Seanad Éireann debate -
Wednesday, 25 Apr 2012

Vol. 214 No. 16

Nursing Education: Motion

Senator Colm Burke

I move:

That Seanad Éireann:

requests the Minister for Health in the review of the undergraduate nursing degree to give serious consideration to the proposal that the degree programme should include more training in the area of gerontology, sociology of ageing, dementia and quality of care aspects for older people;

recalls that the review of Nurse Training is due to conclude its findings in September this year and that it will report on (a) the content of undergraduate programmes and (b) the structure of the current degree programmes including the separate points of entry, clinical placement requirements and governance arrangements;

is mindful that Nursing Home Ireland (NHI) has called for increased incorporation of Gerontology into nursing programmes, eg. specifically the sociology of ageing, quality of care aspects and person centred care;

notes that there are specific training courses for those who wish to qualify in the area of psychiatric care which said qualification is recognised;

recognises that there are a significant amount of vacancies in private nursing homes for qualified nurses and that there is a poor uptake of these vacancies by newly qualified nurses;

notes that according to a report published by the All Ireland Gerontological Nurses Association that:

the care needs of residents are becoming increasingly complex which means that a skilled workforce is required;

the relationship between quality of care in nursing homes and factors such as workforce structure are inextricably linked;

most older people in residential settings live with multiple pathologies and the range of medical diagnoses for people currently in residential care is extensive;

recalls that private nursing homes provide care for over 21,000 residents and that there are over 8,000 residential care beds in public nursing homes;

notes that under the HIQA guidelines, each nursing home is required to have a set number of nurses on call depending on the number of patients in residence in the nursing home;

recalls the recently published Law Reform Commission Report on Professional Home Care and is mindful of the findings that:

the majority of people aged over 65 wish to continue living in their own homes for as long as possible;

the proportion of people living in Ireland that are over 65 has been increasing in recent years and is projected to increase at an even greater rate over the next two decades;

notes that the 2011 Census indicates that the total number of people in Ireland over the age of 65 is 535,393;

recognises the urgent need to introduce a streamlined training course specifically for elderly care nursing at all levels so that health care graduates can access the care professional labour market without difficulty;

notes that by taking measures to ensure that there are more suitably qualified carers in Ireland this will reduce the burden of front line services in Hospitals and other primary care units.

Calls on the Minister for Health to consider options of:

that the current general nursing degree programme should include more training in the area of gerontology, sociology of ageing, dementia and quality of care aspects for older people;

introducing a specific Elderly Care (Gerontological) Nursing Degree Course in third level colleges;

that clear guidelines on the codes of practice required for care assistants working in nursing homes be established; and

review how care workers can provide the best care possible for elderly people outside of hospitals.

I welcome the Minister of State, Deputy Kathleen Lynch, to the House and thank her for setting aside time in her busy schedule for dealing with this motion.

Thirteen higher education institutes deliver 44 undergraduate degree programmes in partnership with 57 main health care agencies. This accounts for 1,570 places in nursing and midwifery at pre-registration level. The National Qualifications Authority of Ireland, NQAI, has placed nursing and midwifery undergraduate programmes at level 8, honours bachelor degree with bachelor of science, BSc, as the academic award. Five programmes are delivered at undergraduate degree level. There are degree courses for children's and general nursing with 100 places, general nursing with 860 places, intellectual disability nursing with 180 places, midwifery with 140 places and psychiatric nursing with 290 places. There is no specific degree course designed for elderly care, however. According to the 2011 census, there are over 535,393 people aged over 65 years of age. This will continue to increase and over the next 20 to 25 years this figure will reach over 1 million. The greatest growth is going to be in the age group over 80 and we now need to start planning to cater for their needs.

In the motion I have outlined the difficulty that many private nursing homes are having in recruiting qualified nurses. In August 2011, there were over 500 vacancies in private nursing homes and Nursing Homes Ireland organised a national recruitment seminar to deal with this shortfall. In a survey carried out, it indicated that 61% of the nursing homes surveyed had one or more nursing vacancies while 71% said they would be in a position to offer nursing employment in the next 12 months. Those surveyed indicated they would require 1,364 fully qualified nurses over the following 12 months.

The private nursing home sector caters for over 21,000 residents with a further 8,000 residential care beds in public nursing homes. This clearly sets out the demands that exist and also the urgent need to review current training practices. A review group was established by the Minister for Health, Deputy James Reilly, in 2011 and it is to report to him on or before September 2012. Its role is to oversee the review of nursing and midwifery programmes having regard to the objectives of the health reform programme, the future workforce needs of the health system and the need to achieve value for money. The review is to examine the content of the undergraduate programmes and examine the structure of the current degree programmes, including the separate points of entry, clinical placement requirements and governance arrangements. It will also analyse the number of student places required to ensure sufficient numbers of nurses and midwife graduates for the new patterns of service delivery in the public health system.

This review, I hope, will also take into account the needs of the private health care area and, in particular, the requirements of private nursing homes. It is acknowledged that Irish graduates are recognised as being well qualified and this is evidenced by the number of overseas recruitment agencies which visit Ireland annually. However, those who are involved in the elderly care area have a strong view that there is insufficient exposure to appropriate person-centred gerontology or older-person-specific environments and limited exposure to private health care environments particularly private and voluntary nursing homes. It is the view of some people that the co-ordination of clinical placements and the overuse of public placements, predominately in acute settings, does not provide ample opportunity to prepare graduates for employment in primary or community care settings where the focus is on preventive health care, chronic disease management and palliative care.

General nurse graduates commonly have poor knowledge of the process and elements of medication management to include prescribing, supply, storage, administration, stock control and the disposal of unused or out-of-date medicines. Again, this is predominately due to the majority of clinical placements being acute or hospital focused. I have already referred to the demographic changes that will occur. In addition, the dementia advisory committee report, Creating Excellence in Dementia Care 2012, projects that up to 140,580 people will be living with dementia in Ireland by 2040. These demographic changes in the population of older people and those living with dementia indicate the general nursing undergraduate programme must be adapted accordingly. Many of the people who are already working in this area are of the view that general nursing graduates are ill-equipped in accessing and care planning, recognising and responding to symptoms of dementia and communication with patients who have varying degrees of cognitive impairment.

Having consulted several people who specialise in this area, they have suggested the following changes in the nurse undergraduate programme. It must incorporate more gerontology, sociology of ageing, quality of care and person-centred care. It should include a greater emphasis on mental health conditions, particularly neurological conditions such as dementia. There also needs to be an increased understanding and awareness of the role and function of allied health professionals, such as occupational therapists, physiotherapists, speech and language therapists, etc, to enable rehabilitation needs and potential of residents to be recognised and to continue the delivery of therapies outside of specialist inputs. Those clinical placements should include experience in gerontological nursing including caring for those with dementia and more private and public nursing homes should be utilised for clinical placement. The nursing home care sector is highly regulated and therefore it could be argued that the standard of nursing care in these settings is being monitored and approved on a more frequent basis than in acute hospital settings.

The timing of placements should be carefully examined and, for example, should students have a placement in the care of an older person in their first or second year when they do not have the requisite nursing skills or confidence to engage in the full range of nursing duties? In some cases this can result in a poor experience and contribute to a negative view of nursing of the elderly. It is suggested that these placements should not occur until the third or fourth year of the degree programme. The academic year runs from September to June, thus reducing the time available for placement, so should placement take place during the summer months? There should be more direct monitoring during the internship placement to make sure that students are gaining the maximum experience and that they are not being used as a resource to reduce labour costs.

These are some of the issues which require careful examination in the review of the undergraduate nursing degree programme. It is now accepted that we will require over 2,650 additional nurses in the elderly care area in the next ten years. Now is the time to plan to accommodate the changes that are required in existing training programmes and, if necessary, to develop new programmes of education to accommodate the needs of those involved in the elderly care area. We will need growth in the numbers in the next few years. I thank the Minister of State for taking the time with us in dealing with this issue.

Senator Michael Comiskey

I second Senator Colm Burke's motion on elderly care qualifications. I would also like to thank the Minister of State, Deputy Kathleen Lynch, for being with us and dedicating the time to take this motion in the Seanad. It is very important that our third level education system caters for appropriate elderly care qualifications. There are many other specific nursing courses, including paediatric nursing, psychiatric nursing, midwifery nursing and disability nursing, etc. Given that people over the age of 65 often require specific care needs it would be very timely to introduce an elderly care nursing course.

As mentioned by Senator Burke, there are over 500 vacancies in private nursing homes for suitably qualified nurses. If an elderly care nursing course was introduced it would show potential students that care of the elderly is a viable and rewarding career path and that there are many career opportunities available. Given that there is enormous pressure on hospitals it would be worthwhile to engage in constructive planning for health care education that would be targeted at elderly care.

I have examined the review of undergraduate nursing and midwifery degree submission by Nursing Homes Ireland and I have noted some interesting points. I was struck by the fact that the report indicates "it is felt that person-centred assessment and care planning standards are generally poor throughout the nursing programme". Graduates are ill-equipped to assess psychosocial needs and to incorporate consultation and participation and personal preferences in planning. Furthermore it was highlighted in the submission that the HSE 2012 service plan cites the need to move services into primary care and, where possible, to treat patients in the community, thereby reducing inappropriate hospital admissions. We all agree that it is very important to treat people in their own community and homes.

Nursing Homes Ireland held a specific recruitment seminar focusing on elderly care nursing last August. The organisation has argued that elderly care nursing is a specialty in its own right, and to be a specialist elderly care nurse requires an advanced set of knowledge skills and expertise particular to meeting the complex health and social care needs of older people. Nurses who possess these attributes and qualities need to proudly present themselves as care nurses. The chief executive of Nursing Homes Ireland, Mr. Tadhg Daly, has stated that "we want nurses to be aware that nursing homes are offering challenging and rewarding employment opportunities in their local communities."

It has been previously mentioned that there are over 500,000 people in Ireland over the age of 65. This is a significant proportion of our population and it is imperative that we have skilled nurses in our health care workforce that will be able to meet the demands of elderly care in a compassionate and skilful manner.

Senator Marc MacSharry

I join other Senators in welcoming the Minister of State to the House, as always. I am glad of the opportunity to make a few points. With regard to the ordering of business for the House, we had an amendment but I was late in submitting it. I thought the deadline was 11 a.m. the day before the debate but it is 11 a.m. two days before the debate. I am sure the Minister of State and the Leader of the House would agree that 24 hours is more than enough time to prepare for an Opposition amendment. That is not to pre-empt what will be put forward by Sinn Féin colleagues——

Senator John Gilroy

It is one to be rejected.

Senator Marc MacSharry

——and our side will support their amendment.

Speaking about equipping staff in a way necessary to deal with rising challenges is important, and my constituency colleague, Senator Comiskey, pointed out very well the statistics on the ageing population of Ireland. Approximately 11% of people are over 65 years and interestingly, where Senator Comiskey and I come from, 26% of people are over 65 and the number is rising. I will come back to that issue in a few minutes and particularly how we should consider budgets and plan for the future.

Nobody would ever doubt the Minister of State's commitment to schemes such as A Vision for Change and providing for more care in the community in the mental health sector. I know she is also committed to elderly care, as it must be a priority for us to ensure people can be maintained in their homes for as long as is humanly possible and for all of life if it can be done. I know that is challenging in the face of budgetary restraints on home care packages, and I am sure we will have many political arguments about cuts in that regard and how best to avoid them.

I agree with the training context of the Government motion. It is preferable to have more training but that should be practical rather than driven by content. That is not to say we should be abusing student nurses and medical staff in the way we have been by using them as cheap labour. That is wrong and it is unproductive. If one goes to see a consultant in the mental health sector or across most of the health service, the first person one sees after the GP is probably the most junior of qualified people, such as a registrar. Perhaps it would be better for people to see the most qualified person initially before working back so somebody who is less qualified or learning a trade can apply the treatment as diagnosed and determined by the most qualified person. That is drifting slightly from the subject but it is a point we should consider in the training context. One's training should not consist of being sent to diagnose problems. Experts should be doing this and teaching junior personnel how to deal with problems. We must take that on board with nursing in particular.

As with any profession, nursing has more glamorous aspects, with certain areas being more attractive. Perhaps gerontology and care of the elderly is not as appealing as other areas. People may be able to discuss the metrics of the profession but I would assume gerontology is not the most glamorous area. We may need to do more to incentivise people who are considering a career in medicine to look at this area and make it more attractive for them. I do not know if this can be achieved through resources, salaries, holidays or other conditions of employment.

We support the guidelines and codes of practice referred to in the Sinn Féin amendment. There is not much to disagree with in that aspect of the motion. However, it would be remiss of Opposition politicians not to use every opportunity to raise issues of particular concern. I mean no disrespect to the Minster of State, but throughout society people are questioning where we are going in the health service. It has a huge budget with a significant pay bill, yet services are being cut across the board. Some 178,000 are on outpatient waiting lists which is high relative to the numbers on the lists going back to 2004.

I have mentioned cuts in specific areas which have been applied nationally. This cannot be done because one size does not fit all in the health service, geographically or across disciplines. The Minister must take on board needs in different areas. For example, 26% of the population in the north west are aged over 65 years, yet the funding of services for the elderly in the region is not proportionate. I will have the opportunity to meet the Minister of State with other Oireachtas colleagues following the debate to discuss an issue in my constituency, the Wisdom Services delivered by Sisters of La Segesse at Cregg House in Sligo since 1955. At the request of the State, they have provided services for people with profound and severe intellectual disabilities since. I cannot impress enough on the Minister of State the essential nature of examining cases individually. One size does not fit all. The budget for the Sligo-Leitrim-west Cavan area is €43 million, of which €39 million is allocated for disability services. Historically Cregg House received a large proportion of that allocation. Unless we are prepared to examine its case on an individual basis, it will not be possible for the Sisters of La Segesse to maintain this service. I hope this might condition the Minister of State's thoughts for our meeting later. I thank her for coming to the House and Fine Gael colleagues for tabling the motion, but we will support Sinn Féin's amendment.

Senator John Gilroy

I welcome the Minister of State. I am delighted to contribute to the debate on this important motion and grateful to Senator Colm Burke and his Fine Gael colleagues for giving us the opportunity to do so. It is a wide-ranging motion and I probably have an opinion on every element of it, but I will confine myself to the issue of nurse training. It is appropriate at this time to recognise the important work the nursing profession carries out quietly, diligently and effectively. There are few people in the country who have not had reason to be thankful to the profession at some point in their lives and when one speaks to patients, they all say how lucky they were to have received such good care. However, it has nothing to do with luck.

Behind this pleasant exterior, nursing is not always a pleasant job. People are at their most vulnerable in sickness, following an accident and near death. Even though people always speak about how nice nurses are, there is a professionalism at the heart of nursing that makes Irish trained nurses the most sought after in the world. I spent 27 years as a mental health nurse and recognise how rewarding and challenging the job can be. If we are to do nurses one favour today, I ask my colleagues to resist the temptation of referring to nursing as a vocation. Every time someone uses the word "vocation" in the context of nursing, every nurse in the country cringes. The perception of nursing as a vocation has retarded its growth and development as a profession. It is among the most important professions in the State and it has changed immeasurably since I was trained. A new graduate scheme has been developed, thanks in the main to a few forward looking nurses who realised that the international direction for nursing was to develop a theory and evidence-based graduate course.

Armed with this new outlook, nursing has become a self-confident, vibrant and vital part of the decision-making apparatus in the health service. Today there are nurse prescribers, clinical nurse specialists, advanced nurse practitioners and significant numbers of practising nurses with masters degrees and PhDs. Many of our nurses have higher competency levels than junior doctors who spend six months on the wards with them. Many junior doctors are reliant on the knowledge and experience of senior nurses during their six month placements. To have effected this radical changeover in training pathways for nurses with minimum of fuss or dislocation to services is testament to the capacity of nurses for innovation, adaptation and professionalism.

The motion calls for a review of training opportunities and the creation of a new specialty of gerontology in nursing. Currently, there are five main specialties, if midwifery is included. The others are children, general, mental health and intellectual disability. The basic pathway in training is diverse and equips newly trained nurses with the full range of skills necessary to practise in a wide variety of settings, which include full competency in the care of our ageing population. The types of morbidity encountered in caring for older people are not unique to them and the specialty of general nursing is well adapted to care for this cohort. Allied to this is a wide number of postgraduate specialties which include gerontology, care of the elderly and other associated disciplines. I am a little concerned that the call for a review of nurse training is being considered in the context of staff shortages in the private nursing home sector. Perhaps the shortage might be better addressed by examining the reasons highly trained professionals are not taking up these positions such as pay and conditions, professional autonomy, workload, skills mix and employers' expectations.

Every nurse I know favours improvements in nursing education. Notwithstanding the ministerial review under way, I wonder whether it is appropriate to call for changes to be made to a system that has served and is serving communities, even with a shortage of staff in private nursing homes. We would be better off examining the issues I have outlined. I am not sure the industry would call for a change to the training of other health care professionals such as doctors, for example, in response to industry shortages. Other issues should be examined first. Last year when services faced a staffing crisis with regard to medics, there was not a single call for changes to training, but all efforts were made, including the introduction of emergency legislation in the House, to facilitate the recruitment of more doctors.

A great number of measures can be taken to ensure there are sufficient nurses in the State. Each year more of our newly qualified nurses leave the country. Therefore, instead of calling for a levelling out in the quality of nurse training, we should look to improve their career pathways by expanding nursing roles to include more clinical nurse specialists, nurse prescribers and advanced nurse practitioners and perhaps remove from nurses some of the duties now not considered to be part of core nursing duties. The expansion of the skills mix is an important step in achieving this, but I worry sometimes that the role of nurses is becoming more and more absorbed in managerial and non-clinical duties.

I thank Fine Gael for giving us the opportunity to discuss this important issue and hope that in the current difficult economic climate we will retain and expand the vital role played by nurses in the health service.

Senator Sean D. Barrett

I thank Senator Colm Burke for tabling the motion. I welcome the Minister of State, as I always enjoy listening to her when she addresses the House.

According to the Department of Health's key trends, 35,993 nurses were employed in the health service in 2011, an increase of 7.8% compared with the figure for 2002. The OECD Health at a Glance report points to a large complement of nurses in Ireland. I am surprised that the ratio is 16.5 per 1,000 of population compared to 4.5 in the United Kingdom, 8.3 in the United States and ten generally in the OECD. Nurses are, therefore, a major element of the health service workforce.

Senator John Gilroy outlined his experience of working in the sector, which was interesting. I asked people in our health section what they thought of the motion and they supported it in the context of nursing education. They say that the work in gerontology should include nurses who tend to people in their homes and also nurses who come from abroad. The international nurses may not have this qualification but the qualification is seen as eminently desirable. As stated in Senator Burke's motion, they would like those who would not have had this opportunity to obtain a postgraduate certificate. It would be useful for those qualified as nurses to have a postgraduate qualification in this area.

I am sure the Minister of State is aware of what is called the red herring argument to the effect that health service budgets do not necessarily have to increase because the population ages. There is much literature on that issue, disputing the previously commonly held view that as the population got older, the health budget would inexorably increase. Even taking both sides of the argument, the issues in the motion are important in that we need to ask how we look after old people in the best way possible at a time when resources are constrained. Recently, I saw a book in the Brookings Institute, Can We Say No? The Challenge of Rationing Health Care. It states the cost could take up the entire GDP. We will not do that, but neither do we want people to be ill unnecessarily.

In addition to the care the motion implies, we should consider later retirement age. How many old people do we know who deteriorate rapidly when they are forced to retire? They want to work as that is where they relate to people socially and form friendships. Does retirement cause some of the problems?

When I visit nursing homes, I am caused to worry about institutionalisation and the dehumanising of the people there. Can we have half-way houses, provide people with more services in their own homes and develop care in the community to enable them keep their independence? All the studies show they want to be independent and have the visitors Senator Burke's motion implies but not to be placed in an institution. It is clear from the Milliman report that we tend to institutionalise. It estimates that VHI keeps people in hospital for 11.6 days for a procedure which they think should be 3.7 days in other countries. That is expensive, costing approximately €1,000 per night, and is probably bad for the people. There must be new ways of looking after old people in a way that is based on what they think. I am aware the Leader has dialogues with people outside the House on what old people want. They want the care set out in the motion, and many want to retire later and live in their own houses for as long as possible.

Having put all those issues together, it is a good idea to review what is in nurse education. There is a view that there are too many places providing qualifications in nursing and that is unnecessarily expensive. Perhaps some rationalisation is possible. I look forward to reading the review when it becomes available in September.

We must remember that Louis le Brocquy, who died today at the age of 95, was painting Bono's portrait just a few years ago. He remained young at heart for very long. The red herring school says we do not have to resign ourselves to putting lots of old people into hospitals and leaving them there for many expensive and probably unhappy years for them. Everything Senator Burke has put before the House is well worth considering. I thank the Minister of State and look forward to hearing her address later.

Senator Cáit Keane

I commend the motion to the House. The discourse around older people and care of our elderly citizens is one of the most important in the health care system. We must recognise their enormous contribution to society and it is the duty of the State, therefore, to ensure public policy reflects the needs of older people and is underpinned by the need to protect the health services required by them and ensure they are second to none.

The motion calls for some changes that must be considered by the Minister of State in respect of the care and approach to care of the elderly by nursing professionals and care assistants in and outside the institutional context. The recent Seanad Public Consultation Committee report on the rights of older people found that:

Medical advances of the past twenty years have extended life expectancy significantly across all first world countries. That extension brings with it an urgent requirement, not just to plan for the needs of older people, but to recognise that new needs will emerge because people will be living longer.

That is a new need that must be recognised in the gerontology training of nurses.

When people live longer, they encounter more medical and health problems. Public policy objectives must ensure older people have fair access to health services and people are adequately trained to provide those services and facilities. As the nursing profession and care assistants deliver care to elderly people, apart from family members, it is paramount that practices and approaches to this care-giving are analysed and reviewed regularly. As stated in the motion, the care needs of the elderly are ever-changing as patterns of life expectancy change. As the life span of older people extends into years not experienced by previous generations, a minority are affected by illness and disabilities associated with ageing that require special care. That special care needs to be catered for in training.

The motion is timely as the health care system is undergoing significant reform with a focus on patient care and patient safety. This review aims to build on the excellence of the current nursing and midwifery programmes in place. We acknowledge that and the work being done by the nurses and care-givers who provide the services and deliver health care to meet changing patient needs.

The review group is due to conclude its deliberations in September this year and make findings on undergraduate programme content and the structure of current degree programmes. The motion is timely in that it can feed into the review process. Following the submission of the review group findings, the Department and the Higher Education Authority are to lead any changes required in the delivery of nursing and midwifery programmes within the higher education system.

Nursing Homes Ireland made a submission to the Department in January as part of the review on the nurse training process. It states there is insufficient exposure of nursing students to appropriate person-centred gerontology and limited exposure to private health care environments, especially private and voluntary nursing homes.

Gerontology is distinct from geriatrics which is the most universally acknowledged brand in medicine that deals with diagnosis and treatment of disease and problems specific to the aged. This is different from the scientific study and analysis in gerontology which includes a whole sector of care for older people. Nursing Homes Ireland has stated that while general nursing graduates have many strengths in terms of academic and clinical knowledge, they are lacking in person care assessment and care planning skills, are ill-equipped to assess psycho-social needs and to include participation and personal preferences in care planning. Members will, no doubt, have read an article in The Sunday Business Post last week on care of the elderly. I am citing Nursing Homes Ireland because it is a body that deals efficiently with care of the elderly. It believes that not enough time is spent in older person specific environments by undergraduate general nurses and, instead, the internship-practical elements of the degree are overly hospital focused. This must change. We are all aware of the benefits of practical training in the field. The result is nurses who are ill-equipped to provide the required care specific to older people and a lack of newly qualified nursing candidates to fill vacancies in private nursing homes.

A new kind of care for people with dementia involves a homely environment where staff take the butterfly approach, being colourful, capturing attention and creating moments of attention. This type of care, as set out in The Sunday Business Post, is being implemented in some nursing homes in Ireland. It is an approach that encapsulates gerontology and encompasses the person as a person rather than a sick, elderly person. The type of care is distinct from the type of care delivered by nurses in a hospital setting and is based on the idea that people with dementia have become primarily emotional beings.

The nursing syllabus needs to be amended to include more gerontology input dealing with the sociology of ageing, quality of care and person-centred care. There is potential to establish a course that would specifically cover elderly nursing care similar to the specialised psychiatric and intellectual disabilities courses on the CAO course list.

To use one example from the UK in regard to gerontological care, in Scotland, the nursing of older people has been perceived as having a lower status and participants reported in that survey that a positive reframing of gerontological nursing was needed. The same would hold true for Ireland if a survey were conducted here. A description and underlying principles were developed by nurses and used as a lens to shape best practice statements. A description enables a person-centred enabling approach to evidence-based gerontological nursing.

In Sweden a survey was carried out and among its findings were that psychosocial theories of ageing covered different aspects of the ageing process but did not address crucial issues regarding the attitudes and structures of good nursing care. These theories provide no clear guidance on how to care for older people or how to support them in the ageing process. However, the analysis showed that the theories contained underlying values that influenced society and staff as regards their views on the ageing process. Nursing interventions to support ageing will be quite different depending on the theoretical perspectives given at training and taken by nursing homes in general.

I commend the motion. It is very important that it is incorporated into any further training to be developed for nursing homes. It should be incorporated into the national strategy for the elderly. The Minister of State might make a statement on that issue because Older and Bolder, the co-ordinating group for all the agencies for the elderly, is most anxious that the national strategy be progressed. The spirit of the motion could be incorporated into that strategy.

Senator Mark Daly

I wish to share time with Senator Ó Domhnaill.

Acting Chairman (Senator Catherine Noone)

Is that agreed? Agreed.

Senator Mark Daly

I welcome the Minister of State to the House to discuss this important topic. I will not discuss all the issues listed on the motion because there are many.

We are concerned about the closure of community hospitals. There is one in my town of Kenmare. It might be the last hospital built for a decade and is a new 40-bed hospital. Given that some 900 beds in community nursing homes are being closed this year alone, 40 beds are a drop in the ocean. Privatisation appears to be happening. The Minister of State spoke on radio this week about the fair deal scheme and its problems.

No system is perfect on the first day it is put in place. Sometimes things do not work the way they were intended or the way we thought they would and therefore have to be re-examined, not just because of the changed economic climate but because the number of families signing up to the property element of the scheme is not the same as what was planned. Nonetheless, we are concerned that 1,000 elderly people will lose their home helps. As we all know, it is much cheaper to keep people in the community in their own homes and proper care packages should be in place. A cut of 630 beds means an increase in waiting times for the fair deal scheme. Many people are on a long waiting list which is not as it should be. People are sitting in hospitals taking up wards in acute care centres. People are left waiting for operations they badly need.

I know the Minister of State's views on privatisation by the back door, which we are concerned about. I know from her background and beliefs it is not something with which she agrees. We are closing community hospitals, as we have seen in Abbeyleix and other areas. If community hospitals are closed it is up to the private sector to look after nursing homes. HIQA has outrageous standards for nursing home centres. We need adequate standards but we do not want private nursing homes which are providing excellent services being closed down. Is privatisation by the back door happening? When will we have clarification on the fair deal scheme?

Senator Brian Ó Domhnaill

The issue of nurses providing care for elderly patients is something which is important to everyone, particularly the patients and their families. The care being provided across the public hospital sector in this country in community hospitals and regional or general hospitals is second to none. The care being provided by nurses is excellent. Very often they go far beyond the call of duty in the delivery of services. I support any efforts made by way of review or otherwise to provide nursing staff with additional educational advancement to allow them to fulfil their duties in a more appropriate and meaningful manner, if that is possible because of the work they already undertake. I would not question the quality or quantity of the work they are undertaking.

On the broader issue of care in the community for people who require it, in private nursing homes or at home, at all times we should try to advance, as far as possible, the life of the person in his or her own home. That can only be done through packages such as the carer's allowance, home support packages and home helps. Unfortunately, the funding for some schemes has been greatly reduced. It is not exclusive to this year; it happened in previous years. This year home help hours are being reduced.

The Government, irrespective of which party is in government, needs to take stock of the financial decisions it is taking to cut packages to keep people at home. Housing grants, which allowed people to stay at home longer, have been cut. The cost to the State of having someone in a public nursing home is at least €1,300 or €1,400 per week and perhaps more. The care provided by carers at home who receive the full rate of €200 per week is a no brainer.

Carers and home help provision should be supported. Today we met representatives from the Centres for Independent Living. They are very concerned about the cuts of at least 3% to the PAs and the constant reviews they and Centres for Independent Living are under from the HSE. They are living in fear. We met people today who are so disabled they would draw a tear from a stone. I ask the Minister of State to make sure there are no further cuts imposed on people who are making a genuine effort to continue living in their homes.

There is an argument about nursing homes. The Government is progressing with the cuts to 800 to 1,000 nursing home beds under the HSE service plan this year, which is very wrong. To force people to be unable to continue to live in their homes through cuts to packages which are important to them is very wrong.

Senator Mary Moran

I thank Senator Colm Burke and the Fine Gael Senators for tabling the motion. I welcome the Minister of State back to the House. She is always very welcome and I look forward to hearing her speak.

I looked through the syllabus for the BSc degree programme in general nursing in UCD, which is over four years. In second year there is a module called "nursing the older adult and other populations" which is studied for a couple of hours a week for one semester. It is not an exclusive study of the care of the older person but also includes the study of persons with altered mental health, others in the community, children, mothers and babies and adults in the perioperative period.

In second or third year the student nurse undertakes a clinical placement for about six weeks in a care of the elderly setting. Out of a total of four years study in clinical placement, it would seem only a small proportion of time is spent studying the area of gerontology in proportion to the total amount of time spent in nurse education. We need to examine this. It is clear from the available statistics that there is a great need for nurses who are qualified in the care of the elderly. Nursing Homes Ireland, the representative organisation for the private and voluntary nursing homes sector, ran a recruitment event last autumn. Before the event it stated there were at least 500 nursing vacancies in private and voluntary nursing homes, with some homes finding it very difficult to recruit nurses, particularly newly qualified nurses.

Why is this happening in these economic times? A nurse working in a nursing home specialising in care of the elderly will have to deal with patients with a wide range of disabilities and medical conditions, usually without the assistance of a doctor on site. There will often be only one registered nurse on duty at night, with responsibility for up to 50 patients, assisted by care staff. Not only this, they are also expected to carry out other duties such as washing dishes or cleaning, apart from their nursing duties. This is a challenging prospect for an experienced nurse, not to mention someone who has just come out of college with little experience of the discipline.

In view of the fact the number of people aged over 65 has increased by 7.3% since 2002, there are now over 500,000 people in that age group in Ireland, and almost 30,000 residents of private and public nursing homes. The demand for nurses and care assistants in care of the elderly is set to increase and there is an urgent need to attract qualified personnel into the discipline. There is a lack of dedicated undergraduate nurse education in gerontology, compared with paediatrics, intellectual disability, psychiatry and midwifery. Thousands of elderly people are being cared for in nursing homes and community hospitals by nurses who areprofessional and dedicated, but who are unlikely to have a specific qualification ingerontology.

We also need to look at why there are so many vacancies for nurses in nursing homes at a time of high unemployment. Is there adequate remuneration for these nurses? What are their possibilities for promotion? Are there opportunities for professional development? What are the staffing levels and why are the staffing levels in private nursing homes much lower compared with the staffing levels in public hospitals? With the embargo on recruitment in the public sector, why is the private sector not attracting more nurses?

I urge the Minister to examine closely the review of nurse training due out in September and, in particular, to question the current situation regarding education in the care of the elderly. We are all agreed we owe it to our senior citizens to ensure they have the best possible care when they need it.

Senator Tony Mulcahy

I welcome the Minister of State, Deputy Kathleen Lynch. It would be remiss of me not to comment on a remark made earlier by Senator MacSharry, who is no longer present, in regard to those with intellectual disabilities. I am on the record as having stated in the past that fine budgets are handed to intellectual disability groups up and down this country. Perhaps they should look at managing those more effectively and we might have a better service for those in care and in day services. We will come to that, however, and the Minister of State has outlined to me that we will have a report on value for money in a couple of months.

I wish to read an excerpt from "The role and contribution of the registered nurse in residential care settings for older people in Ireland: A national study", in which 200 nurses took part, as it is important to put it on the record of the House. It states:

Older people living in residential settings have highly complex care needs. The high complexity of care need in the population currently living in residential care is a strong theme in all the [...] group discussions [that took place]. The older residents are identified as being mostly 80-100 years old with frailty and ‘a plethora of ageing issues' including medical and surgical problems. Most need help with many aspects of their health and daily living, including care for nutrition, skin integrity, fluids. A large proportion have ‘little mobility'. Many residents currently have some degree of dementia and-or are unable to communicate.

Most older people in residential settings live with multiple pathologies and the range of medical diagnoses for people currently in residential care is extensive. Those mentioned in the focus groups include: cerebral vascular accident (CVA), all forms of dementia, cancer, Parkinson's disease, multiple sclerosis, hypertension, peripheral vascular disease, leg ulcers. . . Friedreich's Ataxia.

‘The complexity of care has been greatly increased as people are living longer. The type of residents we are getting are the older old. They are sicker and sicker . . . five medical conditions is not unusual'. . .

‘People live after strokes now so get other things, whereas years ago they would have died from the stroke'. . .

It is important to put the current position in context. I have spoken with the Minister of State in the past and have great confidence in her. I also compliment Senator Colm Burke for putting forward the motion. We have a very difficult job, with funds being short. It is critical we put measures in place to deal with the increased numbers of those in need of a service. I agree with Senator Burke when he says a care of the elderly module must be part of the training programme for nursing students.

Senator Ó Domhnaill raised a good point. I do not see any reason this area could not be integrated into supporting the home care service for the elderly and we need to consider this.

We are short of funds. It is not a matter of firing money at the problem and we have to come up with some other solution in trying to deal with this issue. I support the motion and ask the Minister of State to consider it and the points I have made.

Senator John Crown

I add my welcome for the motion. There is a need for vigorous debate about the way we care for the elderly. I welcome the Minister of State's presence and her attention. I am a gentleman at heart so I will not say what I normally say when Ministers come in and we discuss age-related issues. I have been known to quote the age of some of the Ministers coming in and to inform them that if they were working in the health service, they would have had mandatory retirement. That is to make the point, and I am sure it does not apply in the Minister of State's case. She has a long way to go.

The reality is we need to have a fundamental rethink of how we, as a society, handle the ageing process. It is a given there is a large body of very serious thought about the way we handle birth and that we have to stop abnormalising birth. Although I must admit I have some reservations in some cases with respect to home birth and so on, we have to regard birth as part of the normal life cycle.

Ageing is the same. Everything about ageing is not just medicine, health, decline and decay. There are many other aspects to ageing to which we need to give a focus. That is why I will get in my little dig here, namely, as I have said, we need to have a real and serious look at the antiquated notion of mandatory retirement at the age of 65, or at any age.

We should consider that the laws on mandatory retirement and pension policy were effectively drawn up by Bismarck in 1870, at a time when the average age of death in Germany was about 44 and where the average person who lived to be 65 lived between three and five years longer. We now know that somebody who lives to be 65 in a western country like Ireland will on average live approximately 20 years longer and, of course, will live with better health than would have been the case in those grimmer times. There is not only a social and medical but also an economic imperative for us to look at this notion of mandatory retirement.

To move on to the specifics of the motion, I welcome and urge implementation of an increased curricular emphasis on gerontology, geriatric medicine and nursing, and care of the elderly. This is critically important not only in nursing care but also in medical care — I believe it is fundamental. My colleagues in their carefully crafted motion have used the precedent of psychiatric nursing, which has followed a somewhat unique model in the sense that at the time one starts one's first day of nursing school, one is either designated to be studying psychiatric nursing, adult nursing or children's nursing, whereas in other areas, such as sub-speciality diplomas or, indeed, in the big area of midwifery, people do general nursing first, get their degree and then go on to a postgraduate qualification. I believe that is the way gerontological or geriatric nursing should be structured. It would be a real mistake to separate it off from the first day in college as a separate degree course. It should be something people do at a more senior, diploma or master's, level.

The way to make those courses attractive is to follow what has happened in oncology, namely, to make the possession of that course mandatory to work in the area. In oncology, strict rules are drawn up about the number of trained oncology nurses that have to be present to give recognised cancer care. The same should apply in specialised units for the elderly. It should be mandatory, especially for those in nursing leadership positions, to have postgraduate qualifications. That is how these qualifications attract esteem and how to attract more people to these positions.

There is a difficulty in recruiting staff to work in this area, but it should be acknowledged that it is a difficult area in which to work compared with other areas of nursing. A special skills set is required to work in the environment and with people who, as my colleagues have stated, often have complex medical and social needs. There are other issues of physical and mental decline which make it a challenging working environment. We must devise ways to encourage people to take up such positions. More generally, we should consider the negative effects on morale in nursing. Nurses are forced to do many jobs for which they are overtrained. It is important that the skilled and professional aspects of nursing are held in esteem. Part of the esteem building process involves bringing in more people at the level of nursing assistant and care assistant, etc. who, under the guidance of an expert, trained and experienced nurse, can in a competent and compassionate way do much supportive work. This would free up nurses to undertake the more professionally demanding parts of their job in terms of medication supervision, social interaction and so on.

I commend the motion to the House and call on the Minister of State and her colleagues to consider it carefully. We must increase the attention we give to the care of the elderly in Ireland in graduate nursing courses. We should develop specific postgraduate courses in care of the elderly at either diploma or Masters degree level. However, the Minister of State should think carefully before embarking on a policy of having separate primary degree courses. I am unsure whether that would be the right way to proceed.

I wish to emphasise one lesson learned by doctors who work in specialist areas. In many cases, regardless of the specialist area involved, the specialist nurse is usually the most competent person to advise and guide a doctor rather than the junior doctors in training. This is said with no disrespect to the junior doctors in training, as they are there to train. We should make an investment which would be good not only from the point of view of health care but which would also make great economic sense. We should expand the grade of advanced nurse practitioner who can perform many of the jobs doctors currently perform and can do so just as well and as competently as they can.

We hope to hear back from the Minister in the coming weeks on an unrelated issue, that is, the legislation due before the House to amend the smoking Bill to extend the ban on smoking to cars in which children are travelling. We expect to receive enthusiastic support from the Minister for Health and the relevant Ministers of State on this issue.

Senator Trevor Ó Clochartaigh

I move amendment No. 1:

To delete all words after ‘‘hospitals and other primary care units'' and substitute the following:

notes that recently published waiting lists show that waiting times for orthapaedic and opthalmology services are among the longest, a fact likely to have significant repercussions for care of older people;

notes with concern that the HSE national service plan says that up to 898 community nursing homes are to be closed in the coming months;

notes with concern that the loss of an estimated 3,500 workers in the health care service due to retirements following the public service early retirement scheme will have a significant and likely damaging impact on the quality and scope of delivery of front-line services throughout the country and, in particular, the care of older people; and

condemns the Government's cuts to health care funding, amounting to €750 million, announced in the national service plan, which will likely damage the delivery of care services for older people, including cuts to home help hours.

Calls on the Minister for Health to consider:

that the current general nursing degree programme should include more training in the area of gerontology, sociology of ageing, dementia and quality of care aspects for older people;

introducing a specific elderly care (gerontological) nursing degree course in third level colleges;

that clear guidelines on the codes of practice required for care assistants working in nursing homes be established;

reviewing how care workers can provide the best care possible for elderly people outside of hospitals; and

ensuring that the 2011 level of beds provided in nursing homes are retained and that the 2011 level of home help hours be maintained.

Cuirim fáilte arís roimh an Aire Stáit, is deas é a fheiceáil ar ais anseo. Ba mhaith liom an leasú atá againn a thairiscint go hoifigiúil agus treaslú leis an Seanadóir Burke. Tá rún an-mhaith curtha le chéile aige, tá sé an-chuimsitheach agus tá go leor sonraí ann, agus tá ard-mholadh ag dul dó as an méid sin a dhéanamh. I commend Senator Colm Burke and his colleagues for putting together the motion which is both good and detailed. We support all that is included in it, save the end of it.

I note the expertise Senator John Gilroy brings to the debate. I imagine he has found his experience useful in some of the other debates held in the House. It is good to have people with such experience participating in such debates.

We recognise all that is good in the motion. However, I prefer the amendment brought forward by Sinn Féin. We support much of what is included in the motion, but it is ironic that it has fine aspirations but neglects to recognise the reality of care provision for the elderly. I have no wish to be negative, but we must recognise the reality.

The Government has a poor record on care for the elderly. Such provision has been hit hard by successive Governments. Much of the time they have abdicated responsibility to private groups and families. While credit is due to families for the remarkable efforts made by them in caring for elderly relatives, where the State is not providing an adequate level of care standards will suffer. I agree with the remarks of Seanadór Brian Ó Domhnaill and other Senators who have recognised the remarkable work done by all those involved in the caring professions, especially nurses. They do a remarkable amount of work which should recognised by Members on all sides of the House.

The first obvious example of when Government policy on care for the elderly went awry was in May 2011 with the suspension of the fair deal programme. This caused considerable concern and worry for many people and their families. It was a deeply regrettable episode. While I accept the programme was resumed — a great relief to many — it did not augur well for the Government. In fact, things got worse. The HSE national service plan for this year states up to 898 community nursing home beds will be closed. This will probably include a number of beds in a home in my constituency, namely, St. Francis Home, although we are running a strong campaign to try to ensure the decision is reversed.

We were disappointed recently following a meeting with the powers that be in HSE West. A delegation from St. Francis Home met the Minister for Health, Deputy James Reilly. The local Oireachtas representatives were also present at the meeting. We were given a promise by the Minister that the decision would not go ahead without a review being held. At a recent meeting with HSE personnel we were informed that the decision would go ahead. We were most disappointed by this. I urge the Minister of State to approach the Minister to have the matter reassessed, even in the context of the motion. St. Francis Home is the only community facility available to people living in Galway city. The Independent councillor Catherine Connolly has done an amount of work in the campaign, as have those involved in St. Francis Home. This issue affects other places also, including the nursing home in Crooksling, Abbeyleix, St. Felim's in County Cavan and others.

It is well and good for the Government to refer to codes of practice and the education of nurses. These are important, but there is only so much they can do to compensate for a wholesale loss of beds in nursing homes. As Minister is aware, traditionally the sector is chronically underfunded and the Government has done no better than any of its predecessors. It has been shown that the State, through the National Treatment Purchase Fund, has negotiated unfavourable deals with private providers. Money has been wasted.

Things are not much better in hospitals. Recently published figures show that orthopaedic and ophthalmology waiting lists — largely for cataract-related procedures — are among the longest. These services are most likely to be availed of by the elderly. Therefore, they are facing some of these long waiting times.

When the time comes for elderly patients to leave hospital, it is often not possible for them to leave owing to the complete lack of appropriate convalescent, respite and step-down care facilities. This has added to the problem of the highly inefficient use of acute hospital beds. The Government's inability to address the issue has meant that so-called bed blockers, through no fault of their own, are unnecessarily occupying hospital beds at the expense of other needy patients. All the while the waiting lists lengthen and the quality of care disimproves. Surely, this calls into question the decision to reduce the number of community nursing beds. The Government's approach has been entirely wrong.

What happens when patients return home? There is no question but that there is an army of relatives and friends who do a wonderful job in caring for elderly relatives and they are assisted by many committed and caring home workers. However, the Government is making things even harder at home. Seanadór Brian Ó Domhnaill alluded to this. The number of home help hours will be cut this year by 500,000 compared with the figure for 2011, further depriving older people of much needed support and care.

None of this has been helped by the loss of so many staff under the public sector early retirement scheme. It has also been compounded by the recruitment embargo. On the idea that more can be done for less — this is what is being asked of health care workers — this is simply not possible. These changes will impact on front-line staff.

There is much in the motion with which to commend it. We support the references to gerontological modules and specific courses. However, they should not amount to another barrier to prevent people from working in such places. The proper standards should be observed. We support the setting of standards of care for care assistants and agree with many of the observations made in the first part of the motion. It would be remiss of me, however, not to note at least that the care for the elderly sector is in less than full health and the Government must take more responsibility for some of that, especially the reduction in the number of workers and the loss of beds and home help hours. I call on the Minister of State to examine those matters.

I welcome Senator Keane's comments on the public consultation that took place in the Seanad, which was a positive engagement, but I was disappointed with the report published because it did not call on the Minister of State to publish her national positive ageing strategy. We met the Older and Bolder organisation recently. Will the Minister of State to give Members a commitment in this debate that the national positive ageing strategy will be published and launched before the end of the year? It is important. We do not want to hear it will be launched at some stage. It should be launched before the end of the year.

I concur with Senator Ó Domhnaill on the cuts in the number of personal assistants, PAs, highlighted by the centres for independent living. Táim ag cur chun cinn an leasú seo mar sílim go dtugann sé léargas níos cruinne ar staid an altranais faoi láthair. Tréaslaímid leis na Seanadóirí a chur an rún chun cinn, ach caithfidhmid bheith réalaíoch faoi céard atá ag tarlú i ndáiríre sa réimse seo.

An Leas-Chathaoirleach

Will the Senator confirm he has formally moved the amendment?

Senator Trevor Ó Clochartaigh

I formally moved it as Gaeilge.

Senator Kathryn Reilly

I second the amendment. I will be brief. When I was in college I took a regulation course. An area I examined and on which I wrote one of my assignments was nursing home regulation in the United States and Australia. I found the difference was in the standards used. A rules-based approach was taken in the US which was clinical, detailed and by the book. Everything was written down, including temperatures and so on, whereas Australia had a standards-based system. They took a more broad approach and said there had to be a home-like environment. The studies done found there were better standards and quality of care in Australia. That is an area we should examine in terms of the way we train nurses and treat our care workers, not just for the nursing home environment but also when we examine the issue of home care. That is important, and the motion stresses the importance of home help hours.

In terms of the care we must provide for the elderly, we are giving them holistic treatment but they are not patients. They are people. When I examined the Australian experience I was struck by the fact they said people should have a home-like experience in nursing homes.

In terms of some of the figures that stand out in the motion, there are 21,000 residents in private nursing homes and 8,000 residential care beds. That does not include all the elderly people being cared for at home who are fortunate to have family or friends looking after them. That is reflected in the Law Reform Commission report which states the majority of people over the age of 65 wish to continue living in their homes for as long as possible.

We have proposed an amendment but we also support aspects of the motion, especially the reference to more training in the areas of gerontology, the sociology of ageing, dementia and quality of care in the nursing degree programme, because it is critical we are not just providing the basics in terms of care. It can no longer be that kind of exercise. We must ensure we provide a high quality of care and people enjoy the best quality of life from cradle to grave.

Senator David Norris

Unlike the previous speaker, I have never written a paper on the comparison of nursing services in different countries and lack the expertise of some of my colleagues on both sides of the House who have direct experience as professionals in the area. As a politician, however, I have frequently raised health issues, as the Minister of State is aware. I want to raise specific issues in this debate but I will preface my contribution by making some general remarks.

I was very moved when I heard my colleague, Senator Barrett, refer to the death of Louis le Brocquy, one of Ireland's greatest artists and, I am proud to say, an old friend of mine. His wife, Anne Madden, who is also an extremely distinguished painter, organised a rota of people to keep him company on this journey towards his end. One should salute her as being representative of the many carers within families who are prepared to make that extraordinary sacrifice. I felt I should say that preparatory to whatever else I say in my contribution.

I listened with great interest to what Senator Crown said about getting older being part of the natural process, and he mentioned home birth. That is an interesting area, although there are certain problems with it which were examined in legislative terms in the previous session, a job which is not finished yet. Ageing is a natural process. I know that. I am nearly 68 and I have got to the point where I am proud of being old.

Senator Trevor Ó Clochartaigh

The Senator does not look it.

Senator David Norris

I tell people I am nearly 70 because it brings forth wonderful comments such as that I am marvellous for my age, but it is a natural process.

We often see in nursing homes large rooms with people drooling in front of a loud television set. What they lack is stimulation and the kind of proper care about which Senator Barrett and Senator Crown spoke. People quickly regress when they are old if they are not given that kind of treatment.

One of the most significant points made by Senator Crown was that the inclusion of people with professional expertise in this area should be a requirement because that would heighten the respect. The motion states the current general nursing degree programme should include more training and so on, but that must be more specific. We must consult directly with the nursing schools in the universities. There is one in Trinity College. It is located in a most wonderful building, one of the three greatest buildings from the Art Deco period, which is the old Gas Company building in D'Olier Street. They do fine work there. We must take into account also the profession, the hospitals and the academic nursing programmes. Introducing a gerontological nursing degree course in third level colleges would also be welcome.

I have sympathy with what was said by my colleagues in Sinn Féin. I do not believe they will put it to a vote because their amendment is close to the motion, and in any case they do not have the numbers. They will be asked to stand but they will not have the numbers and, therefore, I am sure they will be content to accept that the Minister of State will take into consideration what has been said.

To be parochial, although the son of an Englishman, I am essentially a midlands person and I raised with the then Senator John Paul Phelan a situation in Bethany House in Carlow. I advise the Minister of State to be suspicious of the Health Information and Quality Authority, HIQA, because places are being closed for the lack of a lick of paint. I know that, and Bethany House is one of them. It is very disturbing for elderly people to be moved.

I am not a natural hospital candidate. I do it, not off the top of my head but when there is clear, factual evidence. I raise the question of Valentia hospital. I was visiting a friend, Bob Joyce, who is with me here today, who has a house in Valentia. The local people came to see me and asked me to get involved with the hospital there. I told them I do not get involved in hospital issues because too often they become political footballs and that is not fair. They asked me to visit the hospital, which I did, and I saw a community in action. There were 20 people in the hospital, which gave employment. Each one of those 20 people had a visitor because it was a Sunday, except for two and they were visited by the other people. The proposal, which would have cost the Exchequer money, was to separate them and locate them a minimum of 70 km away. They would have lost their own company and the company of their friends and neighbours. I raise that issue because I will talk at a meeting in Abbeyleix on Sunday about the situation in there which I ask the Minister of State to take carefully under review. The position in that area is changing.

As an Independent, I am not taking a party political approach. County Laois is my home and there is a strong possibility, owing to the demographic shift, that there will be two separate constituencies of Laois and Offaly, respectively. Even if the Seanad is abolished, I would not have the remotest intention of standing for the Dáil. The demographics are also interesting because the population of County Laois has increased by 20% to more than 80,000 over the past four or five years, while the number of persons aged over 60 years has increased by 14%. The community hospital in Abbeyleix is a resource with which people are happy. When Senator Whelan on the Government side raised this matter a number of weeks ago, a man by the name of Phelan, who is obviously from the same clan as the Senator despite the slightly differently spelling of his surname, was celebrating his 100th birthday. He was perfectly happy in the hospital, as was another man of 96 years. If the facility is closed in circumstances in which more rather than fewer beds will be required in the county, the elderly people affected will be dispersed. Such moves can cause major and sometimes fatal trauma to people.

I urge the Minister of State to return to the Department with the message that while health care staff must be properly and professionally trained, they also need to be employed and deployed in the types of resources that pay community dividends. The community hospital in Abbeyleix, as is the case with the facility on Valentia Island, is a classic example of such a resource. I do not say this as someone who wants to spend money all over the place, believes in hospital candidates distorting the political scene or has any political ambitions outside this House. Should the Seanad be sacrificed to the rather strange ideas of the current leader of the Government, I will not stand for further office. I ask the Minister of State to consider the matters I raise.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

The speech I have with me has probably been delivered by at least five Senators. I thank the proposers of the motion and everyone who contributed to the debate. As with all debates, while all the contributions were worthwhile, some were more worthwhile than others.

One cannot argue with certain statistics and facts. We are spending €1.5 million on older people, a term I hate to use because I am not certain what the correct language is. Home help hours will be reduced from 11.2 million to 10.7 million this year, which is not a dramatic decrease. An additional 2,500 people will receive home care packages this year. This is the type of change we are and should be making.

On the motion, the Department is reviewing how training is delivered to nurses. I concur with Senator Crown on the need to introduce a recognised master's degree for those who have completed a general nursing degree. I will make that point when I speak to the Minister.

We will have to take account of changing demographics, and gerontology must become part and parcel of what we do. My mother was sick for one week before her death at the age of 84 years. She was bright and hale and hearty woman who fed us all and did all the usual things.

I have a different view of later life than many other people. The figures show that only 4.5% of the older population eventually end up in long-term care. While it is necessary to have this type of intensive care setting for some people, namely, those who have greater care needs towards the end of their lives, we must also bear in mind that 95% of us will probably die in our own beds. This is an important statistic. Someone once said the only people who should be sent to war are politicians and old men because they are constantly looking for war. By the same token, the only people who should be sent to nursing homes are politicians because they are the only people who continually talk about them. We have to move away from that type of attitude and thinking.

As I repeatedly point out, I have responsibility for four areas. I do not need to discuss the area of women because women always look after themselves. The other three are mental health, disability and older people. In the areas of mental health and disability I am charged with removing people from institutions. The constant cry I hear about older people is that we must place them in institutions. If I were an older person, I would be depressed by the level of debate on what will happen to people as they age. We need to send a message that people live long and healthy lives in their communities. While some people may not be able to live in their homes, we can ensure that they continue to live in their communities. Rather than focusing solely on step-down care, we need to focus on step-up care and assisted, supported housing.

Senator Daly made a remarkable contribution. He chose not to speak to the motion but instead to ask me whether the Government was engaging in privatisation by the back door. I am not certain what was meant by the question. My job is not about providing support for placing people in nursing homes, whether private or public. The Government is reviewing State-owned and operated community nursing homes because we need to give serious thought to whether we can put right the problems in particular units where they are caused by the environment rather than the care provided. That is what we are doing.

If I had a sibling, parent, husband or child in a nursing home or institution, I would thank God every day for the Health Information and Quality Authority because it has set the bar. HIQA also insists that health care providers reach that bar in respect of both care and the environment in which it is provided. We have reached a point where we must examine how we can change things around. People want to live in their communities. I do not know any older person whose aim in life is to eventually end up in a nursing home. That is definitely not my aim in life and we must ensure people have an option of living in the community.

I spoke today to representatives of Genio, an incredible organisation which runs various projects on living with dementia in the community. These involve providing trained personnel who will assist people to live well in their community. I also spoke today to representatives of another group that is involved in the area of acquired brain injury. They told me something that needs to happen and which can happen right across the range, which is to produce a leaflet that gives carers information necessary to recognise the condition and how to deal with it. These are very simple things. It does not always have to be the high-tech stuff, although the Louth County Council development in respect of high-tech and older people is an example we need to visit, a block of apartments for older people that is so high-tech that they know whether a person's sleep pattern has been disturbed. If we can do that while still allowing people the freedom to live within their own communities, that is where we need to be.

When we look at nurse training, surely it needs to be about community rather than institutions. I was listening to some of the contributions about the embargo and people leaving the service and so on. The Minister of State, Deputy Shortall, has responsibility for primary care but primary care essentially is about delivering a service in the community, and that is how she sees it. She has managed to get an additional 350 new posts for the community. That is where we need to be investing our resources. We have managed to breach the recruitment embargo in the area of mental health and get 420 new posts for community psychiatric teams. These will include physiotherapists, speech therapists, psychologists, psychiatrists and nurses. If anyone tells me that as we age, we do not have the same care needs as other people within the community, then I do not believe that. When it comes to caring in the community for someone who has a disability, a mental health issue or needs in respect of how they age, they are not that different. Those needs are not that different, nor is the way we deliver that care. Perhaps older people have more sense than to watch us debating these issues, but if they are watching us, we need to send out a far more positive message than we are currently doing. As we age in life, 95% of us will be able to do that either within our communities or homes until the end of our lives. That is the message we need to send.

I thank Members for organising this debate. I never walk away from a situation without having learned something, and I most definitely have learned something today. I will take their concerns back to the Minister.

Senator David Norris

On a point of fact, was the Minister of State correct when she said there was a reduction from €11.2 million to €10.7 million, which she expressed as 1%? I think it is closer to 5%. I am not sure but I thought I should mention that.

Deputy Kathleen Lynch

I will check that.

An Leas-Chathaoirleach

I am sure she will clarify that for the Senator in due course.

Deputy Kathleen Lynch

I will explain it later to the Senator. It is a different figure.

Senator Colm Burke

I thank the Minister of State and all those who contributed to this debate. In moving this motion, I was highlighting a particular area where there has been a difficulty in filling posts. It is not just about training, which is one of the concerns. Pay and conditions also explain why some of those posts are not filled. There are several different issues; it is just not one. Once we are reviewing the nurse training programme, which has been in place since 2002 which is why it is appropriate to review it, whatever decision is made by the review at the end of September or by the Minister will put in place what will be available over the next ten to 15 years. It is important there is an open debate on it.

I agree with the Minister of State there must be more emphasis on keeping people at home longer, and putting people into nursing homes should be the last option. The best example of all is my mother-in-law who has been in a wheelchair for the past four or five years. She lives on her own and wants to stay that way. She is fully able to manage and work away on her own, and that is the way she wants it. There are many more like her who want to continue to live at home. It is very important we give the support to people who want to do that, but it is also important we have the health care professionals who can provide that backup for those who want to live at home. That is why we need to focus on that area in the training programmes. I know people doing community nursing go through their own training programme which incorporates care of the elderly. That is a very well run and well thought out course and qualification.

We have a growing elderly population. People are living longer and the average life expectancy in Ireland is above the EU average. This is very welcome and is evidence of the standard of health care in this country. People may be critical of certain aspects of the system but we have invested a great deal of money and effort into developing a health care sector. We now have to ensure we get value for money and improve services, whether they are for people living at home or for people who, unfortunately, cannot any longer and need extra support in nursing homes. It is important the standard of care they get is of the best possible quality and that we have the people with the necessary qualifications and skills to provide it.

I thank the Minister of State and all my colleagues for taking part in this debate. I look forward to the review and the changes when they are decided upon by the Minister.

An Leas-Chathaoirleach

Is the amendment being pressed?

Senator Trevor Ó Clochartaigh

I listened very carefully to the Minister of State's reply. I was disappointed. I agree in principle with what she said but it did not take on board the ethos of what we said about the reality. Of course we want people to stay at home, but there is a reality for those forced into care. The Minister of State did not answer my question either about the positive ageing strategy being made available before the end of the year. We will press the amendment.

Amendment put and declared lost.

Motion put and declared carried.

An Leas-Chathaoirleach

When is it proposed to sit again?

Senator Colm Burke

At 9.30 a.m. on Friday, 27 April 2012.

Sitting suspended at 6.40 p.m. and resumed at 7 p.m.