Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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144. To ask the Minister for Health his plans for implementing the outstanding recommendations from the Citizens' Assembly. [14251/19]

Jim Daly (Cork South West, Fine Gael)
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The Citizens’ Assembly met in June and July 2017 to consider the topic of “How We Best Respond to the Challenges and Opportunities of an Ageing Population.” The Report including the results of votes cast by the Assembly made 21 recommendations.

In response to the challenges of how we as a country respond to the Challenges and Opportunities of an Ageing Population the Department of Health are currently focusing on a number of different areas of work relating to this issue.

The National Positive Ageing Strategy (NPAS), published on 24 April 2013, provides a framework for cooperation to address age-related policy and service delivery across Government and society in the years ahead. The Strategy is intended to promote older people’s health and well being so that older people can continue to contribute to social, economic, cultural and family life in their own communities for as long as possible, thereby representing a vision for an age-friendly society. The Strategy highlights that ageing is not just a health issue, but rather requires a whole of Government approach to address a range of social, economic and environmental factors that affect the health and wellbeing of our ageing citizens.

The inaugural Positive Ageing stakeholder forum took place in 2017. Stakeholders were asked to identify key priorities to propose to Government to consider for its focus in the coming year. Through this forum, clear channels of communication between the stakeholder representative group and relevant Government Departments to discuss these priorities have been facilitated by the Department of Health. The second annual stakeholder forum took place in the Department of Health in October 2018. Again, stakeholder identified clear priorities and collaborative work in this area is ongoing.

As part of the NPAS implementation process, a Healthy and Positive Ageing Initiative (HaPAI) was established in collaboration with the HSE’s Health and Wellbeing Programme and the Atlantic Philanthropies. HaPAI provides an ongoing system for measuring and reporting on positive ageing and implement the research objectives of the National Positive Ageing Strategy (NPAS). It was jointly funded by the Department of Health, the HSE’s Health and Wellbeing Programme, and the Atlantic Philanthropies.

The initiative aims to monitor changes in older people’s health and wellbeing linked to the goals and objectives of the NPAS. This is done primarily through the development of national positive ageing indicators which will be published at suitable intervals. The indicators report will allow all Departments to identify areas of improvement in relation to older persons' health and well-being, as well as areas requiring improvement and potential for evidence-based policy intervention.

Home support is an important part of the supports for enabling older people to remain in their own homes and communities for as long as possible and for facilitating their discharge from acute hospitals. Improving access to home support is a priority for Government. Over the past four years the Government has overseen a considerable increase of nearly €140 million in the budget which has grown from €306 million in 2015 to almost €446 million this year. This year the HSE intend to provide over 18 million home support hoursto be delivered this year to over 53,000 people.

The Department of Health is also currently engaged in the development of a new statutory scheme and system of regulation for home-support services. In preparation for the development of the statutory scheme, the Department commissioned the Health Research Board to carry out a review of the home-care systems in four European countries. In addition, the Department conducted a public consultation on home-care services, on which a report was published in 2018. These reports are available on the Department’s website and will help to ensure that the new scheme is informed both by international experience and by the views of stakeholders, including service-users.

Work is on-going to determine the optimal approach to the development of the statutory scheme within the broader context of the Sláintecare reforms. The Department’s Sláintecare Implementation Strategy commits to the introduction of the statutory scheme in 2021. In 2019 work will focus on the design of the scheme, the options for regulation and a review of existing services. Further consultation will also be undertaken in 2019 (with key stakeholders and service-users) and will continue throughout the process of developing the new scheme.

The development of a new statutory scheme and system of regulation for home-support services is a complex process. Accordingly, it will be early 2020 before it is possible to set out in principle the parameters of the scheme and to seek Government approval to proceed to draft the heads of a bill.

The Assisted Decision-Making (Capacity) Act 2015 is the policy responsibility of the Department of Justice & Equality. The 2015 Act provides for the establishment of the Decision Support Service within the Mental Health Commission to support decision-making by and for adults with capacity difficulties and to regulate individuals who are providing support to people with capacity difficulties. A Steering Group chaired by the Department of Justice and Equality meets monthly to progress the establishment of the DSS. The Decision Support Service is working towards being operational and ready for the commencement of the main provisions of the Act in 2020.

The Department of Health has policy responsibility for Part 8 of the 2015 Act, which provides a legislative framework for advance healthcare directives (AHDs). An AHD is a statement made by a person with capacity setting out his or her will and preferences regarding treatment decisions that may arise in the future when he or she no longer has capacity.

Section 91 of the Act relates to the development of a code of practice to accompany the AHD provisions. On 17 October 2016 the Minister for Health established a multidisciplinary working group to prepare a detailed series of recommendations for the Director of the Decision Support Service (DSS), in relation to the code of practice under section 91(2) of the Act. In anticipation of the completion of that process, the Minister for Health commenced the remainder of section 91 in December 2018 [S.I. No. 527 of 2018]. This will enable the Director of the DSS to progress the preparation of the code of practice on the AHD provisions, based on the working group’s recommendations, and in accordance with the specific process outlined in the Act. The multidisciplinary working group submitted its recommendations on the code of practice to the Director of the DSS on in December 2018.

Once completed the final code of practice can be published by the Director with the Minister's consent. The development of the code of practice to accompany the AHD provisions is a key piece of work in facilitating the subsequent commencement of Part 8 in its entirety.

Elder abuse (in a health sector context) is among the topics which will be covered in a new national policy on adult safeguarding in the health sector, currently being developed by the Department of Health following a Government decision in December 2017. It is intended that the policy will apply across the full spectrum of the Irish health and social care sector i.e. all public, voluntary and private health and social care services. A draft policy (which the Department aims to finalise around the end of 2019) will be the subject of a public consultation exercise. As the policy development process progresses, legislative requirements will also be identified. It is intended that following completion of the Adult Safeguarding policy for the health sector, any underpinning legislation required to give full effect to the policy will be pursued as appropriate.

Other recommendations included in the Report of the Assembly including those relating to taxation, retirement age and pensions do not fall within the remit of the Department of Health.