Tom Fleming (Kerry South, Independent) | Oireachtas source

According to EUROSTAT figures for 2012, Irish males had a life expectancy of 78.7 years, while Irish females were expected to live 4.5 years longer, reaching the grand old age of 83.2 years. These figures have gradually but consistently improved in recent years and there has been an increase of almost three years in lifespan since 2003. The improvement is largely attributed to better survival rates for conditions such as heart disease and cancer in older age groups. Ireland's life expectancy figures should be considered in the context of many of the findings in reports on health inequalities and poverty figures. Ireland's poverty problems have serious implications for health, given the link between poverty and ill health and that those in the lower socio-economic groups have a higher percentage rate of both acute and chronic illnesses.

One very contentious issue concerns access to medical insurance by older people. The cost of medical insurance is very high and, unfortunately, is rising all the time. While older people may gain some consolation from regulations, community rating and open enrolment policies, for instance, the pressure on them to drop or jettison their private insurance cover is considerable and mounting. Senior citizens tend to have less money in the years following their retirement and, typically, the proportion of income spent on medical insurance is rising all the time. They also, naturally, tend to have more illnesses and health care needs.

For a person under the age of 50 or 55 years, the risk associated with dropping medical insurance for a time is lower, as there is a lower risk of illness in that age group. The delay in the reactivation of a policy is about 26 weeks. This would be a high risk strategy for a person over 65 years of age, at the other end of the scale, as the risk of illness is much greater. The time lag before a policy becomes effective after re-enrolment is a minimum of two years, on top of the delay in re-enrolling. Long waiting times are impacting on poorer people without private health insurance, which is not compatible with a health service designed to provide a safe, high quality and effective service for all. Health care is a social right everyone should enjoy and people should be assured care is guaranteed in times of illness or vulnerability. Medical card coverage is necessary and a high priority for all vulnerable persons. Timely access to quality health care services can also prevent higher health care costs in the long run for those who are vulnerable.

The cutbacks in the past seven years have resulted in measures such as high prescription charges and increased thresholds for the drugs repayment scheme, which are most adversely affecting those on low incomes. There is no evidence that funding has been provided to address the needs of an ageing population that will result in a steady increase in older people and people with disabilities accessing services. For example, the number of people over 65 years of age is increasing annually by approximately 20,000. The number of people over 80 years of age who have the greatest health care needs is growing by some 4% annually. This ageing of the population is the most dramatic anticipated change in the future structure of the population.

Current capacity in community services is insufficient to meet the growing demands associated with demographic pressures and this is reflected in the inappropriate levels of admission to, and delayed discharges from, acute hospitals. The acute hospital system which is already under considerable pressure will be unable to operate effectively unless there is a greater shift towards primary and community services. These should be the principal means of meeting home support and continuing care needs, thereby enabling people to live in the community for as long as is possible.

Approximately €4 billion was cut from the health care system between 2008 and 2014. There were more than 12,000 fewer Health Service Executive staff in December 2013 than there were at the height of public health sector employment in 2007. The Department of Health reports there was a 16% reduction in total public health expenditure between 2009 and 2014. Capital expenditure was 42% lower in 2013 than in 2008. These changes took place during a period of rapidly rising unemployment and consequent growth in the numbers qualifying for medical cards, all in an ageing population. A study by the Centre of Health Policy and Management at Trinity College Dublin concludes that, from 2013 onwards, the health system has been under increasing pressure and has had no choice but to do less with less. Given that the Health Service Executive cannot control emergency admissions to hospital, there has been a reduction in the numbers able to access medical cards, as well as day and hospital inpatient treatment and social care in the home. While these structures may result in short-term savings, they may work out more expensive in the longer term if they result in hospital admissions that could have been avoided, not to mention the cost in human suffering.

Although Ireland's population is younger in comparison to those of other European countries, it is still ageing. Between 2006 and 2011, the number of those over 65 years of age increased by 14.4%, while the number of those over 85 years increased by 22%. The most dramatic anticipated change in the future structures of the population is the increase in the number of older people.

The 2011 census showed the disability rate at less than 10% for those in their 20s. The rate is 20% by the age of 60 years and increases sharply for those aged 70 and older. The percentage of the population aged 85 years and over who have a disability is 72.3%, with a rate of 75.1% for females aged 85 or over. There were 58,087 people with disabilities aged 65 years or older living alone, which is a striking increase, given the number of older people now projected, particularly those aged over 85.

There is some evidence that the care needs of older people will not overwhelm the health system and that the changes will happen gradually and slowly. There is also evidence to the contrary which suggests, given the current experience of challenges within the acute hospital system in terms of trolley waits, delayed discharges and increased waiting lists for elective surgery, as well as significant HIQA reports indicating a system under pressure and providing strong evidence of reducing budgets since 2008, allied with an ageing population, related demands are overwhelming the system. A comprehensive report on care services, including integrated services across GP care, public health nursing, home care supports, acute hospital care, rehabilitaton and long-term care, is required.

Many issues have been raised. We have already discussed in this House and elsewhere the dementia problem. I do not have to indicate the dramatic nature of that illness, one the country and its health service will have to face in the future. I congratulate the Minister of State, Deputy Kathleen Lynch, on her participation in devising the dementia strategy which will be very important in the future.

This week I asked the Minister of State for her views on a recent study revealing that a far higher portion of Ireland's elderly population live in long-term nursing homes than the European average and to outline her plans to liaise with other Departments to examine the economics of the provision of services and financial supports for those elderly people who are well enough to say at home. I welcome the Minister of State's written reply to my Dáil question, including the following statement:

The review of the nursing homes support scheme, as well as considering the historical and future operation of the scheme itself, will consider how community and other services should be developed in order to facilitate more older people to stay at home for longer, and towards this end it identifies the services that should be prioritised into the future as resources allow. These include home care, better linkages between acute and community services, short stay beds, the use of assistive technology and consideration of new residential models on a collaborative basis by the Departments of Health and Environment and Local Government. The review is almost complete and will be published as soon as possible.

Thank you, Acting Chairman - I thank the Ceann Comhairle, who was present tonight as well - for presiding over these matters over the past two nights. I know you got into troubled waters for a while but you reached dry land again. On behalf of the Technical Group, I thank all Members who participated in this debate and who gave practical contributions. I thank the Tánaiste and Minister for Social Protection, Deputy Burton, for attending last night. She has a pivotal role to play, as does the Minister of State, Deputy Lynch, who is with us tonight, in giving the necessary supports to many of the Private Members' motions. I thank the Minister of State, Deputy Aodhán Ó Ríordáin, and the Minister of State, Deputy Damien English, who also gave positive contributions. Nick Doyle in my office assisted greatly in this endeavour as well. Some statistics were gained from Alone, Age Action Ireland and Social Justice Ireland.

This is the start of a debate that needs to be pursued and teased out further. We have done a good couple of night's work and I thank everyone who contributed over the two nights.

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