Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I thank the Cathaoirleach for the opportunity to contribute. I thank the proposers of the motion because there are some elements of my brief that do not get as much attention as others. Mental health and disabilities get a disproportionate amount of attention. I welcome former Deputy, Mervyn Taylor, former Minister of State, Ms Áine Brady, and Sam, the young man who is shadowing me today and doing an incredible job in keeping me on my toes, and who has told me he is interested in politics, who are in the Visitors Gallery. Ms Áine Brady was a former holder of my portfolio but has gone to a place where there is less criticism.

The last contributor asked what will happen to the 700 people who are not going to get a bed. That is the reason we are providing an additional 1,000 places within the community for all of those complex issues. We are not just taking the easy option. The transfer of the €23 million in addition to the €315 million which we already provide in terms of community-based care is the way to go. There are different ways of doing things. For example, it is always quoted that 4.5% of people aged over 65 are in nursing home care. I would point out to Senator Marc MacSharry that is what I was talking about with Senator Colm Burke. In Donegal, the number is much less because it has a more holistic approach which combines community-based care with many other factors. That is the type of flexibility we are aiming for throughout the country. If it can be done in Donegal I am convinced it can be done in Cork, Sligo, Leitrim and all other places. An issue on which we are working actively is the transition bed. Senator Jillian van Turnhout is right. Given the notion that one could be in a bed that somebody else needs, transition beds are required. We have already drawn up a plan for such beds and the issue is about getting the resources to provide them. There is no shortage of nursing home beds but the difficulty is that the nursing home beds that are available are not always appropriate because of the more complex needs of people as they reach the end of life. I hate speaking about our older people as if somehow they were an alien force that we will never reach. They are people who are at a different stage in their life. If I could do anything, I would like to stop us speaking about chronological age because I know people of 45 years of age who need substantial supports but, equally, I know people of 85 years of age who are hail and hearty and do not need any supports.

The review of the fair deal scheme will be completed by mid year. It is not just about the cost and the basket but about what can be provided in various settings. We have never refused to meet Nursing Home Ireland and I do not see a difficulty with a forum. The last time I spoke here about older people, I committed to a forum but that will not be a forum on policy. The policy in terms of older people must have stakeholder involvement. There are many people in this country who are prepared to advocate on behalf of people as they age. We must be careful to ensure it is not driven by the private or, solely, by the public sector. It is about having a good consultation process.

I thank the Senators for raising this matter, and providing me with the opportunity to highlight some key elements of our approach to the care and support of people as we age. This Government has from the outset given a high priority to the issues concerning older people, and this continues today across a wide range of policy areas. Like many other countries in Europe, Ireland's population is ageing rapidly. It is estimated that the over-65 population will increase by nearly 220,000 people over the next decade, so by 2024 it is estimated that there will be some 800,000 people over 65. That is something to be celebrated. The percentage increase for the oldest old, those in the over 80 population, is estimated to be even more significant at about 42%, or 60,000, during this same period. These changes will have significant social and economic implications at individual, family and societal levels. The Government believes that the challenges arising from the ageing of our population can be met if we plan effectively so that necessary adjustments are made over time to our services, our mindsets and the structure of our society as a whole. We must remember always that an ageing population is most fundamentally a great success story to be celebrated rather than something to be feared.

The programme for Government gave a commitment to completing and implementing the national positive ageing strategy. The strategy, which was published and launched in April 2013, outlined Ireland's vision for ageing and older people. It contains a large number of action areas around older people's participation in society, health and social care provision, financial and physical security, and the need for an evidence-based approach to policy making. The national positive ageing strategy seeks to change the priority given to older persons' issues and the way in which older people's issues are viewed across the whole of Government. Any exercise of this breadth will take some time to bed in but we have already made good progress and the pace of change will increase over time. The launch of the strategy should be seen as starting a process of change rather than a single event. Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. When the stage is reached where an older person can no longer remain at home, the nursing homes support scheme provides financial support to those who need long-term residential care, with personal contributions related to personal means. It is worth highlighting that this year the budget for long-term residential care is €939 million. It is estimated that this will support over 22,000 people.

At present, more than 75% of people receiving financial support from the State are residents in private nursing homes. It is quite clear that the sector plays a key role in meeting the long-term residential care needs of a great many older people and we recognise the valuable contribution the sector makes. We engage regularly with stakeholders to discuss policies, services and developments and consider their views. In the past we have carried out structured public consultations and sought submissions in relation to, for example, the national carers strategy, the national positive ageing strategy, the dementia strategy, the review of the nursing homes support scheme and the care and welfare regulations for nursing homes.

Informal consultations can be and are often facilitated with the minimum of formality or notice. The private nursing home sector has access to my officials and I, and the views of this key group are listened to very carefully. Officials met recently with representatives of Nursing Homes Ireland. At this meeting, Nursing Homes Ireland again outlined its concerns about how the future need for long-term residential accommodation for older people can be met. Its case draws on a report recently commissioned by its group from BDO Ireland. This is a valuable contribution to the debate on how future needs can be met and its content will be carefully considered. We will continue to engage with Nursing Homes Ireland and with other relevant stakeholders. However, consultation notwithstanding, the responsibility for making final decisions must remain with Government. This is what we have been elected to do.

Ultimately, it will be our responsibility to balance all views and interests and to ensure that decisions, when taken, are first and foremost in the best interests of older people. It must be acknowledged that while there will always be a need for long-term residential care, older people have consistently said that they want to be supported to stay in their own homes and communities for as long as possible. Our policies must take account of how we can best respond to this clear preference. It is in that context that at a policy level, we are looking at how well our current model of provision meets the needs and wishes of older people.

The review of the nursing homes support scheme is giving consideration to how we currently balance residential care with care in the community and whether this needs to be adjusted to better reflect what older people want. The review is at a very advanced stage and I expect it will be completed soon. This will be a significant contribution to the level of future policy on meeting the long-term care needs of older people. Other care options, such as new models of residential care, may also play a part. The Government is pursuing an ambitious programme of reform for our health sector, including developing and reforming the ways we provide social care and care for older people. The priority for 2014 will be the development of an integrated model of care, with a strong emphasis on home and community care.

In this regard, €23 million has been transferred from the nursing homes support scheme budget to community services as a first step in re-aligning the model of care. This is in addition to the budget of €315 million already provided for home help and home care package services, which are delivered to some 56,000 people at any one time. A key priority identified in the HSE's National Service Plan 2014 is the implementation of a single assessment tool to uniformly assess dependency levels, allow resources to be targeted towards those with the greatest needs and enabling supports and services to be designed in the most appropriate way possible. The needs of our older people are, and will remain, a high priority for me and the Government.

The resources that are available to us will always be applied to provide the best possible mix of supports and services for our older people. Recent surveys on life for older people have demonstrated that Ireland ranks high as a place in which to grow old, particularly in areas such as social connections, access to public transport and physical safety. I am happy to have the opportunity here today to reiterate that the national positive aging strategy provides a framework for what we can do to make Ireland a better place in which to grow older. There is no doubt that these are challenging times. However, the Government will continue to prioritise older people and to support them to live full and independent lives.

Only the very lucky manage to reach old age. We all have memories of people who died at an early stage in their lives. It is important to recognise that.