Kathleen Lynch (Cork North Central, Labour)

I thank everybody who spoke. Every contribution was extremely worthwhile, far-ranging and positive. There is one point I hear, not only in this Chamber but at any debate concerning the population of Ireland who happen to be over a certain age. People speak about these people as if they were an elusive group which is ring-fenced and protected. We have devised a positive aging strategy which will be published later this year but when we speak of planning for the future we speak of our own future. This is not an exclusive group; our future is in question. When we look at how we treat people who reach older age we should be very conscious that we are planning for ourselves. We will be very lucky to get there because many people do not reach their old age, something we should be conscious of, and examine. Those preparing the strategy on positive aging will listen very clearly to the voices of the client group we hope to serve in the future. That aspect has been missing from many debates here - listening to the people involved and asking them what they want.

When I was a member of the original health board I remember reading reports which told us very clearly that no matter what stage people are at in life they want to live in their own homes and communities. Surely we should consider having that type of support mechanism to ensure people can continue to live on in their own homes and communities with people they know and trust.

We must be extraordinarily careful in case we frighten people. When we talk about abuse one hopes there will be enough of an inspection regime in place to ensure people no longer have to fear this if they must go into institutional care. We have had a love affair with institutions in this country and those we have loved include schools, industrial homes, Magdalene laundries and care homes. There is an amazing point there. I am very conflicted on this issue for the simple reason that I now spend half my week trying to get back into the community people who have spent an enormous length of time in institutions, such as those who have mental health issues. This applies also to those with a disability. We are seriously bringing into the community people who have spent their lives living with intellectual or physical disabilities, whose homes are now in institutions. On the other hand, we seem to be in a headlong rush to put into institutions people who have reached a certain age. We really need to get our heads around that. What are we doing about it?

We have an enormous budget. I could state that €1.01 billion is set aside for institutions for people who become older because that is what we are discussing. On the other hand one could talk about €200 million odd in terms of community care for people in their later years. Look, for example, at what we are spending on disability. Let us suppose we were to combine budgets and talk about care for people who need care rather than separate out funds according to disciplines or groups, such as people with mental health issues. Why are we not talking about people who need care, whether the care in question refers to mental health issues or disability, or care for people who are older? We should combine the budgets and look at this in a sensible and practical way. The care needed in the community by somebody with a disability is not all that different from that needed by an older person in the community. It is all support and care. Perhaps sometimes it is a matter of technology, at other times of professional care, or care such as meals on wheels, home helps or provision of a carer. Think of what a personal assistant does for a person with a disability who needs such care. Is it all that different from the care needed by an elderly person? We must begin to look at this issue and start to talk about care in the community.

I am conscious that I have not addressed the points raised but will return to them. However, this conversation is very important. We need to get our heads around what the conversation must entail. We have money - we are not completely broke or penniless. We do not have additional money - and will have less - but if we do this properly we can provide better and more appropriate care in more appropriate settings for people who need it. I absolutely believe that. In mental health, for example, the bulk of our staff is found in institutions. We have least staff where they are most needed - in communities. We must switch this round entirely and perhaps we should look at it in terms of everyone else. Why do we not listen to those who need our care or who have reached a certain age? We should listen to ourselves occasionally when we ask where we would like to be. Would we prefer to be maintained at home with a little more help? None of us wants to end up in any institution among strangers, no matter how good or kind they are.

On the €100,000 missing from the subhead, it was not misappropriated. It was spent on therapies in that subhead, on people in nursing homes, although it should not have been spent on those particular therapies and drugs. All of those therapies and drugs were provided for under a different subhead. Again it comes back to how we do this and how we will care for people. Our love affair with institutions must stop.

The Government is committed to keeping older people in their own homes for as long as possible. There is, however, a process where we arrive at the point where that is no longer feasible, and we must accept that there is a place for long-stay care appropriate to needs. We must ensure quality long-term residential care is available. We must also remember less than 5% of older people are in long-term nursing home care at present. The vast majority are at home in their communities, where they want to be.

We speak about older people as if they were a ring-fenced group. As an ageing population, this will present challenges in the years ahead. I look forward to working with all stakeholders to bring about real change and security. If we could bottle that sense of security and give it to those who are getting older, it would cause a fundamental change in their mental health because insecurity about what will happen in their later years contributes to poor mental and physical health.

This conversation has been interesting because I do not see anyone disagreeing about where we should be going. We might disagree about how we get there but where are going, the journey can be as interesting as the destination.