Helen McEntee (Meath East, Fine Gael) | Oireachtas source

I thank the Deputy for introducing the Fianna Fáil motion, which I accept. I believe it reflects much of Government policy and it effectively describes many of the issues and challenges that will arise in terms of supporting those with dementia. We in this Chamber know the figures but many people are not aware that 4,000 people in Ireland are diagnosed with dementia every year, which is 11 people a day. As Deputy Kelleher pointed out, 55,000 people in Ireland live with dementia. Dementia prevalence is set to increase in line with our increasing ageing population, but it is the case that dementia can also strike at a much younger age. I recently met Ms Kathy Ryan, who along with her two sons took part in an awareness campaign. Unfortunately, she first began to see symptoms in her early 40s. That is why we must act and plan ahead.

The challenge facing us is to support those who develop dementia and their families as much as we can, and in doing so to recognise that a great many people can live well with dementia for far longer than most people appreciate. When a person first realises he or she may have dementia, there is often a great deal of fear. There is fear among those affected but also among their families and friends. There is also much confusion about what it means, what happens next, what people can do, where they can go and what advice and assistance is available. They do not know how to access or indeed navigate the relevant public services and supports. I acknowledge the work of the Alzheimer Society of Ireland, which acts in conjunction with the HSE, for the services, assistance and listening ear provided at local level. It is very much an invaluable service and I know we would be lost without it in my county.

Far too many people feel that the life of a person diagnosed with dementia is effectively over. However, life is far from over for a person diagnosed with

The strategy also contains 21 additional actions to be prioritised as resources become available. In parallel with the strategy the Department of Health, the Health Service Executive and the Atlantic Philanthropies agreed to co-fund a national dementia strategy implementation programme over three years to implement specific elements of the strategy, which represents a combined investment of €27.5 million, of which the Atlantic Philanthropies contributes €12 million and the HSE €15.5 million. Key elements of the initiative include the establishment of a national dementia office in the HSE, the roll-out of a programme of intensive home care packages for people with dementia, the provision of additional dementia-specific resources for GPs and primary care teams to include training materials and guidance on local services and contact points, and measures to raise public awareness, address stigma and promote the inclusion and involvement in society of those with dementia. Sometimes people hide their illness or the fact they have been diagnosed, and that is something we must address.

The roll-out of intensive home care packages commenced in January 2015, and monitoring of the allocation and uptake of the packages is ongoing over the lifetime of the strategy. Up to 500 people with dementia and their families are expected to benefit from intensive home care packages over the lifetime of the implementation programme. Understand Together is the second strand of the national dementia strategy implementation programme. It is designed to raise public awareness of dementia and to build community support for people with dementia, their families and carers in a compassionate and inclusive way. The campaign is being led by the HSE and it was developed with partners, including the Alzheimer Society of Ireland and GENIO. I am pleased to say the campaign is being launched next Monday, 24 October.

The third strand of the implementation programme is the PREPARED project which is based in UCC. PREPARED is designed to upskill GPs in dementia diagnosis, and it will train GPs and primary care teams in the management of dementia. Training must be introduced as soon as possible and, where possible, across the board.

Those with dementia require services across many care streams, and that is acknowledged in the national dementia strategy. For example, given the prevalence of dementia in relevant age cohorts, it is inevitable that many of those in receipt of home care will have some degree of dementia. Dementia also arises as a co-morbidity with other conditions, and there are practical reasons it would be difficult and might not make sense to establish a separate funding stream for dementia services. Instead, my priority is to develop services in order that all those in need, including those with dementia, can get an early diagnosis and also all the services and supports they need when they need them. I appreciate that it will take us some time to get to that point, but we have made a real start in terms of the work, which must continue.

The motion calls for progressive increases in home care supports for people with dementia, ring-fenced funding, a scheme similar to the nursing homes support scheme, and a revised dementia strategy. I will deal with the issues one by one. The national dementia strategy already acknowledges that health and social care policy is focused on caring for people with dementia in their home. At a wider level, it is stated Government policy to facilitate older people, including those with dementia, to stay in their home and community for us long as possible. It is not appropriate, therefore, to recast the national dementia strategy which was completed only relatively recently and is still in the course of its implementation. Our energies and resources are better directed towards implementing the strategy effectively rather than trying to rewrite it, given that it already includes what is being requested. While the strategy is set out over three years the intention is that it would continue to develop and evolve, but I do not envisage starting again from scratch. The foundations have been laid and the intention is to build on them.

As well as the intensive home care packages that I have mentioned, a very significant proportion of those in receipt of the HSE's normal home care services have some degree of dementia, and those with the greatest care needs are prioritised in that context. Home support services across the country are being stretched by demands from more people and for more hours outside of core hours, which comes at a cost. Activity at the beginning of last year was at an all-time high and we have had to try to deal with that. Despite the fact that public finances are still very tight, we have responded to service pressures by providing additional resources this year and into next year as indicated in last week's Budget Statement. I agree with the Deputy that there needs to be a particular focus and priority on home help. That is the reason overall funding for services for older people has increased to €765 million, which is an increase of €82 million on the 2016 service plan. More than 80% of funding has focused on home care in particular. While we encourage people to stay at home for as long as possible, the nursing homes support scheme will be funded to the level of €940 million in 2017, which will allow the approval of funding to remain at a maximum of four weeks.

It is clear the existing home care service supports many people with dementia to remain living in their home. The single assessment tool, which is being piloted for older people in a number of hospitals and communities, will improve the provision of far better levels of data on people with dementia. It is intended that as it is rolled out in the coming years, this tool will be used to assess people seeking home care services countrywide on a standardised basis. The data will allow us to prioritise home care allocations more accurately on the basis of care needs, including for those with dementia.

The motion calls for a review of home care based on the model of the nursing homes support scheme which supports residential care. I have asked the Health Research Board to examine international approaches to the financing and regulation of long-term home care. Stemming from that, the Department of Health will develop policy proposals for the financing and regulation of home care services. The motion refers to the work of the World Health Organization, WHO, to make dementia a global health issue and to encourage member states, international organisations and non-governmental partners to work together to meet the challenge of dementia. The WHO has recently launched a consultation on a global action plan on the public health response to dementia. My Department has welcomed the proposal to develop an action plan and is leading the Government's response. The Department of Health and the HSE also take part in an EU governmental expert group on dementia and we are a member of an OECD working group that is looking at the development of dementia indicators.

Other speakers mentioned that family carers are a backbone of care provision in Ireland and the Government has sought to recognise that through the publication of the country's first national carers' strategy in 2012. The guiding principles of the strategy state that carers will be recognised, supported and empowered. The strategy also outlines that training and skill development for carers are to be provided by HSE staff such as public health nurses and through HSE and dementia elevator programmes which are available free of charge.

I agree with the Deputy that there needs to be a broad consensus on the issue, which is one on which we need to work. The strategy that has been put in place is a foundation. It is something on which we must build and that we must adapt where possible.

As the strategy is at an early stage, we need to make sure there are resources there to fully implement it. It is something I will prioritise in my time as Minister of State here.

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