Mr. John Dunne:

It is anybody who is a likely candidate for a home care package. If somebody seeks four hours or an hour a day where somebody will come to the house to do something to help a person function at home, they are being told that the HSE cannot give the money for that but if one wishes to put the person into a nursing home the HSE can give €750 per week. That is systemic waste of resources. Nobody who is party to those cases wants to do that, be it the family, the medical advisers or the HSE administrator. I am not trying to suggest there is somebody cheering this on. It is due to the legal framework so until that legal framework changes, that will not change. It might not sound like much to talk about €700 per week, but we are talking about thousands of people and week-on-week expenditure. In addition, the evidence shows that people who go into residential care decline more rapidly and end up in acute hospitals faster. There is systemic waste in that regard.

That is one example. The second example is even more significant. There is a strategic refocusing of funding geographically within the HSE. We accept there is rebalancing. Somewhat more difficult, although in principle it is difficult to argue against it, is that there is a shift in expenditure onto the people who have the highest level of dependency. What that means in practical terms within the system is that money is being taken out of the home help service, and members will have heard about that on foot of the campaign taking place at present, and it is being transferred across to home care packages. These are, in HSE jargon, enhanced care. They look after personal care needs. The difference is that a home help might go into a house, make a cup of tea, do some cleaning and shopping and might even just keep the person company. It is an important service. In the other case one is talking about somebody who needs physical assistance getting into or out of bed, getting dressed and washed. There might be toilet and many other issues. In our organisation that care can extend all the way to dialysis or blood sugar monitoring. The problem is that under the Croke Park agreement the home helps are losing their hours and, therefore, in danger of losing their jobs. However, they cannot be let go and must be redeployed.