Richard Bruton (Dublin Bay North, Fine Gael) | Oireachtas source

I welcome this debate and the work the Minister of State, Deputy Butler, is doing in this area. In my view longer lives is one of the greatest achievements of humanity but sadly it is too often portrayed as a period of decline or even of burden. We need to see this issue through a different lens. While I welcome the Commission on Care for Older People, I would have to say that again its emphasis on caring and the suggestion of decline is the wrong emphasis for our society at the moment. We need to look at ageing as a huge opportunity that we have not sufficiently developed. It is about the opportunities and of course there are some challenges with it too.

We have done a lot of work on this through the Fine Gael policy lab, of which I am vice chairman. About 500 people were involved in the survey and we held nine workshops looking at the types of challenge. What came out really strongly is that there is a virtual circle that we should be trying to promote, which is staying healthy, staying active, and staying connected. This promotes the individual's well-being and it minimises avoidable illnesses, which are the cause of a lot of the issues we are discussing. It reduces the frequency of treatment but more importantly it reduces the dependency of people during periods of treatment, which is where the huge health costs are incurred. We have not sufficiently looked back up the path to develop the sort of policies that are needed. I believe very strongly that we need a whole-of-government approach to this. This is not in any way to undermine the work the current Minister of State is doing but the reality is that most people reach retirement without the proper preparation. We have not developed the opportunities in the community that we need. There is not a fit between existing State supports and what would make family caring more accessible and deliverable. We have huge gaps in the sort of accommodation people need. There is very little between being in one's own home with no supports and being in a nursing home. This has been traced by numerous policy issues. We do not have sufficient emphasis in the health service on prevention and management of chronic conditions. We also have this issue we are discussing today around home care.

When we try to look at this issue of longer lives through a different lens it is remarkable what we find. The quality of life peaks at the age of 68 and it is not until people reach their 80s that they are back to a quality of life measure similar to in their 50s. This is a period of huge opportunity and well-being if it is managed right. It has been found that 50% of people would like to work beyond their contracted retirement age. This applies to more women than men. The rigidity of the retirement age is a huge obstacle to what we need to do. Other figures show that 40% of older people report isolation and 84% of men and 69% of women report no supportive friendships. These would be the sort of friendships that would help people cope with the challenges that come in their lives. With health, 40% of treatable conditions go undiagnosed so people build up complex health issues later down the track, which are then much more difficult to manage. Under claiming and the uneven distribution of the benefits that we do offer is rampant. There is an unspoken assumption in a lot of the policies that have been unwittingly developed that there is some female member of the family available to provide care. This simply does not fit in with the changing structures of family life.

We need to rethink this in many ways. The organisations that work with care people did a take stock, of which I am sure the Minister of State is aware. Across 15 pillars on which they measured progress, in ten of those areas Ireland ranked at D or less, which meant little or no positive impact. This is just the reality of the challenges we face. I believe a lot of it is because our silos have been too rigid and we have not adapted them to the changing nature of lives. When we talk to people their greatest fear is losing independence. That is the greatest fear people have when they are thinking about their future. The Minister of State may be aware that back in 2019 very good collaborative work was done between the Department of Health and the Department of housing. It came up with the idea that there are eight stages of assisted care between living in one's own home and living in a nursing home. These are various levels of support and assistance. There is a massive gulf in Ireland between level one and level eight.

At that time there was the hope that we could start to build it. To be honest, it got derailed by Covid and by other things. There was a great deal of insight in that report that we must go back to and seek to develop. We make it extremely difficult for people to rightsize. We do not offer the options. There are all sorts of hand trips in access to medical cards and means tests if people do decide to downsize. We are one of the countries that has the highest level of over-accommodation, especially for people over 65 and beyond. We typically live in larger homes than we need, which are often ill-equipped to changing needs. We have not developed the opportunities to change that and to allow people to shift to more appropriate settings.

I welcome in particular one initiative the Minister of State has introduced, namely, enhanced community care. That is a significant shift in the thinking of the Department and the HSE. The hope is there will be 96 of those networks, serving populations of 50,000. That offers the promise of progress but we must see more tangible indications of how this is impacting on people. I struggle to find indicators of how this is rolling out. The experience we had through the work we did was that there simply is not the flexibility on the ground for families trying to support someone with challenges or to respond to a sudden change in circumstances. The carer's allowance and benefit have a rigid number of hours a person must be working or not working. That makes it harder to have the sort of flexibility needed for families who are trying to support care to access those funds. We do not have anything like the domiciliary care allowance, for example, or the incapacitated child tax credit that are given to parents struggling with the challenges of children with special needs. We do not have the same sort of supports for families trying to cope with the challenges of an adult with needs. We must rethink some of those supports in order that they can become more compatible with families being involved, as well the proposals we are discussing here for the development of a statutory home care scheme.

I note the Minister of State has expressed some misgivings as to how easy this is going to be to deliver and whether we would dramatically improve the situation. We must take seriously the misgivings she expresses because she is working at the coalface. I do not balk at the idea of a small charge, a bit like the fair deal, but the reality, according to the ESRI's calculations, is that we would have to have 24 million more hours. The Minister of State has done extraordinarily well to build on the 10 million hours we had in 2012. We now have 22 million hours, which is an extraordinary achievement but it will be a challenge to provide another 24 million.

What we need to do is think more flexibly about reforms that would make a difference in the short term. I strongly believe there is a place for local care partnerships where people who are involved in care could register, access information, supports and flexibility, and where volunteers could provide additional support. That is a way people could be supported without dramatically increasing the obligations and, at the same time, the Minister of State can focus on long-term development.

We should force health insurers and pharmacies into being more active in supporting care in a preventative context. We must have much more screening for those conditions that are undetected. We must also introduce a dignity in care mark for all health settings. Sometimes it is inexcusable the conditions that people face when they are in an emergency situation and they go into certain settings. That is not hugely expensive to change.

The Minister of State should also seriously look at a home care development agency, not unlike what the Minister for Children, Equality, Disability, Integration and Youth is doing in regard to a child care development agency. This is a sector that must be developed in a coherent way. At the moment we rely on private sector initiatives to come forward and develop ideas and they get access to contracts. I acknowledge the progress the Minister of State has made in those contracts.

I have spent a lot of time working in the enterprise sector, where we have a myriad of agencies helping companies doing far less important work than caring for people in difficult years. We have lots of agencies offering both technical support and expertise. We must think in those terms. Again, it is something that would move on a phased basis towards the sort of objectives the Minister of State set for herself.

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