Seán Power (Kildare South, Fianna Fail)

The 70 beds freed up allowed for the discharge from the Mater and Beaumont Hospitals of 35 patients each and investment in home help and community enhanced subventions. A sum of €6.6 million is being targeted for home help and community enhanced subventions nationally from funding under the ten-point plan. This will act as an important preventive measure and facilitate the discharge of older people from acute hospitals.

At the turn of the 20th century, it would have been very unusual to live to the age of 65, whereas today, most of us can expect to live well into our 70s and beyond. This increase in life expectancy has been one of the great achievements of western societies in the 20th century. With advances in living standards and health services, illness and dependency do not feature in many cases until the final few years of a person's life or not at all.

A number of people require medical attention and support to varying degrees, which must be delivered in the most appropriate setting to meet the needs of the individual. One of the best ways to acknowledge the debt we owe them is by providing them with every opportunity to remain in their homes and communities for as long as possible with all the necessary community supports in place. Research has found that those receiving care in their homes live on average two years longer than those in residential care. It has long been the expressed wish of the majority of older people to remain in their homes.

The cornerstone of public care provision is the home help service. This is invaluable in keeping older people at home for longer and often fulfils not only a functional role in terms of helping older people with everyday tasks but also a social role in terms of helping them to stay out and about and active in their community. Supporting care in the community has long been the core Government policy relating to older people. Home care packages are being delivered by the HSE to people whose needs are often complex and go beyond what home helps can provide. Such packages are comprehensive, multidisciplinary and have been making a difference to the lives of people who would, most likely, have ended up in long-term institutional care without this support. They are proving to be a crucial tool not only in helping people to move from acute care back into the community, but also in keeping people in the community where they belong. Various packages are available in different parts of the country. However, one standard package should be available throughout Ireland with one needs assessment process in place. The establishment of the HSE will help to ensure a standard approach is adopted in the future.

No home care package will replace the role of the family or other services provided by the State or voluntary agencies. Rather, home care packages should be used to complement existing services and care. Sheltered housing is a crucial component of community based supports for older people, as it allows older people to remain within the community while offering support and solidarity.

There is no denying that long-term residential care will always be required in the health system. However, currently some 28% of residents in long-stay beds are in the low to medium categories, in other words in residential care for social reasons. This represents over 5,000 people and some of these could be cared for at home if the right level of support were in place. In some cases a minor change may be necessary, allowing the person to live in dignity in his or her home. We will implement a number of measures to make that possible. Entering long-term care should not spell the end of a person's involvement in the community, and nursing homes have an important role to play in ensuring residents are facilitated and encouraged to keep up some level of contact with society.

In line with Government policy, my Department has been examining a number of procurement options with a view to finding the approach that will deliver 850 additional long-stay beds and provide the best services and value for money to the Exchequer. The Department of Health and Children and the Department of Finance have discussed an initiative based on entering into a medium-term service level agreement with the private sector to deliver additional long-stay beds for highly dependant patients. The proposal is being developed further to evaluate its cost effectiveness.

This Government is committed to improving the delivery of accident and emergency services and, by adopting a system-wide approach, I am confident the improvements made will be sustained. In respect of care for the elderly, raised by Deputy Sherlock, the Government announced a package of €50 million on minor capital works throughout the country. This money will be spent immediately, improving the conditions in which people live and making a difference to the quality of their lives.

A number of areas have been mentioned. Speakers from the Labour Party criticised the health service as if there was nothing good in it. We realise we are in the process of reforming the health service and are tackling the difficulties that exist. Over 100,000 people work in the health service, and they are committed to improving the circumstances of the people they treat. It serves little purpose to criticise them continually.

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