Gabrielle McFadden (Fine Gael)
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I welcome the Minister of State to the House again and thank him for coming here so often.

We are all too aware of the problems with overcrowding that affect many hospitals around the country, particularly at this time of the year. We are all deeply concerned about this. None of us wants to see our relatives, or anybody’s, lying on a trolley, especially if they are elderly.

This problem has been with us for over 20 years. I acknowledge that there is no quick-fix solution. The issues are complex and require creative solutions. We know it is not just a matter of throwing more beds at the problem, and this becomes even clearer when one talks to people working at the coalface. It requires a multifaceted approach. An initiative I believe would lead to a significant reduction in hospital referrals is the rolling out of geriatric teams working specifically in the community. Such teams, led by a community-based consultant geriatrician and including specialist and prescribing nurses, could play an important role in supporting the management of the health needs of older people in community settings and in providing services that avoid the necessity for a hospital admission. There are regular admissions to the Midland Regional Hospital, Mullingar, of elderly people presenting with various needs, such as a requirement for intravenous medication. With more community geriatric teams, many of these elderly patients could be assessed and treated in the community. The team would visit local nursing homes, day care centres, community nursing units or people's own homes to assess and treat elderly patients without the need for the hospital admission in many cases.

People over 65 make up 13.5% of the population but currently account for significantly more than half of all the inpatient beds. This segment of the population is projected to grow significantly in the coming years. Many older people admitted to emergency departments, once assessed by a triage nurse, end up spending prolonged periods awaiting treatment. HSE statistics show that patients over 75 years spend three times longer in emergency departments than those aged 65 or younger. Up to 40% of those waiting for more than 24 hours are over 75 years of age. Would it not be significantly better to bring the care to these people rather than bringing them to the care, where they have to wait for long periods exposed to additional infection and putting pressure on an already strained emergency department?

Such an outreach service, provided in an integrated manner, would be a significant support in maintaining older people in their own homes and communities, where we all know they do better. This would not only help to reduce overcrowding in hospitals, such as that in Mullingar, but also, and just as important, preserve the dignity of older people and reduce the stress on their families. I have been in communication with Nursing Homes Ireland and it has assured me that this initiative is one it would very much support.

When I raised this issue previously with the then Minister of State, Ms Kathleen Lynch, she informed me the HSE was to put in place an integrated care programme for elderly people that would examine the variety of ways that health care services could be delivered to older persons and determine the most effective way to do so. Therefore, I ask the current Minister of State to update the House on the status of the integrated care programme for elderly people and, in particular, outline whether he believes a sufficient number of teams, each comprising a geriatrician and specialist nurses working in the community, could provide a more appropriate service to older users and help to relieve the pressure on emergency departments in hospitals, particularly at times of overcapacity.

Jim Daly (Cork South West, Fine Gael)
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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.

Gabrielle McFadden (Fine Gael)
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I thank the Minister of State for his reply. I acknowledge and welcome his support and encouragement as it is refreshing. The elderly have worked all their lives, paid their taxes and never got anything for nothing nor looked for anything for nothing. They deserve the best. I urge the Minister of State to look at a system whereby geriatrician and nursing teams go specifically to nursing homes, community centres and elderly people's own homes to stop them having to go to hospital.

Jim Daly (Cork South West, Fine Gael)
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It is important we get to air these issues and continue to challenge the system. The Senator is 100% correct in what she is looking for which has been proved beyond any doubt. I look forward to working with her to bring it about.