Mr. Sean Dillon:

I thank the committee for providing us with an opportunity to address it. Older and Bolder is a national alliance of organisations that champions the rights of older people in Ireland. Our member organisations are Active Retirement Ireland, Age and Opportunity, the Alzheimer Society, the Carers Association, the Irish Hospice Foundation, the Irish Senior Citizens Parliament and Senior Help Line. Each of the alliance members has its own unique goals and work programme and Older and Bolder's role is to enable our members to speak with a collective and united voice on issues of policy and practice which are critical to the well being of older people.
The issue on which Older and Bolder is currently focused, together with people of all ages and from all parts of the country, is the right to age well at home and we have called our campaign "Make home work". The campaign highlights the obstacles faced by older people, people with chronic illnesses or disabilities and children with life limiting illnesses who want to live well at home but need support to do so. Our campaign also highlights the broader social determinants of health, such as income, transport and social participation, and shows how, together with access to home and community care services, these determinants support people in aging well at home. The focus of our pre-budget presentation this year was guided by our campaign and I intend to avail of this opportunity to make reference to the elements of our pre-budget submission that are relevant to this committee, particularly in respect of home care services.
A few months ago our campaign to make home care work became a campaign to rescue home care after the announcement by the HSE of €22.5 million in cuts to home care services. Some 18% of the cuts announced on 30 August were targeted at home care services and represented a direct attack on old, young and disabled people in their own homes. Not only are the cuts a regressive step in terms of safe and healthy aging, they make no sense from an administrative or care management perspective. We are already failing people who need home and community care services. In the Republic of Ireland in 2006, 14% of older people with limiting disabilities living in the community received no care, compared with 2% in Northern Ireland. That percentage has not changed much since then.
We are being asked to accept assurances that the HSE's priority to is minimise the impact on patients of spending cuts but where is the evidence to support these assurances? There is a complete lack of transparent information about how these cuts are actually being applied. In the case of the home help budget the HSE has predetermined that €8 million will be cut from home help services before the end of the year. To say that the assessment process is based on a review of individual needs is misleading at best. How is the HSE going to engage efficiently and humanely in the individualised assessment of 11 million home help hours resulting in a reduction of a million hours? The examples we hear from around the country of people's hours and services been cut are staggering. In one case a family received a letter from a local HSE office dated 3 September referring to the budget cuts and announcing a cut to the family's home care package. This letter issued just two working days after the cuts were announced. There could not have been time for a clinical assessment of needs.
The whole process has raised many unanswered questions. In the absence of home help hours and home care packages, what will happen to individuals who are medically fit for discharge from acute hospitals but need social care support to return home safely? In the wake of cuts to home care services, will the budget for the nursing home support scheme be increased to cater for increased and earlier admissions to nursing homes? If, as mooted, people currently in receipt of home care services are assured that a service will be maintained, what will happen to individuals and families currently awaiting assessment for access to home help and home care packages? How will an already stretched public health nurse network meet the needs of people in the community who have identified unmet needs and who are at risk?
The key underlying issue is the lack of a legislative framework for home and community care to govern individual entitlement, single assessment, quality of services, etc. This issue once again highlights the vulnerability of community care budgets to cuts in both bad times and good in the absence of legislative protection. Citizens in Ireland have no legal right to care in the home or community. People do not realise this or understand the implications of it until they are in a transitional or crisis situation. It is only when they are looking for care and support for themselves or a family member that they discover there is no right of access to care. The need to clarify the legal situation with regard to home care has been highlighted by various bodies over many years, including the Ombudsman. The HSE service plan for 2012 states that the HSE will continue to work with the Department of Health on legislative proposals for community services. Exactly the same commitment was set out in the 2011 service plan and I suspect we might find it in previous plans. The entire process is characterised by inertia and a failure to plan and act decisively.
Access to home and community care is currently ad hoc, discretionary and dependent on one's illness, where one lives and to whom one speaks. Older and Bolder believes it is time to put in place a commission on long-term care in Ireland so that the statistics, facts, projections for costs, population, dependency needs, etc., can be placed in the public domain and debated publicly. The issues I have outlined reinforce the need for a planned approach to aging, which is why Older and Bolder has campaigned vigorously over the last four years for a national positive aging strategy. The deadline of October 2012 has come and gone and we are now looking at year end before a draft reaches the Cabinet. There can be no further delays.
Cuts to home care services will devastate the prospect of safe aging at home. Cuts to these services have again highlighted the urgency to underpin the delivery of community care services in Ireland with legislative protection and we ask the committee to take the lead in advancing this matter. It is imperative that budget 2013 reflects the vital role home care services play in the delivery of health care in this country. The committee's letter of 9 October 2012 calling on the Minister for Health to reverse the cuts was welcomed by those of us who champion such a move and we ask members to continue to hold to account those who would cut these services.