Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I thank the Ceann Comhairle. I reiterate that everybody has their eye on the reserves. That is how long the reserves last. They are reserves because there is a need for them in an emergency.

In this situation, we need a service - that is correct - but there is a vast difference between the service in the 1950s and the service now and what it entails. In the 1950s, we had large-scale unemployment, many people working in their homes, families working from home and so on. There were many more people available to help out in providing this much-wanted service than there are now. Now, whole families are at work for many different reasons. That is the way things are now, so we now need to develop a situation which continues seamlessly from the moment the person requires care and attention, either in a nursing home or in his or her home. That needs to be introduced in a way that is supportive and conscious of the degree of need in each situation. There are vast differences in that as well. In some cases the person only wants a conversation, a cup of tea, a bit of companionship and so on. That is important too in isolated areas in both urban and rural settings. It also means, however, that there are other situations that become more serious over time whereby people have a particular condition that gets progressively worse and they require a graduated level of service that contemplates the level of their need and how best to address it.

It can be done. Contrary to what many people said a number of years ago, that it will come at a relatively low cost, it will not. Everybody says it is a good idea, but it will cost. We have to be conscious of that fact and provide for it as necessary, otherwise it will not happen. We may pretend that this is a cheap way to deal with everything in lieu of hospital care. It is not because it requires travelling around the countryside and urban areas by a very dedicated team who have a personal knowledge of the patients they are dealing with. They have to travel once, twice or sometimes three times a day, depending on the condition. When they are committed to that, it is important from the point of view of the patient that the patient can rely on the availability of the service without interruption. That is the nature of the situation. The person, the individual, is vulnerable and needs that little reassurance in order to ensure continuity of the service and its seamlessness from the time the patient first requires it and on into the future for as long as necessary, just the same as hospital services and nursing home services are needed.

There should be a continuation of and some link with the nursing homes, whether they be public or private. If the State wants to provide public homes, I think it is the same thing, but there would be a knowledge arising from the link-up between the home care services and the nursing homes that would be available to nobody else, with the exception of a hospital. It would be important to have an overall view of the strengths and weakness of the services daily, if necessary. Where a glitch appears and a case is found where the staff are not able to turn up for a whole pile of reasons, and whether or not the patient's condition and how to respond to it have changed, there needs to be a central location like a nursing home that can provide an emergency response in the event of it being required and at the same time can take the patient into the institution concerned for short-term respite, a few days, a week or whatever the case may be, in order to get over the difficulty that has presented. It will work better that way and there will be a better return for its money from the State's point of view. It will be better for the running and the quality of the service from the State's point of view and the patient's point of view. There will be a wider knowledge among a wider group of people as to what is required in any particular area.

I have always believed that 50 patients can be dealt with much more effectively and efficiently in a residential situation than 50 patients spread across the country in an urban or a rural setting. Particularly in an urban setting in today's world, the provider of the service can spend an awful lot of time in a traffic jam, at traffic lights or at a multiplicity of traffic jams and traffic lights because the country is busy, and that is a good thing. However, we have to plan for it as we find it. This means that we must take into account the number of cases the individual or the individuals have to deal with, the number of individuals who have to deal with it and the quality of the service without in any way diminishing the quality of the service or creating a problem for the person for whom the service has been provided. We must also look at it from the point of view of the ability of the service provider to attend to the totality of someone's requirements on an ongoing basis. People will ask for a guarantee. If we can give the guarantee, by all means let us do it. We should do it. However, it has to be done on the basis of a precise identification of the costs and a meeting of the costs, a precise identification of the number of people required in order to pick up the high-quality service and a precise knowledge that this can be a replacement for the old nursing home care service, which is expensive insofar as the patient is concerned in most cases and unwieldy.

Many people have difficulty getting involved in the service, even though it is subsidised and so on. It is hard to iron out the details and hard to iron out the crinkles in the details and, as a result, there may be factors that may delay the conclusion in a particular case to such an extent that it becomes a debt that hangs on like the old death duties we had in this country once upon a time. They were not of any great help to either the State or the people concerned. It was only when they were abolished that that particular burden was taken from over the heads of a great many people, again in both urban and rural Ireland.

This is an important debate. We need to recognise the extent to which people become dependent on the provision of such a service into the future and, as a result of that, the necessity for those of us in this House to be able to say now and insofar as we can ascertain that we have put in place a service that we have quantified in terms of financial and personnel requirements - both are related - and, for the foreseeable future, that we have a system that will work and continues to work and meet the challenges.

I compliment the Minister of State, who is here in the House, on the work she has done in this particular area and on her knowledge of the area, which is obvious in the situations she has met with and continues to meet with all over the country.

See this speech in context