Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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It is my great pleasure to welcome the Carers' Cross-Border Consortium.

The delegation includes Ms Rosaleen Doonan from the Carers Association; Mr. Sean Caughey, the Carers Trust Northern Ireland; Ms Maria Mulligan, volunteer and social worker; Ms Jennifer Van Aswegen, Disability Federation of Ireland, and Ms Siobhan McEniff from the Health Service Executive. They are welcome to the meeting. We are all passionate about the invaluable work that carers do every day, caring for family or friends who need help because of frailty, illness or disability. It touches an emotion in everyone. Today we will discuss the supports available for carers across the island and explore the opportunities for greater co-operation in developing policy in this important area of health provision.

Before I invite the witnesses to make their presentation I advise them they are protected by absolute privilege in respect of their evidence to the committee. However, if a witness is directed by the committee to cease giving evidence in regard to a particular matter and continues to do so, the witness is entitled thereafter only to a qualified privilege in respect of his or her evidence. Witnesses are directed that only evidence connected with the subject matter of the meeting is admissible and are asked to respect the parliamentary practice that, where possible, they should not criticise or make charges against a Member of either House, etc. I do not think these difficulties will arise.

I invite Ms Doonan to proceed with her opening statement.

Ms Rosaleen Doonan:

I thank the committee for inviting us to outline and discuss North-South co-operation in the area of family carers. I would also like to acknowledge the work of Deputies Joe McHugh and Tony McLoughlin, who have a demonstrated a keen interest in supporting family carers, and I appreciate all the work they have done so far.
This cross-Border consortium came together because we recognised that co-operation in this area makes sense as the increasing challenges facing family carers on both parts of the island are similar. There is no doubt that if we work together, benefits will accrue from pooling expertise, resources and exchanging good practice. This will achieve a better life for family carers on the island of Ireland.
The members of the consortium who are not here today are: Ms Catherine Magowan, Western Trust; Ms Noreen Kettyles, MeUnltd Northern Ireland; Mr. Shane Martin, a psychologist; and Mr. Frank Morrison from the Health Service Executive. We have received guidance and training from Ms Ruth Taillon of the Centre for Cross Border Studies.
A family carer is someone who provides an ongoing significant level of care to a person who is in need of that care in the home due to illness or disability or frailty. A family carer is not identified by gender, colour, creed or nationality, any more than those facing similar caring situations and feelings, irrespective of where they live.
It can be said that there are four kinds of people in the world: those who have been carers; those who will be carers; those who currently are carers; those who need to be cared-for. It is not something we often consider but it is a fact that, one way or another, “caring” will come into all of our lives at some stage and, as a society, we need to grasp that reality and plan around it.
People in both jurisdictions on this island are living longer and it is inevitable that, as this trend continues, the number of family carers will continue to grow, resulting in increased demand for relevant and timely support mechanisms to be in place to provide support to those who have chosen to care for a loved one. "Chosen" is not a very good word because few people choose to be carers. It is usually thrust upon them and is not a job that somebody applies for. There are 396,864 family carers registered on the island of Ireland giving 12,664,644 hours of unpaid care per week. In the Republic of Ireland the 2011 census recorded 187,000 family carers, of which 4,228 were under the age of 15 years, which is startling, yet in Northern Ireland the 2010 census returned a figure of 214,000. There is a clear need to research this glaring difference. Not only do family carers make a profound difference to the health, well-being and quality of life of those for whom they care, but they also make a huge and unacknowledged contribution to the economy. Family carers in the Republic of Ireland contribute €77 million per week, providing 900,000 hours of care daily to the ill, frail and people with disabilities. This is equivalent to one third of the total annual cost of the Health Service Executive, HSE, and is five times what family carers cost the Department of Social Protection in income support. Full-time family carers contribute on average €72,500 a year. Can committee members imagine what would happen if, like the air traffic controllers in France recently, all these people decided to down tools and go on strike, or bring all the people they care for to our community health centres and hospitals? The health service would collapse and thousands would die but we all know this will never happen because no matter what stresses or strains carers have to endure, they will never forsake their jobs. Carers are the backbone of the provision of care in the home and community. We all talk about care in the community but what is care in the community? There is no community. It is individual families and neighbours taking care of people. We have to ask where is this elusive community.
The significant demographic changes to the Irish population structure, expected to occur over the next few years, will have major implications for publicly provided supports and services and, coupled with the reforms in both the structure and delivery model of our health system, this will have profound implications for family carers. It is expected that Ireland’s ageing population and medical advances in treating disability and chronic illness will result in more people of all ages with longer-term and complex care needs who will, according to Government, be cared for in the community. We all know that this in reality means cared for at home by family members. The difference between now and 20 years ago is that people who would be cared for at home would not have a high level of medical intervention or needs. They might have been frail or have had a mild to moderate disability, but they did not have the complex needs that people can now care for at home. I am not saying they cannot be cared for at home but they need support. There is a change and we need to respond to that.
We acknowledge there are positive and rewarding aspects to caring but there are also huge challenges and demands. Research shows that a high percentage of carers experience physical ill health and emotional or psychological problems as a result of long-term caring. This is a fact no matter where in the world one is working. I acknowledge the Government's publication in 2012 of the national carers strategy, Recognised, Supported, Empowered, whose vision statement is:

Carers will be recognised and respected as key care partners. They will be supported to maintain their own health and well-being and to care with confidence. They will be empowered to participate as fully as possible in economic and social life.

This is particularly evident when one looks at how Co-operation and Working Together, CAWT, and other INTERREG funding is dispersed within the health sector. Provision is focused on patients and the agencies taking care of them, but little thought goes into the needs of voluntary carers. Some weeks ago, new funding of €50 million was announced under the CAWT initiative. However, while senior health managers in my area of Donegal and Sligo have been briefed on that funding, no representatives of carers were invited to attend the briefing. Once again, carers are on the outside. In fact, carers in the South do not even have a right to an assessment of their needs, even when they are caring for people with high levels of dependency.

One of the most remarkable and unusual aspects of family caring in Ireland is that despite being a small island, there is a vast difference in how supports are provided depending on which side of the Border one lives. There is a completely different model for delivering supports in each jurisdiction. In Northern Ireland, the model is services-based with low supports, whereas in the Republic it is based around medium supports and little service provision. I do not know which, if either, of these models is best, but it is striking that they are so different.

I will now hand over to my colleague, Mr. Caughey, who has travelled all the way from Belfast this morning.

Mr. Sean Caughey:

In Northern Ireland, according to the 2010 census, there are nearly 214,000 family carers and an estimated 30,000 young carers. Some 49,412 carers are over the age of 60, with 5,816 of them over the age of 75 and 20,340 caring more than 50 hours per week. Amazing as it may sound, 319 carers in Northern Ireland are over the age of 90. When our organisation conducted a snapshot survey recently in the Ballinascreen area of Derry, we found that 71% of carers are caring for more than 20 hours per week. Research shows that the 20-hours threshold is the acceptable level of caring before one risks damage to one's health. Other findings were that 50% of carers have been caring for more than five years, 50% described themselves as scared, worried or anxious, 45% help with personal care for a loved one, and 40% care for more than ten hours per day. These statistics are seen as typical of the situation for carers in rural areas across Northern Ireland.
Support funding for carers' services in the North is mainly provided by the five health trusts and varies depending on the trust area. All areas have a carers co-ordinator. However, the recent austerity cuts have seen the financial commitment for carers dwindle. For example, the Southern Health and Care Trust budget for carers was cut from £150,000 to £90,000. This flies in the face of the recent Compton report, the thrust of which is towards keeping people at home longer. Carer's allowance in the UK is £61.35 compared with €204.00 per week in the Republic.
I will give members testimony from two of the people we have encountered whose circumstances are indicative of the situation for carers in Northern Ireland at this time. The first is from a woman who is caring for her husband:

My name is Louise and I'm 62. My husband had a stroke about ten years ago and I gave up work to care for him. We managed at first but we're struggling to cope financially now. We desperately needed a shower installed and couldn't get help from anywhere so we had to pay for it ourselves on credit. I work part-time to try to make ends meet. I feel like we're in a never-ending downward spiral and we're now in serious debt. I haven't had a break for as long as I can remember.

My name is Alice. I'm 74 and I recently had a stroke. I've lost the use of my left arm. I care for my husband who has various medical problems and can't get about on his own. Since the stroke it's become more difficult to manage the physical things like getting him washed and dressed. Luckily for us we haven't lost our sense of humour and he will say to me, "Ach, Alice, all this running about after me is keeping you fit, girl!" I do all the cooking and shopping. We have a lady comes in to help with cleaning at the moment – we call her Mary Poppins (she doesn't know!) - but this service is being taken away. I can't really understand why. The house won't clean itself.

The physical and emotional impact that caring can have on the well-being of individuals should not be underestimated. With an ageing population, carers will become older and we must ensure that they are properly supported to carry out their role without it negatively affecting their own health and well-being. Parents of children with learning disabilities worry what about will happen when they are no longer able to care for them. So it is vital that as carers become older, they are given reassurance and have peace of mind with regard to the future of their dependants.

Caring for the carer and planning for the future are therefore vitally important. We must develop new models of services for older carers and their families so they have the knowledge, resources and tools to plan for the future. We must also ensure that they are given practical help, including respite and short break care if needed. “Making a difference to the lives of all in our society remains a firm priority for me. Transforming Your Care [document on reform of health service provision in the North ]means more health and social care services will be provided in the community, therefore carers will play an increasingly important role in providing valuable services that complement those delivered by paid care services.

Ms Rosaleen Doonan:

The recent economic collapse in both jurisdictions, north and south, has led to drastic austerity measures by government and health agencies, all of which will have a major impact on family carers throughout the island of Ireland. Reports on reform of the health service on both sides of the Border - Transforming Your Care in the North, and Future Health in the Republic - have many similar strands which will impact on the lives of carers and future carers in terms of the supports available to them. In fact, the interesting thing about those two documents is that they are very similar in what they outline, but the way services are delivered on both sides of the Border is very different.
The Department of Health published Future Health – A Strategic Framework for Reform of the Health Service 2012–2015 in November 2012. According to this document, one of the seven tangible changes patients and clients will experience under the reformed service will be, "More people cared for in their homes: The reforms in social care will help older people and people with disabilities to live in their homes for as long as possible rather than go into residential care". Future Health sets out four pillars of reform, including a commitment by the Government to the development of a comprehensive health and well-being policy framework. The document further clarifies that:

Health is more than merely the absence of disease; it is physical, mental, and social well-being... Prevention policies and programmes can be cost-effective, can reduce health care costs, and can improve the health of the population... The role of the health service must be seen as keeping people healthy as opposed to just treating sick people.

Joe McHugh (Donegal North East, Fine Gael)
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I apologise for interrupting, but I notice there are six pages remaining in the presentation. Members have all received a copy and we can publish the document to our website. Perhaps, in the interests of time, Mr. Caughey might summarise the position?

Mr. Sean Caughey:

Certainly, Chairman. I will just echo the point made by Ms Doonan that Transforming Your Care is very similar to the document produced by the Irish Government. Unfortunately, these similarities include the omission of any indication as to how supports for carers will be resourced and funded.

Joe McHugh (Donegal North East, Fine Gael)
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Perhaps members will now get involved with observations and questions. Mr. Caughey is free to respond.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
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I thank the Chairman, welcome the witnesses and compliment them on their work. They have given a detailed presentation and we should all appreciate the outstanding work done throughout the island and abroad by carers. Ms Doonan and Mr. Caughey made clear that we must support carers in the difficult work they do. Their work is often unsung and unpaid. Along with giving proper recognition and support to carers we should acknowledge the age profile of people in Ireland is rising because we are living longer. It follows that there is a now need to care for people for longer periods. This should be an important element of any proposals on this topic.

There should be a simple all-Ireland policy on this as there are no political difficulties relating to different traditions. The necessary policies and supports in both jurisdictions should apply equally throughout the island. This issue should be raised at the North-South Ministerial Council. In recent years the North-South Inter-Parliamentary Association was established, comprising Members of the Northern Ireland Assembly, Dáil and Seanad, and it has discussed health issues, drugs, alcohol abuse and other matters that affect the entire island. There can be no political difficulties on such matters. I am part of the North-South Inter-Parliamentary Association with Deputies McHugh and Pringle and perhaps we should try to get this issue on its agenda. The Association is jointly chaired by the Ceann Comhairle, Deputy Seán Barrett and the Speaker of the Northern Ireland Assembly, Mr. William Hay, MLA, and I am sure those of us in the Association could seek to have the issue advanced as an item for discussion. This would bring the focus to the all-Ireland element of the issue.

I compliment Ms Doonan, Mr. Caughey and their colleagues on the detailed presentation they gave and their ongoing work. It is important that carers working on their own, almost as sole-traders, have advocates because they do not have sufficient time. I apologise because I must leave now to attend another committee meeting but I will read the report of this meeting.

Mr. Conor Murphy:

I thank the Chair and I thank the witnesses for their presentation. It is clear that carers are a forgotten aspect of health service provision because they do their work out of a sense of love and duty. For this reason it is highly unlikely that they will go on strike and this is how they end up exploited by the health systems on either side of the Border. The point on the Transforming Your Care programme is correct as most people say it is a very good plan, in theory, but no provision has been made to implement it. The idea was to take people away from acute medical treatment and into the community but this happened at the same time as budget cuts on carers. In practice the initiative contradicted itself. This is a tough area and I do not doubt the benefits of an all-Ireland approach, particularly in Border areas where issues such as access to health services, rural transport and so on exacerbate an already difficult situation for carers.

I am very interested in the recommendations to the committee. At the start of the meeting the Chairman said we would focus on health matters and this is one such issue. Often when there is a focus on health matters carers are ignored so we must ensure this issue is part of our deliberations on all-Ireland health matters. We must see if pressure on both Departments, North and South, will help them follow through on decent propositions with practical support.

I too must apologise because I must attend another engagement but I first wanted to register my support for the witnesses and their presentation.

Joe McHugh (Donegal North East, Fine Gael)
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If Mr. Murphy is leaving those present will be delighted to take him up on his proposal. I inform the committee that we are examining a broad spectrum of health matters, not just for one meeting but on an ongoing basis, including cross-Border out-of-hours GP services, cross-Border cardiology services and so on. If a committee member can second Mr. Murphy's proposal we will include the issue of carers North and South in the wide-ranging report.

Mary White (Fianna Fail)
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I second that.

Mr. Sean Caughey:

Could I make a point on Mr. Murphy's statement? According to censuses on both sides of the Border there are 91,000 registered carers in Border areas. That is a substantial number.

Joe McHugh (Donegal North East, Fine Gael)
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Our committee will be in touch with Mr. Murphy at a later date.

Ms Maria Mulligan:

Before Mr. Murphy leaves-----

Joe McHugh (Donegal North East, Fine Gael)
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Is this a personal matter?

Ms Maria Mulligan:

I know Mr. Murphy will raise this amazing project on various agendas. It is a great opportunity to draw the attention of the British and Irish Governments to a policy that is not based on self-interest, making money or saving money. This issue is about the core values of society and acknowledging that we amount to more as a group. Very few areas of Government policy allow us to put such matters on the agenda. This is about who we are as a people - those doing background work matter. I feel passionate about this and ask Mr. Murphy to push it forward.

Mr. Conor Murphy:

Unfortunately we must face the bean counters in the Department and that is part of the battle.

Ms Maria Mulligan:

That is where Mr. Murphy can rattle their jars.

Joe McHugh (Donegal North East, Fine Gael)
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That is fair enough and I appreciate the intervention, enthusiasm and dedication of Ms Mulligan. After this meeting we can pass this issue on to whoever is Minister for Health after next Tuesday. We will also ensure Mr. Edwin Poots, MLA, of the Northern Ireland Assembly, is given a copy of proceedings here. Ms Mulligan can take it she has the support of the committee on this. The North-South Ministerial Council is next Thursday and we will raise this issue then also.

Ms Rosaleen Doonan:

The two health strategies on either side of the Border cannot be implemented without the support of family carers. They are not at the table at the moment. It is impossible for me to get an appointment with Co-operation and Working Together, CAWT. I have tried and I met a person from that organisation but I never heard from the office again and that was 14 months ago. The person seemed enthusiastic but there has been no contact since.

Joe McHugh (Donegal North East, Fine Gael)
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CAWT has been before this committee previously. We will write directly to CAWT to highlight that.

Ms Rosaleen Doonan:

That would be great.

Joe McHugh (Donegal North East, Fine Gael)
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We are all focused on following up today because Senator Mary M. White was very insistent that this committee should not merely listen to presentations but should use the meetings as a vehicle to follow things up.

Mr. Sean Caughey:

The assumption that this is a health issue for carers is wrong, it is much broader than that. We support young carers up to the age of 18 while they try hard to in their leaving certificate or A-level exams. Often they cannot take positions at university because of their caring responsibilities. This is an issue facing all of society that spans areas such as housing and education. It is not only a health issue.

Joe McHugh (Donegal North East, Fine Gael)
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We will make that point at the North-South Ministerial Council.

Mary White (Fianna Fail)
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There is big difference between the carer's allowance in the Six Counties and here. It is €75 there and €204 here.

Mr. Sean Caughey:

Some 30,000 people in Northern Ireland care for over 50 hours per week.

I make the commercial argument that they are working for £1 per hour. If there was a factory anywhere in Ireland where employees were being paid just £1 per hour, there would be uproar.

Ms Rosaleen Doonan:

One must also consider the totality of it in the context of how services for family carers on both sides of the Border are delivered. The services in Northern Ireland are much better than they are here, despite the fact that the support system is not at the same level. As stated earlier, however, I do not know which model is better. The best model might be a combination of both. For example, in Northern Ireland there are carer co-ordinators. Ms McEniff was a carer co-ordinator with the HSE before she took up another position within the organisation. Her previous post was not filled. I accept that we are living in straitened economic times but the position of carer co-ordinator was not considered important enough to fill. There is no carer co-ordinator in place in the Republic at present. That tells its own story. Ms Van Aswegen would have her own insight. This matter is not about spending money, it is about how it is spent in a way that results in the best value being obtained.

If one considers it from an economic perspective, then matters would dictate that the State would seek to begin supporting family carers. The more they are supported, the more people could be removed from residential care, acute hospitals, etc. It is a no-brainer.

Mary White (Fianna Fail)
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Yes, it is a no-brainer.

Ms Rosaleen Doonan:

Everyone on this side of the table knows they reason why such support is not provided. It is not because members do not want to help carers. I know from talking to them that they want to help because they have all had experience of this matter at some stage. The reason support is not provided is due to the position carers occupy within governmental structures. They do not, for example, fall within the remit of either the Department of Health or the Department of Social Protection. That is where the real problem lies. The Ministers for Health and Social Protection do not have responsibility for them and neither does any other Minister. They fall between stools.

Mr. Caughey and I have discussed this matter and we are of the view that if there were a Minister of State with responsibility for carers or a senior official with a dedication to family carers, we would not be discussing this matter.

Mary White (Fianna Fail)
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Is there no one in the Department of Health who is responsible? Someone must have some responsibility.

Ms Rosaleen Doonan:

It would make sense for the Department of Health to be responsible. However, let us consider the matter from a different perspective. If the Department for Health had responsibility and if the supports were coming from the Department of Protection - like all supports, these would be viewed as a drain on the economy - how would that sit with people? I am not even going to discuss paying family carers because that is not the route to go. I am stating that there needs to be national recognition for what they are doing. As Ms Mulligan stated, we need, as a society, to step up to the mark. In fairness, there was never an issue ten or 20 years ago because a grandmother or someone with a mild disability would have been cared for at home. At that time one did not need the services one requires now. People used to be transported to hospital on special beds and stretchers in ambulances, now they are being sent home from hospital with all sorts of paraphernalia in tow. As acting director of nursing in Our Lady's Hospital in Manorhamilton, Ms McEniff is very aware of that and she is very involved in this area. The position has shifted and we need to catch up. That is where the real problem lies.

Joe McHugh (Donegal North East, Fine Gael)
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I am glad we have gone off script and I thank Ms Doonan for expressing her views with such passion.

Thomas Pringle (Donegal South West, Independent)
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I thank our guests for their very interesting presentation. Ms Doonan already answered one of the questions I intended to pose in the context of what our guests are seeking and their interaction with CAWT in recent times. I am of the view that the committee should take up the cudgels in the context of having carers included under CAWT because that would also provide some momentum regarding how cross-Border issues might be dealt with. Like the Chairman, I am a member of the North-South Interparliamentary Association and we will definitely raise the matter with that body in order to increase its profile.

I am of the view that carers fall between stools because there is a view that it is nice to keep it that way because their value to society does not need to be recognised and there is no need to take action in respect of them. The national accounts for the past year were published earlier today and, for the first time, an economic value has been ascribed to prostitution and drug dealing. Would there be any point in trying to estimate the value of carers in the context of the national accounts in order to raise the profile of carers and the work they do? One of the things our guests are seeking from the committee is for it to facilitate access to INTERREG funding for family carers. What do they mean by that? Are they seeking it for research or is it for actual supports, etc.?

Ms Rosaleen Doonan:

Research is extremely important. Until very good bodies of research are compiled, it is not possible to establish benchmarks in the context of from where we should work. That is very important. The way I see it is that there is a circle and inside that is everything to do with the health service. Outside the circle are the carers. However, they are central to the success of everything in the health service going forward. Anything that gets us into the circle as equal partners and which brings about a recognition that we are going to be obliged to deliver on all the new policies the Government is introducing would be welcome. One cannot do anything without funding, be it from CAWT or INTERREG. I recognise that we are all trying to do the best we can with what we have but there are external bodies which are providing a great deal of funding for various different things in the area of health. However, carers are not part of that.

I am not sufficiently qualified to understand how these very large European Union funding mechanisms work. However, I do know INTERREG and CAWT are the mechanisms by means of which funds are disbursed to communities. I am hung up on the word "community". We should say it as it is, namely, that those involved are family carers and that we are sending people home to be looked after. I am not a medical person - I would make a very bad nurse and probably an even worse carer - but I am aware of the extent of the work - such as changing catheters and so on - those involved in care at home must do. Earlier this week I spoke to a woman whose little boy was born with a stem cell tumour. He screams all the time and she is expected to look after him 24-7 outside school hours and without any extra help.

Joe McHugh (Donegal North East, Fine Gael)
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One of the proposals made by our guests is to have the home recognised as a centre of care.

Ms Rosaleen Doonan:

Absolutely. If I had discussed this matter ten or 15 years ago, people would have said it was off the wall. There would not have been a need for such recognition because people who required 24-7 medical care would not have been at home. Times have changed, however. I have visited houses filled with hoists, wheelchairs and all sorts of medical paraphernalia and seen people traipsing in and out all day expecting cups of tea to be made for them. Homes must be made centres of care if we are serious about dealing with this matter. There is another option, namely, to reconsider the health strategies which obtain on both sides of the Border. However, I do not believe that will happen.

We will look at the two health strategies, but I do not think that is going to happen on both sides of the Border.

Before we write up such health strategies on the way forward we must consider what we intend to do and what that will mean for people. I am not necessarily asking for it to happen. There is a willingness among Irish people to look after their loved ones at home. Their loved ones want to be at home. Furthermore, I think it is the place for them. The doors are open. It is just a matter of having the supports to be able to do that without killing oneself. The statistics on ill health among carers are frightening. When one cares for someone in a full-on manner with very little support over a period of five to 20 years, one's health will be hugely compromised. We have done simple things that have made such a difference. We had a programme that thankfully was supported by the HSE in the west. People go to De Exeter House in Kilmacrenan in Donegal for breaks and that makes such a difference.

Mary White (Fianna Fail)
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It is a respite.

Ms Rosaleen Doonan:

People can avail of three days of respite. I cannot describe what it means to the committee. We have sent more than 100 people. I have a stack of cards from them. It made a difference to them and it makes a difference to the economy. If one wants to be black and white about it, one must look at that. We sent people there who were at burnout stage. Following respite, they are no longer burned out, they no longer need a residential place and they are prepared to continue with care at home, thus saving the State huge amounts of money. The financial and economic rationale for looking after carers is a no-brainer. It is the way to go. I am involved at the front line, all day, every day.

One Friday morning when I was in the office I got a telephone call from a man who was distressed. I did not know what was wrong. I usually ask people for their name first but he would not give me his name. The reason he was telephoning me was to tell me that he could no longer care for his mother. He was providing full-on personal care for her but he was giving it up. For a moment I did not know what he was telling me but he wanted us to be able to support his mother when he was gone. I was on the telephone to him for an hour. I will never forget the call. He was really telling me he had decided to end his life. He was going to commit suicide. He had it planned. He was going to Galway. I was on the other end of the telephone. I did not know who he was or where he was from. I tried to elicit the information from him. To make a long story short, I had to figure out where he was. I got on to the public health nurses. I had other people on the telephone checking to see whether he was a client of theirs. One person recognised who it could be and got to him while I was still on the telephone to him. We got him into De Exeter House. He was there for one month. He came out of there and he was perfect. We got supports in to help him. He is still caring for his mother. That is the reality. That is what it is like out there. That should never have happened. It need not have happened.

The man was 53 years of age and his mother was 84 or 85. If that man got the supports he needed the situation would not have arisen. Perhaps he did not ask for them. Sometimes people do not ask for them. One needs to know who those people are. If the man in that case had got the supports in time I would not have had that telephone call. They are the things one does not forget. It is very easy to be isolated from such circumstances when one is not in the business. What did I know about the situation before I got involved with the Carers Association? I was lucky. Those considerations did not come into my sphere of life but now I am acutely aware of them and I know for sure that they will affect me some day. I definitely know that I am either going to be cared for or I will be caring for someone.

Joe McHugh (Donegal North East, Fine Gael)
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In the meantime this committee will look after the aims and objectives outlined by Ms Doonan. I guarantee her that. I do not know what will happen in the future. I am conscious that Ms Van Aswegen has been waiting to contribute.

Ms Jennifer Van Aswegen:

That is okay. I thank Ms Rosaleen Doonan who has probably covered the area I had intended to address. The first point is on the economic rationale. If one looks at page 9 of the report, it reflects the tip of the iceberg of the economic rationale based on investing in carers now in order to prevent them becoming a burden on the health system through burnout and increasing the care burden. That makes absolute economic sense. Deputy Murphy referred to it in terms of counting beans. Such investment makes total financial and economic sense in order to prevent a landslide at the other end and in terms of the burden on the health service. Ms Doonan covered the topic very well with real examples of what happens on the ground much better than we could outline in a scientific way. The real life experiences she outlined gave life to the words on page 9.

Ms Doonan also mentioned research. On pages 8 and 9 of our proposal we examine the proposal put forward by the consortium on cross-Border collaboration. Research plays a key role. We are mindful that much research exists but there is a gap in the research. That is probably an area in which Ms McEniff has some expertise. A core element of the model proposal is around research to inform best practice and policy. We spoke about the disparities between the models in the North and the South. We do not have the answer on which is the most appropriate or best model but through research we hope to identify the needs of carers; whether financial support works best or practical hands-on support that might be more prevalent in Northern Ireland. We are very mindful of the importance of research as an element of any cross-Border collaboration and it is something we will prioritise as part of our project proposal.

Joe McHugh (Donegal North East, Fine Gael)
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I thank Ms Van Aswegen. The witnesses might be ahead of themselves. Ms Van Aswegen might have her homework done. The new round of INTERREG V has not been finalised yet but four themes emerge. What I say must be taken with a pinch of salt, as matters will not be finalised until September but the four themes that emerge first, health; second, research and innovation, including research, health and lifestyle; third, sustainable transport and; fourth, the environment. Assuming that this will be the final make-up of the four areas, Ms Van Aswegen might be on the right track. I hope that is helpful. The witnesses will watch the space closely in the coming months. Are there other observations or questions? We are coming near the conclusion of the meeting.

Tony McLoughlin (Sligo-North Leitrim, Fine Gael)
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I am not a member of this committee but I would like to compliment you, Chairman, and the committee on bringing carers from the North and South together today. I spoke to you on a number of occasions about the issue. Ms Doonan is familiar with my area of Sligo and the north west. The issue is vitally important. It was educational to listen to the presentation. The witnesses are in good hands under the stewardship of the Chairman, Deputy McHugh. This is the right forum to attend this morning in terms of INTERREG funding.

You will appreciate, Chairman, the enthusiasm generated by Ms Doonan. I have been on the receiving end of it in the north west in recent years. I see the work at first hand that is being done with the funds that have been allocated by the carers. Their work and dedication to their loved ones over the years is evident. At times, carers are taken for granted. It is vitally important that support can be provided. I compliment you, Chairman, and the committee for organising this morning’s meeting to bring both groupings together. The meeting is worthwhile and educational for me and others.

This is a step in the right direction.

Joe McHugh (Donegal North East, Fine Gael)
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I am conscious that a vote has been called in the Dáil. Deputy O'Reilly is going to do something he has never done before and make a contribution in 30 seconds.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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I want to join others in welcoming the witnesses because what they do is very important. I sincerely apologise for having to leave earlier. I had to deal with an unavoidable situation but I will not bore them with the details. I join Deputy McLoughlin and the Chairman in their comments, and I am glad there will be a proactive response to the witnesses' submission, which I look forward to reading.

Joe McHugh (Donegal North East, Fine Gael)
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We must conclude as a vote has been called in the Dáil. We have made a number of commitments in terms of follow up. I am conscious that it is not just a health issue but we will give the presentation to the Minister for Health south of the Border and for the information of the Northern Minister, Edwin Poots. The mechanism that might be important is the North South Ministerial Council, NSMC, and we will use that opportunity. Senator White will travel to Armagh next Thursday, and the witnesses can take it as read that she will ensure that this item is on the agenda for the joint secretariat.

Regarding the wide-ranging issues on health that are part of this committee, we are planning that at the moment and the witnesses can take it as read that their North-South carers issues will be incorporated into that.

To recap on INTERREG V, if they are the four emerging thematic areas it will be important to keep a close eye on them. We said also that we would follow up on writing directly to the Co-operation and Working Together, CAWT.

I thank all the witnesses. I thank also the people who may have wanted to make a contribution for their patience but Ms Doonan's passion and commitment to the cause was visible to all of us. We appreciate her, and her colleagues both North and South, being here today.

Mary White (Fianna Fail)
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Without being political, the cut in the respite care grant was heavy stuff. Does the Chairman recall that?

Joe McHugh (Donegal North East, Fine Gael)
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Yes, I know.

Mary White (Fianna Fail)
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That was hurtful.

Joe McHugh (Donegal North East, Fine Gael)
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We will end on that-----

Ms Rosaleen Doonan:

It is a bigger issue. It is about looking at the whole picture.

Ms Maria Mulligan:

It is about the message this sends out.

Joe McHugh (Donegal North East, Fine Gael)
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The meeting is adjourned until 10.15 a.m. on Thursday, 25 September 2014.