David Norris (Independent)

While I have been enlightened by Senator Bradford's contribution, he is mistaken in his interpretation of classical mythology. Had the ancient Greeks said, "Thank you very much" and closed the door in the face of the Trojan horse, history would have been very different. Unfortunately, they were foolish enough to let it in. I could not resist saying that because it is such a charming rewriting of the myth.

The amendments need to be taken together and read in the context of the Bill. It is interesting that the Minister of State has tabled an amendment. Section 7(5) states:

The assessment referred to in subsection (4) shall be carried out by a person or persons (who may be an employee or employees of the Executive) who, in the opinion of the Executive, are suitably qualified to make that assessment and prepare a report in relation to the assessment.

The Government amendment, amendment No. 6, proposes to remove the phrase "by a person or persons (who may be an employee or employees of the Executive)" and substitute "by persons (who may be employees of the Executive)". The effect is to make it more general, which is interesting. I am curious to learn the Minister of State's rationale for so doing. I welcome the fact that she has tabled an amendment, but I am not sure of the motivation behind it.

Section 7(6) provides for an expansion of the meaning of "care needs assessment". It includes the person's ability to carry out the activities of daily living, including cognitive ability, the extent of orientation, etc. While this is a very useful checklist, it implies the existence of people who are professionally competent to make these assessments. I am surprised at the Minister of State's hesitation in using the phrase "multidisciplinary team", especially since the HSE actually stated some time ago that this was what was happening. While I will not rehearse everything I said on the previous occasion, I referred to the learned academic papers, all of which point to the need for a multidisciplinary team. The Minister of State may argue that by combining the phrase "persons (who may be employees of the Executive)" with the checklist we are actually getting, without explicitly mentioning it, a multidisciplinary team. However, I am surprised at the diffidence involved in not spelling it out. On 26 May the Minister of State said, "By maintaining the function of undertaking care needs assessments with the HSE, the legislation ensures that the applicant has access to a multi-disciplinary team of health care professionals located close to his or her place of residence." In speaking to the Houses of the Oireachtas the Minister of State has no difficulty in using the phrase multidisciplinary team, but there is reluctance to include it in the legislation, which some would find confusing.

I strongly support Senator Fitzgerald in her definition of multidisciplinary team. I accept what she says, that it is not necessarily an exhaustive list. I am particularly glad about that because it seems that while, as she says, the team may include the various professionals mentioned and that they may be needed to investigate certain situations in which they have expertise, I would have thought that my amendment, amendment No. 9, was significant, as it proposes to insert the words, "A geriatrician will partake in each care needs assessment". This is the condition in which such persons live. They are in such residences because they are old and have certain conditions by virtue of their age. I would have thought a geriatrician was universally useful in a multidisciplinary team and that it would be absolutely necessary to have one in assessing a case. An amendment was tabled earlier concerning the addition of social workers to the category of specified persons, but even that would not resolve the issue. Social workers need to be assessing individuals, not just applying for assessments, reviews and appealing decisions. One includes a social worker in a multidisciplinary team by specifying section 7(5)(a), which is covered by amendment No. 27. There is a cluster of related amendments which all mention section 7(5)(a). That appears technical so I would like to outline the reason for seeking to insert section 7(5)(a). It is in keeping with the Bill's principle of flexibility, in other words one only gets the team member one needs, as identified or requested by the HSE - the geriatrician or other specified person. Therefore it avoids a situation whereby one must automatically call in everybody on the team, as mentioned in Senator Fitzgerald's amendment, for example. In addition, by including this subsection as an area of appeal, it is in keeping with the principle of guaranteeing older people access to a multidisciplinary team.

Senator Fitzgerald has underlined an important point, which we have dealt with before, identifying a defect in the Government's approach, although one understands what is happening because of the extreme financial situation in which we find ourselves. She said that older people are only guaranteed an assessment, not any particular treatment, and she is correct in that analysis. That is precisely because, as a number of Senators said on Second Stage, this is not rights-based legislation. It is a needs-based Bill, whereby people's needs are assessed and in certain circumstances fulfilled, but there is no legal obligation to do so in every case.