Mr. Pat Healy:

I will go through each of the component parts on the social care side. One of the important steps taken with the additional investment, to which the director general referred, was stabilising the nursing home support scheme which had a very significant impact. We started that last year and brought it initially to 11 weeks in February. Once the additional resource was provided, we brought it to four weeks. This has continued throughout the year and will continue throughout 2016. It is a very important part of it because it was one of the difficulties that gave rise to some of the challenges at the beginning of the year. That addresses the nursing home support scheme. On average, 23,450 people per week will be supported in 2016 which is an increase of just under 650 people a week for 2016.

The other side of it is the short stay beds. As part of the investment the director general set out, we have added an additional 2014 short stay beds which are very important. Dublin in particular suffered because it did not have the same tradition of community hospitals as some of the rest of the country. The 65 beds in Mount Carmel have been very important and have worked very well. There are geriatrician teams which the hospitals link in with very well and it has proved to be very beneficial in supporting the type of integrated care between hospital and community, which is important.

In addition to that, an additional 214 beds have been provided. This includes 16 in Clontarf, 20 in Royal Hospital Donnybrook, 25 in St. Vincent's in Fairview, and ten in St. Mary's Hospital in the Phoenix Park. There were ten beds open in Farranlea Road, four in Heather House in Cork, two in Carndonagh in Donegal, eight in Killybegs, five in Merlin Park in Galway, 17 in the north Tipperary area, 15 in Ballinasloe, and five in Ballina district. Six beds were opened in both the Sacred Heart Hospital in Castlebar and Áras Mhic Dara. They are all open, working and staffed. Some of those only came on stream during the course of the year because we were trying to staff them. One of the benefits for winter 2016 will be that we will have the full capacity of those beds for the full year, which is an important part on the short stay side.

A number of members mentioned home care as being an essential part of that. With the additional resources, we were able to provide 1,650 additional home care packages over and above what was funded. We were approved for 600 additional people to benefit. That was put in early in the year but through the year 1,650 extra home care packages have been provided and the resource will be there in 2016 to continue that higher level of outturn. That is a positive development.

Two things have been happening in terms of home help. There will be 137,000 extra hours provided this year which will be resourced into 2016. An important part of delivery is providing a more flexible service on weekends and weekday nights. Some of the existing hours are being provided out of hours.

That is an additional cost. It is obviously a premium time and we have been able to allow for that in the 2016 service plan, of which this is an important part.

The other point made was the issue of our relationship with the local authority, about which Deputy Costello asked. A number of years ago, as part of the reorganisation of public services, a number of services were moved from the health service to other Departments, and the move of community welfare officers was the largest change at that time. At that time also, EVE Holdings, which was a service in Dublin that used to do that kind of in-home work, was transferred to the Department of the Environment, Community and Local Government. The view at the time was that one should standardise that throughout the country within local government because it had the housing responsibility. There can be a confusion at times in that the HSE, in terms of home care packages or through primary care, provides aids and appliances such as wheelchairs, walking aids, commodes and that type of thing, whereas housing adaptations are dealt with by local government. Therefore, what we try to do is work closely with the local authorities, many of which at this stage have occupational therapists within their own systems. It is about trying to make that work in a joined-up way, which is something on which we will continue to focus.

Deputy Healy mentioned south Tipperary, an area to which we pay particular attention. I visited there in recent weeks. There is challenge there with a number of individuals who have complex care needs and require assistance right across primary care, social care and mental health. We have identified a support for three or four of those to enable them to go home. That type of collaborative working is a feature of the more focused work through the emergency department task force, and I use that as an example of the positive type of change that has been happening. I believe that covers most of the points.