Tim O'Malley (Limerick East, Progressive Democrats)

I welcome the opportunity to address the House on issues relating to the provision of services for older people. I acknowledge the significant investment made by the Government for the care of older people, and palliative care, by the provision of €110 million additional revenue funding in the budget announcement for 2006 and a further €40 million in 2007.

The Government is committed to maintaining older people in dignity and independence in their own homes and, in accordance with their wishes, for as long as possible. It is also committed to providing high quality long-term residential care for older people when living at home is no longer possible. People are generally living longer these days and even though most are leading healthy independent lives, the number of people in need of long-term care is increasing. There is a strong demand for long-stay places and it is imperative that the nursing home places on offer, both public and private, are of a high order and appropriate standard to meet the needs of our older population.

The nursing home sector is governed by the Health (Nursing Homes) Act 1990 and subsequent regulations. The Nursing Home (Care and Welfare) Regulations 1993 set out the standards to which the private nursing home sector must adhere for the purpose of registration under the Health (Nursing Homes) Act 1990. These apply to all beds in private nursing homes whether contracted, subvented or not.

This year, the Minister for Health and Children carried out a public consultation process on the draft scheme and heads of a Bill to establish the Health Information and Quality Authority, HIQA. The office of the chief inspector of social services with specific statutory functions was also established within the authority. The intention is to bring a Bill to Government for approval this session.

The establishment of HIQA is a key feature of the health services reform programme. HIQA will be a vehicle to strengthen quality assurance and information in the health system. It will set standards on safety and quality of services provided by the Health Service Executive and service providers. It will monitor and advise the Minister and the HSE on the level of compliance with those standards. It will investigate services at the request of the Minister or the HSE. At the request or with the approval of the Minister, it will review and make recommendations in respect of services to ensure best outcomes for the resources available. It will operate accreditation programmes. It will evaluate and provide advice to the Minister and the HSE on the clinical and cost effectiveness of health technologies. It will evaluate information and data and identify deficiencies in respect of that information. It will set standards on information and data, including governance arrangements.

In line with commitments made in the health strategy and the new social partnership agreement, Towards 2016, the remit of the social services inspectorate is being widened to include residential care for people with disabilities and older people. The functions of the chief inspector of social services will be to establish registers for residential centres for people with disabilities, children in need of care and protection and older people, including private nursing homes. The chief inspector will have powers to inspect centres, register them, attach conditions to registration and cancel a registration. The chief inspector will also inspect the Health Service Executive's performance of its functions in respect of foster care services, boarding out of older people and inspections of pre-schools. When it is necessary for older people to move into long-term residential care, it is important that they have a choice of top quality nursing home care. For this reason, a working group has been established by the Department to develop appropriate standards for residential care settings for older people. Membership of the group comprises officials from the Department, the HSE, the SSI and the Irish Health Service Accreditation Board. The group has developed draft standards for the inspection of both public and private residential care for older people. It is intended that these draft standards will be the subject of a public consultation process in the coming months.

The Government's commitment to the development of a comprehensive range of services for older people and palliative care can be demonstrated clearly by outlining the resources made available in recent years for service developments. Between 1997 and 2005, additional spending on health care services for older people was in excess of €302 million. In addition, the Minister for Health and Children, Deputy Harney, announced a €150 million package to expand and improve services for older people and palliative care in 2006 and beyond. This has resulted in a major improvement in home and community-based support for older people. A comprehensive health and social care service is being developed, in a way that is reliable and that respects and values older people. This is the largest ever increase in funding for services for older people.

These initiatives set out the Government's continued commitment to older people and putting older people at the centre of health policy now and in the future. The investment package is focused on caring for people at home, in accordance with their expressed wishes. It is a major step in focusing new resources on home care first and foremost, while still supporting appropriate residential care. This is in line with international trends and also reflects the growing independence of older people who want to stay living in their communities.

This new investment involves additional resources of €150 million in a full year, €110 million in 2006 and €40 million more the following year. Reflecting the new emphasis on home and day care, almost three quarters — €109 million — of the full year costs are being committed to community care supports.

This investment is a response by the Government to older peoples' preference to be cared for at home rather than going into residential care. Very often that may require some additional home help or more developed home support, including various therapy services. All the evidence shows that families caring for elderly relatives continue to provide care in partnership with the support services put in place for those that require it.

The budget day package provides for a number of initiatives. The home help service plays a very important role in keeping people at home for as long as possible. An additional €33 million was allocated to this service in the budget for 2006, €30 million of which was for 2006 and will provide a further 1.75 million home help hours.

Home care, including the home help service, is delivered through the HSE in partnership with a range of providers including the executive itself, voluntary groups and the private sector. This has long since been a policy in home care. While public nursing home provision continues to be expanded, it is necessary nonetheless to continue the working partnership with private and voluntary providers to ensure the highest level of additional service delivery possible.

There are, however, no plans to privatise the home help service or give priority to private companies over public or other home care providers. The most important factor in delivering home care and home help is not who provides the service but that an appropriate level of service is delivered in as flexible a manner as possible which is highly responsive to the real needs of the individual.

A comprehensive collective agreement between health employers and SIPTU was finalised in 2000 regarding the terms and conditions for employment of home helps. This agreement provided for a significant improvement in the pay and conditions of employment for home helps. They now receive the same benefits as all other staff in the health services, which include premia pay, paid annual leave and paid sick leave.

It was agreed with SIPTU in February 2006 to establish a high level group with an independent chairman to address, in partnership mode, issues pertaining to the standardisation of home help services, including clarification on the nature of the service and standard criteria for entitlement, among others.

Home care packages deliver a wide range of services and have been piloted successfully in several regions in recent years. They include the services of nurses, home care attendants, home helps and the various therapists, including physiotherapists and occupational therapists. A home care package will vary according to the care needs of the person so that, for example, there might be a greater emphasis in some packages on home care assistants while other packages may require a greater level of therapy and nursing.

The priority is older people living in the community or who are in-patients in an acute hospital and who would need to be admitted to long-term care without this support. The home care packages are also available to those older people who have been admitted to long-term care and who now wish to return to the community. In addition, the packages will be offered to people who are already using existing core services, such as home helps, but need more assistance to continue to live in their community.

As with the home help service, the packages are delivered through the HSE by a range of providers, including the Health Service Executive itself, voluntary groups and the private sector. About 1,100 home care packages were provided to people at the end of 2005. By the end of this year, a total of 2,000 additional home care packages will have been provided. The HSE has advised that 1,800 new clients were in receipt of home care packages in the first six months of 2006. The 2,000 packages will support more than 2,000 persons as, for example, individuals could in some cases need a care package on a temporary basis.

An additional €20 million was allocated to the nursing home subvention scheme for residents of private nursing homes. The additional €20 million is a 2006 full-year cost and is going towards supporting increasing numbers entitled to basic nursing home subvention, reducing waiting lists for enhanced subventions and bringing greater consistency to the different levels of enhanced subvention support throughout the country.

A total of €8 million was provided in the budget to cover the cost of 250 extra nursing home beds which the HSE has sourced from private nursing homes. The HSE has provided over 900 long-stay beds in private nursing homes in the last two years and is currently engaged in contracting 800 additional nursing home beds as part of the winter bed initiative.

Extra funding was also provided, as part of the budget investment package, for a range of other community supports, including day and respite care, which are an integral part of delivering a comprehensive community service for older people; meals on wheels, which again is part of the range of services which help support older people to continue living in their own homes; and sheltered housing, which provides a real alternative to residential care and reflects the desire of older people to live with as much independence as possible.

In addition to services for older people, €9 million was provided in the budget day package for specialist palliative care, including home care and community initiatives in 2006.

It is clear from the package that the Government is firmly committed to developing services for our older people. The emphasis on developing home care packages and the increases in the home help and meals on wheels schemes and other community based supports are assisting older people to remain in their own homes and communities for longer, in accordance with their wishes. In addition, additional funding has been provided to the nursing home subvention scheme to go towards supporting the increasing numbers entitled to subvention and to reduce waiting lists for enhanced subvention.

The Health (Nursing Homes)(Amendment) Bill 2006 is currently being debated in the Oireachtas and is designed to ensure that the existing subvention scheme for private nursing home care is grounded in primary legislation and to help the HSE to implement the scheme on a standardised basis across the country.

The Government is currently considering policies on long-term care. Several principles underlying this policy were agreed with the social partners in Towards 2016. These principles specify, for example, that there should be one standardised national needs assessment for older people needing care. The use of community and home-based care should be maximised. Sheltered housing options will be encouraged. Where residential care is required, it should be quality care and there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. The level of support for residential care should be indifferent as to whether that care is in a public or private facility. The financial model to support any new arrangements must also be financially sustainable.

The Government's commitment to older people is clear. The focus is on supporting older people in their homes and communities for as long as possible, and at the same time supporting those who require residential care if the time comes that such is the most appropriate care required. The Government is committed to ensuring high quality care to all older people in public, private and voluntary nursing homes and is working towards having the best standards and inspection processes in place to achieve this. By its investment programme this year, the Government has demonstrated its commitment to older people. We acknowledge that we must continue to develop policy in this area to meet the growing demand for services.

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