Ceisteanna ó Cheannairí - Leaders' Questions

Yesterday was a very bad day for tens of thousands of families and businesses that need breathing space in respect of their mortgages. The announcement that mortgage breaks will come to an end after this week has caused a great deal of anxiety and stress. These mortgage breaks gave homeowners and businesses some relief as the economic effects of the emergency and public health restrictions bit hard. Nobody expected the mortgage breaks to go on forever but they should certainly have been maintained for as long as the pandemic continued. In other countries, mortgage holders have been given breaks of nine months or even a year but that is not the case here. Here, mortgage holders got a break of three months followed by an extension lasting a further three months.

Yesterday, we learnt that the banks will return to business as usual but it is not a case of business as usual for many families and businesses. There are families and businesses that will simply not be able to return to repaying their mortgages normally. Leaving mortgage holders to go it alone and relying on the sympathy of the banks to deal with individual cases is, frankly, unacceptable.

Yesterday's meeting between senior Government Ministers and the banks was a facade. There was no real intent on the part of the Government to reach a solution that would help mortgage holders. All of this is happening at a time when the cosy connections between the Government and the financial sector are once again on show. We have learnt that the former Minister of State, Senator Michael D'Arcy, is leaving the Seanad to be appointed as CEO of a financial lobbying group. In summary, all of this means that there will be no relief for struggling mortgage holders but a big job for a former Minister of State. What does this say to the families and businesses that were relying on the Government to stand up for them and to go to bat for them? This is the second former Minister of State at the Department of Finance to go through the revolving door from the Government into the world of high finance. In fact, during yesterday's meeting, Ministers from the Taoiseach's Government sat on one side of the table while a former Minister of State at the Department of Finance sat on the other side representing the banks.

The Tánaiste, Deputy Varadkar, has warmly welcomed Senator D'Arcy's new job. He said that he understands why, after 20 years in public life, the Senator might wish to start a new chapter in his life. He said that he will always be welcome should he decide to run for election again. He went on to say that his new employers are fortunate to recruit someone of his calibre.

The Minister, Deputy Eamon Ryan, another of the Taoiseach's colleagues in government, said something different. He said that he has concerns about all of this and that he has shared those concerns with the Taoiseach. We know that the Standards In Public Office Commission, SIPO, has certainly had concerns about this revolving door. Over the last five years, it has approached the Government to seek changes to legislation that would give it the power to investigate and prosecute Ministers who do not adhere to the rules on cooling-off periods before moving to jobs with lobbying groups. SIPO's approaches in this regard have been consistently ignored by the Government. One has to wonder why.

The Tánaiste has one point of view of the appointment. The Minister, Deputy Eamon Ryan, has a different point of view. He says he has concerns and that he has shared these concerns with the Taoiseach. Will the Taoiseach set out for us his position on this matter? Does the Taoiseach share the concerns of the Minister, Deputy Eamon Ryan? If he does, what are those concerns? What action, as Head of Government, does the Taoiseach propose to take on this matter?

There are two substantive issues contained within the question that the Deputy put. In the first instance, I want to say that I fully understand the anxiety and stress that many individual mortgage holders, many people with personal loans and many small and medium-sized enterprises feel in terms of the ongoing impact of Covid-19 on their capacity to repay loans and on the general economic situation. It has to be said that the payment breaks were invaluable to thousands of people in respect of those breaks over six months. Irish SMEs in particular had the highest share of loan repayment breaks up to September. What is interesting is that quite a majority of people were in a position to return to normal repayments after the initial three-month payment break. Elements of Ireland's payment break system compare favourably to other countries in some aspects, in particular the length of the payment break, the wide-ranging nature of the payment break and its uniformity across the system. That is not the same in other European countries.

The meeting yesterday was not a facade. It was a genuine engagement, as there has been continuing genuine engagements between the Minister for Finance, Deputy Paschal Donohoe, the Minister for Public Expenditure and Reform, Deputy McGrath, and the Tánaiste with the banks in terms of ensuring that people are treated fairly and seriously in a sensitive and sensible way. Again, it is important to point out that the 30 September deadline refers to new applications for payment breaks after that date. It is a regulatory application deadline set down by the European Banking Authority. That is the key point in respect of that. It is not the cliff edge, as has been presented in terms of various presentations. There are various protections for consumers and people in mortgage arrears or in difficulties with their loans. Those protections will continue. Government will continue to engage with the banking system to ensure a sensitive and sympathetic approach is adopted. People will obviously have to continue to engage. The next phase is individually tailored approaches to individual loans with a view to providing alternative solutions and proposals for those borrowers in different situations, such as interest-only payments or different approaches that can be adopted by the banks.

In respect of the former Senator and Minister of State, Michael D'Arcy, I believe there should be an effective cooling off period. I am not happy, or in any way comfortable, with people who have been in office taking up positions, particularly in the area they had jurisdiction over or responsibility for, immediately after or within months of having left office. I believe the legislation should be reviewed. Government agreed this morning that the Minister for Public Expenditure and Reform will initiate a review of the standards in public office legislation in that respect.

More widely, I have long been concerned at the fact that parties and movements can raise foreign donations to an extraordinary amount. I think that should be examined by the Standards in Public Office Commission. Deputy McDonald's party has raised $15 million over the years in the United States. I worry about that. That money has been raised from big vested interests, from construction and financial elites, in the United States with which Deputy McDonald seems to have no difficulty. Referendums have been influenced by large amounts of money the origins of which we do not know. That is a more fundamental area to our democracy. Some people have funded projects, including commemorative projects celebrating 1916 and so on. My understanding is that one particular project - I am open to correction and Deputy McDonald might correct me - was funded by loans from abroad but there was a political agenda attached to that as well.

I would favour a review and reform of the SIPO legislation. Any cooling-off period should have the force of law and sanctions and penalties attached to it. That review is on the way by the Government now.

Tea and sympathy for mortgage holders is of no use to them. Of course, some will be in a position to return to full payment of their mortgage sum but many others will not. The question is why the mortgage breaks were stopped for families and businesses that still require them at a time when we are still in the grip of a public emergency, when additional restrictions have been placed on Dublin and Donegal, and when there is the very real prospect that will happen elsewhere throughout the country. That is the issue. The Government left this matter until the eleventh hour and demonstrated no serious intent to secure a continuation of those very necessary and invaluable, as the Taoiseach called them, arrangements for mortgage holders.

My colleagues, Deputies Pearse Doherty and Farrell, have prepared legislation that will be published today in respect of reform of SIPO powers, particularly in terms of section 22, and allowing SIPO to investigate and make concrete sanctions against former Ministers or Ministers of State such as Senator D'Arcy, who has moved through that revolving door from politics to lobbying. The Taoiseach should remember that last week, Senator D'Arcy was on his feet in the Seanad, addressing issues very close to the financial services industry and of great interest to investment managers. This week, we learned that he is moving, changing and going to be a CEO for one of these organisations.

I am glad the Taoiseach has agreed the law needs to be changed. We do not need a lengthy review; we need this change to happen quickly. We are happy to provide the legislation and I hope the Government will support it.

It does need a wide review, not just of this specific issue, which needs to be dealt with, but also of the influence of foreign money on Irish politics. That is something that needs more rigorous inquiry in this country than has been the case to date. I have been through a number of referendums. That has been a concern for me and it continues to be a concern.

It is also a concern that projects, organised by political parties but separate from them, seem to be funded by American money, with a political agenda but, on the face of it, circumventing SIPO guidelines. That is something the Deputy needs to address. She might correct me if I am wrong but that seems to have been the case for the alternative commemoration to the national commemoration of 1916, and the agenda that Sinn Féin represents of the continuing link from 1916 to the war in the North, the conflict and the murder and mayhem that ensued and that the party continues to endorse.

These are very serious political issues, and while the Deputy may not think so, I do. It is not one rule for one group of politicians and a separate rule for others. I accept there has to be a cooling-off period. I do not approve of a former Minister of State going into a post that he had responsibility for as an officeholder. Nevertheless, the other issues I referred to also need to be faced up to once and for all and not fudged continually.

With figures increasing over the past week in respect of Covid-19, we all know now that we are at a crossroads. I want to make a couple of points to the Taoiseach and get his response. Dr. Ronan Glynn said we are going to be living with this for the next six to nine months and that it is going to be a very difficult period. I am glad that he referred to that length of time because people needed to hear it. I have said before in this House that when Covid came, it was the best time for us, as we had spring and then summer. We are now facing into a very difficult six months.

Over the weekend, I met Mairéad, who is over the age of 70. The one question she had for me was whether she would be able to see her only child, her daughter, who is working in London, at Christmas.

I was taken by that because the whole lot of us in the political system, including the Opposition and the Government, need to sign a contract from now until Christmas with the public to say that we will work together and follow a roadmap, which the Government will lead, and then Mairéad might see her daughter at Christmas. Then we will need to do another three-month contract from New Year's Day until St. Patrick's Day so that we can break the back on the difficult six months that are ahead of us. I ask the Taoiseach to commit to something like that. None of us have all of the answers but we need to break this down for the public because they are fatigued and worn out. We need to do it in bite sizes from here until Christmas and then from New Year's Day until St. Patrick's Day. I ask the Taoiseach to consider what I have just said and the Labour Party is happy to sign up to working with the Government on that.

I was taken by what was produced in the winter plan last week. Beds are an important issue but there is no point in having the beds if we do not have the staff. We need to be ingenious in how we will get all of these nurses, doctors and consultants in such a short space of time.

The other issue I want to raise with the Taoiseach is non-Covid healthcare. I have deep concerns about this, especially after talking to people working at different levels in the HSE over the last two weeks. I know the Taoiseach will not have the answer to this today - I am not trying to catch him out. I ask him to do a comparative analysis of coronary care and cancer care to see how many people are being treated and diagnosed month-on-month compared to last year. I would like to know the answer to that because I do not know what it is. Anecdotally, we have all heard of issues with the volume of people who may not be diagnosed this year and that is worrying because we all know that the longer it goes on the less chance one has of survival, particularly with those seriously acute conditions. Could the Taoiseach provide that information to us? I will ask the Taoiseach this question again next week in order that he can provide the answer. I will give him a week to come up with the answer.

Given what Dr. Glynn has said, will the Taoiseach consider a roadmap that is based around two pivotal dates - Christmas and St. Patrick's Day - so that the political class can collectively look at supporting that to get people through the next six months? Will the Taoiseach carry out an analysis of non-Covid critical health issues so that we can see whether we are dealing with them appropriately, as we tried our best to do last year, for example?

I thank the Deputy for his query and I would commit to that. I have publicly said on a number of occasions that the implications of Covid will be with us right through 2021. We need to take it in bite sizes and the immediate necessity is for all of us to take stock on our individual behaviours in reducing social contacts and the level of congregation in which we engage. This is essential to get the numbers down and in some counties and cities to avoid having to be put on level 3, but it is within our grasp. Limerick and other areas have proven that by getting the numbers down. Cities are volatile at the best of times when it comes to Covid because one event or incident can lead to a significant outbreak, as we saw in Cork with restaurants and pubs in one or two areas leading to approximately about 70 cases of Covid-19. The impact of that on our health services is significant.

I share the Deputy's concern about non-Covid services such as coronary care and cancer care but it is essential that we tell people we want to continue non-Covid health services, to get waiting lists down and to improve diagnostics and speed at getting diagnostics. However, a lot of that depends on our behaviour with Covid because the greater the number of Covid patients we have to admit to our hospitals and ICUs, the less capacity we will have to deal with coronary care, cancer care and other key ailments and diseases, etc., that affect the major organs of the body. There is a contract and an objective there. The better we behave collectively and individually, the better we give capacity and space to our front-line workers and hospitals to deal with non-Covid healthcare. The winter initiative is about providing unprecedented resources of €600 million over the next six months to alleviate capacity constraints. It is also aimed at dealing with the resumption of health services and enabling diagnostics and operations to take place in parallel with our approach to Covid.

That is the objective and it very much depends on keeping the lid on increasing cases and suppressing the virus insofar as we can. I urge people to do that so people can see their children and grandchildren at Christmas in a meaningful way. Whether they can will depend on our capacity to suppress the virus and get the numbers down and stabilised over the next number of weeks. It remains the Government's position.

On the winter initiative, we are also looking at increased and enhanced community provision around community diagnostics and around the prevention area in terms of community respiratory clinics. This is to prevent people having to be admitted to hospitals in the first instance and particularly to accident and emergency departments. That is our overarching agenda, along with the home care hours. There will be a very substantial number of home care packages this year.

I say the following genuinely and I hope the Taoiseach takes it in that spirit. We need a new contract with the people for the next six months broken into two blocs, as I said. It would enable the lady I mentioned to see her daughter. I welcome the Taoiseach's comments.

Nevertheless I am concerned about what the Taoiseach said about non-Covid health services. We cannot have a position of robbing Peter to pay Paul. We have to diagnose people with cancer or coronary issues. Capacity issues arise because of Covid-19 but we cannot have one or the other, especially when it comes to issues like those I mentioned. It cannot be one or the other; we must deal with both. Otherwise, the number of people who will die from non-Covid diseases will be more than those who die from Covid-19. I suspect that could be the case already but we do not know. Honestly, I do not know and neither does the Taoiseach. It is why I am asking him to revert with those figures.

I am saying this genuinely as too many consultants and people working in the HSE have said the same to me that I have decided to say to the Taoiseach in the Dáil. I have thought about this for a long time and we need the analysis to ensure we are managing our resources in the best way.

I agree with the Deputy on our engagement with the public over the next three months and the three months after that. By the way, we can stabilise the numbers and get them down. We will do our best at the Government level. I know the deputy Chief Medical Officer and his team will do likewise, as will the HSE. This is important.

We know from experience that too many people up to now and in previous winters were in acute beds for far too long. When the acute phase of treatment was over, hospitals found it very difficult to find suitable placements, particularly when it came to rehabilitation. Some 631 additional rehabilitation beds will be provided up to April 2021 as a key mechanism to ensure people can leave hospital promptly when their treatment is over to go to a suitable placement for treatment afterwards. Approximately 4.76 million additional home care hours will be provided, which is also important, as are the additional acute beds in general hospitals and additional intensive care unit capacity.

We will also utilise the private sector for diagnostics and operations for public patients over the next number of months. I take the Deputy's point and the objective is to manage Covid-19 while also dealing with the non-Covid cases. In the original lockdown period, for a variety of reasons, we could not do that but on this occasion we will go for it and attempt to do it. Its success will be dependent on strict adherence to Covid-19 guidelines and getting the numbers down.

Waiting lists are at a record high. It is all well and good to have a winter plan but we are still waiting for the detail of that plan and what will happen in each of our hospitals around the country. It is difficult to see how our hospitals will cope this winter as some are already struggling and it is still only September and we are facing into a second wave of Covid-19.

At the last Leaders' Questions session I contributed to in July, I spoke about a number of practical measures that could be taken to relieve this pressure.

Patients are also waiting longer for tests. Since April, during a period when only those who are really concerned with their health have gone to the doctor, 38 people have been added every single day to the waiting list for CT scans, MRI scans and other tests. These people are waiting in constant pain. Because of their delayed diagnosis, many will have very poor medical outcomes. We need proactive measures aimed at treating patients as efficiently as possible and we can do this by taking some simple actions.

As an example, I refer to the CT scanner at Portiuncula University Hospital in Ballinasloe, which has been out of action for 144 hours this month alone. Despite this being the tenth time that it has broken down in the past 18 operational months, the HSE has confirmed that it will not be replaced until some time in 2022. It is 63rd on the list for replacement, even though it has been out of warranty sine 2017. Where is the logic in that? These machines are breaking down in hospitals throughout the country. This impacts on our waiting lists and adds to the overcrowding in emergency departments. A perverse example of what is wrong with our health service is provided by a CT scanner just down the road in Roscommon University Hospital. It can cater for many more patients but uses a different software system from the one in Ballinasloe. This is despite the fact that for the past eight and a half years both hospitals have been meant to be working together closely as part of the same hospital group. Is it not about time we had a small bit of joined-up thinking and started to get the basic things right?

I am not responsible for operational decisions at the level of individual CT scanners, but I do not accept that this issue must wait until 2022. I will talk to the Minister for Health and the HSE about what is going on there. To be fair to all concerned, Roscommon hospital has been advanced in recent years. There were political rows about emergency departments and election commitments which perhaps were not grounded in the proper medical approach, but nonetheless effective investments were made in Roscommon hospital's outpatient and diagnostics capacity. There is no reason the CT scanner there should not be used. The Deputy has identified the issues around the CT scanner in Portiuncula. It is faulty to say the least and is not operating to satisfactory levels. It needs replacement, the sooner the better. I will pursue that issue.

On the wider issue, the National Treatment Purchase Fund, NTPF, had arranged up to 66,000 outpatient appointments at the end of August. This supported public hospitals in providing access to diagnostics for patients as well as services for their outpatient departments. The treatment purchase fund will now work on both the diagnostic and the operational side where outpatients are concerned, and it will work to procure additional private sector capacity where it is required to facilitate increased diagnostics along with procedures. That will continue.

It has to be said that Covid-19 did impact on the entire health service. There is no point in pretending that Covid-19 or the lockdown did not happen or that there were not huge restrictions on hospitals which stopped a lot of elective procedures and diagnostics from happening for two or three months. There has been something of a recovery in that regard, albeit constrained by guidelines provided by public health advice, which is important. Patient safety in the context of Covid-19 is always at the forefront of these decisions. Unfortunately this has negatively impacted on throughput, volume of procedures and volume of diagnostics. Of that there is no doubt. The work to improve the situation around diagnostics is continuing.

I know the Deputy has for several years raised the issue of the situation in County Roscommon and the utilisation of the technology there. He has been pursuing the issue for the past five to six years and may know operationally what is going on there on the ground and be familiar with the inability of the two groups in question to connect more effectively. I will certainly pursue the matter and work with the Deputy and others to see whether we can get it resolved.

I accept this is an operational matter, but every Member can tell a similar story in respect of other hospitals across the country. It is not just about the lack of upgrading of equipment or the purchase of a software package. The issue of medical politics is also at play. After I placed pressure on the then Government in 2015, it eventually installed a state-of-the-art telemedicine rapid access for stroke and neurological assessment, TRASNA, telemedicine stroke machine at Portiuncla University Hospital which would allow doctors at other hospitals to make life-saving stroke diagnoses of patients in Ballinalsoe, thus providing it with a 24-7 stroke service. However, that never happened because clinicians within the Saolta University Health Care Group would not agree to operate the machine or another machine at Mayo University Hospital. The same type of machines were installed in hospitals in Mullingar, Kerry and Wexford, as well as in St. Luke's General Hospital in Kilkenny. How many stroke patients were treated using those machines in those hospitals? These are basic things that the taxpayer is funding to a significant scale within the hospital system, but A is not joined up to B and then not connected to C and, as a result, patients' lives are being put at risk and hard-earned public funds are being wasted.

Medical politics should not be dictating these issues. There should be a commonsense approach in these situations. As I stated, I am not aware of the detail of the situation on the ground. The Deputy is saying to me that clinicians within the Saolta group are not willing to use these facilities whereas clinicians in other HSE hospital groups are prepared to use them. That seems to be the Deputy's assertion.

Deputies representing other parts of the country can speak for themselves as to what is happening in their areas.

The Deputy made that assertion and it raises legitimate questions in respect of why this particular technology is not being used within the Saolta group. I will initiate inquiries as to why that is the case and ask the HSE and the Saolta Group for a report on the points raised by the Deputy. As soon as I have it, I will revert to the Deputy.

I wish to start off by registering my concern at the closure of beds in Killarney Community Hospital. Its capacity has gone from 38 beds to 23 beds, a loss of 15 beds. Bed numbers at St. Columbanus public nursing home have dropped from 92 to 65, a loss of 27 beds, including bed losses on the Fuschia ward which caters for patients with dementia. These are savage cuts. A total of 42 beds have been taken out of these hospitals in Killarney and I wish to register my concern about that. What is the Government's plan in respect of people who get sick in the Killarney area? Is it telling them not to get sick? Is it telling people who are getting old and must go into a public nursing home not to get old? The Government stated it would increase bed capacity around the country but it is closing beds in Killarney. What is it going to do about this issue? How is it going to cater for people who get sick?

I wish to highlight on behalf of parents and families of adult children with intellectual disabilities that they have been badly let down since the start of the virus pandemic. Very few daycare centre services are open. Some of them open for two or three hours on one day per week, but that is not good enough. A woman named Mary who lives in County Kerry has a 20-year-old son named Conor. He is a big strong boy who needs routine and was doing very well in the service he was attending but it has closed. She works in the public sector. Her husband, who works for himself, has hardly worked since March because he has been minding his intellectually impaired son. They have three other children but cannot bring them anywhere. The children must make do and get to matches and other events by themselves.

They need financial assistance to hire trained people to help them out. Otherwise, many of these parents will be unable to continue under this pressure. Their mental health is suffering.

It is the same with families who have a partner or husband, mother or father, with dementia. I refer to all the services of the day-care centres that the buses used to bring them to, such as Rockmount in Kilgarvan, four or five days a week. Such centres are all closed. There were wonderful highly trained people running all these places - Rathmore, Scartaglin, Castleisland and Knocknagashel. The closure of these centres placed savage pressure on husbands and wives and sons and daughters. The Government needs to provide financial assistance for the families.

We need to talk about home help. Old people who wanted to stay in their homes as long as possible are not getting the home help they should get. This is putting more pressure on our hospitals and nursing homes by not providing more home help for them to stay in their homes longer. That could happen if the services were provided for them. I ask the Taoiseach and the Minister for Health to do something about these issues that I am raising.

I thank the Deputy for raising two issues in his leaders' question. The first relates to the closure of beds. I do not know the specific local circumstances of Killarney or, indeed, Columbanus house which the Deputy mentioned. I met with the HSE for the south region on Friday last. They said they were actively looking for additional beds, in terms of community nursing beds and rehabilitation beds, with a view to making sure that there were proper placements and appropriate beds, for example, for patients who had left acute hospitals and who needed convalescence or nursing home beds. It would appear to me that this may be a HIQA reconfiguration where HIQA would say one has to move from the wards to better single-room en suite accommodation. That has been going on for quite some time and has had an impact on certain centres. I do not know whether that applies here or not. What I know is that quite a substantial amount of funding has been provided to enable the HSE in all regions of the country to procure and provide for additional rehabilitation beds and additional beds in nursing homes with a view to making sure that there is a proper flow through our acute hospital system on an ongoing basis from here right through to the middle of next year and beyond. If the Deputy gives me the details of the specific cases, I will pursue them and get replies for him. It is more, not less, beds we need to deal with the impact of Covid-19.

Second, Covid-19 has had an unfortunate negative impact on the provision of services for adults with disabilities, particularly in terms of day-care services. Nonetheless, there has been a programme since August of restoring aspects of those disability services for as many people as possible. For example, 19,000 people with a disability attend the adult day services. I refer to the disability day-service locations which closed in March. Day services reopened at approximately 40% capacity throughout August and early September. The increased funding has been provided already so that the level of service available to people attending adult day services can be increased as well. Additional funding has been provided in the winter initiative to provide for an additional services and additional volume of services, likewise for school-leavers and also intensive support packages to deliver to quite a number of individuals who are in a chronic situation. There is quite a number of people in emergency situations which I am particularly concerned about, as are the services on the ground. We intend to work with the service providers to see can we deal with those emergency situations more effectively than has been the case to date.

In that case, in relation to the families with children with physical and or mental disabilities, where the Taoiseach cannot provide the service, could he give them financial help so that they themselves could hire somebody because they cannot continue under the pressure they are experiencing at present?

The district hospital and the Columbanus Home in Killarney are on the same campus. We read that the Government was going to provide more beds but the opposite is happening in Killarney which only has the one community hospital. Where are people who get sick or need a short period of rehabilitation after an operation in Cork or Tralee general hospital supposed to go? There has been a savage cut in Killarney. We are told that HIQA has demanded this. Where was HIQA for the last 20 years, when the same number of people were going? There have already been ward closures in the district hospital in Killarney. To close more now is absolutely scandalous and ridiculous when people are presenting with different things-----

Thank you Deputy.

-----and maybe coronavirus as well. Will the Taoiseach look at it and talk to HIQA? If it was good enough all the time since March, how is it not fit for purpose now all of a sudden?

I am glad the Deputy has clarified that aspect of it. I suspected that it might be a reconfiguration of the hospital because HIQA's guidelines said that what was there was not optimal. I will get a report on it. I met with the HSE South team last week. The need for additional beds outside acute hospitals to provide placements for people is an area of considerable concern to it. I know it is engaging with many providers to get additional capacity. The money is there to get additional capacity and it needs to procure it.

On disability, of the additional €10 million, some €7.5 million will go to disability day services. There will be an extra day a week for over 14,000 adults. The other €2.5 million will go to 210 intensive support packages to enable young adults with complex or high support needs to remain at home and in their communities. The packages are person-centred and tailored to the needs of the individual and their families. It is a resource-intense area, but it is needed. It will help people in their homes. We must continue to build on that.