Dara Calleary (Mayo, Fianna Fail)
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I thank the Ceann Comhairle for allowing me to raise this issue. Deputy Lisa Chambers and I have been approached by the Alzheimer Society of Ireland and some of the 12 clients from across County Mayo who use the Castlebar centre on a Monday-to-Friday basis for respite and other services.

From the end of May, this will become a three-day service and no transport will be provided from various parts of the county to the Castlebar centre. As the Minister of State can imagine, this is causing huge distress to the families of the 12 clients involved, who depend on the service and on the transport to the service, and to the Alzheimer Society of Ireland, which provides an excellent service, along with Western Alzheimers, across County Mayo. Over the years, much of the response to Alzheimer's and dementia across County Mayo has been driven by communities, not the HSE. The HSE has taken on board some of the projects but has cut funding to other projects, leading to a very bumpy service across the county. What has happened in all these instances is that the patients who were using the community services, which were subsequently cut, and their families were then forced into either primary care providers across the county or Mayo University Hospital, thereby adding pressure to an already overstretched system.

In respect of the Castlebar centre, there is a shortfall of only some €30,000 annually. The HSE has not increased funding to the centre for a number of years. The clients contribute over €13,000 a year to the five-day service and the transport, with the HSE contributing just over €34,000 and fundraising led by the Alzheimer Society of Ireland just under €33,000. For want of this relatively small amount of money, which can be found within the budget, this service, this lifeline to families, and this transport will be restricted to three days and possibly to an even greater extent. The Alzheimer Society of Ireland has endeavoured for some years to try to engage the HSE on this issue. The HSE has written to both Deputy Lisa Chambers and me to tell us it is not cutting funding this year. However, the difficulty is that it is not increasing it either and the costs of providing the service are increasing. Transport alone has seen an increase in insurance costs. In addition, three people who have a relationship with the clients involved and whose relationship with the families of these clients is absolutely essential to the clients' well-being will be laid off this project. It is beyond me how a small, community-led service which is providing such a difference will now be curtailed in this manner because of a refusal on the part of the HSE to engage in the practical realities and practical, day-to-day expenses involved. This has happened previously. There was a wonderful project called Community Action on Dementia in Mayo, a community-led response project, which was providing a fantastic service. It had its money curtailed because the HSE took a decision locally not to support it. The services it provided were phenomenal.

I ask the Minister of State to engage with the HSE. It does not seem to understand the damage it is doing or the short-sighted nature of the decision it is taking. For the want of €30,000-odd, these 12 people will be put on a three-day service, thereby adding pressure to our primary care services and to Mayo University Hospital, which cannot stand any more pressure than that which it already faces.

Jim Daly (Cork South West, Fine Gael)
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I thank Deputy Calleary for raising this issue. Some 55,000 people in Ireland have dementia, and this number is expected to increase to 157,000 by 2046 as the number of older people in Ireland increases. The national dementia strategy emphasises that, with the right supports, people with dementia can continue to live well and participate in their own communities for a long lime.

A €27.5 million national dementia strategy implementation programme is being implemented. This includes dementia-specific intensive home care packages, a dementia information and awareness campaign called Understand Together and a programme to upskill GPs and primary care teams in dementia diagnosis and management. The HSE's National Dementia Office is undertaking numerous projects to progress the implementation of other strands of the strategy, including in the areas of dementia diagnosis, post-diagnostic support and acute hospital care.

Social care services are an important component of enabling people with dementia to remain living at home and participating in their own homes and communities. They also provide valuable supports to carers. The HSE, the National Dementia Office and the Alzheimer Society of Ireland have undertaken a project to identify what dementia-specific services are available in communities across Ireland and the results of this have been made available through an online service finder. In addition, the National Dementia Office and the HSE are working to identify the generic services that people with dementia access.

Regarding the specific issue of the day care centre in Castlebar, the Alzheimer Society of Ireland, ASI, receives annual funding from the HSE to provide services and supports in Mayo to people with dementia, their families and carers. These services are in addition to supports provided directly by the HSE.

Since its opening in 2006, the Alzheimer's day centre in Castlebar has offered a valuable service to people with dementia and their families and carers in Castlebar and the surrounding areas. The hard work of the centre's staff and volunteers has allowed people with dementia to remain living in their own communities with dignity and respect.

The HSE and the Alzheimer Society of Ireland have been engaging on the issue of service and funding in respect of this centre. The level of funding provided by the HSE to the ASI for this service in 2018 is the same as it was in 2017. However, due to an existing financial deficit, the ASI has informed the HSE that it cannot deliver the existing level of service without additional funding.

Regrettably, the HSE is unable to provide additional allocations to this individual service as the HSE must operate within the resources available to it. While all community health organisations endeavour to support such services in their areas as much as possible, they must do so within the context of the budgetary resources that exist.

The HSE understands the disappointment of people with dementia and their families who avail of the day care centre in Castlebar. Nonetheless, the centre will continue to operate for three days per week and provide services to clients during those days. I wish to emphasise that my Department aims to implement the national dementia strategy in full and ensure the provision of services to support and meet the needs of people with dementia and their families throughout the country, including in County Mayo.

Dara Calleary (Mayo, Fianna Fail)
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That is an incredibly cold response on the part of the HSE. I know it is not the Minister of State's response or his feeling on the matter. One cannot just dispatch people from a five-day service to a three-day service. One cannot speak about a national dementia strategy and people in communities and then cut their service in this manner, give them a pat on the head and hope they will not be affected. They will be affected. The HSE funds Alzheimer Society of Ireland services to an average of approximately 63%, but the Castlebar-based service is getting 31% funding, so there is a major gap in the funding level. As I said, it is a relatively small amount, and it is within the HSE's gift. Considering the amount of money it spends and wastes in many areas, it could find this money and deliver it to maintain the five-day service. The biggest impact of a lack of funding would be the complete exclusion of transport on the other two days. Clients will be faced with a reduction from a five to a three-day service but will actually not be able to get to the service because their families will not be in a position to bring them to Castlebar and back on the two other days. There is therefore the cut from the five-day to the three-day service and the complete cut in transport. The service is being undermined entirely and all the HSE can say is, "Tough. There is nothing we can do about it." This is a consistent response. The Minister of State can speak about a national dementia strategy but these are community-led and community-based initiatives that are keeping people in their communities and, more importantly, at home and they face small, penurious cuts in funding. It is typical of the HSE's approach, which is penny wise and pound foolish. This people will end up in Mayo University Hospital or at the local GP, where there are already serious pressures on services.

I know what the Minister of State has read out is not his response. I ask him, on Deputy Lisa Chambers' behalf and mine, to intervene personally with the HSE to explore with it whether there is any way it will reverse this decision.

Jim Daly (Cork South West, Fine Gael)
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I absolutely accept the Deputy's invitation to take a look at this. I also accept his comment on the finite nature of the response. It could certainly have been a little more hopeful for the people who use the services. For my part, as the Minister of State with responsibility for this area, I will take the matter up with the HSE and have a look at it. The Deputy will understand how this works, that we devolve the responsibility to decide who gets what as opposed to the Minister deciding, but I know he is not suggesting that that is how it works. However, I have responsibility to ensure we do not just say the words but that we ensure people continue to live in their own homes, supported and enabled in their own communities, and that we actually back this up with action and the supports necessary. This is a responsibility I take very seriously, and I will take the matter up with the HSE locally. I do not know what the specific issues are. I am not an auditor and I will not comment on the financial situation in respect of the centre. There may be some aspect to it that I am not aware of. I will ask the HSE to come back to me with a much fuller and much more detailed brief and I will ask it to review this decision in light of the conversation we have had. I will come back directly to Deputies Lisa Chambers and Calleary, having done that with the HSE, without any delay.