Dr. Marita O'Brien:

Deputy Collins made some good points on the number of people who will require support, particularly in light of the demographics. In 2017 we will have 20,000 more people who are aged 65 and over. Some 2,500 are in the older age group of 85 years and over but our home help budget for older people, which was €211 million in 2008, has decreased to €192 million. We have 30% more people in the over 65 group. The funding has dropped by 30% since 2008 but the population has increased by 30%, so one could say there is a 60% deficit.

Small interventions can make such a difference to people. A project on older people funded by the UK Department of Health found that every £1 spent on low-level interventions for older people gained an extra £1.20 for the acute care budget. Here we seem to crisis manage. It appears that when things come to a crisis, such as someone going to hospital, it is then that we start to look at what will happen to the person because he or she cannot go home and needs support. A total of 60% of the older people's budget goes on the nursing home support scheme and only 30% goes to services in the community.

This shows the bias. The policy is to support people to age at home but the budget follows residential care. This is because the nursing home support scheme is legislatively underpinned and a statutory process is in place. It is very transparent and easy to apply for and, as has been stated, it is easier to move people from an acute hospital because the process is quite easy. It takes much longer for those seeking home care packages or home adaptations. We incentivise people to move to a more costly outcome than is needed.

I often notice the discourse about older people and, in the context of emergency departments, people wonder about nursing home beds. Very rarely do people wonder about community care for these people, although it has been mentioned over the past year. We seem to have a way of thinking and this needs to be changed. Perhaps that is something the committee could examine.

The care could be strength-based rather than deficit-based in nature, and Ms Loughnane has referred to this. This means looking at people's strengths and how they can be supported at a lower level. Someone could be given home help for four or five hours, which people do not get at present. People may get home care packages but not home help in many areas.

Deputy Harty made an important point on innovation. We must be innovative. We cannot just think this is how we do things. We must think of different ways of doing things. We could examine the salaries of GPs who are in disadvantaged areas. They could be trained to work in such areas so they understand the wider circumstances. This type of localised approach would be much more cost-effective and generally more effective in the long term than having an overall blanket idea of how it has to be. These are interesting ways to look at simple ways of doing things rather than more complicated ways which cost more.