Michael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister of State, Deputy Kathleen Lynch, to the House.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I move:

That Seanad Éireann--

- notes the HSE National Operational Plan 2013 which states that ‘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’;
- notes the finding by the Centre for Ageing Research and Development in Ireland, CARDI, in its report, Future Demand for Long Term Care in Ireland, that ‘even with greater emphasis on care at home and more resources provided to realise it, the demand for residential care is going to increase significantly in the next decade’;
- notes the concerns of Age Action December 2013 “that the switch in some of the funding from nursing home supports to community supports which the HSE is planning will be insufficient to meet the needs of the sickest of older people who will be affected”
- notes the report of the National Economic and Social Council (NESC), Quality & Standards in Human Services in Ireland: Residential Care for Older People, July 2012, and the recommendation ‘A problem-solving group of those influencing provision of long term care (e.g. providers, the Department of Health, and HIQA) may be useful to examine and address the challenges of providing sufficient quality long term care in an equitable and sustainable way.’
- notes a new report on Ireland’s long-term residential care sector by accountants BDO commissioned by NHI, ‘Health’s Ageing Crisis: Time For Action, A Future Strategy for Ireland’s Long-Term Residential Care Sector’, which 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 people and their families and the acute hospital system;
- notes the comments by distinguished gerontologist Professor Des O Neill that ‘present and future generations will regard with dismay the failure of successive Ministers and senior officials in the Department of Health and the HSE to remedy a deficit, widely recognised for many decades, in nursing home places, particularly in urban areas;’

and
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, especially to prevent a crisis in nursing home capacity for the future.".

The HSE's 2013 operational plan advocated that to cater for the 4% that would be required there would be a very significant deficit by 2014.

I will not interrupt the Senator and the Minister of State.

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

We are listening.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Senator is listening, fair play to him.

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

Just because I am not saying anything does not mean I am not listening.

Michael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I ask Senator MacSharry to proceed.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I will proceed. I am sure we are all aware of Health's Ageing Crisis: Time For Action, A Future Strategy for Ireland's Long-Term Residential Care Sector, prepared by BDO, which predicts that we will have a deficit of approximately 8,000 beds by 2021. It will probably be half of that by 2016 and we took 700 out this year. This is the HSE's position. The Centre for Ageing Research and Development in Ireland's report on future demand for long-term care stressed that even with the greater emphasis on care at home and more resources provided to realise it, the demand for residential care will increase significantly in the next decade.
Age Action has claimed that the switch in some of the funding from nursing home supports to community supports that the HSE plans will be insufficient to meet the needs of the sickest and oldest people who will be affected. The National Economic and Social Council's Quality and Standards in Human Service in Ireland: Residential Care for Older People report in July 2012 recommended that "A problem-solving group of those influencing provision of long term care (e.g. providers, the Department of Health, and HIQA) may be useful to examine and address the challenges of providing sufficient quality long term care in an equitable and sustainable way". In essence the purpose of our motion is to see a move to that.
The BDO report estimated 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 people's families and the acute hospital system. Notwithstanding the ambition of all of us to be cared for at home, in reality it is impossible for that to be the case for everybody. Without space for these people who require residential care, it will effectively have a huge impact on the acute-hospital system. While I did not check the website today to see how many are on trolleys in hospitals, we all know how those headlines are frequently used. Our acute-hospital system is under serious pressure at the moment as a result of cutbacks.
Last week I dealt with the case of an 84-year old man who had stents inserted in University College Hospital Galway and was dispatched to the coronary-care unit in Sligo. However, the wonderful managers in our new hospital group did not check appropriately with the hospital in Sligo to ensure there was a bed for this 84-year old cardiac patient who had just had a procedure. When the family could not find their 84-year old relative in the coronary-care unit, they managed to find him in the accident and emergency unit where he stayed for four hours.
These are the kinds of pressures already on the health system and Government Members are saying - with a straight face it would seem - that we can continue without a plan and without resources to provide adequate care for the elderly. I gave examples at the beginning of how we have collectively failed to do that. Recent budgets have made cuts without focusing on those people who have a little bit more and, while they would not like it, could contribute a bit more to secure the relative health of our elderly population.
I hope the motion can be taken in the spirit in which it was tabled. It is non-adversarial and merely proposes that the Government set up, without any cost to the Exchequer, a forum with the stakeholders, including some of the groups I have mentioned, to move the debate forward with tangible proposals and funding arrangements, which will obviously need to be innovative.
I thank Age Action, Nursing Homes Ireland, the Centre for Ageing Research and Development in Ireland, Third Age, and the National Economic and Social Council for their contributions and work in this area so far.

Diarmuid Wilson (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I second the motion and reserve my right to speak in due course.

Colm Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I move amendment No. 1:

To delete all words after "Seanad Éireann" and substitute the following:

- acknowledges that demographic trends must be taken into account in the planning of public services and determining policy in relation to meeting the healthcare and social care needs of the population, within available resources;
- endorses Healthy Ireland, the Government framework designed to improve health and wellbeing for all people, at all stages of life and in all sections of society, and to support the implementation of strategies such as the National Positive Ageing Strategy;
- notes and supports the policy of the Government, which is to facilitate and support older people to remain living in their own homes and communities for as long as it is viable for them to do so;
- acknowledges that the options to be considered in designing services and supports for our older population include not only residential provision but also community and home-based supports and new models of residential care;
- Notes that in 2014 an additional €23m has been allocated to strengthen the alignment of the model of care towards home and community supports;
- notes that this is in addition to the budget of €315m for home help and home care package services, which are delivered to some 56,000 people at any one time;
- notes that a key priority in the HSE National Service Plan 2014 is the implementation of a Single Assessment Tool to uniformly assess dependency levels, allowing resources to be targeted towards those with the greatest needs and enabling supports and services to be designed in the most appropriate way possible;
- notes that the review of the Nursing Homes Support Scheme which is currently underway is examining a range of issues relating to supports for older persons, including alternative approaches to balancing residential and community services and supports;
- acknowledges the recent report on Long-Term Residential Care, commissioned by Nursing Homes Ireland, as a contribution to the debate on how future needs can be met;
- acknowledges that decisions in relation to the provision of residential care must be taken by Government in a way that balances all interests and that places the needs of older people themselves first.

The provision of additional nursing home beds is not the answer to all of the difficulties we face in this area. The last budget included an allocation of €350 million for home help and other schemes to assist those who require support at home. An additional €23 million was added for that purpose this year, despite the huge demands we face in terms of reducing borrowing levels and retaining existing services. The way forward is about developing and growing support levels for people living at home. It is one of the issues on which we must engage in a very proactive way.

An issue of particular concern, which I have raised on more than one occasion in the past, relates to step-down facilities, an area in which we have not been sufficiently proactive. It is an issue we must examine carefully. The report of the first national audit of dementia care in Ireland makes interesting reading. It shows that where patients with dementia were admitted from their own home to hospital and subsequently discharged back to their own home, the average hospital stay was 22 days. In the case of people admitted from a nursing home to hospital and then discharged back to a nursing home, the average hospital stay was 17 days. Finally, when a patient is admitted from his or her own home to hospital and subsequently discharged to a nursing home, the average stay is 59 days. If we take it that the average weekly cost of hospitalisation per patient is €6,000, then the difference between 59 days and 22 days amounts to a cost differential to the taxpayer of €36,000 per patient, a sum which would make up a substantial portion of that patient's nursing home care. I am not sure of the numbers involved, but the huge gap in average hospital stays clearly highlights the need to examine the provision of step-down facilities.

We need to do significant forward planning in this area. I do not agree with Senator MacSharry regarding the setting up a formal forum, but I accept there is a need for joint consultation on an ongoing basis between all stakeholders. It is something I have suggested at the health committee and in this House. Nursing Homes Ireland has pointed out that while it enjoys ongoing consultation with the Department, there is a need, from time to time, for a joint approach which would encompass not just policy planning but how to deal with issues as they arise. That is a little different from Senator MacSharry's proposal to set up a forum dealing with policy.

I welcome this debate. It is a debate that must be ongoing and comprehensive if we are to deal with these issues and have adequate forward planning.

Michael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Before calling Senator Jillian van Turnhout, I welcome former Deputy Áine Brady and our other distinguished visitors in the Gallery.

Jillian van Turnhout (Independent)
Link to this: Individually | In context | Oireachtas source

I welcome this debate. It is vital to take on board the demographic trends. We have seen a dramatic rise in those aged 65 and older, which is a positive development. One sometimes gets the impression, however, that this demographic change is viewed wholly in the light of representing a negative burden on the State. In fact, notwithstanding the increased demand on public health services arising from an aging population, it should be a cause for celebration that public health improvements have reached a stage where people are living longer. Recent Central Statistics Office projections indicate that by 2021, the number of older people will have increased by 200,000. The number aged over 65 is expected to reach 1.4 million by 2046, with the number of over 80s projected to grow as large as 484,000 by that year. These projections certainly do represent a significant demographic challenge, but we have the advantage that we can see it coming.
Returning to the present, it is clear that existing services - community services in particular, as well as bed capacity - are under significant pressure. Nursing Homes Ireland has pointed out that the figures already point to a significant deficit of long-stay beds for older people in a context where demand for residential care will increase significantly in the next decade. Policy relating to long-term care of older people, Nursing Homes Ireland argues, must focus on community-based services and supports and home-based care initiatives.
The Neurological Alliance of Ireland's national survey, Living with a Neurological Condition in Ireland, published last month, examined many aspects of living with a neurological condition such as access to services, the impact of health cutbacks and the overall recession, and the need for community-based services and supports. Although this report does not relate exclusively to older people, the issues are all interrelated. I have asked for a debate in this House on the report because it explores many important issues.
Another important report, which I referred to previously in the House, is the document produced by the Economic and Social Research Institute on behalf of the Irish Heart Foundation. It indicates that the direct annual cost of stroke in Ireland is as much as €557 million per annum, of which €414 million is spent on nursing home care and only €7 million on rehabilitation in the community. The discrepancy in those figures is startling in a context where we know that many stroke survivors, including older people, want to be cared for in the community. Instead of putting the resources in place to accommodate that, we are merely funnelling people towards nursing home beds.
Data from the 2011 census data show that 4.8% of our older population are in nursing homes or hospitals. The nursing home support scheme operated by the Health Service Executive is subject to a multidisciplinary team assessment and provides financial support to people of high and maximum dependency to access long-term nursing care in approved private, voluntary and public nursing homes. Under the scheme, participants make a contribution towards the cost of their care, with the State paying the balance. I am aware of large numbers of people in hospital who are unable to access a place in a nursing home. Everybody knows about this, but it does not seem to be incentivising us to do anything. There are undoubtedly psychological effects for patients who know they should be in nursing home care, which is a significantly different type of care from the medical care one receives in a hospital. The significant majority of people requiring nursing home care are older people, with 22% of those aged 85 and over requiring such care.
Under the HSE's service plan for 2014, which was published last December, an allocation of €23 million from the fair deal budget was earmarked for care in the community and home-based care initiatives. These initiatives include intensive care packages which will benefit 250 people, intermediate transition beds to benefit 650 people, and 130 beds for patients presenting with more complex issues. However, Age Action Ireland has indicated to me its serious concern about the impact of the HSE service plan for 2014 on the 700 to 1,700 infirm and vulnerable older people who will not get a nursing home bed in 2014. How will those people be cared for? The service plan acknowledges that waiting times for a nursing home bed under the fair deal scheme will increase in 2014, with 700 fewer beds being funded. There were already 394 older people on the waiting list when the decision to fund fewer beds was made last October.
The newly published report by Nursing Homes Ireland, Health's Aging Crisis: Time for Action - A Future Strategy for Ireland's Long-Term Residential Care, predicts a shortfall in nursing home beds of approximately 4,000 by 2016 and 8,000 by 2021. Nursing Homes Ireland has argued that the lack of a clear policy and national strategy regarding the long-term care of our older population combined with the current uncertainty around future funding arrangements represent the most significant challenges to the long-term sustainability of the nursing home sector. People left waiting for a nursing home bed as a result of the changes made in the service plan will become more ill. They will be sent by their GP to the local accident and emergency department where they will be admitted to hospital. This is putting additional pressure on the system. Demand is already outweighing a supply that is insufficient to meet the needs of the sickest of our older people.

Jillian van Turnhout (Independent)
Link to this: Individually | In context | Oireachtas source

We are aware of the dramatic rise in those aged 65 and older. If we put party politics aside, everybody wants that we care appropriately for older people. I do not believe there is anybody in this Chamber who does not want that. We cannot just speak about bed capacity but rather community capacity and how we can enable that capacity. From my perspective, every time there is a cut, community capacity suffers. I have met many older people who cannot find a place in a nursing home or in a community. They may have been in rented accommodation or their current home needs adaption and there are questions as to whether they will last long enough to make it worth adapting that home. Given all that, there is a need to resource and support community care, to ensure that people feel secure and safe, that the State cares for older people and that we have a strategy not only for bed places, but community capacity and how to ensure they work together. As life comes and ebbs and flows, and as the need arises, a nursing home must be available, but equally community care and the supports they must be in place to support people as they age, as all of us will hopefully age and be looking for those supports.

Michael Mullins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I can allow the Minister of State to contribute if she wishes and the debate will continue.

David Cullinane (Sinn Fein)
Link to this: Individually | In context | Oireachtas source

We may have a couple of speakers.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | 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.

David Cullinane (Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I support this Fianna Fáil motion, which while well-crafted and well-intentioned, excludes any acceptance by that party of any responsibility for its policy failures in this area for many years. I acknowledge that during the 2011 general election the public passed judgment on the Fianna Fáil Party, and rightly so. That judgment was not good or positive because of its failures economically and socially. Senator MacSharry spoke about keeping a straight face. It is difficult for any of us to accept that when Fianna Fáil does not take responsibility for its policy failures in this area.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Senator was not listening.

David Cullinane (Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I did not interrupt the Senator.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Senator was not listening.

David Cullinane (Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The response of this Government in terms of supporting older people has not been much better. Let us review the record of Fine Gael and the Labour Party in this area. Under this Government, there have been cuts to home help hours and home care packages, illegal implementation of the mobility allowance and motorised transport grant scheme and a reduction in palliative care experts and hospice places. In my home city of Waterford, which has a population of more than 500,000 people, there is still no palliative care unit. The Government has promised this unit will be provided but as yet no funding is forthcoming. Also, owing to the estimated cost of this project the people of Waterford city and county and the south east are being told they will have to come up with matching funding.

This Government has also failed to provide adequate care for people with chronic diseases. Automatic entitlement to a medical card for over 70s has been abolished and there have been cuts to the fuel and phone allowances. There are still insufficient community nursing units and beds across this State. In Waterford city in 2008, we saw the closure of St. Brigid's ward in St. Patrick's Hospital, which is a geriatric care facility. There were more than 20 beds in that unit, which was closed by the Health Information and Quality Authority, HIQA. The then Minister for Health promised the people of Waterford and the south east that a new 50-bed unit to replace the beds lost would be constructed. The Government is now promising to construct a 100-bed unit, which sounds great and I welcome it but only six to eight additional beds will be provided because a number of units, owing to their being located in buildings that are not up to standard, are to be closed. Following construction of the new unit, bed capacity will still not be at the level it was in 2008. I am sure that not a day or week goes by that representatives in Waterford and elsewhere do not have to make a representation to St. Patrick's Hospital or other facility on behalf of a family of an older person seeking convalescence, long-stay accommodation or other supports. The reality is that there are not enough places.

This Government is also responsible for the outsourcing of home help hours, which we know is impacting on the people working in this sector in terms of their conditions of employment. I have been lobbied on this issue by many home help workers and trade unions. Elderly people are now being forced into private nursing homes, with the subvention they receive in this regard having to be topped up by their families. Just as we are doing with people in terms of housing provision, we are pushing elderly people into the private sector. There is no provision of public places. This is what Fine Gael does and it is currently being supported in doing so by the Labour Party. We now know that the average home care visit for older people is 15 minutes, which is wholly inadequate. I have met many home care workers who operate in the public and private sectors. They are very concerned about the supports older people are receiving owing to cuts in this area.

The pointed edge of this cuts agenda has been the drastic reduction in the number of public nursing home beds and a failure to prepare and implement a strategy to cater for the long-term residential care needs of our aging population. This is a Government which promised us a lot more than what we got. The austerity agenda it has pursued for the past six years has been, in the main, driven by Fine Gael, who believe that cuts are better than taxing people who can afford to pay a bit more to provide the services which people need. This is what Fine Gael promised and it is what it is delivering. The fact that it is being supported in this by the Labour Party is shameful. The people who are losing out are older people who are not getting the supports or services they need and their families who can only look on in horror because there is not sufficient home care help hours available for their mother, father and so on and no long-term residential facility to which they can go. They might also be finding it difficult to find a place in a private nursing home. Where they do, their families have to top up the subvention provided under the fair deal scheme.

They do not have the money themselves and may have people out of work. They have had their own problems with all the cuts they have had to take, yet they have to come up with more money again and again. We are simply not responding to the changing demographics, given that we have an ageing population. We must invest in this area otherwise we will end up with long waiting lists and people not getting the support they require.

I welcome the publication of the National Positive Ageing Strategy and recognise that this is a step forward. Its goals can be summarised as follows: to remove barriers to participation; to provide more opportunities for the continued involvement of people as they age in all aspects of cultural, economic and social life in their communities according to their needs, preferences and capacities; and to support people as they age to maintain, improve or manage their physical and mental health and well-being.

I have sharp criticisms of this Government but I acknowledge that some positive steps have been taken. We must welcome the positive aspects while at the same time criticising the Government for its failures. I have no doubt that if the Minister of State was in opposition and a similar motion was tabled by any party in Government, when one considers the cuts that have been put in place, he would be making exactly the same points as I am today. That is because he knows it is a fact and a reality that we are not investing enough to ensure older people get the supports they need. That is the Minister of State's responsibility. He was elected to do that job, so he cannot blame the previous government or other opposition parties. He must take responsibility for his policy failures, but I do not see it happening. All I can see is more of the same, including more cuts. There is also a refusal to increase taxes on those who can afford to pay most so we can provide the services that people need. That is all we are asking for from the Government.

While I support the Fianna Fáil motion, I do so acknowledging the fact that the party has also failed in this area given its participation in previous governments.

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

It never fails to surprise me that when politicians start talking about health policy, examples are always put forward of how busy our clinics are concerning health representations. This may be what is wrong with our health system. Is it not funny that when people need information about the health service they go to their politicians rather than their doctor? Politicians, myself included, sometimes encourage this kind of behaviour. It strikes me as going particularly to the heart of what is wrong with our health service.

I welcome the Minister of State to the Chamber. I have read the Fianna Fáil motion, which is excellent. There is nothing in it with which I could disagree, if the motion was used for the purpose for which it was tabled, rather than having Senator MacSharry delivering a ten-minute tirade against Government policy. If he had promoted the motion as tabled, we would have been better off.

Senator MacSharry casually stated that if we could find €200 million or €300 million we would be able to protect everyone against cutbacks and reductions in services. Fianna Fáil has repeatedly failed in pre-budget submissions or elsewhere to state where we might find this trifling figure of €200 million or €300 million. Basing an argument on being able to pluck such figures out of the air is an unreasonable and unrealistic proposal.

I note what the Minister of State has said about undergoing a great period of change in our health services. No doubt we would all like to see more resources being spent on older people and the health service in general. However, we are spending almost €1 billion a year on the nursing home support scheme which caters for 22,000 people. That is a major and significant amount of money.

I also note that €315 million has been provided for home help and home care packages. This is a lot of money and some 56,000 people are being supported by these schemes, which are welcome. I would like to see more being done but we are constrained by the economic circumstances in which we currently find ourselves. That is unfortunate.

As the age profile of our population increases there will be more challenges facing us in future due to the strain on resources. It is important to consult all stakeholders on the best way forward. My family recently had cause to avail of the services for older people. I was very impressed with the services provided by a combination of the public, private and voluntary sector. The services offered by the Alzheimer's Society in particular were fantastic. The services of the public health nurse were excellent. One private sector company offered a fantastic home care service. The money paid to that company is all tax deductible, which makes it affordable. Luckily, my family and I could afford the cost, but I am concerned about what would happen and how much more difficult it would be if we were not able to afford such services from the private sector. That is a matter of real concern to me.

There should be some way of drawing together more comprehensively, or in a more co-ordinated manner, the voluntary, private and public health services. That is an absolute requirement. In the end, my relative took advantage of the nursing home support scheme which was a smooth transition from home and community care to residential care. I was impressed by the way it worked. Perhaps we were just lucky but I feel that people in the service do receive a good level of care. Gaining access to the service might be where the real challenges lie.

The Fianna Fáil motion is a good one and I cannot see much in it that I could not support. The Government is elected to make policy and be responsible for it. I may only differ with Senator MacSharry's proposal on a matter of emphasis or focus. If the Government delegated its policy-making and implementation we would probably get a lot of criticism also. Previous governments handed everything over to the HSE to run while trying to immunise themselves from criticism by so doing. That attracted much criticism at the time.

While we will not support the motion as drafted, we are very close to it in terms of policy. Our response to it in the Government amendment is more or less the same. I wonder, therefore, why we found it necessary to move an amendment rather than having an agreed position. Everybody in the Oireachtas and the country at large wants to see the very best services being provided for the elderly.

Feargal Quinn (Independent)
Link to this: Individually | In context | Oireachtas source

The Minister of State is very welcome to the House for this interesting and worthwhile debate. I should declare an interest in that, having checked Nealon's Guide, I see that I am the oldest Member of the Oireachtas. I agree with Senator Gilroy in that I do not see anything wrong with the Fianna Fáil motion. I do not think there was a need to table an amendment because it could have been accepted. Nonetheless, I welcome the debate because we should discuss this topic more often. The Government needs to pay much more attention and take more interest in how we handle our ageing population and, in particular, how we will care for our elderly in future. I am pleased the Minister of State is here because I know she is enthusiastic and her heart is in the right place.
Recent research by the Alzheimer's Society of Ireland drew attention to the fact that society and Government do not think enough about the relationship between older people and human rights. The research says that ageism continues to be a major problem in Ireland. Indeed, negative ageist attitudes towards older people are so ingrained in our society that we need to challenge them. That is why this debate is worthwhile. It could be argued that such attitudes go far more unchallenged than other forms of prejudice such as racism or sexism, which are challenged.

However, we do not hear the challenge to ageism. The research states that we need to change the attitudes of politicians, namely, us, and policymakers, namely, us, in order that ageing is not only seen as a social welfare issue. Society needs to move beyond seeing older people as charity cases and move towards a human rights approach whereby they enjoy the same rights as everyone else.

I offer one example of older people's human rights being impeded. Let us consider the fact that older people face barriers in accessing work. As an employer for many years I was well aware of this and did my best to give older people a chance. My business reaped the benefits of an enthusiastic and knowledgeable workforce. When someone reached the age of 65 years we did not instruct them to retire. We recognised that they might want to retire but we encouraged them to come back for several hours a week or several days a week. We got the benefit of that because they were able to transfer their knowledge and the experience they had gained over the years to younger people. It was such a joy on occasion to see so many people come back. One such lady was Betty Reilly. I was in Superquinn in Sutton the other day. She is 86 years old and she invited me to her 86th birthday. She has been with us for approximately 30 years and she comes to work two or three days a week. She does not do a full day but she loves it and she has such enthusiasm.

I remember one man, John Davitt, who came to me approximately 20 years ago. He came to me in mid-December and said that he would be 65 years old on 31 December. He said he realised the company liked people to come back again but that he and his wife had decided that there were things they wanted to do. He said that he had worked in the company for nine years - he had worked at various other jobs for a further 40 years - he had not missed a day and that he woke up in the morning looking forward to going to work. He said he would look at his watch in the afternoon thinking that it must be 4 p.m. only to discover that it was 6 p.m. and that the day had gone faster than he thought. He died on Christmas Day that year, six days before he was due to retire. He had been looking forward to his retirement. His wife died three days later. We had two funerals in the Ballinteer church during that Christmas week. We talked about his words afterwards. He had said that he woke up in the morning looking forward to coming to work and he looked at his watch thinking it would be 4 p.m. only to discover that it was 6 p.m. We said to ourselves that we should set that as a challenge not only for our company but for Ireland and that it would be great to find a way that people of that age could get up in the morning and look forward to going to work. He did so and how sad it was when both of them died in that week.

The question of employment is one I could wax on about a good deal more. The question of care is important as well, as is the question of nursing homes and how we ensure that we have appropriate facilities. There is a need for specialised care for older people. We have an interesting model that is worth highlighting. The problem with regular accident and emergency departments is that they are often small and old. In regular hospitals patients are triaged, which means they go down the list as people with more serious injuries are admitted. They are put down the line because they are not the most serious injuries since they are old. It is decided on that basis.

The rapid access clinic for the elderly in Smithfield, Dublin, funded by the HSE, is a system which caters for those over 70 years and is free of charge. It keeps older people away from hospitals. Instead, if an older person is feeling unwell or has memory problems he or she can be seen in the clinic and then can go back to his or her doctor with an individually tailored care plan. The clinic has been really appreciated by elderly patients. Let us remember that this type of service is preventive care. The acute and non-acute services need not be together. Does the Government have any plans to expand this type of system throughout the country? It is a great system. This example seems to provide a far better and much-needed service to patients and serves as a model for the larger health system.

I welcome the chance to speak on the subject. I am keen to hear whether the Minister of State could address some of the challenges we are hearing about today on the basis of what we are hearing and what we can do.

Reference has been made to the specific area of elderly care. I agree with the notion that we need more policy and more direction in this area, especially for nursing homes. It is great that we live in a State where so much is done to keep people living in their homes independently. My mother-in-law died two years ago in her 102nd year. She wanted to stay at home and she did stay at home for as long as she could, which was until the last year. People want to live in their homes independently. I know several older people who have been able to live independently because of the State. The have home help, which involves someone coming in to assist them with some tasks such as cooking and cleaning. This is backed up by various subsidies and other financial assistance. It makes me proud that we live in a country where we look after our older people like this, unlike some other countries. I imagine other Senators will have examples of older people who can stay in their homes and this is positive to see.

I am pleased to have the Minister of State in the House and to have this debate. I welcome the Fianna Fáil motion and I cannot disagree with the Government amendment either. However, I question whether we should not be able to get together and ensure the best of both is taken into account.

Catherine Noone (Fine Gael)
Link to this: Individually | In context | 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.

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.

Paschal Mooney (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister. While the motion and Government amendment are similar, the Fianna Fáil Party will divide the House on the issue because, as my colleague, Senator MacSharry, noted, we do not wish to the status quo to continue. Although others have made many of the points I propose to make, it is important to emphasise them in the context of the contributions that have been made. Senator Quinn's contribution focused on the value of those over a particular age who wish to continue to live long, fruitful and productive lives. If there is anything the Government can do to eliminate the culture of ageism that persists in certain parts of society, it will be applauded for doing so.

The motion notes 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 people, their families and the acute hospital system". Unlike Senator Noone, I support Senator MacSharry's call for the immediate establishment of a Department of Health led forum to consider and develop an appropriate policy on the long-term care of the older population, especially to prevent a crisis in nursing home capacity in the future.

The Fianna Fáil Party can be accused of many things. In the years immediately after the crash any Government, irrespective of its political colour, would have been forced to address the immediate problem and engage in crisis management, as occurred under the previous Government led by the then Taoiseach, Mr. Brian Cowen. Fianna Fáil has always been proud of its heritage, policy and outlook on care for the aged. We stand on our record in that regard and no one, on any objective analysis of our policy over the decades, could argue with that view. The motion continues our proud tradition of looking after the aged and most vulnerable.

The Health Service Executive's operational plan refers to having in place sufficient long-stay bed stock to meet the needs of the growing elderly population for the next two years. As has been noted, beds are not evenly spread geographically and certain areas have an under-supply while others having an over-supply. The HSE service plan for this year provides that the overall number of people to be supported in long-term care has been reduced by 700. It justifies this reduction by referring to a shift in emphasis in the model of care to home and community supports, which will, it states, enable an additional 1,000 older people to continue to live at home. I applaud the concept of people living independent lives for as long as possible. My late mother - God be good to her - continued to live in her home and looked after herself independently until she was hospitalised and passed way at the age of 86 years. I am a strong supporter of any Government policy or HSE service plan that shifts the emphasis to independent living. However, the issue is the need to ensure that those who wish to live independent lives in their own homes receive all necessary support services. Home care and home help, to which Senator Quinn referred, should be maintained and strengthened. Sadly, however, both services have suffered as a result of the economic downturn. If the Government is serious about saving money, it would allow people to live at home rather than be placed in institutional care.

The 2014 target is to reduce by 1,702 the number of nursing home beds funded under the scheme at the end of 2013. Some 394 people were on the waiting list for a nursing home bed in October 2013. It is not clear from the plan what how the 1,700 people who will not secure a nursing home bed next year will be cared for. The Centre for Ageing Research and Development in Ireland, CARDI, produced a report entitled, Future Demand for Long Term Care in Ireland, which noted that there has been an increase of 59% in the number of people in the State aged more than 65 years who are using residential long-term care. It also notes an increase of 57% since 2006 in the number of people who use formal home care. At a time when thousands of medical cards for people 70 years and over have been withdrawn, community supports are under severe pressure and health care demands are increasing as a result of the ageing population, Age Action has expressed deep concern about how the Health Service Executive will meet the needs of the most vulnerable older people in 2014. This is a recurring theme in the contributions made thus far, at least on this side of the House. How will the HSE and, by extension, the Government meet the needs of the most vulnerable of older people based on the figures provided, including the reduction in funding?

The Nursing Homes Ireland report, Health’s Ageing Crisis: Time For Action, A Future Strategy for Ireland’s Long-Term Residential Care Sector, states that Ireland's population is ageing, with notable growth in the cohort of the population whose care needs have been independently assessed as requiring long-term residential care. This is a sad development. One would expect that with modern medical care, the number of people requiring long-term residential care would decline. Perhaps this development raises questions about health policy and the manner in which the Government approaches the medical needs of those who are elderly. The population of those aged 65 years and over has been increasing at a faster rate than in other European Union member states. We frequently hear we have one of the youngest populations in Europe but it is sometimes forgotten that the older population is increasing at a faster rate here than among our neighbours. This is surprising considering that in some European countries, notably Germany, the cohort of those aged 65 years and older is set to cause a major crisis.

A new and emerging trend in Ireland's demographic profile is the substantial increase that has also taken place in the number of people over 85 years of age. This cohort is forecast to rise by 46% in the period to which I refer.

I fully support both the motion and the recommendation to the effect that the Department of Health should establish a forum to consider and develop appropriate policy in respect of the long-term care of elderly people in order, primarily, to prevent a crisis, as outlined very eloquently and in great detail by my friend and colleague, Senator MacSharry, in the context of the provision of nursing home care.

Maurice Cummins (Fine Gael)
Link to this: Individually | In context | Oireachtas source

I commend Senator MacSharry on tabling the motion. It is important to ensure the issue of older people remains on the political agenda. As previous speakers indicated, there is very little difference between the motion and the Government amendment. Senator Mooney has stated, however, that the matter will be put to a vote. I am of the view that the intent behind the amendment and the motion, namely, to assist older people in any way possible, is the same.

Senator Cullinane engaged in his usual effort to bring a plague on all our houses and stated that we are all - Fianna Fáil, Fine Gael, Labour, etc. - to blame for everything. He referred to an agenda of cuts. I would be the first to admit that, out of necessity, there have been cuts in many areas and Departments. It is all very well to refer to cuts but the Senator's party has criticised the Department of Health for possibly going over budget to the tune of €49 million in the first quarter of this year. Sinn Féin's spokesperson has castigated the Government for spending so much money on health. The party to which I refer cannot have it both ways. Its members come before the House regularly and advocate the introduction of policies in this jurisdiction which are different from those it is implementing in the North. I will not, however, engage in a debate on Sinn Féin's policies or the lack thereof at this point.

The positive ageing strategy refers to home care. People who are growing older want to continue to live independently in their homes for as long as possible. The positive ageing strategy commits the Government to assisting, in any way possible, people to continue to live at home. It is my experience that once people enter nursing homes, many of them give up the ghost and say "I am finished because I have left my home". I am not in any way seeking to castigate the staff of nursing and residential homes who do a wonderful job in the context of stimulating the elderly people in their care. It is a fact, however, that many people believe themselves to be finished once they enter a nursing home. That is very sad. Older people in nursing homes have informed me, as have their relatives, that this is how they feel.

I compliment the many voluntary groups and organisations that provide assistance in keeping people in their own homes for as long as possible. These groups and organisations do wonderful work. The House has been at the forefront in advocating the cause of the elderly. When it was established, the first thing the Seanad Public Consultation Committee did was to invite representatives from various non-governmental organisations, NGOs, which deal with the elderly and those who advocate on their behalf to come before it. The committee produced a report which contained many recommendations. Most of those recommendations are included in the positive ageing strategy. We can take pride in the fact that this House gave the lead in respect of this matter in the context of the report it produced. Even though the positive ageing strategy was only published last year, it is time we reviewed the position with regard to how the recommendations to which I refer are being acted upon. Such a review could be carried out over six or 12 months. We need to obtain regular updates on the actions that are having a positive effect and those which are not being implemented at all by the Government. There is a need for an ongoing review to take place in respect of this matter.

Senator Noone referred to a statement made by Nursing Homes Ireland. I have no gripe against nursing homes and I am of the view they do a wonderful job. I accept also that private nursing homes must make profits. However, I do not agree with the use of terms such as "a market solution" and "profit" where the elderly are concerned. I honestly do not believe it is acceptable to refer to a marketplace in the context of older people who have done so much for our country over a long number of difficult years and, indeed, decades.

I reiterate that I commend Senator MacSharry on tabling the motion in order that issues relating to the elderly might be kept on the agenda. The Minister of State has come before the House on many occasions, she was present for the debate on the report of the Seanad Public Consultation Committee and she ensured its recommendations were included in the positive ageing strategy. As she stated, issues relating to the elderly have not perhaps been the subject of the same level of debate in this House or elsewhere as has been the case with other matters. This matter is going to go to a vote. However, I believe we are all in favour of achieving the same goal in respect of it.

Brian Ó Domhnaill (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I commend Senator MacSharry on tabling the motion. As those on the Government side have acknowledged, this is a very important motion. A country is often judged on how it treats its older people. Given that the population of such individuals in this country is increasing, as proven by statistics provided by the HSE, NGOs and the Central Statistics Office, there is a need to focus on how we intend to care for the elderly into the future.

I spoke to the HSE manager in my county and he acknowledged there is a difficulty in respect of this matter and also there is no plan. While feedback from each of the areas has been fed into a central HSE framework, there is a need for a dedicated stream of funding to be made available. In 2002, the then Minister for Social Welfare, Ms Mary Coughlan, initiated a funding model and commissioned Mercers to compile a report in respect of the industry.

It looked at future demand and the international experience. While the HSE operational plan for 2013 and the service plan in 2014 acknowledge the increased demand to date and the fact that it will continue to increase significantly in the years ahead, there appears to be a lack of any plan as to how such demand will be met. Many of us have older people in our families. Everyone's objective is to help elderly persons live independently in their homes for as long as possible. Older people will always favour that as the first option. Unfortunately, in certain circumstances of family life and physical difficulty, there may be a requirement for an elderly person to use the services of a public or private nursing home.

Figures have been mentioned on the cost of care. One can quantify the cost of a public or private nursing home but it is a debate that may not be completely relevant to the long-term projection. Cost must be looked at, however, in the context of the differential between a private bed in a private hospital versus a public bed in a public hospital. In some instances, there is a difference of 300%. Obviously, there is an additional cost to be borne by the taxpayer as a result.

Senator Mooney touched on the issue highlighted in the Health's Ageing Crisis: Time for Action document. When elderly people are in acute hospital settings, the cost per week can be approximately €6,000. The cost in a private nursing unit can be €750. Members often deal with situations where a family gets in touch because an elderly relative is in hospital and needs respite care. The hospital may feel the person is not competent to be allowed home and there is a sudden breakdown in the system because there are no residential care beds available in community hospitals or nursing homes. It is regrettable and must be challenged.

Senator MacSharry is 100% correct to highlight this issue and to call for the Department to initiate and lead a forum to develop a policy in this area. Such a policy would cover the financing of long-term care in a capital expenditure context, examine demographics and consider the lack of commitment by the Government in light of the 2014 service plan. There will be 700 fewer nursing home beds available in 2014 than were available in 2013, notwithstanding the fact that there was a backlog at the end of October 2013 of 394 people waiting for nursing home beds. If one adds the backlog to the 2014 cut, it suggests there will be a cut of more than 1,000 beds, or 5%.

There is a lack of commitment and forward planning and it must be addressed. Ultimately, the HSE is well aware of the figures and forward projections for our ageing population. While it is great that we have an ageing population and to see people living longer with a better mortality rate than existed many years ago, Government policy and financing must go hand in hand with it. If people cannot live independently, they must be facilitated to live in nursing homes. I see the Minister of State is nodding her head, but the sad reality is-----

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I was shaking it. That was not a nod. The Senator is as bad at reading the signals as he is at listening.

Brian Ó Domhnaill (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The reality is that many elderly people aged over 65 can no longer afford to live in their own homes. All of the housing aid for the elderly grants have been cut. The disabled person's grants have been cut or are not available. I can give the Minister of State the figures. They have been cut by up to 90% since the Government took office. I deal with these issues every week and see where the cuts have been made. Examples include the capacity to install simple things like a level-deck shower or a bedroom extension downstairs.

If we are serious about caring for elderly people, we must look at this holistically and examine independent living at home. If we are serious about that, funding must be made available. While funding may have been abused in years gone by, that is not to say those in need should be denied access to it. There is a massive problem and a lack of commitment to solving it. There is certainly a lack of commitment this year - on the Minister of State's watch - where the number of beds in our nursing homes has been cut by almost 800. That is regrettable. The health service must save money, but why cut the funding for those who need the care most and cannot provide for themselves?

I commend Senator MacSharry on rasing the issue. It may not be the sexy political issue of the day, but it is a vitally important one for every family and elderly person in the country. Whether a person is confined to a bed or is mobile, he or she should be allowed to live in dignity. The Government should have a planned strategy in place as we approach 2016. Given the 100 year commemoration we face, it would be disrespectful not to have that plan in place.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am disappointed that more speakers from all sides did not participate in the debate. I am not here for commendation from anyone. In fact, I hate it. However, I thank Senators.

I have a couple of points of rebuttal. Senator Burke said we are putting in €23 million, but that is being specifically taken out of the fair deal scheme. That leads to 700 fewer beds. The Minister of State appears to be contradicting the HSE which says there is a crisis in long-term care. She says there is not. She might clarify that. I said €300 million might be gathered up to offset the need to cut telephone allowances, medical cards and other provisions. Does Senator Gilroy want to know where I got that?

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

Out of the air, I would say.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Labour Party manifesto of 2011. It was a good proposal which the party did not manage to push over the line in the programme for Government with Fine Gael.

Colm Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

The number of medical cards has increased.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Those are some general points. Senator Burke said he commended me on raising the matter and keeping the debate going. I am sick of keeping the debate going. Let us keep it on the agenda. The Minister of State said the elderly formed a neglected part of her portfolio.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I did not say that.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Her entire Department is neglected. She said there was too great a focus on mental health.

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

By the Seanad. The Deputy cannot be telling lies.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Her entire Department is neglected in terms of underfunding and the lip service it is paid. While there are similarities between the motion and the Fine Gael amendment, there is no question of us not calling a vote. To fail to call a vote would be to suggest there was no problem. There is a very serious problem. While we can choose at a point in time to take refuge in the circumstantial statistics that might justify inaction based on the beds available in Donegal, that is not an excuse for failing to plan adequately for the future. BDO is a professional set of accountants. The Minister of State can blindly shake her head all she wants but the experts are telling us this. When did she last meet Third Age or Nursing Homes Ireland?

Paddy Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

The Senator cannot question the Minister. She does not have the right to respond.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

If we are waiting for these organisations, the Minister of State says: "Let us not have a forum because Governments must make policy."

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I did not say that at all.

Paddy Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Senator MacSharry, without interruption.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Minister of State said she did not want to answer. It is either a "Yes" or a "No".

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

The Senator cannot get away with that nonsense.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The reality is the Minister of State said she would meet these people. When did she last meet, for example, Nursing Homes Ireland or Third Age, whose representatives are present?

Kathleen Lynch (Cork North Central, Labour)
Link to this: Individually | In context | Oireachtas source

I did not say that.

Paddy Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Senator MacSharry without interruption.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

When was it? Was it last week, last month, last year or has she met them since the formation of the Government? It is a simple question. I will take her silence to mean that she has not met them yet.

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

On a point of order-----

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I did not interrupt anybody.

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

On a point of order, is the Senator allowed make up something off the top of his head or must he remain within the bounds of reason?

Paddy Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

That is not a point of order.

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

It is.

Paddy Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

That is not a point of order.

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

He is making this up. If he remained in the Chamber during the debate, he might know a little more about what was said.

Paddy Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is not a point of order. The Chair cannot say whether it is right or wrong. The Senator should resume his seat.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I took a quick convenience break. I hope the Senator did not time it. I apologise to Senator Noone for the 30 seconds for which I was absent but I am sure she will forgive me for that.

Paddy Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

The Senator should stick to the motion.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I was commended by Members one after another for bringing up this issue.

John Gilroy (Labour)
Link to this: Individually | In context | Oireachtas source

Keep it honest.

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am making a suggestion, which is my right in closing the debate, that the Minister of State has not met the organisations or engaged in the level of dialogue required. She is so out of touch that the HSE is saying one thing regarding a crisis in long-term stay beds while she is saying something completely different. BDO, the experts in the field, are shouting from the rooftops that there is a problem in this area but the Government is sticking its head in the sand and cherry-picking statistics that might defend or paper over the inaction in this area. As I said in my opening contribution, this is not a criticism of the Minister of State whose personal commitment I do not doubt. However, she is treated like the whipping boy of the Government because she is starved of resources to deal with the problems of the health sector whether they relate to mental health, disability services or the elderly in this scenario.

I mentioned at the outset that the Oireachtas has failed and continues to fail the elderly. This includes the current and the previous Government. Now people want to put their heads back in the sand and say everything is rosy in the garden, we do not need to set up a forum and we do not want to engage with the people who know in this area. The Minister of State's silence indicates she never bothered to meet them. We will put this issue to a division and will continue to raise it until those who cannot speak for themselves and who depend on excellent advocacy groups such as Nursing Homes Ireland or Third Age do so on their behalf have been looked after.

Paddy Burke (Fine Gael)
Link to this: Individually | In context | Oireachtas source

Is the amendment being pressed?

Marc MacSharry (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Yes.