Alan Kelly (Tipperary, Labour) | Oireachtas source

I welcome the Bill and I thank Deputy O'Dea for putting it forward. It is timely. I had a brief opportunity to speak to Deputy O'Dea about the Bill yesterday. In fairness, I thank the Minister of State as well for the time she gave me this week to discuss the matter.

The legislation is timely because of the situation in which we find ourselves. We need a comprehensive plan. I am rather taken by what everyone else has said. There is unanimity on the need for a plan, something that does not happen often in this House. We are heading over the cliff in a demographic sense. We are going to have 1.5 million in the elderly bracket in the not-too-distant future. There is going to be a serious bubble in our demographics. We need to prepare for this and quickly. Whatever the duration of this Dáil, I believe this is something the Minister of State can put her stamp on and put in place a plan. That is why I am pleased we have reached some consensus on a way forward. That is what we need.

A statutory scheme for home care is necessary. Once we agree that, we can have a debate afterwards on the terms of the scheme and how it should work. A considerable amount of nitty-gritty needs to be sorted out. Considerable legal issues arise. Certainly, comprehensive regulatory issues arise and I have particular views and concerns on these. They are not easily addressed; they are particularly tricky. We cannot have the same regulatory processes for a home, which is a completely different setting to a nursing home. This is virgin territory; we have not been here before. We need to work this through. That is why I am glad we will have time to consult the relevant people. During the consultation period, perhaps we should work in parallel with some of the very capable individuals on the regulatory side within the Department to determine how it would work. I know that people will, through the consultation process, express their views on how the scheme should work and emphasise a need for the scheme. Perhaps the last aspect will not get as much focus. I call on the Minister of State to focus on this element because it might trip us up when we make decisions. I am referring to the status of the home, which is not just a normal building. I wonder what status the home will have and how it will be managed, how the regulatory framework will work, the type of regulatory framework and what standards will pertain. I do not think we can be definitive about this matter. We will have to customise some rules to make a statutory scheme work.

I have been very much taken by the comments made by many of my colleagues. Let us suppose that in six months' time we reach the point of making a decision on this initiative. I genuinely hope that we reach that point. We need a plan to ensure that we have community capacity to support the initiative. Without such support, the initiative will have been a waste of time.

Like Deputy Harty, I am a member of the excellent Committee on the Future of Healthcare. We have made significant progress because everyone has left their political baggage outside of the committee room door. The work is not easy. It is tough and we need to be thorough, but we will get there. I was very much taken by a submission made by Professor Colette Cowan. She is the regional chief executive of the University of Limerick hospitals group and the network of hospitals in the mid-west. She is under severe pressure working in one of the most difficult working environments that I have ever seen. When she made her presentation to the committee, she told us that the best way to prevent her having to tackle the current crisis in emergency care is to take a whole block of her funding and, over a period, invest it in the community to prevent people ending up in hospital in the first instance. I know this lady for some time. She started off as a normal nurse and worked her way up through the HSE. Therefore, she knows all strands and knows what is needed at every level of the hospitals of which he is in charge. I take what she says very seriously. In parallel with this plan, we need to ensure that the community intervention teams, primary care centres, geriatricians, occupational therapists and physiotherapists are all in place.

We all have constituencies. By way of example, what operates in north Tipperary is very different from what operates in the south of the county and there is no standard or commonality. Community intervention teams work different hours. Beyond Thurles, the teams work different hours. There are major gaps in service. All of this relates to the issue of GPs and the new GP contract. In rural areas, in particular, the new GP contract has become a major problem. Deputy Harty and I are trying to deal with GP issues in east Clare. I take an interest in east Clare because I live close by. There are significant problems with the GP issue in the area. If we do not have GPs working in these areas, then we will not be able to implement this plan. Certainly, we need a variation of what Deputy O'Dea has proposed, and it must be supported by the Minister of State and this House. All of the issues that I have outlined are interlinked. We need to sort out the GP issue. We need to ensure that we have community funding. We need to ensure that all positions are filled. If the services are not interlinked, we will not solve this critical issue.

Where are we going with this? I believe the proposal made by Deputy O'Dea is sincere. I also believe that the views of the Minister of State should be taken into account and that she has made sincere statements. She will have the energy to push this initiative. However, in six months' time we should revisit this matter. On the basis of what I have said, the Bill proposed by the Deputy is a good starting point. However, it needs tweaking.

Having said that, we can get there.

I believe that the process by which we will put this in place needs a huge volume of consideration. In the intervening time, I ask that we not alone open up and take on board all the consultations but also that we tease it out with the Minister of State's office, the Department of Health and, in particular, the HSE in order that in six months' time we are not then starting at the base line of teasing out the community requirements. Hopefully we will have made progress on the GP contract and on the issue of how we are going to manage the regulatory process. If we have done all that in six months' time, I will be delighted and this House will have done a service. On that basis, the Labour Party and I will be supporting the compromise that has been reached. We will review it in six months' time on the condition that all that happens. I will certainly play my part in supporting that in any way I can.

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