Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

At the outset, I would like to thank the Ceann Comhairle and his office for giving me the opportunity to address the House on the Irish national dementia strategy and its implementation.

Irish people are living longer now than ever before and thankfully the signs are that this trend will continue into the future. Better health care, better nutrition and greater awareness of how we are managing our own health have all contributed to this and it is something to be celebrated. Not only are we living longer but a great many Irish people are staying healthy. We are enjoying full and busy lives for longer than our parents or grandparents could ever have contemplated. However, while this is something to be celebrated, longer life will unfortunately mean that more people will live long enough to develop dementia. It is estimated that there are approximately 50,000 people with dementia in Ireland today. These numbers are expected to increase to over 140,000 by 2041 as the number of older people in Ireland increases. For this reason, in our programme for Government we committed to developing a national Alzheimer's and other dementias strategy to increase awareness, ensure timely diagnosis and intervention and ensure development of enhanced community-based services.

A research review funded by the Atlantic Philanthropies, entitled Creating Excellence in Dementia Care - A Research Review for Ireland's National Dementia Strategy, was published in January 2012. A public consultation process to inform the development of the strategy was also conducted in 2012 and a report on the consultation was published in February 2013. A working group representing of key stakeholders from the Department of Health, the HSE, the medical professions and the community and voluntary sectors was convened to advise on the publication of the strategy. The working group faced a challenging task in that there was little prospect of significant additional resources becoming available. However, an extremely generous offer by Atlantic Philanthropies to fund the implementation of key elements of the strategy has allowed us to put together a concrete implementation programme.

In December 2014, the Taoiseach, the Tánaiste and I launched the Irish national dementia strategy, which sets out a number of principles to underpin the provision of care and supports for people with dementia. It advises that we take account of dementia in the development and implementation of existing and future health policies. People with dementia should be encouraged to participate in society and in their own communities as fully as possible for as long as possible. End of life care for those with dementia should be prioritised and provided in the most appropriate setting. All those caring for or providing services to people with dementia should be appropriately trained and supervised. Resources should be directed to provide the best possible outcome for those with dementia, as well as for their families and carers.

The strategy emphasises that most people with dementia live in their own communities and can continue to live well and to participate in those communities for far longer than many people appreciate. A number of actions have been identified for early implementation. Clear responsibility for dementia is to be assigned in the HSE with the establishment of a national dementia office. Clear descriptions of care pathways and better information and guidance on services are to be made available to GPs and to people with dementia and their families and carers. A better understanding of dementia, including modifiable risk factors, is to be promoted. The use of existing resources is to be reviewed to ensure that they are used in the best way possible. Research to inform the design and delivery of dementia services in Ireland should be supported and given appropriate priority.

While the initial emphasis was on doing things better within existing resources, I have already mentioned the timely and very welcome boost provided by Atlantic Philanthropies which has agreed a joint initiative with the Department of Health and the HSE to implement key elements of the strategy over the period from 2014 to 2017. The national dementia strategy implementation programme will represent a combined investment of €27.5 million, with Atlantic Philanthropies contributing €12 million and the HSE contributing €15.5 million. The programme will promote a greater focus on timely diagnosis of dementia and on the value of early intervention, along with the long-term objective of making people in Ireland generally more aware and understanding of the needs of people with dementia and of the contribution that those with dementia continue to make to our society. The initiative includes the following three key elements. First, a programme will be rolled out to provide intensive home supports and home care packages for people with dementia. Second, additional dementia specific resources will be provided for GPs, who are the critical initial point of contact with the health system for those with dementia. This resource material will include training materials and guidance on local services and contact points that are relevant. The GP programme is being led by Dr. Tony Foley in Kinsale and training will be delivered in the nine community health organisations commencing in October 2015. Third, a campaign will be pursued to raise public awareness about the issue of stigma and to promote the inclusion and involvement in society of those with dementia. The involvement of Atlantic Philanthropies will allow us to do more of what we want to do sooner than would otherwise have been the case. Our agreement with that organisation provides for robust monitoring, evaluation and accountability. It will also facilitate the development of a strong evidence base to inform future policies and service design.

A monitoring group chaired by the Department of Health has been established to assist with and advise on implementation of the national dementia strategy, including the national dementia strategy implementation programme. This group includes health professionals, administrators, researchers and advocates. In addition, the group includes a person living with dementia and a representative of those who care for people with dementia. A draft implementation plan has been developed and was presented for discussion at the first meeting of the monitoring group on 1 April 2015. Feedback on the plan will be considered at the group's next meeting in June 2015.

The strategy acknowledges that while current health and social policy is focused on caring for people with dementia in their own homes, there will come a time for many when home care is no longer feasible or appropriate and long-term residential care is the best option. This can be particularly acute where 24-hour care is needed or where the person with dementia is living alone. As highlighted in the dementia services information and development centre report, A National Survey of Dementia in Long-Term Residential Care, some people need dementia specific facilities, particularly where the dementia is accompanied by behavioural and psychological symptoms such as agitation, aggression, disinhibition, wandering and sleep disturbance. These behaviours can occur at any stage of the illness but they can pose significant challenges for staff and other patients, as well as being potentially dangerous and distressing for the person with dementia. However, the majority of people with dementia currently reside in generic residential care facilities and a high proportion of existing nursing home residents are considered to be affected by dementia. The national quality standards for residential care settings for older people in Ireland, which apply to nursing homes generally, were developed from this perspective. The national dementia strategy therefore stresses the importance of residential standards generally being designed to accommodate the needs of people with dementia. The standards require service providers to deliver a person centred and comprehensive service that promotes health, well-being and quality of life. The nursing home resident must be the key stakeholder in service design from the outset. Each individual should be assessed immediately before or on admission to a nursing home so that an individualised care plan can be developed and reviewed on an ongoing basis. The care plan will set out how care is to be provided in a way that provides for the individual's wishes and health needs. The service provider must meet residents' needs, including the needs of those with dementia.

The review of the nursing home support scheme, which is due to be completed shortly, includes a general consideration of how services for the elderly are to be provided. This will include a consideration of whether pricing for residential care can better reflect the differences in care needs that inevitably arise. The current waiting time for people on the national placement list for funding under the nursing home support scheme improved significantly following the allocation of additional funding in two tranches this year. The first tranche of €10 million was part of an overall €25 million allocated to the HSE to relieve the problem of delayed discharges from acute hospitals. More recently the Government approved additional funding of €74 million, of which €44 million has been allocated to the nursing home support scheme to provide an additional 1,600 places and reduce the waiting time for approved applicants from the current 11 weeks to the previous norm of four weeks for the rest of the year. The remaining €30 million will cover the cost of additional transitional care beds through June and additional community, convalescence and district hospital beds on a permanent basis.

In addition to the nursing home support scheme, the HSE supports people to leave hospital with home care services such as home help and home care packages. Over the past number of months there has been a specific focus on the provision of home care to those in hospital requiring discharge in a timely manner. The recipients of these home supports include many people with dementia.

I regret to say that we have no cure for most forms of dementia and a diagnosis of dementia remains a challenge. However, most people can enjoy productive, fulfilling and happy lives even after a diagnosis of dementia. The aim of this strategy is to make sure that life is as good as possible for as long as possible for those affected by this condition. I am determined that the strategy will be effectively implemented and that the monitoring group I have appointed will oversee this implementation to its successful completion.

As I have often been told, we in this country are very good at strategy. Our weakness is implementation. Developing implementation alongside strategy is key to how we do things in future.

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