Bernard Durkan (Kildare North, Fine Gael)
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I thank our witnesses for coming in and for giving us the benefit of their insight into the care system.

A number of things come to mind. Over the years I have made numerous references to the way the care has to be distributed and the competition between community-based care, institutional care, private hospital nursing home care and public hospital nursing home care. There seems to be a great deal of competition between all those sources. The demand is getting bigger. The demographics mean more caring is required. There are competing demands. For example, 20 years ago a house probably cost £60,000 or £70,000, which would have a relatively small mortgage. Family members were able to meet mortgage repayments and provide care at the same time, very often with carer's allowance, a supplement or part carer's allowance. That day is gone. The demand from mortgages is much bigger and the repayments are the equivalent of one wage. We have a number of demands and added to them are the family circumstances. I find in my area that if a person is returned from hospital to be cared for at home very often the family will opt for a local nursing home if it is nearby. The critical issue is whether it is nearby, both for respite and support.

Questions have been raised about carer's allowance. The idea in the assessment of carer's allowance is to refuse almost everyone at the start. An interesting factor in respect of young people, teenagers and those in their 20s is the idea that their carers are doing no more than is required to care for a normal child or teenager. It is rubbish. It is crazy stuff. It meets the financial requirements but it does not deal with the requirements of the child or family concerned. I have seen instances where it was outrageous to suggest the child required no more attention than a normal child of the same age. It creates a serious issue for the family if that idea is relied upon.

There are people from other countries outside the European Union who may be here illegally and who work as carers. We need to talk to the Department responsible for dealing with them to enable them to remain in the country and provide a service because there is a demand for it. There is not much sense telling them they do not comply with regulations so they must leave. It is fine from an immigration point of view but it does not solve the other issue we have. There is a necessity to do it. They are very good caring people from a number of countries.

We also need to recognise that caring in the community requires a huge input. It is not simple. In years gone by it was portrayed as simple, inexpensive and readily available but it is not. It requires huge input. I heard what the various speakers said about costs. There is a requirement for greater budgetary investment in the area. It has to be balanced. I am saying it as a member of the Government party. I cannot say we will do it straight away. It is not possible. If we compare it with the situation in 2007 or 2008, we see the experience from then on was not great. Somebody mentioned austerity. The real reason there were cuts is because there were not sufficient resources to meet the demand and the payments. The Government could not pay. There was nothing there. There is a danger we might separate that in our minds and say it was austerity that caused it. It was not. Austerity was a result of circumstances that arose and it was not possible to pay the public or private sector or both depending on the extent to which they were affected. We also need to look at the extent to which we have competing groups in the same business. It would be much better to have a single authority or body seamlessly delivering the service and having responsibility rather than a multiplicity of people trying to provide the same service and competing with each other for resources and staff. They provide the best they can in difficult circumstances. We need to look at the area again in a different light, taking into account the increasing demands, demographics and costs involved and find out how best to provide a good quality service without putting patients at risk or creating an impossible situation for family carers and at the same time make it possible to bring people into the service.

I have also noticed that when families apply for care support in the home, they usually get a package or part of a package and they might have to wait some time for it. There is no time to wait. Time may be a very serious issue at that stage. A week can be a very long time and sometimes it takes two or three weeks to put it into place. The next issue is that some of the carers are not as experienced as others. It puts pressure on their colleagues. In some cases lifting equipment, for example, is not being used because there are not the people to operate it. There have been instances of an older person caring for another older person. It creates huge problems for both. If there is any lifting involved, an older person will not last too long at it. It cannot work. It cannot happen. In those circumstances there is a need for more systemic intervention in terms of respite care for a week or two weeks in order to give the carer a breather if he or she is a family member. It would also give the caring system a bit of space to allow it to do its work.

What I have said comes from my experience of dealing with cases, some of which I am dealing with at present. They are all reflected in the issues that are being raised. They are reflective of the increasing demand. The issue is how to meet those issues while at the same time providing people with good quality care and the services to which they are entitled. They will all say they never looked for anything before in their lives. That is the opening statement of people, some of whom are 80 years of age. They have never looked for anything previously in their lives. They rightly feel there is an opportunity for the system to which they contributed all their lives to come to their rescue and they deserve it.