Dáil debates

Thursday, 14 May 2015

Implementation of National Dementia Strategy: Statements (Resumed)


1:30 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the opportunity to speak on the national dementia strategy and thank the Government for providing the opportunity to do so. We called for a debate on the issue some time ago, so I thank it for this response. There is significant interest on the part of all parties in this issue and in the need for the strategy to be implemented. We understand the challenge facing the Government in the context of resources, but the strategy should be prioritised in terms of resources. We need commitment and determination to ensure the strategy is implemented in full.

Fianna Fáil supports the call for the findings of the midterm review to be utilised to develop the revised dementia plan. Earlier this morning, in another context, we discussed the need to learn from assessment of what does or does not work and should continue to implement what works best when developing any strategy. We should also try to reduce the impediments to development. At times when developing strategies, we are inclined to compartmentalise them and separate them from the rest of the health services. This strategy is dependent on the health services in general being able to deliver on the needs of people with dementia.

There are approximately 47,000 people with dementia living in Ireland, most of them women. Approximately 30,000 are women and 17,000 are men. If the current trend continues, the number of people with dementia is expected to rise to almost 70,000 by 2021, but what is even more alarming is that we could have 130,000 dementia sufferers by 2041. This may seem a long way down the road, but it is critical we start to plan in advance how to provide assistance and support to this huge cohort of people. We need to plan how to provide all the services required to ensure people with dementia have support.

When talking about strategies, a key issue is the complementary systems in place that need to be augmented and reinforced. We talk about primary care and independent, supported and assisted living in the home. These all need to be put in place to ensure we have continual, evolving support for the huge cohort of people we expect to have living with dementia in Ireland by 2041. This will require a determined effort on the part of the Government, particularly in view of the fact that 2041 appears to be a long time away. It is a natural phenomenon in the Oireachtas that priority is given on an electoral cycle and individuals here and Departments do not get recognition for longer term strategic planning. This is an inevitable consequence of our electoral system. Therefore, it takes bravery and determination on the part of Ministers and Departments to follow through and plant the seeds of a long-term strategy, although they may not benefit from the consequence. I am not saying this is true in regard to everything a Minister does, but the system corrals people into planning for the short and medium term, despite the challenges to be addressed in the long-term in regard to the increase in the number of people who will be living with dementia. The strategy is clear and highlights what needs to be done and the actions already in place.

When I met with the Alzheimer Society I made a suggestion for additional resource centres. We need community centres to support people to live independently in the community for longer. We could be imaginative in how we use the resources we already have in our communities such as GAA clubs, soccer clubs and rugby clubs, which all have fine facilities but are probably not being used in early midweek. A lot of them have been grant-aided by the State with sports capital grants over the years and could be used as day centres where people could come and meet clinicians, specialists and peers to talk and otherwise interact. In the next number of years there will be huge challenges to capital programmes and I do not expect day centres can be built in every parish or community. However, they already exist in the shape of these sports centres. If the necessary infrastructure was in place in terms of personnel to support the voluntary sector we could open up these facilities. We have spoken about day centres, health centres and resource centres but a lot of the bricks and mortar is already in our communities and we should interact with organisations such as the GAA, soccer clubs, rugby clubs and maybe even schools to make this come about.

Many more younger people will have dementia in the coming years, which is something we may not have addressed as a society. We need to keep people as active as possible and we should support people with dementia in remaining with their families. We should also help the families with a member who has contracted dementia. Fear often affects a person and that person's family when there has been a diagnosis of dementia or another neurological disease. We have to ensure there are strong supports in such cases and provide information and reassurance to people that they will not be left alone to deal with their issues. This is outlined in the strategy. I have referred to the suggestion that dementia awareness training be rolled out to local communities and accommodation will be needed for that, as it is for resource centres, active age groups and various other community groups. It is in such a context that we could look at sporting organisations because there are many GAA clubs today which will not see any activity until 5 p.m. or 6 p.m. when they start their training programmes and matches.

I was alarmed by the findings of the study which stated that only 11% of long-term residential care homes have dedicated dementia units. We know that huge challenges face residential units in general with the new HIQA regulations, the fact that we have an ageing demographic profile and a projected increase in the numbers with dementia in the years ahead. We have to be brave in how we tackle this issue. We discussed how we deal with the existing demographic profile in the discussion on care for the elderly and we need to tackle this in a non-partisan and non-political way. It should not be for the benefit of Deputy Billy Kelleher or the Minister of State, Deputy Kathleen Lynch, but of society. We need to work out how we fund and put in place the resource infrastructure to care for elderly people.

The review of the fair deal is ongoing but it is going to be a huge challenge for us and we need to be honest and upfront with ourselves about how we fund care for the elderly in the years ahead. We have spoken about the need for increases in peoples' contributions but we cannot pretend that the State can indefinitely fund this out of current expenditure on an annual basis. We have to be brave and set up some mechanism to ensure there is sufficient funding on a multi-annual basis so that we can plan ahead and an individual with dementia, as well as the population in general, can know what contributions they will have to make.

There needs to be an assurance that whatever facilities are in place meet the required standards. HIQA has set a benchmark and we must continue that standard of care for our elderly people. We saw what happened to people with intellectual disabilities in Áras Attracta and that could very easily happen in the case of older people and those with dementia. In increasing capacity in community and residential long-stay facilities we must ensure standards are in place and an inspection process exists to ensure they are maintained.

There is huge goodwill in our communities towards the idea of voluntary work, which we see even in those who volunteer to canvass for candidates in elections, such as the Minister of State or myself. Other people get involved in meals on wheels or community associations such as Older and Bolder, and volunteerism is an important component across the whole spectrum of society. It is a critically important component of how we structure and support society and how we support communities and individuals within the community. There has been huge pressure on the funding programmes for voluntary organisations because there have been consistent reviews of overlapping areas to ensure that we have good administration systems and that any funding goes directly to the services for which it is intended.

We need to ensure that volunteers are supported and assisted in delivering care, no more so than in the area of dementia and other neurological illnesses and diseases. In commending the new strategy I insist that its implementation be consistently monitored and that we be brave in planning a strategy not just for a horizon of 2015 or 2016 but well beyond that, so that people in the early stages of the disease know that support and services will be available to them after that.


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