Martin Daly: Ireland must act now on the ageing care crisis

Thank you to Age Action Loan and Professor Roseanne Kenney and Dr. Siobhan Kennedy for coming here this morning. It's not often we can say this because many claims are made about world-class research in Ireland and when you examine it, it doesn't stand up, but the TILDA study is a piece of world-class research which is a pre-eminent piece of work in this field by anywhere in the world and I just want to recognise that. It is just an outstanding piece of work and data matters and that's why what you say here today, Professor Kenney, in relation, you're basing it on fact, on real, real data. And I just want to go straight into the ageing piece. In Ireland we are just sorely deficient in policy and planning and human, physical and infrastructural systems and we really do need to take this seriously with this impending tsunami of ageing and we heard this morning on the radio that people are taking out mortgages now for the first time in 40 years of age, which means they're going to carry financial burden into their later life. Our birth rate has fallen so we're going to have less people to look after our older people and we do need to address that through housing and proper childcare and that is happening. We were with Minister Norma Foley last night and she was talking about that very particular issue, but just coming back to the under-diagnosis and under-treatment of chronic disease that will impact in later life in terms of dementia, heart failure, kidney failure. So I mean, this is disappointing, but it has improved since the introduction of the chronic disease programme, it must be said, but it isn't nearly at scale and it's not keeping pace with the problem. And maybe we need to look at alternatives to this. I mean, are we utilising our pharmacies, for example, to their maximum capacity? Are there other ways that we can implement screening which will enable it to be scaled rapidly but be sufficient to inform changes in intervention? So general practitioners should always be involved of course, but maybe at the decision-making end of things rather than the actual process. Do we need to invert the way we looked at this? We have invested huge amounts of money in hospital care, huge amounts of money in congregated nursing home care and primary care remains, and community care remains, the Cinderella of the system and now with this demand, that's exactly where our resources should be placed. I totally agree with that and at the last count, 20% of practices were vacant across the country and there are some areas that find it very difficult to fill places. So yes, I think that we need to incentivise people to engage in primary care. You talked about the adverse effects of medication in older people, people over 50, it's hard to believe they're older people, but we are getting older, but that's the reality, but we haven't placed enough emphasis on medication review and actually funding it because it does take time and in busy surgeries and in busy pharmacies, it doesn't often happen, not because no one wants to, but it needs protective time and resourcing. You could save a lot of money by avoiding the falls, the trips, the head injuries and also save a lot of money on the cost of drugs because if you do go down through lists, you strip out drugs from those lists. So the age-friendly programme has introduced the 4Ms as a quality measure and this needs again to be escalated and can be used across the health service. 4Ms are what's your mobility like, what matters to you, what medications are you taking, apropos your last point, and the other M is for mental state, that means cognition, mood, depression, anxiety, etc. They're very good metrics. The other thing that I've taken by, and there's a couple of other things, I'm on the clock, but the burden of informal care in this country, we have presumed upon families that they are going to take that burden up. The estimate of £4 billion to replace that care in 2017 would be a multiple of that now. We need to plan better, don't we, in relation to that? Absolutely, it will be a multiple of that now, that's the fact, and it will increase year on year, that's a fact. And where people want to be looked after, older people want to be in their communities, in their own homes, and yet many of them end up in nursing, and I don't mean end up, it's a pejorative word, but finish their lives out in settings that they would prefer not to be in. And again, the data bears that out. So on one hand is what they want, and the other hand is what happens to them. Other cultures have managed to do this better, certainly, than we are at the moment, and I think we need to look at those models and see how best we can replicate that shift from an emphasis on nursing home care to ageing in place, wherever that place is within the community. I'd just like to add that intergenerational ageing in place is really important. Warehousing older people is not what you or I or anybody else would want at a certain age. Our view on carers allowance and home help is far too narrow. I mean, people need to be literally disabled in their own homes, rather than taking a view that if you can, you gave a very good example of a lady with bilateral rotator cuff injury who simply needed someone to make a cup of tea for her, answer the phone, and do some basic work to keep her in her own home, keep her out of a nursing home, and keep her away from a hospital setting. It's far too narrow. So that's where flexibility comes in. We have to broaden the scope. And Tilda looks at this, it looks at activities, what makes up the tapestry of your life, and how can we as a system engage with that flexibly for the period of time somebody needs it. It may not be consistent over a long period of time, or it may. That's flexibility and that's choice. And again, I'm coming back to this reflection because of an emerging sense by older people that there's ageism creeping in to their management because the systems are under pressure in the hospital. In the west of Ireland, we have the longest waiting time, the interval between a decision to discharge and get someone into the community. We have the least access to primary care therapies. We have the least access to respite care. And there are older people who say to me, in my own clinic, will say to me, I don't want to go to hospital. I'm treated differently because I'm older. And I don't believe it's a philosophy, but I think it is a creeping philosophy that older people are now seen as a burden to be managed and got out of hospital, bed blockers, whatever pejorative term we want to use. So I test bed at consultant colleagues across the country, and this is a consistent theme, ageism in hospitals. It's about numbers, it's about bed days, no metric of quality of care, but the 4Ms and access to rehabilitation are a solution to that within the hospital. It's extremely concerning that there would be a sense, we don't tolerate racism, we don't tolerate genderism, we are beginning to tolerate ageism, which is absolutely unacceptable. And finally, primary care, on that clock, we are over-dependent on the provision of primary care infrastructure by private providers. And this is a statement, because you won't have time to answer that question, but our GP practices up and down the country are dependent on private investment, and where it was in deprived urban areas and rural areas, it's now an issue for the East Coast, where you have growing populations and a lack of GPs. Thank you, Chair.