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

I move amendment No. 1:

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

"recognising that:

— the Government is very aware of the future projections and of their implications for services and supports for our future older population, this includes not only residential provision but also community and home based supports; and

— people should be supported in the care setting that is appropriate to their needs and that most older people prefer to stay in their own homes and communities for as long as possible; it is incumbent on Government to take account of this in decisions on how services and supports are structured;

and acknowledges that:

— in 2014 the budget for the Nursing Homes Support Scheme is €939 million and this is supporting over 22,000 people in residential care; the budget for community services is €315 million and this is providing home help and home care package services to some 56,000 people at any one time; and in addition community and home based supports were strengthened in 2014 by a further €23 million to allow more people to stay in their own homes for longer;

— in July this year the Health Service Executive (HSE) allocated €5 million for an initiative to improve access to appropriate care for older people; to date, this has funded over 300 transitional care beds for patients in acute hospital from the placement list for the Nursing Homes Support Scheme and over 200 home care packages to assist patients in the acute hospitals who require a home care package to be discharged;

— the Government has provided additional funding of €25 million in 2015 to address delayed discharges, which will include provision for an increased allocation to the Nursing Homes Support Scheme; planning for this initiative is well advanced; and details will be finalised in the HSE’s Service Plan later this month, with a view to their early implementation; and

— the Review of the Nursing Homes Support Scheme, which is currently underway, will consider the future funding and sustainability of the scheme as well as how community and residential services are balanced; this Review will be completed in the coming months, following which the Government will be considering how best to meet the needs of older people in the future."

I wish to share time with Deputies Patrick O'Donovan and Pat Deering. Deputy Kelleher and I represent the same constituency and in my view we have virtually the same approach to politics in that we usually play the ball rather than the man or woman. I do not normally engage in this House in bandying around insults. I am very solution-focused. Where I see a problem I try to find a solution. The contributions of Deputies Fleming and Cowen were very hard to stomach. That they can come in here and say that they cannot accept that as the Minister for Health said this problem arises because of a cap on the budget, as if somehow Fianna Fáil had no part to play in the collapse of the economy and this country, which, by the way, has led us to this point, is amazing.

It is amazing but Deputy Barry Cowen's expertise with figures was greatly missed by the last Fianna Fáil-led Government. Do any of them remember the Minister for Finance, Charlie McCreevy, who told us all that we were pseudo pinkos and to party on? At long last we have a plan in place to deal with the demographic issues which are coming down the line. We knew all of this in 2005-2006 when the Fianna Fáil-led Government was awash with money and did not know how to give it away. Where was its planning? Where is Fianna Fáil's health strategy now? As far as I can see, it does not have one. It is all about this awful Government. This awful Government has steadied the ship which Fianna Fáil managed to hole below the water. If there are difficulties in this economy and we do not have enough money to put things right, Fianna Fáil is part and parcel of the reason for that. A friend of mine used to say to me: "If Fianna Fáil can go out and knock on doors with that brass neck, surely you can." I concur with that. It is very difficult to listen to this kind of claptrap from Fianna Fáil.

I genuinely thank the Deputies for raising this serious issue, with which we must deal, and for providing me the opportunity to highlight some key elements of our approach to the care and support of our older people, in particular the issues around the nursing homes support scheme. The budget for the health service in 2014 was €12.7 billion. For 2015, there will be an increase in Exchequer funding of €305 million, bringing the Exchequer contribution to more than €13 billion. Further once-off revenue measures of €330 million will also be available to support services. This means that there will be an increase of €635 million in current spending for the health services compared with the start of 2014. The total capital budget for 2015 will be a further €382 million. Notwithstanding the additional resources in place for next year and the improving economic environment generally, it is important to remember that resources remain tight and many areas continue to face real challenges in meeting the demands on their services.

Those over 75 years and especially those over 85 years tend to have the biggest health care needs and the greatest dependencies. The HSE provides for the care of older persons through both community services and the nursing homes support scheme. Care is provided through a variety of community supports, specialist services and long-stay residential care.

From the community perspective, the main supports available are the home help service and home care packages, the budget for which is €315 million in total. The traditional home help service consisted of domestic chores, such as help with cleaning and cooking. In recent years, however, the emphasis has been on assisting with personal care. In 2014, the HSE will provide approximately 10.3 million home help hours which will benefit more than 50,000 clients. The service is not means tested and allocation of hours is based on need and availability of resources rather than ability to pay, which is how it should stay.

In addition to mainstream home help, home care packages are provided to persons with higher dependency levels who require a higher level of assistance. A home care package will assist with personal care, such as bathing and dressing, as well as more medical-type care, such as nursing and physiotherapy. These packages facilitate clients to remain at home for as long as possible.

Home care packages are provided within the budget available each year. In 2014, 10,870 people were targeted to receive a home care package at any one time. At the end of August 2014, more than 13,000 persons were in receipt of a home care package, which is 20% ahead of target and despite the tight resources.

The nursing homes support scheme is the focus of this motion. Despite what Deputy Barry Cowen said, I believe this an excellent scheme introduced by the previous Government. This scheme provides financial support for those who need long-term residential care. Residents contribute according to their means with the State paying the balance. It is worth highlighting that the State contribution is normally the greater part of the total cost. More than 22,000 people are supported under the scheme, which has a budget of €939 million this year. This is a massive commitment by the taxpayer to the welfare of older people.

The population under the age of 65 is expected to grow by 1% between 2014 and 2017, while the population aged 65 and over is expected to increase by 10% during the same period. The Government is very aware of these future demographic projections and of their implications for services and supports, both residential and community-based, for our future older population, but we knew this ten years ago.

The fact that more of our people can expect to reach old age should be seen as a great achievement and something to be celebrated. Not only are people living longer but they are staying healthier and living better for longer. Society is already benefiting and this will continue and increase in future. Voluntary organisations will gain volunteers, grandparents will have more time to spend with their grandchildren and businesses will expand to cater for older people. There are new opportunities.

There is also a challenging side to this demographic change. Older people have more need for supports and services and we are already seeing increases in demand for health and social care services, in particular for those most specifically relevant to older people. The number of people with conditions like dementia will increase significantly. It is estimated that there are 47,000 people with dementia in Ireland. These numbers are expected to increase significantly in the years ahead, with a projected growth to more than 140,000 by 2041. As a result, the programme for Government for 2011 to 2016 committed to developing a national Alzheimer's and other dementias strategy to increase awareness, ensure early diagnosis and intervention, and develop enhanced community-based services which was long overdue. This strategy will be brought to Government shortly for approval. In the interests of social cohesion and of older people themselves, resources will have to be deployed efficiently and services will have to be well designed and thought out. It is too simplistic to suggest we can solve the problem by a straightforward expansion of services across the board, in line with projected increases in demand, as suggested in the motion. It would be extremely expensive for future Governments and taxpayers, but even if the resources could be found, it would be the wrong thing to do.

Some older people will always need long-term care while many will need it for some period in their lives, and we must try to meet this need where it exists. Older people consistently say they want to stay at home in their familiar surroundings, within their communities, and to retain their independence. Mary Harney was the first person to say that and it certainly rang true, and it still does. We must look at the future in a more nuanced way and in a way that is open to new approaches.

The single assessment tool, which will provide a consistent basis for assessment of need and allocation of services, is in development by the HSE and is expected to become operational by the end of 2015. This will be of benefit across all care approaches to ensure that need is accurately and consistently assessed and that we provide what is needed in so far as this is possible. Community supports are provided and are being developed further, and increasingly it will be necessary to direct our focus into community and alternative models of care for older people. This means providing a range of flexible supports, including better home supports, increased use of technology, supported living models and quality residential care, both short-stay and long-stay. All of these services contribute to support the person in their journey of care.

For example, there is clear evidence that greater access to rehabilitation services both within hospital and community settings can lead to better outcomes for older people. Short-stay and rehabilitation beds are another important element. Telecare services and the use of technology have been developing for some years and are now widely recognised as enabling people to remain in their own homes as opposed to entering long-term care. The range of technologies and services available, such as mobility aids, sensors and alarms, can assist in ensuring the wishes of older people to remain at home can be facilitated for as long as possible.

International experience suggests that new residential models that would bridge the gap between independent living at home and full-time nursing home care should be considered. The contribution that supported housing schemes, which are linked to appropriate community care services, can make to the welfare of older people is widely recognised. These assisted facilities can also provide rehabilitative care to older people following a hospital stay. The issue before us this evening revolves around the nursing homes support scheme which supports residential care. To match the funding available at any given time to demand, the HSE operates a national placement list. All applicants who are approved for funding are put on this placement list in order of their approval date. Funding issues to applicants in this strict order to ensure equity nationally. Unfortunately, it can happen that demand exceeds the amounts of funding that can be released, and in these circumstances waiting times get longer. This has been an issue during 2014, and the current waiting time is about 15 weeks, with 1,993 people on the list awaiting release of funding. That has changed because as of today the HSE has released funding for an additional 180 new places. The figure is not low enough yet but we will get there. In July 2014, the HSE allocated €5 million for an initiative to improve access to appropriate care for older people. To date, this has funded over 300 transitional care beds for patients in acute hospitals who are on the scheme's placement list and over 200 home care packages to assist patients in the acute hospitals who require a home care package to be discharged. We moved €23 million. We did not take it from one cohort and give it to another. We used it for the same cohort of people and it is disingenuous to say otherwise.

This year, an additional €25 million has also been provided in the 2015 budget, aimed at hospital and community services which can effectively address the specific needs of delayed discharge patients and improve timelines for admissions from emergency departments and waiting lists. It will include provision for an increased allocation to the nursing homes support scheme. Planning for this initiative is well advanced. Details will be finalised in the HSE's 2015 service plan later this month, with a view to their early implementation. The review of the nursing homes support scheme, as well as considering how the scheme has operated to date, is expected to identify some of the issues that will need to be considered and tested more fully into the future, including the future financing of the full range of supports for older people. Work is well advanced on this review, and it will be completed and published by early 2015.

Whether we respond successfully to the aging of our population will depend on the willingness of every sector of Irish society including the statutory, community, voluntary and private sectors, to adapt in good time to the changes that population aging will present in the coming decades. The health reforms which the Government is working to implement are intended to ensure that everyone, including older people, receives safe, timely and efficient care and treatment, at the lowest level of complexity and as close to home as possible. The Government believes that the challenges ahead can be met and opportunities in health care exploited by planning now to ensure that Irish society is an 'age-friendly' one in the years ahead.

That type of planning should have been done when this country was awash with money but Fianna Fáil thought it would never again see a poor day so it did not need to plan. It did not care. It could throw as much money at it as it liked. In response to Deputy Kelleher, the average waiting time for assessment is still four weeks. It is the release of the funding that takes longer. I readily admit that but we need to get the facts right.

The health budget has increased. I will detail the planning for long-term residential care needs. We are well aware of the demographic factors. We knew this ten years ago but that did not matter to Fianna Fáil then. The over-65 population will increase by nearly 220,000 over the next decade. There will be 60,000 more people aged over 80 in the same period. We need to consider seriously what we will do. Mount Carmel will be part of that. It will provide rehabilitation, short stay and respite care, and long-term care. Next year we build on that to 65 beds, specifically for the north side of Dublin because that is where the demand is in the city. We need to do more of that. As Deputy Fleming said, there are old community homes and hospitals which, with a bit of forward planning and capital, could have been made useful for dealing with our aging population. We are planning for that. The budget is very tight. We have to be very careful about how we spend our money. Fianna Fáil was awash with money and did not know what to do with it. People were getting increases every week but it did no planning and that is why we are at the point we are now at.

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