Gerald Nash (Labour) | Oireachtas source

I was happy to cede the floor to my colleague.

I am pleased that what we have heard to date has been a measured approach to the debate on health because that has not always been possible in this Chamber or in the other Chamber. I can understand why colleagues would want to take some time to focus their attention and that of the Minister on the emergency department crisis around the country. We all have our own experience of dealing with crises in emergency departments on a local basis and in some cases on a national basis. I have had much experience over the years of dealing with the perennial problem in my local hospital, Our Lady of Lourdes Hospital in Drogheda. Despite the best efforts of staff, HSE officials and successive Ministers it has always been very difficult to address the issues that both staff and patients face. It is very easy to kick the Minister of the day and accuse him or her, the HSE and hospital managers and staff of not doing enough and claiming they do not care about the state of the health service and the lack of adequate resources.

I am pleased that there is a degree of consensus in this Chamber on the issue as the approach I outlined is not one we want to take. We will not fix the problem facing constituents and the far too many people who are lying on hospital trolleys by taking that approach. After all, Ministers for Health are human beings too. They are compassionate, concerned individuals who do not want to have to preside over such a situation. I take the Minister's interventions on the issue at face value and I accept his bona fides that he is doing his utmost in difficult circumstances to resolve an issue that has confronted this State for far too long. Very tough decisions will have to be taken about how we resource and manage the health service. I hope it is not beyond our ability in this Chamber and across the political system to do that on a consensus basis to a large degree because the challenges are too great to become overtly politicised. There is a broad degree of consensus on what needs to be done in the health service while there are some differences about how the system can be resourced. The Minister is correct; issues such as bed capacity, retention and recruitment and how we properly resource and plan the primary care system are key to resolving the problem experienced in the expensive acute service area.

The challenges that face emergency departments across the country cannot be separated from the question of how we deal, for example, with our frail elderly population. That is an area in which I have become particularly interested in recent years. I am especially concerned about how we might better confront the challenges presented to citizens, families and the health service in general by the growing number of people with dementia and Alzheimer's in terms of taking a patient-centred approach to the delivery of appropriate care for them. Talking to those who work in emergency departments I am always struck by the number of possibly avoidable admissions of frail elderly people to hospital. I refer to people with dementia and Alzheimer's who might be better served in a different type of system. In fairness, thinking in the health service and the political arena has evolved considerably in terms of how we deal with those challenges.

The development of the national dementia strategy is very welcome. It has often been the case that many of us working in our constituencies over the years have found it difficult to access integrated services for people with dementia and Alzheimer's. Families become extremely frustrated at the difficulties they have in accessing the type of integrated services their older loved ones require. In the national dementia strategy reference is made to the consideration of appointing community dementia case managers. If we took such initiatives the health service and society would be much better off. Active consideration is being given to that approach in County Louth where there are approximately 1,200 to 1,400 people currently with dementia. County Louth is Ireland's first age-friendly county. The HSE, local authorities, DKIT, voluntary bodies and others have come together in recent years in a very co-ordinated fashion to look at how we can better deliver services for older people and how to meet some of the challenges that face society and the immediate community in the near future. The appointment of a community dementia case manager is being actively considered and would be a great boon for service users and their families.It would also allow health care professionals to take a closer look under the bonnet at what is needed for the frail elderly, particularly those with dementia. Families would also have the benefit of having a go-to person to allow them to access the broad type of services that people with dementia need. The ambition would be to develop that further over the next few years and, for example, resource community dementia case managers with the euros and expertise that they need to commission services that could be provided for people who need them in a very timely and efficacious way. There is a gap in the primary care system in terms of how we deal with cases like this, notwithstanding that significant improvements have been made in recent years and the new emphasis on primary care, which should be acknowledged.

I do not expect that the Minister will have an answer today to these types of very localised challenges, but it is something to consider. It is reflected in the national dementia strategy that we should be looking at different ways of dealing with the frail elderly with dementia to avoid repeated hospital admissions, which have a considerable knock-on effect in terms of bed capacity, staff and so on. There is a better way of dealing with people with dementia and the type of primary care services they require, such as speech and language therapy, physiotherapy, occupational therapy and so on. The outcomes would be much better. We need to put the patient, the client, the citizen, at the centre of the delivery of all our health services. A co-ordinated strategy would be better for our hospitals, patients and families and would allow the system to get improved data on how we can provide better services for the frail elderly, particularly those with dementia and Alzheimer's disease. As all of us in this Chamber know, this challenge is becoming deeper and we need to be better prepared. The national dementia strategy allows us to do that and there has been a new emphasis in this and previous budgets on how we can better address those issues.