tadhg Daly that it is not a battle between our two sectors. There is a place for residential care and a place for home care. We must be careful about creating an artificial demand through the placing of budgets in silos, so to speak. A little over a year ago, the Minister gave figures of 29% of people in residential care being deemed low dependency and 16% medium dependency. Clinically, 30% of people could be looked after at home and their preference is for this.

One of my members told me about an interesting case recently. It concerned a 93 year old woman who lived independently in the Wexford area. She had to go into hospital for a procedure and the hospital told her that she would need care when she left. They told her she had to apply for the fair deal scheme but she replied that she wanted to live at home and intended to apply for a home care package. She applied for both schemes on the insistence of the hospital and was refused a home care package but received the fair deal scheme. The woman is now living in a residential care home where she does not want to be and the cost to the State is €1,000 per week when it could have been €200 or €300.

With regard to Deputy Fitzpatrick's point on regulation and staff, one of our major bugbears is that the home care sector is not regulated. From our point of view, we should probably have regulated that sector before the nursing home sector. The mere fact that the nursing home sector has people around means there is some control in place. Some 95% of home care service is delivered one to one with vulnerable adults.

Regina Doherty (Meath East, Fine Gael)
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We should have a statutory right to home care packages, as opposed to forcing people into residential settings when they do not want to be there because the resources are not available at home. It is barmy.

Mr. Michael Harty:

The interesting point is that it is a win-win situation politically by giving constituents what they want yet saving significant sums of money. The major savings for the health sector will be in community care moving up the acuity level and being able to look after more acute cases in the community. In order to foster a cadre of professional providers in the community, we must let money follow the patient.

Peter Fitzpatrick (Louth, Fine Gael)
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I am very confused. If a person with a medical card goes to visit a GP and needs a blood test, can the doctor charge the person extra for getting a blood test?

Dr. Matthew Sadlier:

Individual GPs will make that decision. As an organisation, the Irish Medical Organisation does not get involved in giving advice or keeping a register of that. I have no specific answer.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister was very clear on the matter and we are all of one mind that they should not be charged.

Mr. John Hannigan:

The question addressed to me was from Senator van Turnhout and concerned children leaving school and becoming adults, why there is a difference and why some are in limbo. There are statutory provisions and protection for children up to the age of 18. Once they hit 18 years of age, all of that falls away and all funding and support they receive at that point falls away. There is a requirement to separate children and adult services and, as a result, there is constant negotiation between the HSE and providers of care to provide support for those individuals. I support the idea of money following the individual. That would ensure the continuum of care would be there for individuals. The individuals we support are those who work across all elements of services here. It is most important to try to keep people in the community as long as possible, which has been Government policy for quite a period. We support that, but at this point it is more difficult to do that because the requirements are to ensure they are kept safe. For statutory bodies, keeping them safe means keeping them in an institution. There is clear evidence that it is cheaper for the State, better for the individual from the perspective of mental health and better from the primary health perspective to remain at home and to be supported at home. As well as improving the carer's allowance and respite allowances for people living in their own homes, members must continue to advocate for that.

Ms Angela Edghill:

I thank the members for the responses to the submissions. Deputy Ó Caoláin asked about training. As budgets are squeezed and staff are not replaced when on leave or ill, it becomes more difficult for services to release staff for training. We appreciate that. Children's palliative care is a particularly specialised area. This is an ongoing problem. The Irish Hospice Foundation provides much in-house training in hospitals. We find staff are decent and will come in to do training when they are not rostered to come in or when they are on their day off. We cannot rely on people to continue to do that and it is unfair on them when they are already under stress and working hard.

It is an ongoing problem. We appreciate that it is a budgetary problem too and that it costs more to release staff and to replace them while they are being trained. It is an area we need to keep an eye on. The difficulty is that staff are trained, for instance in communications. In particular with children, a lot of it would be about working not only with the child but with the family. A lot of work needs to go into that. If it is not constantly regenerated, all that learning is lost if those staff move on to a different area or leave. It is an ongoing difficulty. I am sorry I cannot be more specific. We are not the direct service provider but I could happily get the committee to talk to one of the children's outreach nurses who would be able to explain the situation a little better.

Senator Marie-Louise O'Donnell asked me what would happen if the budget is reduced any further. What would happen first is that the voluntary sector would try to fill the gap, as it always does, but that would become more and more difficult. In the event that it is now cut to the bone – and it is – in various areas of the country, for instance in Waterford they are paying €400,000 a year towards their home care team. In Kerry the voluntary hospice sector is paying nothing because the HSE fills the gap. The picture is different all around the country.

Palliative care is a relatively new specialty in Ireland and hospices are relatively new here in their current form. The whole situation is a little fragmented and a bit underdeveloped. It will become more so. There may well be waiting lists. Referrals to palliative care come at the very end of life. Often, one does not have a month, two months or three months to think about a waiting list. That may happen. This is conjecture but what we envisage is that the situation will become more fragmented and it will also stifle development. As an organisation, the Irish Hospice Foundation itself invests more than €5.7 million a year into development. A lot of the development is in partnership with people in the HSE and voluntary hospices. They will not always have the resources to give us that back if they do not have the money because they will not have the staff. It is a bit more than two.

Senator Burke asked what would happen if Marymount gets all it is supposed to get. That was in the 2013 HSE south service plan so we hope that will not come out of 2014 and that the money will be ring-fenced. It is a bit like that. We are constantly robbing Peter to pay Paul. There is already inequity around the country and it would be very unfair if it did not happen.

Senator van Turnhout inquired about sustainable funding and where is the gap. There are ongoing discussions with the HSE. We are fearful that the budget might be reduced further. That said, people constantly step up to the plate. All of the organisations would say that. The voluntary sector constantly steps up but there will come a stage where one just cannot step up any further.

Mr. John Hannigan:

Senator Burke inquired about tax exemption for people on the fair deal scheme. The reality, as pointed out by Mr. Naughton at the previous hearing, is that it assumes that people are working and can benefit from it. The large proportion of people in those care situations would not benefit because they are probably not working or there would be a marginal benefit because they might only have a pension which would not be at a sizeable level. While tax exemption might be helpful it might not be supportive of what is required.

Jerry Buttimer (Cork South Central, Fine Gael)
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I thank Mr. Hannigan and all of the witnesses. It has been a rapid-fire session but we are trying to get as much coverage as we can today as part of our pre-budget submission. I thank all the witnesses for being present and for making their presentations.

Jerry Buttimer (Cork South Central, Fine Gael)
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Our third and final sequence of meetings will discuss pre-budget submissions from various voluntary organisations working in the health and children sector. I welcome representatives from the Children's Rights Alliance and the National Youth Council of Ireland to our meeting. I thank them for the work they undertake on behalf of all of us and for both their oral presentation and the written submission they made to us.

I remind people that their mobile telephones should be turned off and not left on airplane mode as they interfere with the recording of the proceedings and with the quality of the sound, and our staff should not have to put up with that.

As was the case in the two previous sessions I ask witnesses to remain within the time remit of three minutes each. I hope we can have a good discussion similar to the two previous discussions. I apologise for the absence of some of our members who had to attend other meetings. Unfortunately, it is part of life in Leinster House that when we are at the end of a session members drift off to other events and I apologise for that.

Regarding privilege, witnesses are protected by absolute privilege in respect of the evidence they are to give to the joint committee. However, if they are directed by the committee to cease giving evidence on a particular matter and continue to so do, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against a person or an entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing ruling of the Chair and parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable. I again welcome Ms Tanya Ward, Ms Saoirse Brady and Mr. James Doorley to our proceedings and I ask Ms Ward to make her opening statement.

Ms Tanya Ward:

I thank the committee for the invitation to speak here today. We believe the committee's scrutiny of the budget is crucial. It is playing a very important role in examining and reviewing children's services and budgetary decisions around children. We welcome that the committee is taking the time to look at the budget.

I am from the Children's Rights Alliance. We unite over 100 organisations and our aim is to make Ireland one of the best places in the world to be a child but we are also a member of the End Child Poverty Coalition so this is an area that is very close to our hearts.

Before giving members an overview of what we want to talk about today I will paint a picture of children in Ireland so that they can have a profile and understand what we are dealing with. According to the census the number of children in the country is growing. Since 2006 there has been a 13.4% increase in the number of children in Ireland. That brings the number of children here to 1,148,687 and at the same time we are making serious cuts to child benefits. Since 2009 we have made a cut of €450 million to child income supplements while at the same time the number of children is growing. There is a complete disconnect between the way we are making budgetary decisions and the needs of the people at large.

Members will see from the presentation we have given them that we have included some statistics on the deprivation levels of families living here. It is from the EU SILC survey. They will see that in 2011 over 30% of families were living in deprivation. There are 11 different indicators of deprivation but what that means is that in every second meal children might get to have a piece of chicken or other meat, they are wearing second-hand clothes, they do not get two new pairs of shoes each year and they do not have the opportunity to have a roast dinner every week. Those are the kind of things people take for granted. Over 30% of people here do not enjoy that in their everyday experience. The number of children in families at risk of poverty increases to just 18%, therefore, nearly 20% of children in this country are at risk of poverty and over 9% of children are living in consistent poverty today. Those statistics reflect the changing dynamics of the recession but we must keep them in mind when we are making decisions about budgetary cuts.

In terms of the issues I want to talk about today, one is child benefit and the back to school allowance. Our view is that child benefit is incredibly important as it is one of the only measures the State has to address child poverty.

If one thinks about it, it is one of the only things one gets if one is a parent and is caring for a child. It is the one thing that distinguishes one from a family that does not have children. We are calling for no further cuts to child benefit. We do not think families can afford and survive another cut.

We are also calling for the back-to-school allowance to be reinstated. A €50 cut was imposed last year, which is a significant amount of money for a family on low income. It is a pair of cheap shoes, two pairs of socks and a vest. That is what was taken from families last year. The only real saving to the Exchequer was €17 million, which is not a huge amount when one considers that almost 200,000 families benefit from the allowance. We are calling for it to be reinstated, which we think will have a big impact on family life.

The other issue to which I wish to bring members' attention is the lack of investment in children's services. The IMF and others say our welfare rates are very high compared to those in other countries. However, one has to look at the amount of money we invest in children's services. The cost of living in other countries is cheaper and it is cheaper to raise children because they invest in services for children. They have free schoolbooks, highly subsidised child care and free health care for children. We do not have these services. Every cut the Government makes has a serious impact on the enjoyment of children's rights. Much of the €450 million cut from child benefit and income supplement over the past number of years has been lost to children and families and it has not been reinvested.

The last point I wish to raise concerns the new child and family agency. A Bill is going through the Houses at the moment. It is the biggest public sector reform that this Government will lead. It will combine 4,000 people providing services for children. The budget currently is approximately €550 million. We are calling on the Government not to reduce the budget of this agency. Five hundred and fifty million euro is not a lot of money when one considers the number of children in this country. We calculate that the budget breaks down to approximately €479 per child. If there was an effective service which was not crisis-driven and going from one crisis to another but which actually invested in early intervention and the prevention of abuse and neglect, it would be closer to the €1,000 mark. We call on the Government not to cut this budget but to increase it going forward.

Jerry Buttimer (Cork South Central, Fine Gael)
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I welcome Mr. James Doorley, deputy director of the National Youth Council of Ireland.

Mr. James Doorley:

I thank the Chairman, Deputies and Senators for the opportunity to speak today. The National Youth Council of Ireland is the representative body for 45 national voluntary youth organisations working with young people. I have no doubt all the members are very familiar with the work of our members. The title of our submission is "Beyond Austerity", because we believe that after five years and numerous budgets in which there have been cuts and adjustments, we need to give young people some hope and a plan for the future and something beyond the troika leaving Ireland and regaining our sovereignty.

One of the key issues for us is that funding for youth work organisations working in every community in Ireland has been cut by approximately 30% since 2008. It is a sector that works with many young people. In 2012, we commissioned Indecon to undertake an assessment and it found that our members engaged with more than 380,000 young people. There are 40,000 volunteers and approximately 1,300 paid staff. It is a service and a support for young people which is very much led by organisations and volunteers and which is obviously complemented by staff. However, it has been very badly hit over the past number of years.

Even though youth work services comprises only 14% of the budget of the Department of Children and Youth Affairs, last year it comprised 33% of the overall budget. Organisations have had to make savings and, unfortunately, have had to reduce services to young people, reduce hours and cut back pay. Up to now we have been struggling on, but another €3 million cut has been pinpointed for 2014. Essentially, our pre-budget submission is stating that this sector has already taken a 30% cut and a fairly heavy share of the burden. We would like the sector to be spared in 2014.

Another issue on which we are very much working is youth unemployment. We welcome the Government's work in the area of the youth guarantee, which our organisation first proposed in March 2011. The key thing is a high-quality education, training and work experience opportunity. It is not enough to get young people off the live register; it is important to get them onto a sustainable path and into sustainable work. We know the Government has set up an interdepartmental working group, which is very positive. A plan is going to the European Commission. Ireland must put money up front but it could also access significant funding from the European Union's youth employment initiative.

We are particularly concerned about the young people who have been on the live register the longest. Approximately 28,000 have been on the live register for a year or more. We are concerned that if the fund is focused only on those closest to the labour market, those young people will be left behind. In our pre-budget submission, we propose that a strand of the youth guarantee be used to assist young people who are most disadvantaged. Our member organisations, which have a track record and credibility, could contribute significantly. Some are doing this in a small way with limited resources. We would certainly like to see an overall budget of €20 million in the youth guarantee budget ring-fenced for that.

Ms Ward mentioned the whole area of child poverty. We are also members of the End Child Poverty Coalition and I will not go over the points she made. I refer to alcohol-related harm. Given the day that is in it, Arthur's Day, we have a proposal in our pre-budget submission about revenue-raising. Many people come in here and say they want the Government to spend more. We were members of the national steering group on substance misuse which proposed a social responsibility levy. We have added a bit more detail to it and are saying there should be a 1% levy on the turnover of drinks manufacturers - the large companies producing the alcohol. Based on the drinks industry's own data, we estimate it could potentially bring in approximately €25 million. We believe that money could be used to support initiatives to work with young people to tackle alcohol-related harm and to replace drinks sponsorship of sport and fund activities.

I refer to the issue of emigration. We produced a report in May entitled "Time to Go?", which looked at the issue of emigration. Obviously, we want young people to stay in Ireland and we need to create opportunities for them here, but we must face the reality that young people are leaving. Our research, which we conducted with young people in Canada and in the UK, indicated that many of them were going with either a lack of information or insufficient information and support. Some additional supports are needed. A very modest sum, an extra €1 million, should be provided to groups to give young people who have already decided to emigrate more assistance and perhaps to engage more with the large number of young people who have left so that we can encourage them to come back when, hopefully, the jobs and opportunities are available in Ireland. I will be happy to answer questions.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I welcome our last panellists this morning. It has been a very busy morning in which we have addressed many issues. I thank the Children's Rights Alliance for its presentation. I am sorry I missed the beginning of it but I am familiar with it. I refer to the child and family agency Bill, Committee Stage of which we will address shortly. I believe we have a fine Minister for Children and Youth Affairs and the establishment of the new Department was arguably one of the best decisions of the new Government since 2011, although the legislative programme is progressing a little slower than we would have wished. Following the successful passage of the referendum on children's rights, there is a programme of work which I am very happy to support. My concern, reflected by Ms Ward, relates to resourcing. I refer to the transition from the family support agency within the Health Service Executive to the transition period and on to the child and family agency, which hopefully will be in situ at the earliest point in 2014. We had hoped it would have been in place by 2013.

If it gets off to a bad start in terms of resourcing it will be such a disappointment having regard to all of the hope and expectation surrounding it in terms of what could be realised from it. I strongly endorse Ms Ward's point about resourcing. It is not enough to have the right policy, we must also have the commitment. The Minister, Deputy Frances Fitzgerald, cannot be burdened with the responsibility alone of ensuring there is adequate resourcing. I make that appeal and urge all voices, irrespective of their political disposition, to do so. This is a Cabinet responsibility. The issue of children transcends several Departments and we need joined-up thinking in relation to children especially, as never before. We must recognise that the needs of children incorporate education, health, social protection - I could go on. Those respective Departments all have a shared role in this respect. The Minister, Deputy Howlin, in his role and responsibility, must ensure that there is adequate resourcing.

We are considering the introduction of new legislation on the registration of child care facilities, including after-school care. This is something we will be addressing. The Minister has only just got it across the line in terms of agreement on it at Cabinet. It is important that resourcing would be an integral part of it but I would welcome the registration process. I am not sure if the Children's Rights Alliance commented on this in the document before me. Agreements on it with Cabinet got across the line yesterday morning and I would like to hear what the representative of the Children's Rights Alliance might have to add about it.

I wish to deal with a further matter covered in Mr. James Doorley's submission on child benefit. As a working Deputy on the ground, I know from dealing with cases, as I have in several of the instances that have presented, and this is not anecdotal, that decisions were made to significantly reduce child benefit over a number of years. Mr. Doorley has starkly presented the figures on a compendium over 2011 to 2013 showing the impact on families with three or more children being that of a cut of €100. That is a significant sum of money that has had a negative impact on families with the burden of responsibility most often falling on the shoulders of the mother. I am eating into the Fianna Fáil time now.

Jerry Buttimer (Cork South Central, Fine Gael)
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The Deputy is well into it.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I welcome Mr. James Doorley. He made the point that there should be no further cuts to child benefit for those currently in receipt of social welfare benefits. We have to turn this around at some point and no further cuts should be in any way contemplated and we have to start to restore child benefit. We need to use language like that, particularly when there is an opportunity perhaps for more imaginative measures at this time.

Children and young people should not be disproportionately affected by the cuts but we know that they most certainly have been. I recall saying this to Mr. Doorley on a previous occasion but opportunities for children are closed to an ever-growing number of young people across Irish society because their parents can no longer afford these options, which are important in filling the day, the week and the lives of young people. Childhood passes so quickly. Because of the economic situation that is particularly affecting those most challenged, those dependent on social protection and those on low to middle incomes, and children are suffering as a result. They suffer with potential life-long consequences because they are the excluded and marginalised and they become acutely aware of it within their peer group and at school. Some are able to continue to enjoy social options and outlets but it is no longer a choice for others. It is very sad and this must be realised and faced up to if we are to have a society of equals, which is what it should be all about.

Jerry Buttimer (Cork South Central, Fine Gael)
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The Deputy is eating into Government time now. I call Senator van Turnhout.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That would also be appropriate, never mind Fianna Fáil's time.

Jillian van Turnhout (Independent)
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I must make a declaration of interest as I was a former chief executive of the Children's Rights Alliance and a former president of the National Youth Council of Ireland. They say that every day is a school day and the figure Ms Tanya Ward gave initially, which Deputy Ó Caoláin just missed, was that there has been a 13.4% increase in the child population since 2006. We have to contrast that against the cuts. We have an increasing child population, which all the economists tell us is important for demographics purposes, and yet we are not protecting their childhoods. Another stark statistic is the back to school clothing and footwear allowance figure Ms Ward gave of €17 million received by 200,000 families and what it would actually cover. We need to examine that. Often when we have a debate on child benefit, and I will go out and defend it, we are told that we do know what it is spent on. We are very clear on what the back to school allowance is about, so I am concerned about that aspect.

With regard to the child and family agency, I am a little concerned with already having to ask for there to be no cut in its resourcing. How do we know that the amount that is being allocated to the new agency is a fair proportion of what should be allocated from the HSE? How do we know that the starting point is fair and that the agency is not already starting way behind the starting line? That is a concern I have on that issue.

Regarding youth work services and the question of cuts, there has been an increased legislative basis for youth work with vetting, and rightly so, but has that removed costs for organisations that provide such services? The Seanad is currently discussing the issue of bullying and that arises when an issue becomes a problem, whereas youth work involves getting in much earlier and engaging in preventive early intervention work which we should be supporting.

We are all concerned about the level of youth unemployment. Mr. Doorley mentioned the youth guarantee and leveraging EU funding. Will the State have to also leverage funding and what will be the relationship and the timeline in that respect?

My final point is on alcohol-related harm given the day that it is. We made a very strong statement in the previous session which I would advise the representatives to read. People are not aware that youth organisations will not take funding from alcohol companies. This is not said enough. Often it is said that the sports organisations are torn about this issue. The other day I tweeted about the events of today and I had a difficulty that an organisation, drinkaware.ie, was promoting alcohol. I got a telephone call from the organisation questioning my action of tweeting. The problem is that the drinks industry funds this body which then promotes the drinks industry. If youth work organisations will not take funding from the drinks industry, there is an issue for them; this relates to the levy Mr. Doorley spoke about and that money could go to youth work organisations and in that way there would be a legitimate way for such money to go to them. That is not heard in the public debate. I would encourage youth work organisations to say clearly and strongly to the public that every youth organisation has a policy that it will not take money from the drinks industry.

Jerry Buttimer (Cork South Central, Fine Gael)
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I call Senator Colm Burke.

Colm Burke (Fine Gael)
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I thank the representatives for their presentations. I would point out to Mr. James Doorley that I started off in politics as a direct result of being on a national executive of a youth organisation. I remember being in Leinster House lobbying to try to retain funding for youth organisations many years ago when youth organisations were only beginning to get some degree of recognition. We have come a long way since then. Now more than ever, and Mr. Doorley emphasised the point, we need to do much more. As has been said, the birth rate has increased from 60,000 a year to 75,000 and while it has dropped back in the past 12 months, we face major challenges in the years ahead. Does Mr. Doorley consider there could be more co-ordination of the funding made available to youth organisations to ensure better use is made of it? What can be done in that area?

One of the difficulties I have encountered in respect of EU funding relates to the delays on the part of the Departments in trying to access such funding. The first matter they tend to consider is the amount of money they will be obliged to provide before they apply for that funding. This issue was brought home to me in 2009 when Dell closed its operations in Limerick and the relevant Departments were not even aware of the existence of the European globalisation fund. A problem arose because at that time, the rules relating to the fund stipulated that 50% of the moneys would be provided by the EU and the other 50% by the Irish Government. We were advised that the Government would not be in a position to put its share of the money forward, so we convinced the European Union to increase its portion to 66%. As a result, €21 million was made available to the Limerick area. Is Mr. Doorley satisfied that Departments are doing enough to ensure we obtain the maximum benefit from the EU funding that is on offer in order that the maximum number of people here will benefit?

Regina Doherty (Meath East, Fine Gael)
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I thank our guests for their presentations. Child benefit is a universal payment. Notwithstanding the fact that there have been cuts to this payment, some of which could not be borne by certain families, the simple fact is that not all children are equal. Where does Ms Ward stand with regard to the universality of the payment? Should child benefit be taxed in the case of wealthier families? Would this have a direct impact on the children involved, even though they come from such families?

I could not agree more with Ms Ward regarding the back to school allowance. Those who are genuine in accessing this payment are down to pennies. It is not a case that they have pounds and shilling left. There is a real need - the Minister for Education and Skills has been trying to take action in this regard - to question the level of common sense displayed by schools. Some schools continue to oblige parents to spend €40 or €50 on tracksuits for children as young as six and seven. Those children might wear their tracksuits for 15 minutes of PE per week. The €40 to €50 to which I refer is additional to the money the parents are obliged to pay for school uniforms. It is bizarre. I would not care if we had money coming out of our ears. This should not be happening and it should be questioned.

I am scared that Ms Ward referred to the fact that the budget for the new child and family agency might be cut. Why is she of this view? Is it because everything else has been cut or is there another reason for her concern?

We all hope that the youth guarantee scheme will have a positive impact. Mr. Doorley referred to an amount of €20 million. Is there a specific strand he would like to see developed in respect of the scheme and, if so, will he describe it?

Ms Tanya Ward:

Deputy Ó Caoláin referred to the registration system which has been introduced and which we welcome. The system for early childhood education has been developed in a very ad hoc way. The impact of this has been that there is a real lack of quality across the board. In other jurisdictions, early childhood education has been developed in a way that is properly resourced and subsidised by the state. The authorities in those jurisdictions have much more control over the quality of the education that is provided. We took a different tack and decided to give child benefit payments of substance to parents. Effectively, we did not choose to regulate the sector and we are dealing with the costs and consequences as a result. It is astonishing that when we established the early childhood year, on which we are spending a great deal of money, we did not even introduce either a basic registration system or a quality assurance system. We welcome what the Minister is doing in this area because it is a very important step forward. However, there is a long way to go in the area of early childhood education. What the authorities need to do is introduce a second free preschool year. This is extremely important because not only does the free preschool year subsidise the cost of early childhood care for families, it also means we obtain a better bang for our buck. In last year's budget, €136 million was cut from child benefit but only €18.4 million of this was reinvested into after-school clubs. What the Government should have done was used some of the money saved to establish a second free early childhood year because this would have been a good investment of resources. These are the type of issues we need to consider.

I could not agree more with the Deputy regarding the cost of poverty on children's lives. We are all aware that children who are living in poverty stop asking their parents for things. They do not ask for new shoes for school and they are happy to go to school in second-hand clothes. They are excluded by their peers, they do not go to the cinema, cafes, etc. They cannot take part in all the other activities in which other children are involved. They do not expect good presents - or any presents at all - at Christmas or on birthdays. They stop expecting all those things which are considered to be good about a child's life. That is the cost of poverty for children. One of the good ways in which this could have been addressed would have been through maintaining child benefit supplement. In the context of Deputy Regina Doherty's point, we are of the view that child benefit should remain universal. If one wants to tax people who are on high incomes, then one should use the tax system to do so. This might be politically unpopular, but if one wants to increase revenues, one uses the tax system to do so. Child benefit is the only thing families and children actually receive, so it should remain universal.

In compiling its report, the advisory group on tax and social welfare, which was chaired by Ita Mangan, did some work on reforming child income supplement. We would support research in this area but we are opposed to some of the recommendations contained in the advisory group's report. The group recommended that child benefit should remain universal but that it should be reduced and that a second tier payment should be introduced. To obtain the second tier payment, the suggested threshold would mean that one's income would have to be approximately €25,000 per year. That is not much more than what a family of two on the dole receives. In the context of trying to get people into work and out of the welfare trap, the recommendations in the report are very problematic.

On the points raised by Senator van Turnhout and Deputy Regina Doherty in respect of the child and family agency, our view on the costings involved is actually right. No one has carried out a proper costing with regard to what the agency needs to start up operations. It is dealing with many of the problems in the child protection system by bringing the different services together. Members will recall the report on child deaths which was published last year, the Ryan report and the report on child abuse in Roscommon. These reports highlighted that there are many problems around inter-agency co-operation, and a lack of information sharing. One of the key problems, however, is the lack of resources. There are just not enough social workers to deal with the high number of case files. What will happen the new agency if it does not have adequate resources? It will simply focus on child protection and it will not place an emphasis on early intervention. Children have a right to grow with their families. There is an obligation on the State to provide families with as much support as possible early on to prevent a scenario where they end up in foster care situations.

We are extremely concerned that the agency's existing budget is going to be cut. We have spoken to political insiders who indicated that it is a serious possibility. The new agency represents the largest reform of the public sector the Government has introduced and there is a possibility that its budget is going to be cut. One would expect that it would receive an injection of funds during its first year of operations to allow it to introduce new management systems. There is a huge job to be done by the new agency in integrating all the different systems. There is also a huge job to be done in the context of introducing new management systems within the agency. If one speaks to social workers who were working within the HSE several years ago, they will state that they could have been going about their business for three years without anyone discussing their caseloads with them or what was happening with the children involved. That was the background to it.

My final point in respect of the agency's budget is that it is carrying forward a historical deficit from the HSE. The amount involved is difficult to assess. Depending on to whom one speaks, it can be as high as €50 million or as low as €20 million.

Jillian van Turnhout (Independent)
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That is crazy.

Ms Tanya Ward:

It is important to focus attention on any deficit the agency is carrying forward. We must ensure it is not obliged to carry such a deficit. We need to give Gordon Jeyes and his team a fighting chance to get matters right for children. The first key the decision the Government needs to make relates to resourcing for the agency.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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No more debt going forward.

Mr. James Doorley:

Deputy Ó Caoláin referred to the disproportionate cuts to services for young people. Unfortunately, it can be a case of penny wise and pound foolish, particularly in the context of the long-term impacts of high levels of unemployment and young people leaving school early.

We even see it with the figures relating to mental health and, unfortunately, young people who die by suicide. The activities, sports and services that our members provide to young people can make a difference. We all know from the small spaces and activities which young people are involved in that the situation outside the school environment can make a big difference. A significant adult can make a big difference to the lives of many young people. Thankfully, many young people have one within the family but many people do not and sometimes they turn to someone who can help and support them. The Indecon report we received last year showed as much. Indecon is an economic consultancy that examined investment very much from the perspective of pounds, shillings and pence. It concluded that for every euro the State invests in youth work, it gets back €2.2 in the long term.

The National Economic and Social Council and the OECD issued statements last week. They indicated that in terms of employment young people have been hardest hit. We are not trying to create an intergenerational conflict; we are trying to emphasise the need to recognise that children and young people have been hard hit. There was some talk when the promissory note was announced in terms of lessening the €3.1 billion this year. For these young people the numbers are increasing but the challenges they are facing are increasing as well. Youth work services have already taken a 30% cut in 2014. We are not looking for more money but we are calling for the cut to be cancelled in 2014.

Senator van Turnhout will be well aware of the position because of her work in the sector. Most youth services in the country are provided by voluntary organisations. They have pushed and lobbied for vetting, quality standards and a range of other things but these come with extra costs and pressures. The committee is aware that the sector has 40,000 volunteers and 1,300 full-time staff equivalent. It is primarily a volunteer-led service. The extra requirements that they must meet reduces the amount of time they have to work with young people. On top of that they must find money to run the services. Furthermore, they have been hit by the double-whammy of reduced public funding while many have significantly reduced fund-raising. Many organisations are trying to raise money in all sorts of ways to run their activities.

The alcohol issue was raised. I was on the sports marketing group some years back which discussed getting rid of drinks industry sponsorship of sport. As a GAA fan, I always believed that it was wrong. I understand where sports organisations are coming from and that they are getting the money to provide the services, but I always took the view as a GAA fan that the money they were getting was coming from companies that were doing a good deal of damage to the young people they were meant to be working with. The irony is that for any young person who wishes to excel in sport, drinking alcohol is counterproductive. I agree that youth organisations should not accept money from the alcohol industry. It is simply against our principles. We are in place to assist young people. We would have no difficulty getting money in the morning and we need to remember that in the current context. This is why we believe in a social responsibility levy. This would involve the State imposing a levy. Alcohol is not an ordinary commodity; it is a product that has always been licensed because it is seen as a product that has consequences. We believe the State should impose such a levy.

Senator Burke referred to value for money. A value-for-money review is currently being conducted by the Department of Children and Youth Affairs. We believe that we must make better use of public funds, there is no doubt about that. However, sometimes because of the way the system is organised, in many cases there is no incentive for organisations to try to do things in a better way because organisations get cut across the board anyway. An organisation that has saved a great deal of money gets punished because it is told that it has cut costs here and there and therefore it will get less because it has been seen to reduce the budget. We need to consider incentivising organisations. This is not to say that many organisations have not cut budgets and costs already. Most organisations froze increments in 2008, most have cut pay and salaries and most have let people go and reduced services. There is a limit to the extent to which organisations can cut back. The irony is that it is possible for organisations to end up with staff but no money to do anything and that is not sustainable either.

I agree completely with the comments on EU funding. A total of between €6 billion and €8 billion is coming down the track with the youth guarantee. That represents a great opportunity for Ireland. It has been estimated that we could potentially access between €100 million and €150 million. I agree that we need to ensure this money is drawn down and spent well. There is only a two-year window for the youth guarantee. Our concern is that the money might be used to top up or replace some existing schemes and that would not be good enough.

Deputy Doherty made a particular point about the youth guarantee. We believe the youth guarantee should support all young people who are jobseekers to get them into work. We recognise that some young people who have left school or college recently may need a little support to get into a job or extra training but we are particularly concerned about the most disadvantaged young people because many of them have been on the live register for a long time. We maintain that of the potential €100 million or €150 million, at least a strand of it should be solely for those young people who are long-term unemployed and who perhaps have limited skills and qualifications.

The youth guarantee in Sweden and Finland has been successful. Ireland is not Sweden or Finland but those countries found it far more challenging to engage with the young people who were longer-term unemployed. More work needs to be done in this area. Some of these young people need what is called prevocational work. They may have literacy issues, substance misuse problems or family issues or they may have had a bad experience in school and need a little extra support. To throw a person into a job when, for example, he has literacy issues only creates more problems. I heard a representative of a major shopping retailer state recently that the business was sent 28 people who had been unemployed to fill positions. The business decided that none of them were ready to start work because they needed a good deal more support before they would be ready. Those people may well be ready in six months or a year. This is where the youth guarantee gives us a great opportunity but it is a short timeframe. I am involved in the pilot in Ballymun. It is a challenge to get all the organisations and statutory agencies to work together. It is a great opportunity but I agree that we need to ensure we use the money well because it is badly needed.

Jerry Buttimer (Cork South Central, Fine Gael)
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I thank Ms Ward, Ms Brady and Mr. Doorley for being here this morning, for their presentations and for the work they do with young people. I thank members for their input, forbearance and genuine commitment. Next Thursday, the Select Sub-Committee on Children and Youth Affairs will meet to deal with the Bill. Unfortunately for Senators that is for Deputies only.

Colm Burke (Fine Gael)
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That means 50% of your members will be gone.

Jerry Buttimer (Cork South Central, Fine Gael)
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Yes.