In Module 1 the Commission was charged with setting out the current situation in respect of health and social care—essentially ‘what is’. In Module 2 the Commission was requested to change direction and to set out ‘what should be’. This report represents the output of Module 1 of the work of the Commission.

Collated themes from Commission members’ learning submissions - The paragraphs below bring together the key lessons that the Commission has learned in Module 1, which will be used to inform the work that is carried out in Module 2. The lessons learned draw on the existing expertise and knowledge of the Commission members and on what members learned through the information-gathering process in Module 1, including the insights provided by stakeholders through the Commission’s Reference Group; a public consultation; presentations from experts; and discussion amongst members.

Supporting people to live their best lives - It is a triumph of modern society that, by addressing the wider social determinants of health and through better healthcare provision, our population is living longer and our older population is projected to double in the coming two decades. We have opportunities across the lifespan to build resilience, enable functional capacity and to support healthy ageing in place.

One key learning from Module 1 is that, based upon these demographic changes and opportunities that exist, there is a need to change the narrative about care for older people. Rather than being thought of in terms of managing decline, care should be seen as facilitating the ongoing enjoyment of life and as helping people to thrive in later life. Care should help people to remain in their homes, with their families, and in their communities for as long as possible and to continue participating in the life of their communities. The Commission learnt about the importance of a psychosocial as well as a biomedical approach to achieving the goals of meeting older people’s care-needs and allowing them to participate in family and community life.

Healthy ageing - There has been increased focus on healthier ageing in Ireland, and policies and frameworks such as the Health Service Executive (HSE)’s Health Services Healthy Ireland Implementation Plan 2023–2027 (2023) aim to ‘increase the proportion of people who are healthy at all stages of life’.4 This framework provides the central platform for addressing the social determinants of health that affect how well people can live their lives. It includes a suite of actions to encourage and enable the population to keep well. The Commission also learned of the many health benefits of physical movement nd strength-training to improve balance and reduce the risk of falls as well as of the positive mental health benefits that this type of movement provides. These benefits not only improve physical and mental outcomes but they help develop the confidence and autonomy in older people.

The ‘shift left, stay left’ model that is a central feature of Sláintecare advocates for shifts in focus from illness to wellness, from hospital to home and from a clinician-centred to a person-centred health system. While inroads into developing the model are being made, the current system often remains reactive instead of proactive, with a heavy focus on downstream rather than upstream funding to tackle risk-factors that may impede healthy ageing earlier in the life-course. For example, the Commission noted that a Lancet Commission report showed that up to 45% of cases of dementia worldwide are potentially preventable by addressing modifiable risk-factors throughout the life-course, starting in childhood and continuing throughout life.5 Primary care can play a crucial role in dementia prevention, managing conditions like diabetes, mid-life hypertension and obesity, and supporting people to adopt healthy behaviours such as increasing physical activities, adopting healthier diets and encouraging social engagement to reduce loneliness and depression...