John Dolan (Independent) | Oireachtas source

I tabled four questions, including one on how the health service engages with areas outside health care. I very much appreciate the response provided, which focused on employment, the national disability strategy and housing. Other areas could have been referenced but I asked for three areas to be highlighted. I will watch to see how the health service, namely, the Department and Health Service Executive, advocates and follows up on these three areas because real value can be secured in health when people are able to operate outside the health system.

I also asked about the 1,200 young people with disabilities who are in nursing homes, the section 38 and 39 organisations and personal assistance services. On the 1,200 young people in nursing homes, I appreciate the HSE engagement in this area in recent times, including the work it is doing with the Disability Federation of Ireland and others. Referring to this group, the response states that while a substantial level of this vulnerable group falls into the above category, it is critically important to note that this intervention can also be an appropriate care option where persons concerned have clinically assessed complex medical and social care needs requiring this form of support. I am not comfortable with this response. I fully accept, however, that many of the individuals concerned have complex and critical clinical and medical needs.

We are putting people aged 30, 40, 50 and 60 into nursing homes where the average length of stay for a resident, who is typically in his or her 80s and beyond, before death occurs is some two years. Such settings are absolutely inappropriate for younger people who have an expectation of many years of life ahead of them. I asked about the necessity of ensuring there is a programme of decongregation from nursing homes for such patients, the response to which took off in the direction of discussing the decongregation process in respect of patients with intellectual disabilities. That is not what I was asking about, although, in fairness, the response does refer to the identification in the report of the number of people inappropriately placed in nursing homes. There seems to be a fixation on the notion that decongregation relates only to intellectual disability services. The latter is undoubtedly an issue and progress in that regard has been slower that any of us would have anticipated, although I understand some 200 people are being moved. However, we have an utterly ironic situation where somebody working in one HSE office is doing his or her damnedest to get a person out of a congregated setting while, at the same time, a staff member in the next office is offering a congregated setting placement to somebody who has never lived in one before. This problem must be progressed more stridently and I am interested in any observations the Minister or his officials might have in that regard.

In regard to sections 38 and 39 organisations, many of the relevant issues have already been ventilated this morning. Last June, I asked whether the Department would adequately, and in a timely fashion, deal with the negative impact of pay increases on the delivery of services by organisations funded under section 39. I am amazed to read in the response I received today that under the provisions of the section 39 grant, there is no stipulation as to what proportion is to be allocated to pay and what proportion to the funding of other aspects of the service provision. This avoids the fact, which was acknowledged in the answer given the last day, that it is up to section 39 organisations to negotiate salaries with their staff as part of their employment relationships and within the overall funding available for the delivery of agreed services. A service level agreement, SLA, is not about handing over some money and asking that an organisation does the best it can with it, and rightly so. Rather, it is a case of allocating X funding and setting out the outputs and outcomes that are required in return. Whether or not we are talking about a public service organisation in the sense of its coming under the FEMPI legislation, those organisations are funded under the section 39 provisions because they provide a public service.

The crunch issue is the impact on the delivery of quality services, and that has been acknowledged by the Director General and the Secretary General. Mr. O'Brien noted earlier that while there were concurrent cuts to the section 39 organisations going back to the early days of the recession, as pay levels have been restored, the HSE has not had its funding increased to reflect that reality. The Secretary General made the same point today that was made the last day, namely, that the resolution is not likely to be a unified or one-size-fits-all model, which is how, traditionally, the matter was dealt with on the other side. I see no evidence, even though it was invited, of any engagement having taken place with these organisations. I do not contradict who the employer is, but there is a contract between the State and those employers to deliver a quantum of service. That arrangement is in jeopardy, to a greater or lesser extent, because of the migration of staff and, in certain organisations, the churning of staff. In some cases, the organisation is effectively a training place for people who will go on to work elsewhere. That is fine for the individuals involved but not for the delivery of services. We must grab this issue by the scruff of the neck and make sure it is addressed in a practical way. We can no longer tolerate this type of roundabout process where the organisations are saying they do not have the money and the unions know that is the case, but still they all trot down to engage in discussions. The one person who is not in the room in that scenario is the person who can give account for the making available or not making available of the funding. The whole process is becoming a circus that does not lead to anything. The Department must take a strong hand in the matter if the problem is to be resolved.

The other issue I raised was in regard to personal assistance, PA, provision. I see now that some of the detailed information I sought in this regard was available all along within the HSE. According to the executive's key performance indicators for service planning, there are just under 1,000 people in receipt of one to five PA hours per week; just over 500 availing of six to ten hours per week; 400 getting 11 to 20 hours; 240 receiving between 21 and 40 hours; and 67 persons in receipt of 60 plus PA hours per week. It seems there is an absolute reticence on the part of the HSE and the Department to set that situation out clearly. The figures show that only a handful of people are getting what amounts to one whole-time equivalent worth of PA hours. If we average the whole lot, only a tiny number are receiving seven hours of care per day. What is the problem with saying clearly that the service is providing five or six hours per week to X number of people? Of course, such a provision is not within the spirit or meaning of what a personal assistance service should be.

Mr. O'Brien noted that the Sláinte Care report provides the diagnosis and the prescription for the delivery of health care, but that does not really solve our problem. Will the resources and the steel necessary to dispense the prescription be in place? Saying we know what the problem is and what the answer should be does not mean we actually have a solution. The answer is that, as a State, we must front up to the problems we face in the delivery of health care by acknowledging the resources that are needed and the commitment and steel that are required to deliver those resources in a context where hard decisions must be made.

Mr. O'Brien spoke very well about general practice, which should rightly be regarded as a critical specialism in its own right. We often think of the GP as the handyman or handywoman, offering patients a bit of everything before sending them on somewhere else. In fact, general practice functions as the linchpin of care for people.

It is important to talk it up as a core specialty in the health service.