John Brassil (Kerry, Fianna Fail)
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I thank Mr. Quinn for his comprehensive presentation. I will focus briefly on two areas. On commissioning, the Health Service Executive acts as the purchaser and provider. Will Mr. Quinn explain who the purchaser would be in the model he envisages?

Mr. Quinn spoke about home care, which is an issue that is raised consistently with Deputies in their constituencies. The vast majority of people who are unwell desire to be cared for at home. Deputies spend a great deal of time trying to secure home care packages and assistance for such persons and, as my colleagues will agree, this is always a struggle.

My concern in respect of HIQA is that it has very high standards, which is appropriate, but if are to increase the number of people who are cared for at home, I doubt that many homes would meet the standards that HIQA would require. This would exclude home care as an option in many cases.

It will be against the desire of the person and the family. One is looking at the practicality of door widths, bathroom access and so on in respect of which most people will say "We will be fine and will manage", but HIQA will not accept that. It will say that for a home care package, a €20,000 modification to the house is required which the person will not have. I envisage huge practical problems here. Does HIQA envisage the same? HIQA is a standards authority and has high standards, which is the way it should be, but from a practical perspective on the ground, I wonder if the whole home care idea will unravel because of this. I would be very interested in the opinions and comments of the witnesses on that.