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

This is a long and detailed motion but it is also non-contentious and I compliment Deputy Mary Butler for her work in researching and formulating it. Many organisations advocate on behalf of people with dementia, Alzheimer's disease and other neurological illnesses. We are tabling the motion to give everybody the chance to plan ahead for what is going to be an avalanche of challenges for the State, society and many individuals. As Deputy Butler said, within 30 years 150,000 or 160,000 people will have dementia, Alzheimer's or other neurological diseases.

That poses significant challenges and we will fail future generations of people suffering with dementia if we do not accept that we have to start planning now, not only in the context of what we say but in what we do in terms of infrastructure, support and training services, and training professionals to enhance the capacity of the State and society to deal with something we know will happen.

The statistics and empirical evidence are available. Let us be honest. We have 55,000 people with dementia and we do not have the supports and services in place nor the infrastructure, both built and personnel, to support that. If we continue as we are, we certainly will be denying many any opportunity to live with dignity as independently as is practical with their conditions and allow them remain in their home or community for as long as possible. It is the right thing to do for many reasons. It is right because it is proven, medically and clinically, that home is the best place for a person with dementia or Alzheimer's disease. If we do not put these supports in place now, we simply will not be able to cater for them in the community and we will have a situation where we will be denying them their rights and entitlements, herding them into nursing homes and acute hospital settings, and not allowing them to live with dignity and to fulfil their opportunities. In that context, the motion is non-contentious but lays out the obligations we have and the services we must put in place.

There are areas where we have failed dramatically in terms of how we deal with community services. Obviously, we have the HSE and the statutory community services that are part of that and underpin it, but there is also a significant cohort of people and goodwill in the voluntary organisations. As I drive past the closed doors of the fine wheelchair accessible facilities of a GAA, rugby or soccer club or other community organisation that has been funded by the State, I wonder why we are not more imaginative in how we use these facilities to ensure people have a place to go where the HSE would provide services and supports in communities. If we accept that we will have significant challenges, we must be creative in how we confront them and in how we come up with solutions to address them. In the context of primary care teams and community care settings, although we do not have the physical infrastructure in place in many communities, we have a lot of goodwill with communities and voluntary organisations. It would be beneficial if one could underpin that goodwill with statutory supports and using those types of facilities which exist throughout the country. We all talk about the primary care centres, and if we are honest, the roll-out of those has been quite slow. We have facilities available and we should be imaginative. It would allow people to interact within their community and seek the supports and services required within their community and as near as practical to the home setting. It is something we are not harnessing beneficially for the community and the individuals who would avail of that service.

Given where we have come from as a people in recent years and the changing demographics, not only in terms of neurological diseases and illnesses but also in terms of age profiling, we are brought back to a number of issues. While we wait for the Committee on the Future of Healthcare to come up with a strategy to develop our health care system, there are some knowns we can address. Training programmes should be put in place to ensure we have the professionals and the capacity to deal with what happens next year, in four years' time, eight years' time, 12 years' time and right up to 2046 when we will have 150,000 people with Alzheimer's disease, according to the World Health Organization, the HSE and the Department of Health.

We have certain information we have not looked at. We should conduct the assessments. There is no need to have a grand plan for this. We know there will be considerable demands in certain areas, such as community services, care for the elderly and supporting the elderly in the home care setting and all that requires. What we have in terms of personnel, training programmes and professional enhancement programmes is limited in turning out the necessary number of staff in the form of quality graduates, professionals and clinicians, ancillary staff and allied health professionals. It has to be asked if one of the reasons we slow down this enhancing of capacity is because we do not want to recruit them when they graduate or qualify. We must look beyond that and not merely make the effort to ensure we have sufficient capacity or else we will repeatedly have shortages of nurses, allied health professionals, nurse specialists, consultants and GPs.

The national dementia strategy is a new strategy. It is short term in that it is only for three years and then we will have to look at the process again. My experience is that we are fairly good at drawing up strategies. Professor Tom Keane, who implemented the cancer care strategy, was before the Committee on the Future of Healthcare today. He was presented with an exceptionally good strategy. It had been through the cancer forum. There was broad buy-in from the various stakeholders in society for the delivery of cancer care, but the critical component was full buy-in from the State, political cover and the resourcing put in place to implement the strategy, and it was implemented. We have many strategies but there does not seem to be the political will to resource and prioritise certain areas to implement the strategies. This area is one we know we have to start planning for in the here and now or else we will be failing many individuals and their families and broader society. From that perspective, it is time for the Department and the HSE to step up to the plate, look at what is required in the short and medium term and put plans in place to address that for beyond the horizon.

Deputy Mary Butler highlighted why we tabled the motion. It is non-contentious and has been accepted by everybody in the Dáil. We knew that would be the case when we tabled it because everybody in the House is conscious of the needs and obligations that should be placed on the health and broader community services to deal with this issue. The motion highlights this and keeps it to the fore with policy-makers, which includes the House, the Government, the Department of Health, the HSE and advocacy groups. We can often forget what is beyond the horizon, and much Government policy is short term. It normally looks not much further than the next political cycle and general election. That is not a criticism, merely an observation of most western world democracies where the cycles are short and targeted. Our policy-makers need to be able to look beyond that in terms of developing policy.

The Minister of State, Deputy McEntee, has obligations in terms of the present dementia strategy which have to be fulfilled. She needs to expand the home care packages and ensure quicker diagnosis is available. I note that many suffering with dementia have not yet been diagnosed and may never be because of poor diagnostic services. Those are areas the Minister of State needs to address: home care, beefing up the community care system and its supports and expanding primary care teams. If we are to wait for the primary care centres to be established to enhance our primary care structures, I can assure the Minister of State we will be forever talking about when we will roll out primary care. We have become obsessed with the primary care centres and we have not instilled within the community the belief in the primary care team concept where all the specialties, State agencies, individual clinicians such as the GP, the nurse and the nurse specialist, and consultants work with the acute hospital in discharging patients from hospitals into the community and keeping them there. That is all still disparate and scattered and there is an obligation on us to deal with that. In discussing the dementia strategy, we need to ensure the primary care strategy, which has been around a long time, is implemented and resourced in full.

If we do not do that, all the other areas referred to in the motion will fall and that means we will deny many individuals, their families and future generations the opportunity to live with dignity at home for as long as is possible and practicable, for their sake but also for the sake of the health service and to ensure people are retained in the community as opposed to being in the acute hospital setting or in long-term residential care. I commend the motion to the House.

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