Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I thank the Senator for raising this issue, which she has been raising for some time. There is nothing more impressive in politics than consistency. The Senator is certainly consistent, and she certainly has been consistent on this topic. She has been following it for a number of years. She referred to the predecessor of my predecessor, Ms Kathleen Lynch. Therefore, it is quite a while since the Senator first proposed what she is now proposing.

It is the role of public representatives, including Senator McFadden in her role as a Senator, to continue to challenge the system. The HSE manages the delivery of services to elderly people and the entire population.It is up to us as public representatives to continue to challenge how things are done. If we continue to do what we always did, we will not bring about the real change demanded by the people we represent. I thank the Senator for raising this matter because it gives my officials and I the opportunity to refocus our efforts on getting geriatric teams into the community to deliver health care. The last place for the elderly is in an emergency department or acute hospital. The health challenges they face in such environments are enormous. It is important we continue to help people to live longer and better lives in their own homes where it is safer.

The integrated care programme for older persons, working in conjunction with the national clinical programme for older people, is leading on the development of cohesive primary and secondary care services for older people with a specific focus on those with more complex needs and frailty. To date, 12 pioneer sites have been supported and are in development nationally. Six were commenced in 2016 and a further six in 2017. These sites are working to a ten-step framework informed by a local population based approach, delivered by multidisciplinary teams working across traditional service boundaries and adopting a case-management approach. The integrated care team for older persons in the pioneer sites works, in partnership with community services, primary care, social care and health and well-being services, to promote healthy outcomes and reduce morbidity to enable older people to lead independent and purposeful lives in their communities.

The integrated care programme for older persons pioneer sites have focused on developing improved care pathways which address areas of older persons care such as integration across acute and community services, emergency department older persons flow and inpatient flow. While delivery of the pioneer sites is in the early stages, initial indications are positive with the integrated care programme for older person teams demonstrating they are providing multidisciplinary interventions for the majority of older persons in their own homes or in a community day hospital setting. There is substantial emerging evidence, locally and internationally, to show that approaches that use the models of care outlined in the national and integrated care programmes for older people demonstrate improved outcomes, particularly with regard to frailty.

Further evaluation is ongoing to better understand the impact of integrated care on outcomes for older people in the Irish context.