Mr. Bernard O'Regan:

I would like to add to Mr. O'Donnell's comments. Some of the pressure on services at present is coming on the back of years of cutbacks. While there has been investment in service developments in recent years, it has come on the back of years when the investment in services had reduced significantly. As the investment in services is happening now, it must also retrospectively deal with the cuts in services that had happened over those years, the consequences of those cuts and the impact they had on families. We are seeing extensive evidence and experience of families who have survived, and I use the word advisedly, through those very difficult years and who are now finding it extremely hard. The pace of investment over the next few years will need to be significant to catch up and start meeting the need.

Reference was made to decongregation and congregated settings. The position of the national federation is to endorse the national policy. We were part of the development of that policy and contributed to it. As the representatives from HIQA said earlier, there is much evidence that those models of service were developed when that was the best that was known but we now know different. We have different models of service that we can and should be providing for people. That area also requires investment and, as the HIQA representatives said, it cannot just be done overnight. We are talking about people's lives and about places that have been their homes for decades. Any consideration of what a different service or support arrangement might look like must be based on each person, their assessed needs and how it might be best designed. The transition from where people are currently living to any new arrangement must be as carefully thought out as is the outcome for people at the end of the process.

I have no data on reduction in services but I have no doubt there has been some experience of organisations not expanding their services because they have had to raise the standards of the services they provide or that may have been obliged to curtail what they do in some way. There are examples of providers deciding not to continue with a service because the costs of getting it to the standard where it complies with regulations may have been prohibitive and they may have had to look at alternatives. That has not always been a bad thing; it has sometimes created opportunities for innovation in developing different models of service or exploring what different models might look like. It is not always a negative thing. It has also created some opportunities around it.

Senator Dolan referred earlier to "hot-bedding" and with respite and the use of people's beds, it certainly is an issue that has raised some difficulties. It goes back to a fundamental issue about what we believe home looks like. I live in my family home but I am here in Dublin tonight because I have meetings today and tomorrow. While the prospect that somebody might use my bed in my absence as a respite bed has a certain economic benefit, it presents huge issues around what is my private space, my sense of home and so on. The challenge for providers is to maintain good quality and adequate levels of respite service but in a way that safeguards the interests of people using respite and the interests of people whose home it is. The challenge can be seen in some instances where it has not been possible for a provider to figure out a solution to that; they have had to make a decision about whether a bed is a respite bed or a residential bed. I am aware, for example, that in a number of services there is a respite bed in a residential home and the provider has sought to dedicate a bedroom that is only used for respite and is not a person's bedroom. They try to ensure there is only a small number, maybe three or four people, using that bed for respite so the people who live in the facility do not experience 20 different people coming in and out of their home in the space of a month. It is a case of trying to find the best solution against a difficult backdrop of limited resources and of trying to meet a range of needs within those services, as well as complying with regulations and what is set out there.