Colm Burke (Cork North Central, Fine Gael)
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What action is the Department taking in evolving strategies to divert the flow of older patients from accident and emergency departments into more suitable pathways? I ask the Minister to make a statement on the matter.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for this important question. The Government is committed to the delivery of health and social care services that enable older people to live and age well in their homes and communities. The enhanced community care programme aims to implement an end-to-end care pathway that will care for people at home and, over time, prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so.

The integrated care programme for older persons, ICPOP, which the Deputy will know well, seeks to ensure older people with complex care needs can access care quickly, at or near home through care pathways specifically designed for older people and targeting frailty, falls and dementia. To date, 28 ICPOP community specialist teams have been established throughout the country. We often speak about different things that are game changers but in my opinion the ICPOP teams have made such a significant difference.

The Government continues to prioritise investment in home support, day centres and meals on wheels services that support frail older people to live at home. I call it the "triangle of supports". I know the Deputy will be delighted to hear that in 2023 we delivered 22 million hours of home care, which amounts to an additional 3 million hours in the lifetime of this Government. I know there was a huge demand for these services but it is really important that people get this care in their homes. We also have 323 day centres that are now open, including 52 dementia-specific day centres. Meals on wheels services are also important. These services are supporting older people to live well at home.

I am delighted to say that Ireland has the highest life expectancy in the EU, as determined by the World Health Organization. This did not happen by accident. A lot of good work has been done. I will revert in detail about acute hospitals in the next part of my response.

Colm Burke (Cork North Central, Fine Gael)
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There is still a problem when an older person ends up in an accident and emergency department for different reasons. All of us, including the Minister of State, have been contacted by people who have an elderly family member who has spent 48 hours or more in an accident and emergency and still not been assigned a bed in a ward. It is very distressing for the elderly person involved but also for their families. Can more be done within the hospital structure to try to fast-track older people and get them into the appropriate accommodation so that their health condition does not deteriorate?

I also welcome what is being done with regard to nursing homes, where a nursing home is putting pressure for someone to be admitted to hospital, and we have teams that will call to the hospital to do the assessment and give the advice. I wonder if, within the hospital structure itself, we need to do a little bit more with regard to dealing with elderly people when they are admitted.

Mary Butler (Waterford, Fianna Fail)
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Last summer, the Minister, Deputy Donnelly, initiated our new approach to urgent and emergency care planning. This plan focused on improving primary measures, two of the most important being 8 a.m. trolley numbers and improving patient experience time for the over-75s as a priority patient cohort, and those most likely to require longer hospital stays. The last six months of 2023, compared to the same period in 2022, brought about a 22% reduction in the 8 a.m. trolley numbers and a 38% drop in the number of older patients waiting in emergency departments.

However, the Deputy is quite right. We have cases that we do not want to see. I think it varies from hospital to hospital but transitional care funding is really important. We allocated that over 10,000 times last year. We use it for hospital avoidance, and we use it for transfer to nursing homes if appropriate. I believe what the Deputy has said, in that with the teams now going into the nursing homes, it is hugely important.

Colm Burke (Cork North Central, Fine Gael)
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I thank the Minister of State. The challenge that we now have is where the Minister of State has talked about the programme being put in place for over-75s. That is going to be a growing challenge because we have more people living longer. The Minister of State is right in that life expectancy in Ireland is one of the best across Europe. That is now going to present its own challenges. The number of people over 65 is going to increase from more than 805,000 up to more than 1 million within the next five to six years. There is going to be growing demand but we need to continue to innovate and deal with the issues - especially where people arrive into the hospital - making sure that they are assigned to the appropriate level of care. I know it is complicated and in a sense, if someone falls and breaks a leg or a hip then it is even more complicated. However, in a lot of cases, it is just a condition of healthcare that the GP or the nursing home cannot deal with and that is the one we need to work on, that is, how we can fast track them from the accident and emergency department into the appropriate setting in the hospital system.

Mary Butler (Waterford, Fianna Fail)
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I agree with the Deputy, and what is really important here is hospital avoidance in the first place. We spoke about the teams going into the nursing homes. We now have a situation where if a resident in a nursing home, whether public, private or voluntary, needs an X-ray, the X-ray team is going in there. That is really important and it means that person will not have to be brought by ambulance to the emergency department.

There is a dedicated focus in the HSE to do the very best we can to avoid having elderly people in particular on trolleys for lengths of time. It does not always happen that way but that focus is very clear. We are also investing hugely in step-down beds, respite and rehab. For example, when older people in a hospital are deemed ready to leave the hospital and no longer need the support of a consultant in an acute hospital setting but still need care in the community, we are transferring people, where appropriate, to nursing homes but also to respite and rehab. These elements are really important to make sure that we have a good flow through the acute hospital settings.