Áine Brady (Kildare North, Fianna Fail)

These amendments all concern the issue of who may undertake the care needs assessments. Amendments Nos. 6 and 7 would require all assessments to be carried out by more than one person and by a multidisciplinary team. I can assure Senators that applicants will have access to assessment by a multidisciplinary team, as required. As stated previously, the care needs assessment is intended to be a flexible, person-centred process. It acknowledges the reality that some applicants will require a greater level of assessment by a wider range of health care professionals than others. The legislation mirrors this, enabling a person to be assessed by more than one professional, as necessary. This approach is appropriate as forcing applicants to be assessed by all professionals, regardless of their particular care needs, would detract from the flexible nature of the assessment, divert precious health care resources away from front-line services and into unnecessary assessments and could cause needless delays for persons requiring long-term residential care. In addition, the term "multidisciplinary team" is not defined in legislation and I would be concerned as to whether the term could be legally contentious. For these reasons, I do not propose to accept amendments Nos. 6 and 7.

Amendment No. 8 proposes that care needs assessments would be undertaken by a representative of the Health Information and Quality Authority, HIQA. The function of HIQA will be to register and inspect all designated centres, including public, private and voluntary nursing homes. The undertaking of care needs assessments would be outside HIQA's role and would distract from its critical role as a national regulatory authority. It would also represent an inefficient use of public resources. By maintaining the function of undertaking care needs assessment within the HSE, the legislation ensures the applicant has access to a multidisciplinary team of health care professionals located close to the applicant's place of residence. Such health care professionals will simultaneously be engaged in the provision of care, either within the acute sector as part of their primary care teams or in the community setting generally. The transfer of this function to HIQA would require significant dedicated resources to be provided, with a resulting drain on the provision of front-line health care staff from the HSE. The fact that HIQA is a centralised regulatory authority would also represent problems in terms of providing efficient and cost-effective assessments to applicants at local level. For these reasons, I do not propose to accept this amendment.

Amendment No. 9 seeks to stipulate expressly that the person carrying out the care needs assessment must have experience in caring for older persons. The legislation provides that such persons must be suitable, which is defined in section 3 to mean the person has the necessary qualifications, training or experience, or combination thereof, to perform that function. As such, the proposed amendment is superfluous. I do not propose to accept amendment No. 9.

Amendments Nos. 11 to 14, inclusive, all concern the issue of examinations conducted under section 7(7). This subsection is merely an enabling provision which relates to physical examinations under the care needs assessment only. The actual legal basis for undertaking care needs assessment is section 7(5) which states that care needs assessments shall be carried out by persons who, in the opinion of the HSE, are suitably qualified to make the assessment. The intent and purpose of subsection 7(5) is to ensure a multidisciplinary team may carry out assessments on a flexible basis, as required. As such, I can confirm that the section will enable assessment by social workers, as necessary.

On a related note, the parameters of the care needs assessment as set out in section 7(6) extend to social as well as medical and health issues. The assessment is, therefore, holistic in nature. I trust this clarification addresses the concerns of Senators. On this basis, I do not propose to accept amendments Nos. 11 to 14, inclusive.