I welcome the Minister of State at the Departments of Health and Justice and Equality with responsibility for disability, equality, mental health and older people, Deputy Kathleen Lynch. On my behalf and on behalf of the committee, I congratulate her on her appointment. As a member of the Oireachtas and in a personal capacity, Deputy Kathleen Lynch has been a strong advocate for disabled people, those with mental health issues and our older people. This is a very good appointment as Minister of State and I wish her well in her tenure in the Department. I also welcome her officials, Ms Bairbre Nic Aongusa and Ms Geraldine Fitzpatrick. In a moment, we will be joined in the Visitors Gallery by members of the Older and Bolder group.
Priority Health Issues: Discussion with Minister of State
I congratulate the Chairman on his appointment. The position of Chairman is not onerous but if one is interested, the Joint Committee on Health and Children gets a lot of attention. As a former member of the committee, it is a committee that can do a great deal of work and bring a degree of attention to issues that sometimes do not receive the attention they deserve. I thank the Chairman for his kind words of welcome and I wish the members of the committee the very best of luck in their deliberations. This is an interesting committee and one that can provide a great degree of satisfaction if the effort is made. I know that the members of this committee will do so.
I thank the joint committee for providing me with the opportunity to outline my priority policies for the coming year. The areas that I have been given responsibility for, including disability, equality, mental health and older people, have not always been afforded the highest priority through the years, not just by successive Governments but by society as a whole. We have made great strides in improving these services over the past two decades or so but the reality is that there is always more to do and now we need to do it with less. However, it is my intention to ensure that as far as possible people with disabilities, those with mental health issues and older people are protected from the harsh financial realities that we know we soon have to face in the forthcoming budget.
Regarding disability services, a major priority for the Government and for me in the coming months will be to finalise the current value for money and policy review of disability services to ensure the existing funding for people with disabilities is spent to best effect. We can all agree that it is now more important than ever that large-scale spending programmes of this nature are subject to detailed periodic review. The review is not solely about accounting for the approximately €1.5 billion sum spent annually by the HSE on services for people with disabilities. It will also assess how well current services for people with disabilities are meeting their objectives and support the future planning and development of services within the appropriate policy framework. The value for money efficiency and effectiveness review will make recommendations that will ensure the very substantial funding provided to the sector is used to maximum benefit for persons with disability, having regard to overall resource constraints that affect all sectors at this time.
We are also looking beyond the value for money exercise to an expert reference group on disability policy, which has been working in parallel, as part of the overall value for money review, to look specifically at existing disability policy and whether it needs to be changed to better meet the expectations and objectives of people with disabilities. My predecessor as Minister of State, John Moloney, announced the key themes of the emerging policy review in late 2010. I acknowledge the substantial preparatory work done in this area under his tenure. Circumstances dictate that he is no longer in that position but I acknowledge his dedication and work in this area.
The disability policy report proposes a very significant reframing of disability services with a move to individualised supports and the introduction of individualised budgeting for people with disabilities in order to put more choice and control directly in their hands. Choice and control were the two keywords which emerged from a public consultation exercise conducted with service users and interested parties late last year.
Having circulated the report within my Department and to other Departments, I intend to release it for public comment in the coming week. I take this opportunity to urge all with an interest in this area, particularly service users and their families, to study the report and have their say on this important policy document. The consultation on the disability policy report and the value for money review will be completed before year end and submitted to Government for its consideration.
The issue of the current lack of regulation of residential services for people with disabilities is a matter of concern to me and one I am anxious to address. It goes without saying that we must ensure that vulnerable people with disabilities in residential services are safeguarded and protected, and that their quality of life is enhanced. The current programme for Government includes a specific commitment to put the HIQA standards for residential services for people with disabilities on a statutory footing and to ensure that the services are inspected by HIQA. As I announced on 16 June, discussions have already begun between the Department of Health and HIQA to progress this commitment at my request.
It is now generally accepted that large residential institutions are no longer appropriate for the provision of accommodation for people with disabilities. In this context, the report Time to Move on from Congregated Settings was published on Tuesday, 28 June 2011 by the HSE. Congregated settings are defined as living arrangements whose primary purpose is the provision of services to people with intellectual, physical or sensory disabilities where ten or more people share a single living unit or where the living arrangements are campus-based. The report recommends a move away from congregated institutional-type settings for the 4,000 people who resided in such settings in 2008, to community-based settings over a seven year time frame. Since 2008, the number residing in such settings has been reduced to approximately 3,600 and there are plans in place to move a further 50 people to community-based settings in 2011. The HSE will engage with all relevant stakeholders to devise an implementation plan and a seven-year implementation timeframe is envisaged.
Regarding the national housing strategy, the Department of Health has also collaborated with the Department of the Environment, Community and Local Government on the development of a housing strategy for people with disabilities. This will take account of the findings of the congregated settings report. The strategy's vision is to facilitate access for people with disabilities to the appropriate range of housing and related support services, delivered in an integrated and sustainable manner which promotes equality of opportunity, individual choice and independent living.
The two Departments are working closely to ensure that at a strategic level, people with disabilities who are currently in institutional or congregated settings will be eligible to be assessed for access to appropriate housing. In line with mainstreaming policy, responsibility for funding of the housing needs of people with disabilities and those with mental health issues rests with the housing authorities.
The joint departmental approach aims to develop proposals on how a housing strategy can contribute to the implementation of a deinstitutionalisation programme in parallel with the planned implementation of the congregated settings report. However, this would depend on funding issues being addressed in due course. This housing strategy is due to be formally launched on 6 October 2011 by my colleague, the Minister of State with responsibility for housing and planning, Deputy Willie Penrose.
Another issue in regard to people with disabilities is in the area of employment. In the programme for Government, we are committed to facilitating people with disabilities in achieving a greater level of participation in employment, training and education. People with disabilities have consistently stated that access to training and employment is a key element in enabling them to live independent lives as part of their community. I reiterate that I will work with other Departments and agencies to develop a cross-sectoral comprehensive employment strategy to assist people with disabilities to access employment opportunities. FÁS will have a major role to play in this regard and we are in negotiation with it about this issue.
A review of HSE funded adult day services has also been completed. The main purpose of this review is to move towards a reconfiguration and modernisation of HSE funded day services so as to embrace the principles of person-centeredness, access, accountability and quality. The new approach should deliver better outcomes for service users, provide good value for money and be in line with relevant legislation, national standards and best practice.
The final report, New Directions - Personal Support Services for Adults with Disabilities, envisages that the supports available in communities will be mobilised so that people will have the widest possible choices and options about how they live their lives and spend their time so that being part of one's local community is a real option. The objective is that State supports will be tailored to individual need and will need to be flexible, responsive and person-centred with the boundaries between special and mainstream services being reduced so that people can access the support most suited to their needs.
In conclusion, on disability issues, I hope the emerging policy direction of my office in this area, coupled with the recommendations in these reports, will provide the necessary impetus for the move towards a new model of disability service provision, one that is both cost-effective and focused on the needs of the services users in the first instance.
In regard to mental health, my priority will be to further advance the implementation of A Vision for Change, the report of the Expert Group on Mental Health Policy 2006 and Reach Out, the National Strategy for Action on Suicide Prevention 2005. This will mean ensuring early intervention for people experiencing mental health difficulties, improving access to appropriate mental health services, closing unsuitable psychiatric hospitals and moving patients to more appropriate community based facilities. My vision is to develop a person centred, community based mental health service with a much reduced reliance on hospital care and where service users are active participants in their own care and recovery.
The programme for Government commits to reducing the stigma of mental illness and ensuring early and appropriate intervention for adults and children. We will improve access to modern mental health services in the community and ensure that people can access mental health services such as psychologists and counsellors in the primary care setting. To achieve this, and to progress the implementation of Reach Out, the National Strategy for Suicide Prevention, the programme for Government commits to the ring-fencing of €35 million annually from within the health budget.
Five years on from the publication of A Vision for Change, it is acknowledged that some progress has been made in implementing its recommendations but the rate of progress is still much too slow. I have therefore requested that the HSE prepare an implementation plan which will identify specific recommendations of A Vision for Change and Reach Out to be progressed over the next three years, with timelines, detailed costs, persons responsible for implementation, etc.
I propose the appointment of an appropriate senior person within the HSE to have corporate responsibility for driving the implementation of the recommendations in A Vision for Change and Reach Out and, in particular, for delivering on the commitments in the programme for Government. I see this person being responsible and accountable for allocation of the ring-fenced €35 million to mental health services around the country and also to specific initiatives for suicide prevention.
Another priority in the area of mental health is the review of the Mental Health Act 2001. The Act, when it became law, put in place an improved and modernised structure for the involuntary detention of persons for psychiatric care and treatment and established, for the first time, a system of automatic and independent review of all detentions. The Act has served us well in this regard. I am committed to reviewing the Act in line with the commitment in the programme for Government and informed by human rights standards and in consultation with service users, carers and other stakeholders.
I recently set up a steering group to oversee the review and earlier this month I launched a public consultation on it. I wish to hear from all with an interest in our mental health services as to how they feel the Act has operated to date and how it might be improved in the future. The review is due to be completed by June 2012. I am committed to tackling the problems in our mental health services and to addressing the alarming trends in our suicide rates. With the right leadership in the HSE and the Government's commitment of €35 million, we can bring about significant improvements.
As Minister of State with responsibility for older people, I am tasked with bringing greater coherence to government planning, policy and service delivery for older people. We are at a very important juncture in terms of future policies and services for older people in Ireland. Currently, we have the distinction of having the lowest proportion of the population aged 65 and over in the EU. Our population, however, will age quite rapidly from this point onwards, with all demographic projections pointing to substantially greater numbers of older people in Ireland in the years ahead. The expected demographic changes will bring significant challenges but also great opportunities. These challenges can be successfully met and the opportunities fully exploited by planning ahead now, just as we must plan for any change.
Next year is the European Year for Active Ageing and Solidarity between Generations. Together with our fellow EU member states, Ireland will celebrate and promote positive and active ageing. We will undertake a series of events and initiatives to mobilise the potential of our rapidly growing population in their 50s and over. On behalf of the Government, the office for older people in my Department is co-ordinating Irish participation in the European year and preparations are well underway to develop an Irish programme for 2012.
I refer to a positive ageing strategy. In this context, a key priority for me will be to carry through on the commitment in the current programme for Government and complete the national positive ageing strategy. The strategy is being developed within the constraints obviously posed by the present fiscal situation. In that regard, it is not the intention that it will propose new service developments. Instead, it will set the strategic direction for future policies,programmes and services for older people. It will establish a common framework for the development of operational plans by Departments and clarify their objectives relating to older people. It will also involve the development of ongoing mechanisms designed to monitor progress and to identify challenges facing older people in the future.
A central ingredient to good planning and policy development is the availability of key data and evidence about the ageing process. Towards this end, I strongly support the work of the Irish longitudinal study on ageing. This ten year study of a large statistically representative sample of 8,000 people aged 50 years and over will over time collect in-depth information on relevant aspects of older people's lives. The findings will thus enhance both the quantity and quality of data available for all concerned and so better inform policies for older people in the years ahead.
Another priority area for me, as highlighted in the programme for Government, is the need for investment to underpin more and better care for older people, both in the community and in residential settings. A key objective of Government policy is to support older people to live at home and in their communities for as long as possible. This option, the preferred choice of most older people, will be maximised through enhancing the range of HSE services such as home-help, home care packages and day or respite care. In addition, the Department, in consultation with the HSE, is currently preparing proposals to ensure that access to community services is provided on a nationally consistent and equitable basis, having regard to each person's care needs and means.
The Department is currently reviewing the provision of public residential care in the light of the need to meet national standards and regulations, local demographic pressures, and public and private provision. The review will serve as a platform for discussion and will inform the development of an overall strategy on how the HSE should continue to provide this service in future in view of current budgetary and other pressures. The review must also be seen in the light of the wider health reform programme, to which the Government is committed, and the position of social care services in a future health service.
The issuing of approvals for financial support under the nursing homes support scheme was suspended for a month from May to June 2011, while an examination of funding was being carried out. The examination identified a number of factors that are putting pressure on the long-term residential care subhead for 2011. These included an unexpected and so far unexplained increase in the average length of stay for nursing home residents, a resultant higher net demand for nursing home places and an increase in nursing home costs. The Department is working closely with the HSE to monitor the long-term residential care subhead, and to implement more rigorous governance and reporting measures. In 2012 the Department will continue to support and monitor HSE administration of the scheme, in accordance with the legislation and budgetary constraints.
On the important issue of tackling elder abuse, I reiterate my full commitment to keeping this high on the Government's agenda. It is important also to say that elder abuse is a societal problem, and not just a health issue, and therefore requires us all to confront it in all its forms, and especially to report it to the relevant authorities.
The Government is aware of the challenges that Alzheimer's disease and other dementias pose for us. The programme for Government commits us to developing a national strategy by 2013. This will support the delivery of long-term care services, having regard to future demographic development, and the resulting increase in demand for long-term care. The strategy will be developed on the basis of the best evidence available from national and international sources.
The Department has started the process of developing a strategy on dementia. Officials have engaged with relevant stakeholder groups on the first stage of the process. This initial work will lead to a report containing the research and evidence upon which the strategy will be developed. Following this, formal work will begin on the development of the strategy.
I once again thank the members of the committee for allowing me the opportunity to set out my priorities and the challenges that I see ahead of me in the important areas for which I have been given responsibility. I assure the committee that, working with the Minister for Health and my officials, we will do all we can to improve services step by step where we can and manage to best effect areas that may be subject to funding constraints. I look forward to working with committee members in this regard.
I thank the Minister of State for that comprehensive presentation and I welcome to the Visitors Gallery members of the Older and Bolder organisation.
The Minister of State has a very wide portfolio and I wish her well in it. I hope it will keep her busy and out of the constituency.
So far.
I missed the early part of the Minister of State's speech. Who is taking the lead now in the National Office of Suicide Prevention? Is the Director for Mental Health taking the lead following the resignations?
The document A Vision for Change is innovative and all political parties have bought into it, as have the professions and society in general. That is the challenge that faces us in the context of the economic constraints placed on the Government when trying to deliver services. Clearly, the notion of primary care units as the frontline provider of health services in the community has been rolled out more slowly than anticipated. That was a policy developed by the previous Government, to provide frontline primary care and mental health services in primary care units. Is there any way to speed up this process? The Minister of State talked about an implementation body to assess the roll-out of A Vision for Change but it is dependent on the establishment of the primary care units. That is a clear challenge.
Psychiatric units throughout the country are being closed and the funds from the disposal of those assets are to be used for investment in the implementation of A Vision for Change. The asset values have diminished since we first assessed them during the economic boom. That will leave a large hole in the expected potential for roll-out. What does the Minister of State intend to do in that context?
The fair deal nursing home subvention scheme has seen people being informed that they are being approved but that there is no funding in place. There can be waiting times of up to 12 weeks, which is unacceptable and was not the intention when the Minister suspended and reintroduced it again. There are funding pressures but the Minister stated clearly in the Dáil in July that the scheme was being reintroduced and that he expected processing, application approval and funding to be streamlined. A waiting period of ten to 12 weeks is unacceptable.
Of all the issues in the Minister of State's brief, mental health is a huge challenge. We should all concentrate on it to ensure it is implemented. How will the Minister of State fund its implementation due to the financial constraints based on budget cuts and shortfalls due to asset depreciation?
I apologise for my late arrival, I was speaking in the House. I also apologise that my party colleague, Deputy Caoimhghín Ó Caoláin, cannot be here; he is attending a North-South forum meeting in Stormont today. I further apologise that as soon as I finish speaking here, I must leave to attend another meeting. My colleague, Senator Cullinane, will be listening closely to the Minister of State's responses.
I totally understand.
I welcome the Minister of State to the meeting and recognise this is a very broad and demanding portfolio. It carries huge responsibilities and covers very important issues. Even in prosperous times the people represented by the Minister of State were not receiving the level of support and recognition of their rights to which they were not entitled. The tragedy now is that in times of recession, they bear the brunt of cutbacks and there is a risk the weak and the vulnerable will be further damaged by that awful term "equality of pain". People are not equal and pain should not be administered equally; the weak and the vulnerable must be protected. We need to be very careful when discussing reform in funding. People are fearful that such terminology is being used as a cloak for further cutbacks. We have seen it in the past couple of years in the wider health services and my colleague Deputy Ó Caoláin referred to it as death by a thousand cuts.
I commend the submission from Inclusion Ireland - National Association for People with an Intellectual Disability, which has asked some very straight questions. It asked when inspections of services for adults and children with disabilities will commence; when the recommendations of the report of the working group on congregated setting will be implemented; when implementation of the recommendations will start; what timeframe is acceptable and when the review of disability services will be published; and if the Minister of State had concerns about the effectiveness of the €1.5 billion which is spent on disability services and its impact on people with disabilities. I reiterate its call for the HIQA to begin inspection as soon as possible of services for children and adults with disability.
In regard to the fair deal scheme, Deputy Ó Caoláin has also brought to the attention of the Minister the overcharging of people in nursing homes. This is a very serious problem. Will the Minister of State state ascertain if her Department or the HIQA have yet dealt with specific cases of over-charging and if the chief inspector has ever refused to register a home for non-compliance with the regulations? How many people are currently on the waiting list for the fair deal scheme?
I am not trying to be unfair to the Deputy, but the Minister of State, may not have to hand information on some of those questions. It may be better to table a parliamentary question.
I accept that. I would be happy with a written response to them.
What is the average waiting time from the time of application to the time of admission to the home under the fair deal scheme? We argue that there needs to be a proactive ombudsman for older people. I did not hear the Minister of State refer to this in her speech.
It is unanimously acknowledged that A Vision for Change is a good document on the direction of mental health services. The problem is that the choices and decisions we make can result in members moving further from that direction rather than towards it. We must crystalise the targets set out in A Vision for Change and ensure that every decision we make is measured in terms of its impact on vulnerable people.
I regret that I am unable to wait for the response to my questions.
I welcome the Minister of State, Deputy Kathleen Lynch and her officials to the meeting. I thank her for outlining her programme, which is very broad and covers very significant and important areas. The time available to this committee will not do justice to the various areas that have been covered in her submission.
I wish to raise general issues in the submission, particularly the protection of vulnerable people with disabilities and those coming under the categories of older people and the mental health services. I am sure that I and every other committee member see that services that were available in the past have become less available. I am being contacted daily by people with problems.
Older people have been refused heating supplement payment through the community welfare service on the basis that €20 per week is adequate, which it is not in very many cases. The level of fuel poverty among older people is quite high. I am contacted on a daily basis about the reduction of home help and care assistant service hours or that applications for the services and payments are being routinely refused.
It is now becoming almost rare to find an application for a carer's allowance that is being approved. It appears that the bar is being raised and the assessments are becoming stringent. One can seek a review if the application is not approved. The review process took about two weeks in the past and now takes six weeks. If one fails that review one can make an appeal, which will take 12 months or more. That is totally unacceptable. I ask the Minister of State to address these areas, which impinge on the daily lives of people, older people, those with disability and those with mental health issues. We have been told there has been no reduction in these various services, but the bar is being raised and services that are essential for people to live at home in their communities are being undermined.
The Minister of State stresses the need for consultation with service users. I totally agree and am passionate about the need for consultation. I hope it happens. I regret to say this does not happen in the HSE. Decisions are made by the HSE without any prior consultation and over the heads of stakeholders. Once the decision is made, the HSE will contact stakeholders about the implementation of the decision. I would describe the HSE as a train out of control in this respect. I believe that HSE consultation with stakeholders is at best a book exercise. That is not good enough and will give rise to a situation where there is no trust, no confidence and no agreement in the area of policy.
I do not propose to discuss mental health services in detail as the Minister of State, whom I have met on the issue a number of times, will be well aware of my views on them. I reiterate that I am fully committed to the policies proposed under A Vision for Change. Mental health services are outdated and, some would argue, unfit for purpose. They must be urgently modernised on the basis of a preponderance of community services. Not only does A Vision for Change provide for such a scenario but it also proposes the implementation of inpatient services and specialist services, two areas which are not being addressed by the Health Service Executive which is cherry-picking the document to suit its own misguided centralisation policies.
It is vital that stakeholders are involved in the development of policies. Until now, this has not been the case as local service users have not been consulted. I sound a note of caution regarding the claims by certain individuals and organisations to represent local service users. I have had substantial discussions with representatives of the voluntary sector in this regard and fully support its involvement in this area. It is important that the designated stakeholders include those who have been involved in the mental health service, including carers and service users. Consultation is vital for the development of mental health services. If we fail to consult properly, I fear we will end up with a service that is as bad, if not worse, than the current one.
I ask the Minister of State and her officials to examine how policies such as those proposed in A Vision for Change have been implemented elsewhere, including Australia, where community based services were implemented side by side with existing services and existing levels of inpatient services were reduced in parallel with the implementation of successful the community based services.
I thank the Deputies who contributed. I will first respond to Deputy Kelleher, who made the most wide-ranging contribution on how the Department will implement A Vision for Change. In doing so, I may answer many of the questions asked by other speakers.
The mental health budget in the Department of Health is €920 million per annum. The difficulty facing the Government is that we have a cross-departmental approach to all aspects of life. For this reason, the €920 million allocated to the Department does not include the funding available to the Departments of Transport, Education and Skills and other Departments. It is important to extract this type of information from the figures. In addition to the €920 million provided to run day-to-day mental health services, the programme for Government contains a commitment to provide a ring-fenced sum of €35 million per annum from the health budget for the implementation of A Vision for Change.
While I understand how someone could come to believe that this money will be used for new buildings in the primary care area, it is strictly for posts in the mental health service. We intend to establish multidisciplinary teams around the country, each of which is to serve a population of 50,000. The teams will include occupational therapists. Some people have a knowledge of mental health services. Until now, we would not have considered occupational therapy to be part of mental health services. Clearly, however, it is a key component. The teams will also include psychologists and counsellors.
The cost of mental health services provided by general practitioner services is not taken into account, despite the fact that 90% of those with mental health issues first present at their general practitioner. The two options available to GPs in most parts of the country, although in some areas the GP service is highly developed, are to prescribe or send the presenting patient to an acute unit. In most cases, neither option is the best option for the person needing a service. We need to establish a counselling service, in other words, a person to whom people can speak. While there may be scope for having a psychological side to the service, psychiatrists are probably the last people individuals in need should see.
We need to ensure mental health problems are addressed at the first port of call in a holistic and comprehensive fashion. While I am not an expert on health financing, I am informed that €35 million will give us a comprehensive community mental health service. Deputy Healy and I agree that acute beds will always be needed. When people have an acute psychotic episode they will need to be hospitalised to be stabilised. We need to reduce the number of acute admissions and the time spent in acute units. The days of locking people up in old institutions are gone. That practice is not necessary and should not continue. However, there is no point in closing down the old institutions and transferring services to the community if the culture and thinking in mental health services do not change. Transferring a service we do not want to continue to another area would not be of any benefit.
We need to look at A Vision for Change as something we can do. We could also do other things with the budget available. The care package required by people with a disability, whether sensory, physical or intellectual, old people and those with mental health issues are not substantially different. They are supports the individuals in question need to live in communities. We should look at providing care packages rather than engage in silo thinking in which mental health, disability and older people are viewed separately. This morning, I spoke to someone who is doing research on older people who have become confused. The research has found that many older people are not sufficiently hydrated and have poor diet because they are not able to look after themselves. Their confusion does not lead to dementia but can be addressed by education more than anything else. While the health needs of the various groups must be kept separate, it is the social care package that is important. The issue is one of keeping people well.
The issue of the fair deal was raised. I have some figures for same and, if necessary, I will give them later. Some 2,600 applications were approved since May, 500 applications are on a placement list awaiting final approval but it is hoped to have them cleared by the end of the year. Currently 21,897 people are in the long-term care. The numbers are not huge.
I find myself in a peculiar position. I am charged with taking people with mental illness and people with disabilities out of large institutions. On the other hand I am desperately foraging around for places for older people. The housing strategy which will soon be launched will provide different options on how we live our lives in later years. It will be about more community-based and supported living. The housing strategy will be key. We might eventually say God bless NAMA if it can give us the physical resources needed to do this. It is important that the Government's approach brings all of that together. All the people for whom I am responsible do not live separate lives from the rest of us. They live in the same places as us and we need to ensure we facilitate them to live there for a longer period. If there are any questions I have not answered-----
There are three groups remaining. I call Senator Jillian van Turnhout, Deputy Derek Keating, Senator John Gilroy followed by Senator Colm Burke, Senator David Cullinane and Deputy Catherine Byrne and finally, Deputy Peter Fitzpatrick and Deputy Robert Dowds. I remind members to keep their comments brief.
I will also keep my comments brief. I just thought it was better to give a global view.
I will keep my comments short. I apologise that I have to leave at 1 o'clock.
The Senator will not take 18 minutes.
I promise I will not need that amount of time. However, I have a number of questions and I will not repeat questions that have already been asked, especially in the disability sector for children, as I take it they have been asked. In the area of mental health I have some particular concerns. The moratorium on staffing and recruitment is having a disproportionate impact. Some 20% of posts have gone but they represent only 9% of the workforce. Therefore, it is a very blunt instrument that is disproportionately affecting the mental health sector. We have lost 1,200 to 1,500 key people. In one establishment a team of four nurses was in place for the past 30 years but now the number is down to one nurse. I understand that Ennis has closed its community services in order to support the hospital while everyone around the table agrees with the concept of community services but because of what is happening it is not working. A safe level is 9,500 but I am concerned when we dip below that figure in the mental health services arena. In parallel there is also the ban on agency staff and overtime.
The Minister of State mentioned that a senior person in the HSE is responsible for mental health. If I recall correctly, she mentioned in an interview the possibility of a director and a directorate for mental health services. That is something I would welcome and perhaps the budget would be linked. Will the Minister of State clarify that issue? From my background in children's rights I am aware that works well where there is consolidation with cross-cutting. I wish to give whatever encouragement I can. Certainly we need a director and directorate with its budget.
The Minister mentioned the Mental Health Act. The consultations taking place are desirable. The timeframe for civil society organisations in which to make their submissions by 7 October is short. Perhaps the Minister of State will elaborate briefly on what will happen in the lead-up to 2012? How do we ensure we continue that engagement and that we all end up with what we wish to have?
My final point on mental health concerns the use of force as a means to cure emotional distress. I am seeking a ban on electroconvulsive therapy, ECT. I declare a family relationship with Mr. John McCarthy of Mad Pride. Given that I am related I would not be forgiven if I did not raise this important issue. I know the Minister of State is well aware of the issue.
I wish to raise one issue on older people relating to the national positive aging strategy. I am fearful we will be constrained by fiscal considerations and will forget about the vision. My experience is from the children's arena. We have just completed a ten year national children's strategy and are embarking on developing a new five-year national children and youth strategy that will have vision and will be focused on outcomes. It will not have all the fiscal measures we would wish to have to make Ireland one of the best places in the world to be a child but it will ensure that the blocks are in place and the pathways are set. Given that the national children's strategy will, hopefully, be in place by the middle of next year, why not have a positive aging strategy running parallel because many of the issues faced by older people are similar to those of children. Why not have this ambition for the positive aging strategy? Why not have a vision? Why not have Ireland as the best place to be an older person? We must ensure we do not use the fiscal crisis to bring us down but use it as an overarching strategy to point the destination to which we wish to go. What can be done now given that we have all agreed this is where we are going? Let us be ambitious in what we are doing.
I join with the Chairman and Members of the committee in welcoming and congratulating the Minister of State on her appointment. I also welcome her staff.
I wish to refer briefly to the positive aging strategy which is enshrined in the programme for Government. I am aware of the financial constraints and what the Minister and the Government has inherited given the treatment of our economy by the previous Administration. There are particular difficulties there and financial constraints. Perhaps the Minister of State will elaborate on what she considers can be achieved.
I recall, as I am sure the Minister of State does, what I consider to be one of the most powerful demonstrations of recent years when our senior citizens took to the streets demanding their entitlements. I met some of them at the gate today and saw the slogan, "making positive aging happen". The committee as a group is committed to that. It is important to look at some of the areas on which we need to focus - equality for senior citizens, respect and dignity, fairer health care, effective home and community care, clarity of their rights and entitlements. How we do hope to achieve that?
The Department of Social Protection contributes approximately €30 million per year to public transport. I and other members of the committee and the Oireachtas receive representations regularly from people in view of the restrictions in public transport and the changes taking place. The vast majority of those who contact me on issues such as this are senior citizens. When an audit of transportation is being carried out, I understand that often those with travel passes are not taken into consideration. Many of the particular bus routes which are being taken off are used by senior citizens who have travel passes. While these services will not be seen by the authorities to be financially viable, they are nonetheless important.
I was pleased but not surprised to hear the Minister of State refer to suicide because I know she is deeply committed to making an impact during the lifetime of this Government on working to resolve this growing problem. Suicide takes place among our elderly also. I am concerned that some community based care and social services for the elderly are being curtailed and the resources are being transferred to other areas, such as child protection. These are services which make a wonderful contribution to the quality of life of our senior citizens and help positive aging. Issues affecting senior citizens, such as elderly abuse, the moderate depression from which many of them suffer and isolation are also matters of great concern.
I already alluded to the issue of transportation. Many senior citizens benefit from the free travel pass and rural transportation schemes. Is the Minister of State in a position to commit to retaining those services for the benefit of senior citizens? These services help senior citizens connect with their communities and families and help them keep in contact with people and use local community services such as shops and banks. They help them to live independently.
I welcome the Minister of State. As mentioned already, she has an expansive workload. Any one of the four areas for which she has responsibility could make a portfolio for a junior Minister. The Minister of State's commitment to effecting change in this area is undoubted and despite her workload there is nobody I would rather see in charge of this area.
I will confine myself to the area of mental health on this occasion. I started work in 1984 in the mental health services and in that year a plan entitled Planning for the Future was introduced and published. Unfortunately, 27 years later as my career finishes, Planning for the Future has not been fully implemented. It has been superseded now by A Vision for Change. I was involved in a review some time ago which examined international policy documents on mental health and A Vision for Change stood head and shoulders above any of those we examined. The only one that came close was the UK model.
Sometimes the implementation of public policy is frustrated by issues outside of the Department's control. Senator van Turnhout mentioned the moratorium on staff has reduced staffing levels to what many might say are dangerously low levels, below the 9,500 professionals required to provide a safe service. It is likely a further 600 retirements will take place between now and next February, which will reduce the number of mental health professionals to below 8,500, possibly down to 8,000. I welcome that some €35 million has been ringfenced to provide for 300 posts a year over five years, which will barely return the levels to what is required. I have concerns that A Vision for Change could, unintentionally, go the same way as Planning for the Future. There is evidence that some community residences are closing and staff and residents are being moved back into the institutions. This is at variance with what the Minister of State is trying to achieve. What comment would she make on that?
I welcome the review of the Mental Health Act. Senator van Turnhout mentioned ECT. As a professional I have seen this used, but I never agreed with its use and excluded myself from participating in it. Does the Minister of State have plans to review the section of the Act which requires just two consultant psychiatrists to agree to non-voluntary ECT taking place? I am aware of a case in Naas recently which received national headlines.
My view on the Reach Out document may be somewhat controversial and may not coincide with what is the perceived wisdom in this area. I have serious concerns about this document which was published in 2005. It suggested we could expect to see a decrease or a levelling out of the figures on suicide, but, unfortunately, with the exception of 2006, we have seen the figures continue to increase. Of the 90 recommendations in the document, some 30 refer to reviews of one kind or another, reviews which should just be desktop research operations. I am unsure these have even been carried out. The Minister of State's personal commitment is undoubted, but there is no review mechanism in a document which has a lifespan of ten years, such as the national suicide prevention policy. Does the Minister of State have any plans to sit down at this stage - more than half way through it - to review it?
There is much more I would like to say, but I will not do so now. At our previous meeting I was critical of the HSE for the level of jargon used at these meetings. This is the first time I have heard the phrase "congregated settings". Sometimes it makes me almost cry to think that somebody is being paid to sit down and come up with this jargon.
I thank those who have contributed. I will begin with the question of the review and its timeframe. The original plan was to issue the review in August, but we decided that was a non-runner and would wait until September and asked some people in the sector whether that was all right because we did not want to be accused of holding it back. Any further contributions required to be made after 2 October will be considered, but after that we must take a serious look at the legal implications, because we need to be very careful with regard to these.
I will deal with the questions raised by Senator Gilroy and then those raised by Deputy Keating, and ask them to remind me of any issue I might forget. With regard to the staff issue relating to the closure of community services, we do not have the luxury of having both acute units and community based services. What we need to do is ensure the service we provide is the best possible service. Therefore, when our acute services are understaffed, for the sake of the health and safety of service users we must focus on these and ensure they are staffed properly. If that means pulling people from community services, that is what must be none. There is no point in glossing over what needs to be done. How we can get around that is to ensure we have multidisciplinary teams in each community so as to ensure a service is provided within the community. We do not, however, have the luxury of both an acute unit and a community service.
Under A Vision for Change our aim is to have as few acute beds as possible - 50 beds in most areas - and to ensure we have a proper, community based mental health service. That is our intention. The €35 million will provide the posts to do that. Staffing is a major issue because of the type of work involved. The age for psychiatric nursing is higher than for nurses in other sectors and the age of retirement is lower. We cannot blame people if they want to take early retirement, because it is a tough job. It is a job that takes its toll on those doing it. The mental health sector has contributed more to the Croke Park agreement with regard to staff departures than any other area. I make the argument that the sector should get some compensation in return. We believe that when the service is community based, it will become more attractive for people to enter. Right now, it is not an attractive service for young nurses. Senator Gilroy would know that better than anyone else. It will become far more attractive when the service is community based. There has already been a breach in the recruitment moratorium for psychiatric nurses, with 100 a year for three years, and we are hoping to breach that moratorium again. We have no choice other than to breach that moratorium. I hope that in breaching it, we will not take from other sectors.
In respect of ECT, we have taken out "unwilling" as a result of the former Senator Boyle's Act. We made that commitment in the first week. We are taking a serious look at "unable" as well.
There is no such thing as a static service. The expectations of people who use a service change dramatically every ten years. Who would have believed ten years ago that the Gallery today would be filled by members of an organisation called Older and Bolder? It is the expectations of people that change. When they change, then our policy and how we deliver it must change. The difficulty with Reach Out and A Vision for Change is that they have never had either the resources or the implementation for us to determine whether they can fulfil the expectations. With Reach Out, it is not just about governments, be it the previous one, this one or the next one. None of them can deal on its own with the issue of suicide. It is a societal issue. We must all become aware of it and we must all begin to recognise when people start to have a difficulty. We need to get that into our heads.
Geoff Day has left the National Office of Suicide Prevention and he did tremendous work. He drove on that office and put in place the structures that will allow us to move forward. Now that we have a new director in the office, maybe it is time to take another look. I do not have a difficulty with that or with people telling me there is a better way to do it. I do not believe anybody has all the knowledge on these things. Maybe it is time to take a look at how we can move forward. The structures are now there. The recognition of the office is there. The resources are available, whether in research or any of the other pieces that we need to bring together. Maybe now we need to do things differently. Maybe the emphasis needs to be placed on a different part.
We will put a directorate in place for mental health. It will not be a large, grandiose office. We are not talking about a floor in the Merrion Hotel. It will be led by somebody who knows what he or she is doing in respect of A Vision for Change. We will allow that person to pick two others from within the system, because the knowledge in the system on these issues is phenomenal. However, there is no point in putting a director or a directorate in place if they do not have the budget and the power to drive it on. All the plans are there, but we have to have the budget and the power.
Deputy Keating spoke about the positive ageing strategy and I could not agree with him more. I am not certain that the positive ageing strategy is in fact about resources. It is about financial resources. So much of the work has been done by the non-governmental agencies anyway. We are so blessed in this country to have the Irish Senior Citizens' Parliament, Older and Bolder, and Age Action. It really is about a change of mindset and about an education piece which states that older people make a contribution, and that this is not about burden. With the input from these groups, it will be a good strategy and it will be about putting in place a vision, so that when things turn around, we will at least have the framework in order to move forward.
Thank you. I call on Senators Burke and Cullinane and Deputy Byrne.
I thank the Minister of State for coming here today and providing a very comprehensive submission to the committee.
I am concerned about the waiting time in respect of the fair deal scheme. When people are going into a nursing home, they have suffered trauma from what they have gone through already. They are probably coming out of hospital and there will be a worry about whether a nursing home bed is available. We have not really developed step-down facilities to a great extent. There is a period of time when people do not need to be in hospital, but are still not well enough to go home or go into nursing home care. I cannot understand how we never developed step-down facilities immediately adjacent to hospitals. We seem to develop them as far away as possible, which I do not understand. We should look at this in the long term.
I was recently dealing with somebody who is now in the CUH for over 12 weeks, even though the family were told 12 weeks ago that nothing more could be done for the person, that he needs to go into a nursing home and is not well enough to go home. There is no upper limit in the fair deal scheme in respect of property ownership. We should all be saying that such people should not be complaining, but unfortunately people take a particular view on this. Perhaps we need to bring in some amendments to deal with an upper limit of deductions under the fair deal scheme. I understand that this is a particular problem with the farming community. It is an issue that needs to be examined. This particular case was about that issue. The person involved was not well enough to sign on the dotted line, but nobody else would sign on the dotted line either, because the person was the owner of assets. The deduction of 5% per annum for three years is a very good scheme, but there is no upper limit. I am open to correction on this, but that is the advice I have been given.
I would also like to raise the issue of structured training for those who are caring for elderly people who stay at home. Representatives of a community hospital were in contact with me recently. They were prepared to take people in under JobBridge, not because they wanted cheap labour, as they had more than enough staff. They wanted to encourage people to train in how to care for elderly people. They would have the experience of dealing with them in a very structured way, putting in place a very structured training programme in a community hospital. Lo and behold, they were told that the hospital did not come under the JobBridge criteria. I have already written to the Minister for Social Protection about this. It is an ideal opportunity. We are really lacking people who have trained and who have the experience of caring for elderly people at home. People's circumstances change at home. There is a different issue every week and it is important that we have people who are skilled to deal with that. It is an ideal opportunity and we need to have a structured training programme to train people who are working as carers or home helps under the service. We also need to make sure that as many people as possible can stay at home for as long as possible instead of having a nursing home as the only option.
Nursing home repayment provision is an issue I have been involved with for many years, since 2004. A substantial amount of money had to be repaid by the Department as a result of the identification of illegal deductions. I have raised this at the request of a particular family. A member of the family has money on deposit and the family wants to assist a certain hospital by using some of this money to improve its facilities, but the hospital is saying it cannot touch the account. I can see the point of view of the hospital because it is obviously concerned about legal issues. However, I wonder whether the Department can examine situations in which there is a large amount of money on deposit and the hospital is on a tight budget and cannot improve its facilities, yet it cannot use that money for the benefit of the patient. I know there are not a large number of people in that situation. The Minister of State gave figures for people who have been in psychiatric care for over 15 years, and there are quite a number in that category, so I ask that this issue be considered.
I welcome the Minister of State back to the committee. I listened carefully to what she said in response to previous questions and I am pleased that in policy terms at least, we are moving in the right direction in the area of provision for older people and people with disabilities.
Deputy Colreavy raised the issue of overcharging by some private nursing homes. Has any research been carried out within the Department comparing the cost of nursing home care in the public sector and the private sector? Some of the quotes patients and families are given for long-stay care in private nursing homes seem to be outrageous. Do we have any data of the cost per bed in public nursing homes? That would help us to see whether the private sector is out of kilter.
The issue of step-down facilities was raised by Senator Burke. I want to raise a related issue. We know that many patients in our acute services must wait some time before they get a place in a nursing home, whether public or private. Community liaison nurses do a good job finding places for people, but they are stretched and unfortunately, people end up stuck as patients in acute services. I dealt with three families last week in my own county who had family members in hospital and were trying to obtain nursing home places for them but were unable to do so. In fairness to the liaison nurses, they were trying their best, but the beds were just not there when the patients wanted them. There is an issue of capacity throughout the State and certainly in Waterford, where there seems to be a lack of space. In St. Patrick's nursing home, a geriatric care facility in Waterford, beds have been removed. Another member raised the issue of the embargo on recruitment in the public service; because of this, we could lose more beds, which will result in more pressure. Ultimately, more older people will be in acute services for longer than they should be. How can the Minister of State address that?
I was interested in what the Minister of State said about how NAMA might give us something good in terms of new options for older people and those being cared for in the home. However, we must put that in the context of those who are currently cared for in their homes and whose home help hours are being cut. We all deal with that every single day of the week, as the cutting of home help hours is having an impact. I agree with the Minister of State on the policy - it is the right move - but resources will be important. If we are cutting home help hours and moving towards this new model, it is critical that the resources are there to make sure people get the care they require and that their supports are not cut.
The Minister of State will be aware that the summary of key proposals from the review of disability policy, which was published in 2010, recommended moving towards a model of individualised supports, with State funding allocated based on independent assessments of individual needs. As part of the value for money review, there was a consultation process. Half of those consulted said that people with disabilities should get to manage their own services, but 68% also said they were dissatisfied with the choices and options that were open to them and the control that those with disabilities had over their own lives. That is something that should be factored in when we consider moving towards greater community care provision. People with disabilities should have options and the right to control the levels of support and the options that are available to them.
One of my questions, about public and private beds in nursing homes, has already been asked by Senator Cullinane. What plans does the Department to have to widen the mental health services available in the community, especially for young people? People as young as 14, 15 or 16 years of age are now turning up in their doctors' surgeries with mental health problems, some of which are contributed to by drinking and so on.
With regard to the €35 million that has been ring-fenced for suicide prevention, is there a breakdown of the organisations that will get this money and how the money will be given out, particularly at community level? If the Minister of State does not have that information now, she might forward it to us.
I thank the Minister of State for being here and wish her every success in her wide portfolio. She is responsible for dealing with many areas, some of which need to be tweaked or have problems that need to be solved. She has a mountain to climb, but I am sure that with the staff she has she will succeed at some stage.
As a member of this committee, I do not often get very angry - I am not a person who flies off the handle - but when I listen to people, particularly those who were in the previous Government, sit here and criticise services that the Minister is trying to take out of a big black hole, I wonder whether they have any shame and where they are coming from. Many community services are in that black pit because of bad management. Buckets of money went into these services, but they were not managed properly over the last number of years. The reason we are in the current situation, with the budget having to be cut and each Department being asked to make savings, is bad management, not only within the Minister's office but particularly in the HSE. I get very angry about that.
I would like to say a little about disability services. I welcome the housing strategy that is to be announced by the Minister of State at the Department of the Environment, Community and Local Government, Deputy Penrose, but unfortunately, there are a large number of elderly people and people with disabilities out there in the community living in poor accommodation. In my own constituency, there is really bad accommodation, particularly in flat complexes, with people being asked to climb three or four flights of stairs to get to their homes. Some of these people cannot walk outside their flats to get their messages; people have to go for them. I hope the strategy will deal with this issue.
Although this is probably not the right forum, I compliment Dublin City Council, which I generally find helpful, particularly in the area of grants for people with disabilities and the provision of bathrooms, stairlifts and so on. It must be complimented on that. With regard to footpaths, there is a new initiative to make places more accessible for people with disabilities. I welcome the housing strategy.
I was moved to tears by the recent television programme "Behind the Walls" and realised there have been people with mental illnesses in families throughout the years. There were also people who were just different for one reason or another, were locked up in institutions and never saw the light of day. Some people were locked up for 30 or 40 years. One wonders where we all were, not just the State, when we allowed family members to be put away for so long. It upsets me to think about it. There is a stigma attached to mental illness.
I attended a very sad funeral yesterday morning of a beautiful 35-year-old woman who had suffered from mental illness for most of her life. With continued help from family and friends she had made it to last Thursday until she took her life. I sat in the church and looked at the young people and her colleagues and had to reflect on the fact that even though services were in place something inside this woman meant she did not wish to continue to live, even though people around her saw her in a different light.
There is a stigma about mental illness in the workplace. The young woman was told by her workplace that if she missed any more days of work through illness it would have to consider her position. I am not saying that was the straw that broke the camel's back. When people are identified as having depression they are regarded in a completely different way by their employers. People do not ask to develop the illness.
We need to inform companies, in particular State workplaces, that depression is an illness that is not contagious and can be treated, but people need to be handled very carefully. A family lost a beautiful daughter they can never replace. It took hope from the fact that so many of her friends who had helped her along the way were in the church. We need to emphasise that mental illness should like breaking an arm or a leg and not be treated differently.
I want to refer to the fair deal. Since it was introduced I have found difficult to cope with people visiting my constituency office, in terms of leading them through the jargon and paperwork. I have to put their fears about homes being taken from them aside. The system has been simplified but it could be re-examined. A lot of work needs to be done.
In the past two months beds have been closed in Cherry Orchard and Brú Chaoimhín was closed because HIQA said it was not suitable for older people. I can understand closures due to health reasons. I read in a newspaper yesterday that a planning application has been submitted for Brú Chaoimhín to be refurbished and revitalised for students. Why could the money not have been spent on keeping long-term residents there instead of sending them to Tallaght and other places in Dublin? They were happy living in the heart of the inner city surrounded by their families.
I hope the delegates are still our friends after December. Unfortunately, any organisation in any community is struggling to keep going. I have been very fortunate in my parish to have an active retirement group and many other groups participating in club events, running children's homework clubs and helping young people to advance in terms of self-awareness.
The contribution made by older people - I am in that bracket - such as minding their grandchildren and supporting children is significant. We all know many young people have huge mortgages, therefore two people have to work if they are lucky enough to have jobs. Without the support of grandparents or older people in the community many young people would not be able to survive.
I wish I could say to Older and Bolder and others in the community there will be no cuts in the budget but I do not have a clue what is coming down the road. I hope certain community services are not touched, particularly home health services and keeping people active. Above all, we should make sure that people who participate in activities in communities continue to do so because, as the Minister of State and many others said today, the best thing Dublin and City Council ever did was bring its local offices into communities. It provided a new image of what the council was about and it was a reflection of how services should be based in communities.
If there is any way out of the black hole we are in, it will only be through community services and people in communities lending a hand on a financial or voluntary basis.
I will be as brief as possible. On the difference in price between private and public beds, on average in the private sector the cost is approximately €900 per week and in the public sector, which is a more reliable figure because it is governed by many factors, it is €1,350 per week. There is an upper limit of 15%, 5% over a three-year period. I can provide Senators with the exact details.
The 5% refers to the total assets. There is no upper limit in the total assets which is why people will not sign up to the scheme. Someone who is not able to sign himself or herself-----
I understand that. We cannot tell a person he or she can only have X amount of wealth.
People are not signing up to the scheme because there is no upper limit on what can be charged. I know it is 5%.
The good thing about the scheme is that one has the freedom to sign up or not. I will write to the Senator with more comprehensive information.
Problems are arising where people cannot get into a private nursing home because the level of care they require is not available.
They have to go public.
They have to go public and they cannot get into the public system unless they sign up to the fair deal. If immediate family are not prepared to sign up to the scheme it causes problems. I ask that the matter be examined.
Perhaps we will examine the issue.
The comments on step down facilities are correct. I always thought the phrase "bed blocker" was grossly insulting and it is outrageous to call a person that where there simply are not the types of necessary facilities for people to go to. Such facilities have not been developed in this country and we need to seriously examine the issue.
FÁS runs a training course for handling but it needs to be expanded. We will make contact with the Minister for Social Protection in regard to JobBridge. Not all home helps are provided by State agencies, some NGOs also provide the service. They are all trained to FETAC level 5 and accredited. That is part and parcel of the job description. With regard to the NGOs or voluntary groups who provide the service, we could talk to the Minister for Social Protection about that.
Senator Cullinane asked about personalised budgets. That is the road we are going down, but it is not as straightforward as people might think. It will be about choice. People with disabilities should be allowed choices. Not everyone with a disability would know how to buy a service, what pathways to take or even what service he or she needs. I am not thinking about capacity because I hope capacity legislation will deal with that. We are looking at the possibility of a procurement agency that would work for Government but be independent of it. It would be able to procure services, as the National Treatment Purchase Fund procured medical procedures. The agency might be able to buy in services in a more streamlined fashion on behalf of people who need them. We are thinking along those lines.
I could not agree more with what Deputy Catherine Byrne said. Unfortunately, we will always have a rate of suicide. The current rate is far too high. Something could have been done for many of the people who died from suicide if we had got to them sooner or if they could have reached the available services. Sometimes the stigma surrounding suicide prevents people from seeking help. We must get rid of that. Today's session will help towards that because speaking about suicide out loud is very important.
The contribution of older people is important. We have all been helped by those who went before us. Society would not function without that contribution.
The €35 million which has been ring-fenced for suicide prevention is to put in place multidisciplinary teams in order to deliver A Vision for Change and Reach Out. It is not about organisations. This is separate funding. It will fund specific posts in psychiatry, psychology, occupational therapy and counselling. Nurses will be vital because they are usually the link into the community. The €35 million is specifically targeted.
The quality of the questions asked of the Minister of State was very good. My mother is 85 years old and is in the Dealgan House Nursing Home in Dundalk. The nurses and carers there do a fantastic job. I am a firm believer that nurses and carers have a vocation. They do wonders to make residents comfortable. Fair play to them.
I was under the impression that approximately 500 people per month were admitted to nursing homes. I am shocked to hear that a total of 500 will be admitted between now and Christmas.
Coming from a business background, I find it difficult to understand how nursing home fees are going up, although I heard the Minister of State explain this to a Senator earlier. An increase from €900 to €1,300 does not make sense. I am sure there are people who would be willing to work for less. I am not suggesting we cut back on costs. We must try to admit more people to nursing homes or build more homes to facilitate people who need nursing home care. Can the Minister of State tell the committee what is the average length of time a resident lives in a nursing home?
County Louth is an age-friendly county. An experiment has been carried out in Barrack Street, Dundalk. Sixteen two-bedroom apartments have been built for elderly people. Fifteen of the apartments are occupied and the other is used as a show apartment for visitors to Dundalk who wish to inspect the project. I invite the Minister of State to Dundalk to see this project. We are a nice wee town close to the Border. This is a positive development and I would like the Minister of State to come and look at it.
I thank the Deputy.
I welcome the Minister of State. I am pleased she holds her present position because I know of her absolute commitment to what she is doing. I also welcome the visitors in the Gallery.
The Minister of State's remit depends on society working well and having a strong sense of community, which will help us to tackle many issues. A society that consists of strong communities will keep people sane and able to operate. This means we need to organise our society so that people can continue to interact with each other, whether through organisations or by simply going about their business. This is something we must all think about. Many pressures are driving people towards isolation. We need to counter these pressures continually. The simple fact of people not actually going into a bank to do their banking business means they do not meet other members of their communities. Some apparent savings may not be such in the long term.
The Minister and Ministers of State at the Department of Health are facing a difficult budget. I suggest that the Minister of State discuss with active age groups how best to deal with this difficult situation. That might avoid the type of confrontation which arose between elderly people and the previous Government on the issue of medical cards. There might not be a meeting of minds but when Ministers are upfront with people they generally have a positive dialogue with them. One can see this in the case of the Minister for Education and Skills and one saw it in the participation of the Minister for Social Protection on "The Frontline" last Monday.
When reviewing disability services, I ask the Minister of State to look at the question of children with disabilities moving into adulthood, when their situation becomes more difficult. There are many supports at school level but there is need for more support beyond school level. For example, a parent will need a break from looking after a young person with a disability. Provision for that would help a great deal. Perhaps there are ways in which services can be skewed so that a little more assistance goes to homes at a post-school level.
May I ask a couple of questions about services to senior citizens? Are there any plans to provide that in the future, nursing homes and sheltered accommodation could be located in proximity to each other? It is easier for people who may in the end have to move into nursing homes if their sheltered accommodation is located on the same site because they can then stay in the community they know.
I ask the Minister of State to do all she can to encourage therapeutic activities to provide a stimulus to those people living in nursing homes. This is an issue which is dealt with to a more satisfactory degree in Britain although it is not a perfect solution.
I had the recent experience of trying to find a hotel with suitable accommodation for a person with a disability and it was very difficult. While every hotel stated that services were in place, in fact, very few hotels had suitable accommodation for people with physical disability. It would be useful to have a register giving an accurate impression of what is available.
I will try to be brief in my answers because I know that people may be a little weary at this stage. The 500 people on the list is the complete number. I agree there will be additions to that list but it is not 500 per month. We hope these 500 people will be dealt with before the end of the year.
I agree there is a great discrepancy as regards the cost of nursing home beds and we need to investigate the reason. We all recognise it is probably to do with pay and conditions for staff and this is not a secret. I will illustrate the point by referring to a conversation I had with a service provider who is also a service provider in the UK. He agrees that the cost is an issue but he told me there have been so many cuts that he was concerned as to the people he could employ. There is a balance required. I acknowledge that budgets and funding is an issue for all of us because we will not get more money next year or the year after. However, on the question of the staff employed and how the service is delivered we must always keep in mind a person such as the Deputy's mother. We want the service to be right and we want that sort of home from home atmosphere to continue. If there are so many cutbacks then this might not be possible. This is the balance and we need to be very careful. I heard this from a service provider and it would have been in his interest to have a lower staff wages bill but even he said he was unsure about some of the people available for employment at lower wages.
On the transition from a three-bedroomed house into nursing home care, the housing strategy will provide that flexibility. Housing associations will have to be brought on board as they have the freedom and flexibility with regard to the delivery of housing which is not an option for the State. I note the development of little villages catering for people with low level needs who still require supervision such as an on-call service but who can live independently. Such a form of protected living is vital. The housing strategy will provide this to some extent but housing associations will be a key component. The interconnectivity between Departments will be crucial.
In answer to Deputy Dowds's observations about hotel facilities, in my view we have missed the planning boat as regards people with disabilities and this is not just with regard to hotel facilities. Where were the planners during the boom? Why were houses not built which are capable of being used throughout one's life, from babyhood to old age? Such houses would not be hazardous for any age group and there would be no need to resize doorways or install wetrooms. These facilities were not a planning priority. They would not have cost any more at the time of building. It might have involved a longer building time and perhaps this may not be a bad thing. This type of planning and development will need to be legislated for. The notion that the hotel room for use by a disabled person can be on the fifth floor is not acceptable and does not make sense. We need to see a change of mindset and we must be conscious of the needs of others. Proper planning and universal design is good for everyone and not just for those who need particular facilities. I refer to the Chairman's expertise in the area of disability and I am very conscious that he has experience within his family.
I refer to Deputy Séamus Healy's question which I did not answer earlier. There has never been more consultation and not just with the stakeholders who are usually the people providing the service. We consult with both the stakeholders and the service users. Sometimes service users within a geographically specific service find it difficult to speak their minds because they are at a disadvantage. It takes a person who knows the system and the service to speak on behalf of others. I acknowledge those courageous people who may not be in power themselves but who say how they want a service to be different. I do not for one moment question Deputy Healy's commitment to mental health. However, it is useful at times to step back and to listen to other voices.
I thank the Minister of State and I welcome her to the meeting.
I wish to make a few brief comments.
I will remind the committee that the statistics show the average speaking time of members at today's meeting has been seven minutes.
I will not be anything like that. In the areas of disability, mental health services or services for older people, the policy objective is to keep those people living in their own communities with good quality of life and if possible, living at home, for as long as possible. Unfortunately, my experience is that this policy objective is being frustrated and undermined by decisions of the Department of Social Protection and by the Health Service Executive regarding a range of services which are either being cut back or reduced, such as home help services or fuel services, care assistance services or carer's allowance services. It appears that decisions in these areas are now being made on a financial basis rather than on any other basis. Any discretion previously used is now being exercised to the detriment of applicants. I would hope the Minister of State would take up this issue with the Department of Social Protection and the HSE. I wish to indicate my support for the Mental Health Reform group's pre-budget submission, particularly in the context of some of the areas to which previous speakers referred. The first point made in the submission states:
The Government must ensure that the overall mental health service staffing level is maintained and that funding for posts is preserved at the level of Budget 2011 in order to allow recruitment of staff to reconfigure services towards AVFC [A Vision for Change] model.
The embargo on recruitment must be lifted if we are to implement A Vision for Change.
Unfortunately, I disagree fundamentally with the Minister of State's final point. I am aware of two recent instances where the Health Service Executive made decisions without first engaging in consultations with the stakeholders involved. These decisions were made and announced overnight. That type of behaviour is not good for the service and neither is it good in the context of the implementation of policy because it creates mistrust and a lack of confidence among people.
As the Minister of State indicated earlier, there is a need for a consistency of approach. To be fair, she is certainly striving to ensure that such consistency will become a reality. I thank the Minister of State and her officials for coming before the committee. I welcome the Minister of State's comments regarding the closure of institutions. She is absolutely correct - it is not just a case of changing mindsets, there is also a need to change the existing culture. She has been given a wide brief and she is obliged to deal with people with disabilities, those with mental health issues and the elderly. Given that we are discussing people, there is certainly a need for a consistency of approach. There is also a need to put support structures in place, be these in community settings or wherever.
There is also a need for the HSE to have a consistency of approach. I agree with Deputy Healy that there is no joined-up thinking between the HSE and the Departments of Social Protection and Health. I make that comment as someone who deals with the Department of Health and the HSE each week. There definitely appears to be an issue in this regard. I had intended to pose a series of questions but I will include them in an e-mail to the Minister of State and perhaps she can reply to them at a later date.
I take this opportunity to thank the representatives from Older and Bolder, the Carers Association of Ireland and Cabra community development project who were present in the Visitors Gallery during the meeting. It is important that we should promote the work of this committee and also that of the Minister of State. Part of the Oireachtas's outreach programme is that our work should not be confined to the Leinster House campus but that people from outside should have an opportunity to witness it. As our visitors have seen, the Minister of State spent the best part of two hours discussing issues with members and that she did not merely read out a script.
I reiterate my thanks to the Minister of State. I am aware that she is extremely committed and passionate in respect of the brief she has been given. We wish her well in her endeavours and during her term of office.
I thank the Chairman.
I propose that we go into private session in order to conclude our remaining work.
The joint committee went into private session at 1.55 p.m. and adjourned at 2 p.m. until 11.30 a.m. on Thursday, 6 October 2011.