Catherine Noone (Fine Gael) | Oireachtas source

I welcome the Minister of State to the House. The debate is worthwhile and necessary. It is an issue that needs to be constantly monitored because the demographics show that by 2041 there will be approximately 1.3 million to 1.4 million people aged over 65 years in the country. It is important to get our approach and strategy right since the number of older people in our population continues to increase.
While there will always be a need for long-term residential care, older people consistently say that they want to be facilitated and supported to stay in their own homes. I understand where Senator Cullinane is coming from when he speaks of costs in this area. It is frustrating that we have had to make cuts in this particular area. The budget for residential care is being augmented by an additional €24 million to strengthen community and home-based services and to develop more flexible, accessible and responsive approaches to care. We badly need this type of measure.
The motion selectively quotes from several reports. For example, the motion quotes from the HSE national operational plan 2013, which states "Based on population projections, there will be a significant national deficit of long stay beds by 2016 based on the HSE's target of 4% of older persons in long stay care." However, the report further states the broader context:

The composition of units and number of long stay care beds have changed significantly in the last number of years, predominantly due to financial constraints, reduction in capital funding, introduction of HIQA standards, public service moratorium and legislative changes including the implementation of the Nursing Homes Support Scheme Act 2009. A target of no more than 4 – 4.5% of persons over 65 years of age in long stay care has been set by the HSE. However, this target can only be achieved through strong community and support services being in place to assist people living at home for as long as possible, and the achievability of this target is dependent on the expansion of community and support services.

We need to continue to develop strong community and support services to help people to live at home for as long as is practical and possible. The HSE national operational plan 2013 highlights exactly what we are saying, namely, that we need a flexible and agile approach to this area and we want to assist people to live at home for as long as possible.
Similarly, the motion quotes from the finding by the Centre for Ageing Research and Development in Ireland, CARDI, on future demand for long-term care in Ireland to the effect that even with greater emphasis on care at home and more resources provided to realise that aim, the demand for residential care will increase significantly in the next decade. This is something we all know and acknowledge and this is why an additional €23 million was provided to strengthen community services in addition to the budget of €315 million which has already been provided for home care services. Incidentally, these services are delivered to 56,000 people at any one time.
The motion notes a new report on Ireland's long-term residential sector produced by accountants BDO and commissioned by Nursing Homes Ireland, entitled Health's Ageing Crisis: Time For Action, A Future Strategy for Ireland's Long-Term Residential Care Sector.

The report estimates that for every 1,000 people who cannot access nursing home care due to the State's strategy, the cost to the Exchequer will be €273 million annually, in addition to the immeasurable impact on individuals, their families and the acute hospital system. Is it appropriate to use in the motion a report commissioned by a private profit-making organisation with a strong vested interest? A presentation available on the Nursing Homes Ireland website states, "A market solution requires profits". This sentence sums up best the reason we cannot adopt the single-track approach advocated in the motion.

The motion subsequently calls on Ministers and senior officials in the Department of Health and Health Service Executive to "remedy a deficit, widely recognised for many decades, in nursing home places, particularly in urban areas". I am concerned about this statement as it appears to advocate a one-track approach to the issue, namely, the use of nursing homes and nothing else. Such an approach does not correspond to the national strategy, nor does it make sense for urban areas.

First and foremost, we must work to enable people to remain in their homes for as long as practicable and possible. The motion calls for the immediate establishment of a Department of Health-led forum to "consider and develop appropriate policy relating to long-term care of our older population". This is misplaced in the sense that while the Department should consult stakeholders, ultimately its role is to develop its approach without any external influence from private companies which could benefit from the approach adopted. The establishment of a forum along the lines suggested would, in effect, give Nursing Homes Ireland an input into future budgetary and other decisions in which it has clear, commercial vested interests. This would not be appropriate.

As I noted, Nursing Homes Ireland already has clear channels of communication with the Department. I understand a meeting took place as recently as 2 April and officials will continue to meet regularly with representatives of the organisation and other stakeholders. The establishment of such a forum would be deeply unfair and detrimental as it would blur the line between the private and public sectors and give Nursing Homes Ireland an advantage over competitors. As I noted, the organisation's website advocates a market solution which requires profit.

It is important to continue to pursue a multifaceted approach of empowering community and home based services. We need to maintain the overall strategy of which I spoke. As such, the increase in funding to strengthen community and home based services and allow for a more agile, flexible and responsive approach is to be welcomed. I concur with Senator Gilroy that Members on all sides of the Houses want a fully functioning, excellent service for older people. The way in which a country treats its youth and elderly people says a great deal.