Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I move amendment No. 2:

To delete all words after “Dáil Éireann” and substitute the following:"acknowledges:

— the Health Service Executive (HSE) community based supports currently in place for older people, including vulnerable older people; and

— the imperative to maximise service delivery in all relevant respects in line with current or expected overall resource availability;

recognises the significant existing investment of, for example, in the region of €320 million this year for home help and home care packages and overall for the wide range of HSE health and personal social services generally, including mainstream home help, enhanced home care packages, meals-on-wheels and day or respite care, which meet the preferred wishes of many vulnerable older people and help reduce pressures elsewhere in the wider health system;

notes the complex and multi-disciplinary nature of such services, including the partnership by the HSE with non-statutory agencies to complement its overall funded provision;

welcomes progress by the Government so far, to consolidate and improve the planning and delivery of such services, including maximising the use of limited resources while promoting quality, safety and equity for both providers and care recipients alike;

acknowledges various quality related initiatives led by the HSE, including developing new guidelines and a new procurement framework for its home care services;

welcomes the recent publication by this Government of the National Carers’ Strategy, which reinforces the Government’s recognition of, and commitment to, all those caring in whatever capacity for vulnerable people;

welcomes progress by the Government to advance the long awaited National Positive Ageing Strategy, now being finalised, to enhance a more strategic and co-ordinated approach to the well-being of older people and the intention of the Minister for Health to bring a draft of the completed Strategy to Cabinet before the end of the year;

acknowledges that it is best practice to keep home help and other services for older people under review, so that such assistance is in keeping with their individual requirements, as assessed by the local health team, which may increase as well as diminish;

and commits to keeping the position in relation to home help and home care packages under review for the remainder of the year, and that anyone who has been assessed as needing a service will have that service provided."

With the agreement of the House, I will share time with Deputies Michael McCarthy and Catherine Byrne.

No one I know, no one involved in politics and no one who has direct experience of elderly people in the community underestimates the value of home helps. Everyone recognises the incredible work they do. I do not disagree with anything Deputy Jonathan O'Brien said about his father. I know the experience his family had. It was not a pleasant experience but it was made manageable by the supports the family received. A cup of tea can be as valuable in certain circumstances as intensive help would be in another. We cannot forget that.

Home helps work across a range of services. They wash, move and turn bedridden people. They care for families and do household chores. The flexibility within the service is what makes it so valuable. In other care settings there can be a rigidity and demarcation of responsibility leading to inflexibility and, in some cases, a lack of the homely atmosphere that we can only have in our own homes.

Fortunately, the majority of older people do not require dedicated intervention until absolutely necessary and, unlike some other care options, community based services for older people are intended as an individual and family support. That needs to be reiterated. In some cases it is not one person who is being helped within his or her own home, but an entire family.

I fully appreciate, through feedback from various sources, the difference quality home care can make to individuals and their families. It is estimated that there are around 100,000 people over the age of 65 who receive some form of HSE community based supports each year. The HSE Service Plan 2012 provides for various community based services such as mainstream home help, enhanced home care packages, meals-on-wheels and day or respite care.

It is widely acknowledged, both in Ireland and internationally, that the home help service is one of the key services in the community care of older people. It is a critical factor in helping to maintain older people in their own homes and communities. That is not in dispute. The service is discretionary and flexible and this allows it to be targeted at those most in need. The home help service primarily includes the provision of personal care and essential domestic support, mainly for older people. The level of service provided depends on the resources available. We all understand that perfectly.

The service is provided, depending on local arrangements, by HSE employed home help staff and-or through a partnership of private or voluntary sector organisations. In the last year, my experience in the Dublin area has been that several voluntary organisations provide home help and home care. They have done an exceptional job for many years and continue to do so. We need to bear that in mind.

In 2011, there were just over 11 million home help hours provided to about 51,000 clients nationally. Approximately 11,000 clients were in receipt of a home care package, HCP. At the end of July 2012, some 6,072 million home help hours had been provided to clients nationally in the first seven months of this year. The number of people in receipt of home help services at the end of July was 50,139. The vast majority of clients in receipt of services at that time were older persons, with smaller numbers of people with disabilities, children and families, or those with mental health problems benefiting from the service. It is sometimes forgotten that home helps provide service across a range of disabilities.

In addition to mainstream home help, the HSE also provides, either directly through HSE employees or indirectly through voluntary or private organisations, home care packages, HCPs. It is important to emphasise that such packages do not replace existing services. At the end of July 2012 there were 11,119 people in receipt of a home care package. A home care package is an enhanced level of services for those people living in the community that require additional home supports. The purpose of home care packages is to facilitate timely discharge of older clients from acute services; reduce inappropriate admissions of older people to acute care or residential care; reduce pressures on accident and emergency departments; support older people to continue to live, or return to live, in their own homes or communities; and support carers so that they might be able to continue to provide care for older people.

We are working on mechanisms to ensure that people can leave acute hospitals and return to their own homes. I was working on this issue this afternoon. I agree with Deputy Ó Caoláin that helping people to leave acute beds and return to their homes, or to a step-down facility, is something we must address as a matter of urgency. We have been working on this actively.

The HSE has a statutory responsibility to live within the budget voted to it by the Oireachtas. In this context, the HSE developed a range of proposals for discussion, which would reduce spending and yield cash between now and the end of 2012, which is not an easy task. It is a priority for the HSE to minimise the impact on patients and clients of any spending reductions. Many of the proposals, therefore, focused on areas that do not have a direct patient impact, such as furniture, education and training, office expenses, ICT, travel and subsistence or similar measures.

The target in the HSE service plan for 2012 was to deliver 10.7 million home help hours to 50,000 people with a budget of €200 million. In addition, just over 15,700 people were targeted to receive a home care package in 2012, at a budget of €138 million. That is all outside the fair deal scheme.

It is proposed that there will be a reduction of approximately €8 million in spending on home help hours between now and the end of December, and €1.2 million for home care packages. However, the HSE intends that the impact of these reductions will be minimised for individual recipients by ensuring that services are provided in the first instance for direct patient cars.

Decisions in regard to the provision of home help hours will continue to be based on a review of individual needs and no current recipient of this service and who has an assessed need for this will be without a service. That is something we have insisted on. Similarly, the HSE is reducing the home care package budget by €1.2 million from an overall target of €138 million, and the same principles in regard to minimising client impact apply.

This has been a challenging year for the health services overall, including maintaining services in line with evolving resource pressures. The overall provision of home support services is therefore regularly reviewed at national and local levels, in the context of client need and resource availability. Notwithstanding the recently announced reductions for HSE home support provision over the remainder of 2012, investment in these services remains significant, with expenditure of about €320 million expected for home help and home care packages this year.

The HSE has been developing various operational initiatives to improve its approach nationally to all relevant aspects of its home care services. These include various new guidelines for home care and recently adopting a new procurement framework for approved agencies providing such services on its behalf. While ongoing developments have been designed to standardise and maximise the use of limited resources in the face of increasing demand, they are also intended to enhance quality, safety and other key aspects of planning and delivering services for both providers and care recipients alike. We are all aware of the financial circumstances in which the country finds itself, but the applications for home help and home care packages have not stopped. They are still being accepted and people are still being assessed. We are working on the assessment of need because we believe a great deal more can be done to ascertain the person's true needs, be they social or medical. We must take the social needs into account as well.

Following a national procurement process concluded earlier this year, approved external providers of home care packages must meet certain criteria, including requirements relating to staff training, elder abuse, infection control, recruitment of staff, supervision of staff and monitoring of care. Each provider must sign a service level agreement with the HSE and these incorporate quality, safety and monitoring requirements. The new procurement process will not impact on existing service providers and will only apply to any new home care packages to be assigned during the lifetime of the agreement. The fundamental motivation for this tender was the introduction of improved standards for enhanced home care services for clients nationwide. The tender is due for review in 2013.

On a broader but related front, we will progress the commitment contained in the programme for Government to develop and implement national standards for home support services. These, as envisaged, will be subject to inspection by the Health Information and Quality Authority, HIQA. Various options are currently being examined, including the complex legal issues involved. However, the strategic reality we face is a need to prioritise legislation across the wider social care area, such as that relating to widely accepted requirements in the child care and disabilities areas. As regards the latter, the Government continues to fund a broad range of services to the tune of €1.4 billioneach year. In 2012, the Health Service Executive national service plan commits to providing residential places for 9,100 people, day services for 18,600 people with intellectual disability, residential support for 6,300 people and 1.64 million hours of personal assistant or home support hours.

While this programme provides support for the full cohort of people with disabilities, older people in this category also benefit through respite and personal support services. A number of other significant developments are also underway to transfer more people with disabilities from congregated residential settings into the community and to put in place a system of registration and inspection of residential services by HIQA, which is expected to be up and running by the middle of next year. We hope to have the standards developed by HIQA published in January next.

As Minister with responsibility for older people, I am keenly aware of the importance of positive ageing, not only for each of us as individuals, but also for our communities and for Irish society as whole. The Government acknowledges the need "to better recognise the position of older people in Irish society". The programme for Government has committed to completing and implementing the national positive ageing strategy so older people are recognised, supported and enabled to live as full and independent lives as possible. The strategy will set the strategic direction for future policies, programmes and services for older people. It will set out a common framework for the development of operational plans by a number of Government Departments which will clearly set out each Department's objectives relating to older people. Mechanisms designed to monitor the implementation of measures contained in operational plans will also be included in the strategy. However, I do not envisage that the strategy will propose new service developments. Instead, it will set the strategic direction for future policies, programmes and services for older people. A considerable amount of preparatory work has already been completed. It is my intention that a draft of the strategy will be brought to the Government at the end of this year.

Carers are vital to the achievement of Government policy for older people, children and adults with an illness or a disability, which is to support them to live in dignity and independence in their own homes and communities for as long as possible. I am fully aware that every day in this country tens of thousands of family members, friends, partners, parents, children, neighbours or home helps provide care for someone who, through a variety of circumstances, is in need of that care. The Government is under no illusion about the challenges carers face on a daily basis. That is why the Taoiseach committed to developing the National Carers' Strategy, which was launched in July of this year. The strategy sets the strategic direction for future policies, services and supports provided by Government Departments and agencies for carers.

The National Carers' Strategy is the first of its kind to be developed in recognition of the invaluable role and contribution of carers. It places carers firmly on the national agenda and sets the strategic direction for future policies, services and supports provided by Departments and agencies for carers. It sets out a vision to work towards and an ambitious set of national goals and objectives to guide policy development and service delivery to ensure carers feel valued and supported to manage their caring responsibilities with confidence and are empowered to have a life of their own outside of caring.

It is very important that available resources are targeted at those most in need and that care is provided in the community and the home as much as possible. The continuing pressure on resources in the health sector generally will make it an imperative that we obtain the best targeting of resources towards those most in need. Members can rest assured that this will entail follow through on all the commitments outlined in the programme for Government, including progressing regulation of the home care sector and considering new ways to fund home care, similar to the model pertaining for long-term residential care, or the fair deal scheme as it has become known.

The Government will make every effort to protect front-line home support services for vulnerable older people. The position next year will be considered in the context of concluding the Estimates and budget process for 2013. I have been listening to the contributions from Deputies and will take their comments on board.

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