Martin Mansergh (Tipperary South, Fianna Fail)

I will take the Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The overarching policy of the Government is to support older people to live in dignity and independence in their homes and communities for as long as possible. Where this is not possible, the HSE supports access to quality, long-term residential care where appropriate.

In line with this overall approach, a priority of Government in recent years has been to develop a range of community-based supports such as home help, home care packages, and day respite care. Between 2006 and 2010, additional investment of more than €200 million was provided to the HSE to develop community based services for older people. Without these initiatives, many older people would spend longer than necessary in acute hospitals or would be admitted to residential care earlier than might be required. The HSE service plan 2010, approved by the Minister for Health and Children in February, commits the HSE to providing agreed levels of service nationally for these key community support areas. The plan includes respite care provision, often available via day care facilities or as part of a home care package. These services are delivered either directly by the HSE, or in partnership with the voluntary or private sectors.

Broadly speaking, the level of community supports for older people in 2010 is in line with the 2009 provision. This includes an increase this year in the number of home care packages available, due to an additional funding of €10 million given for this purpose in the last budget. The key activity targets contained in this year's HSE service plan are almost 12 million home help hours to around 54,500 people; increased home care package provision from 8,700 recipients at any one time in 2009, to 9,600 in 2010; and a total of 21,300 day care places, which is estimated to cater for up to 80,000 people. While this target is slightly down from a comparable figure of 21,600 places last year, the respite element of day care would be generally compensated for in the overall 2010 home care service picture. It should be noted that any changes to these national target commitments, as part of the agreed HSE service plan, must be notified to the Department.

The HSE provides more than 750 designated respite care beds benefiting an estimated 19,000 people. It also provides in excess of 1,000 dedicated rehabilitative, convalescence and assessment beds within its own facilities. In addition, the HSE is currently working to reconfigure services within its own facilities to ensure that the best possible use is made of public resources with regard to the provision of both long-term and short-term residential care services. The Department of Social Protection provides a respite care grant which may be used to purchase short-term care in private nursing homes.

Other important initiatives are also being undertaken at a strategic level to improve community based services for older people. Arising from an evaluation of home care packages, published by the Department last December, the HSE established a task group to progress various improvements in home care provision this year. The Department accepts the need for a more standardised approach to home care generally, whether by public or private provision. This year the HSE intends to introduce standardised access and operational guidelines for the delivery of home care packages; adopt a voluntary code of quality guidelines for home care support services for older people; and progress a new procurement framework for home care services. These initiatives will, as I have indicated, facilitate the HSE to implement a more standardised approach generally to home care services, including respite care, in the context of interlinking with the wider range of services throughout the acute hospital and primary care areas.

With regard to the particular case raised by the Deputy, I understand that the facility in question is still providing some respite and other care services, but faces challenges from new standard requirements and staffing issues. The HSE locally is arranging replacement care at present, as required, in local private nursing homes, or in St. Vincent's, Athy. This is done through the local public health liaison nurse who manages individual requests for respite.

As the Deputy is aware, the HSE has operational responsibility for the delivery of health and social services nationally. He will appreciate that all developments relating to older people, including respite care, have to be addressed in the light of the current economic and budgetary pressures. The HSE has been asked to make a rigorous examination of how existing funding might be reconfigured or re-allocated to ensure maximum service provision is achieved. This requires a stringent ongoing review of the application of the resources currently available. It is, consequently, a matter for the HSE to manage the services I outlined, at national, regional, or local level, bearing in mind all relevant factors such as overall resources, local circumstances, or evolving service priorities. This includes the provision of services at individual facilities within County Kildare, or elsewhere.

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