Ned O'Sullivan (Fianna Fail)
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I welcome the Minister of State at the Department of Health, Deputy Catherine Byrne, to the House.

Colette Kelleher (Independent)
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I thank the Cathaoirleach for allowing me to raise this important issue. I welcome the Minister of State, Deputy Catherine Byrne, to the House. The Minister of State, Deputy Jim Daly, has responsibility for this issue, so I hope the Minister of State, Deputy Catherine Byrne, will be able to pass this on. Dementia is an issue that affects people in every community in Ireland. There are an estimated 55,000 people with dementia in Ireland. The number is set to double by 2036. People with dementia need a wide range of community services and support to assist them from the moment of diagnosis and we are all aware of significant gaps that exist in these vital services.

In December 2014, the Government published Ireland's first national dementia strategy. The strategy was welcome and has the potential to improve the lives of people living with dementia in Ireland. The mid-term review of the implementation of the national dementia strategy has now been published. The review acknowledges that the strategy was initially intended to be cost neutral. Since publication of the strategy in 2014, the understanding of the scale of need and how that need should be met has deepened considerably. There is now an acknowledgment that the strategies to meet the needs of people with dementia will rightly call on the public purse.

The mid-term review acknowledges that the pace of implementation can be frustrating but I would say it is traumatic for people living with dementia, their families and service providers as they are still dealing with inadequate services and are waiting for supports. It also states that additional funding or redeployment of existing resources will be required to move from this preparatory implementation phase into the establishment of new dementia services, supports and structures. Specifically, the review notes that considerable resources, both financial and staffing, will be required in the following areas: post diagnostic and diagnostic support pathways; key posts in which I would include dementia advisers to close the gaps identified in the recently published mapping project; appropriate home care for the growing population, even though we are at capacity for home care at present; an appropriate care pathway for people in acute hospitals because people go to hospital with dementia and come out considerably worse; and the provision of immediate options for care other than nursing home care. There is a need for a dedicated budget.

The first strategy was co-financed between Atlantic Philanthropies, which donated €12.5 million, and the Department of Health. At the same time it should be noted that the Alzheimer's Society of Ireland contributed €14 million, which was more than the sum contributed by the Atlantic Philanthropies and almost as much as the Government.This funding now comes to an end in 2018. Multi-annual funding is critically needed beyond 2018 because we know that dementia is not going away. In fact, it is going to increase. We cannot rely on shaking buckets and the goodwill of people to finance core services. As a co-convenor of the all-party Oireachtas group, along with Deputy Mary Butler, I am acutely aware of the lack of equity in the provision of dementia services. To mention one service as an example, counties Wexford, Laois and Leitrim do not have any day care services. People in just 13 counties have access to dementia advisers. The provision of dementia-specific services is patchy and based on a geographic lottery. There is no link between the needs of people with dementia and what is available to them.

Today is the first day of carer's week. We often break the health of elderly people by requiring them to provide care to people with dementia, which is an unacceptable burden. In our budget 2018 proposals, we advised the Government to provide funding for 30 dementia advisers and to increase this number to 90 over time. The all-party Oireachtas group also identified gaps in intensive home care for people who wish to stay at home in their communities. We also advised on supports for people with Down's syndrome, who are much more likely than the general population to develop dementia. These needs were not addressed in the last budget. We were not listened to.

I am asking the Minister of State, Deputy Jim Daly, to give a commitment that he will listen to these proposals, which are quite modest relative to the scale of need. They should be included and prioritised in budget 2019. I welcome the work of the HSE's National Dementia Office, which needs resources so it can do its work. The strategy needs to be resourced properly. We need to plug the gap in dementia services so that we do not place unacceptable burdens on carers. Therefore, I call on the Minister of State to ensure the findings of the mid-term review are acted on. He should set out specific actions and the timeframe within which those actions will be taken. The needs, gaps and solutions of people with dementia and their carers have been identified and well documented.

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister of State, Deputy Jim Daly, I thank Senator Kelleher for raising this matter. The national dementia strategy, which was published in 2014, sets out a framework for the development of dementia supports and services in Ireland. The overarching aim of the strategy is to provide dementia care so that people with dementia can live well for as long as possible and can live out their lives in comfort and dignity with services and supports delivered in the best way possible.

As part of the implementation of the national dementia strategy, the Department of Health committed to conducting a mid-term review of the progress being made. This review, which was prepared in partnership with the National Dementia Office, highlights the considerable amount of work that has been completed to date and the actions that are to be carried out over the next 12 months. The review was launched on 23 May last and is available on the website of the Department of Health.

The implementation of the national dementia strategy was boosted at the time of its launch by a joint programme of investment by the HSE and the Atlantic Philanthropies which was valued at €27.5 million. This investment allowed a number of key actions in the strategy to be resourced and implemented. It part-funded a programme that offers education and clinical resources for general practitioners and primary care teams, intensive homecare packages for people with dementia, the Understand Together awareness campaign and the establishment of the National Dementia Office. The National Dementia Office, which has an important role in implementing the national dementia strategy, has made substantial progress in developing evidence-based care pathways for people with dementia.

A dementia diagnostic project has been set up to ensure timely diagnosis of dementia. A post-diagnostic support pathway project will offer the information and support that people with dementia and their families need following a diagnosis. Work is ongoing to develop a dementia care pathway within acute hospitals. Clinical guidelines are being developed on the appropriate use of psychotropic medications in people with dementia. Education programmes have been developed for health and social care professionals, public-facing staff and carers. Other important work undertaken by the National Dementia Office includes mapping of dementia-specific, community-based services in partnership with the Alzheimer Society of Ireland, and a review of the dementia information resources that are currently available.The Department recognises that full implementation of the strategy will require investment and change.

The Minister of State, Deputy Daly, has held high level meetings with his officials and the HSE and acknowledges that further work needs to be done to fully implement the strategy. The level of funding for dementia services will be considered as part of the national Estimates and budgetary process.

Changes are needed in how the HSE organises and delivers its services and, equally, additional investment is needed to fill gaps in services and expand existing services to meet the needs of the rising numbers of people with dementia. The Department is committed to implementing the national dementia strategy in full and ensuring a provision of services that meets the needs of people with dementia across the country. I will come back in to answer some of the Senator's other questions.

Colette Kelleher (Independent)
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I thank the Minister of State for her response. It is good to hear that the Department of Health recognises that full implementation of the strategy will require investment and change. I am looking for specifics from the Minister of State on what that change will involve. That is why I tabled this Commencement matter. Indicating good intent or that something will happen is not the same as giving detail. It certainly does not give people with dementia and their carers the kind of information and comfort they need.

The Minister of State noted the following:

The Minister of State, Deputy Daly, has held high level meetings with his officials and the HSE and acknowledges that further work needs to be done to fully implement the strategy. The level of funding for dementia services will be considered as part of the national Estimates and budgetary process.

How much funding will be provided next year and in the years after that? By 2036, more than 100,000 people will have dementia. We need answers on this issue. I agree with the Minister of State that changes are needed but what changes are proposed? While it is good the Minister of State is in the Chamber, the detail she provided is very sketchy. We know what we need to do and we want to know what the Department of Health and Minister intend to do. How much money will be provided and where will we see progress for people with dementia and their overburdened carers?