Simon Harris (Wicklow, Fine Gael) | Oireachtas source

The Department and I set policy, not the HSE. It is not my policy or that of the Government to diminish the role of public community hospitals or public nursing homes. However, it has been the policy of this and successive Governments to ensure these facilities will be brought up to appropriate HIQA standards. With Deputy Margaret Murphy O'Mahony, I visited the community hospital in Bandon in her constituency. It is an example of the capital investment work being undertaken to provide state-of-the-art facilities for older people in a public setting in a community hospital.

The reduction in bed numbers is temporary. Using the Deputy's case as an example, it is a reflection of the fact that in some wards there are beds upon beds and shared bathrooms which must be replaced with single rooms and en suite facilities in order that people will have the dignity we all expect them to have within a public setting. As the Deputies know, we are making major investments to upgrade these facilities. As we move towards capital reviews and providing for additional expenditure on building projects in the health sector, I expect us to increase capacity in public settings. Bed capacity is another factor that will have to be considered.

I have never approached this matter from an ideological view. People have a right to a choice. Some will choose private nursing home facilities, while others will prefer to be able to avail of public beds in community hospitals. It can be either-or, but there is an important role for community hospitals and public nursing homes to play. This is an issue Deputy Bernard J. Durkan raises with me regularly, which is right and proper, but we have a significant body of work to do to ensure the facilities will be of a standard that people in 21st century Ireland should expect to see. The care provided is excellent. I am referring to the infrastructural facilities and not in any way demeaning the care given or the dedication of the staff. Needing to make this investment should not be an excuse for removing ourselves from this service provision.

Deputy Margaret Murphy O'Mahony mentioned how there were still pressures in seeking access to some services, even though the graph was upwards and investment had increased, but the population of older people has also increased. A useful example for discussion is how well we have done in mapping demographic pressures in the education system. The Department of Education and Skills knows this because a certain number of children will turn four, five or six years of age and need school places in September. It also knows that a certain number of teachers, schools, school buildings, extensions, classrooms and so on will be needed. We need to undertake that demographic analysis in the health service. The bed capacity review forms a large part of it, accompanied by the model of care provided.

The figures before the committee show an increase in the numbers of home help hours and packages, including intensive home care packages, in 2017. However, I will level with the committee. My view - one that is shared across the House - is that until we do in the home care area what we did in the nursing home area, this will continue to be a challenge. We need a statutory scheme. We will probably disagree on what it should look like, given the wide variety of views held, but we cannot say we want people to be able to grow old at home or in their communities if the only statutory scheme available to them is the fair deal scheme. In fairness to the HSE and its predecessors, they have been providing home help without the service being underpinned by statutory provision or the clear rules, guidelines and budget lines of the fair deal scheme. If committee members examine the fair deal scheme, they will see the amount of money allocated and the turnaround time, etc. The metrics are clear. We need the same in the home help area.

The Government is committed to reverting to the Dáil within six months of debating Deputy Willie O'Dea's Bill. My colleague, the Minister of State, Deputy Helen McEntee, will launch in May a stakeholder consultation process on future statutory home care schemes. We cannot transpose the fair deal scheme in the home care area. Presumably, we do not want HIQA to regulate what happens in people's sitting rooms. We must be conscious that the setting is someone's home, but we need to consider how to place the schemes on a statutory basis.

The Minister of State is also reviewing the nursing homes support scheme. There are a number of concerns about how small business owners and farmers are treated in terms of how their assets are considered.

Deputy Louise O'Reilly asked a similar question about public versus private services. Although it is a valid question, it is an operational one, but I will get her a detailed note from the HSE on the public-private mix, tenders and the roll-out of the single assessment tool.

I have been in many CHOs where it has been used, but I will get the Deputy a note on it.