Catherine Connolly (Galway West, Independent) | Oireachtas source

I congratulate Deputy Harty and his colleagues on bringing this motion before the House, and for his opening statement where he placed his emphasis on the delivery of this service through the public system. I welcome that. I welcome the Government's confirmation that it is accepting the motion. It is positive, but it prompts the question of why this proposal was not brought forward by the previous Government, with its overwhelming majority, given the cost effective nature of the proposal. It gives the lie to the constant mantra that this Dáil is paralysed. This is a good example of the new politics working and making a difference.

Our population, while relatively young compared with other European countries, is still ageing. Figures have been quoted tonight of 637,567 aged over 65 years. Over a quarter of those live alone and independently. That is 100,000 more people than were aged 65 years in 2011. The significant increase in the numbers aged over 65 years, and over 85 years, which is some 68,000, requires careful planning and investment. The lack of an integrated service, poor transport, disconnectivity and inappropriate housing is actively leading to unnecessary admissions to long term care and into hospitals. These admissions are completely preventable. What is needed is quality support to enable people to remain in their own home which is the key and in line with what people want. Most importantly, it is the most cost effective policy which any sensible Government would have pursued long ago.

Unfortunately that has not happened. Approximately 60% of the current budget for the provision of services for older people, around €1.7 billion, is spent on long term residential care. That is 80% to 20% going into private, for profit institutions. Only around 4% of people over 65 years live in long term residential care. The reality therefore, which has never been discussed, is that 96% of people over 65 years do not live in long-term residential settings and, most importantly, do not wish to. They want to be involved in the decision making process as to how they will spend their lives, and to be part of the democratic process. From replies to parliamentary questions by myself and other Deputies, we know that in practice home care packages and home help hours have been reduced significantly and are less than they were in 2008. Home care packages have increased but the net increase is not an increase because the demand is higher than what has been provided.

The lack of a proper service to help people to remain in their own homes adds to the acute crisis in our hospitals. It leads to delayed discharges and admissions. In responses to my parliamentary questions echo what many Deputies have said this evening, that families are fighting tooth and nail to the most basic home care package. There are people who have suffered a stroke or other serious illness who want to go home, their families want to take them home and they face a battle of only getting ten hours, for instance. If they fight or they go to a Deputy they might get more, but then again they might not. That is the level of what is happening on the ground.

It has been said already that what is needed is a statutory entitlement to home care. It will require increased spending but only in the short term. In the long term it will save the State money and lead to a healthier population in that age group. More respite care is also needed. We need extra investment in community nursing home facilities. I have been told a figure of 80% to 20% for private care which does not represent a balanced market. We need long-term planning and investment given the significant demographic changes.

Deputy MacSharry has said that he raised the following matter, and I raised it subsequently last week at the Committee of Public Accounts. The General Secretary had not considered that it might be more cost effective to look at the domiciliary care allowance, the carers allowance and providing home care packages and to do a cost-benefit analysis of it compared to the cost of long term residential care which is approaching €1 billion. It was just under €1 billion in 2017, and that was catering for only approximately 23,000. If one looks at all the other packages, which for much less money care for an extraordinary proportion of the population. It came as a surprise to me and to Deputy MacSharry that this had not even been considered and that across Departments, they might look at more cost-effective ways.

Finally, I will be parochial. All this makes perfect sense and the Minister has nodded many times to speakers tonight. However, there seems to be a disconnect, or a cognitive dissonance, between what people want and what public representatives say in the Dáil on their behalf, and what the HSE is actually doing on the ground. I lár na Gaeltachta, sa Spidéal i nGaillimh, tá dream agus níl siad in ann aon áit a fháil chun cruinniú a bheith acu i lár na Gaeltachta. A group, the average age of whose members is 80, is not allowed to meet in a premises owned by the HSE which, for over a year and a half, has remained empty. On the one hand the HSE gives the group a grant but on the other it refuses to facilitate them in a building it owns. This leaves us having to write lots of letters.

I support this motion in a general way but I have one reservation over the fact that it is to be done on the basis of the fair deal scheme. I believe fair deal is really "unfair deal" and I would be most unhappy if we went down that road. However, I certainly agree with the sentiment of the motion.

See this speech in context