Jim Daly (Cork South West, Fine Gael) | Oireachtas source

Táim buíoch as ucht an deis labhairt faoin ábhar tábhachtach seo. Sa chéad áit, ba mhaith liom mo bhuíochas a ghabháil chuig na Teachtaí as ucht an méid atá ráite go dtí seo.

I thank the Deputies opposite for raising this important issue. In particular, I thank Deputy Mary Butler, who always has been, if anything, highly consistent and commendable in her approach to issues affecting the elderly, especially in the areas of dementia and home care. I wish to acknowledge at the outset her consistency and collaborative approach in working on this issue at all times. Although she is a very nice person socially, I dread meeting her on the corridors. I find myself ducking the corridors more often than not because of her utter consistency and care in this matter. I wish to acknowledge her collaborative approach. She is always constructive and collaborative and wants to work with others as opposed to scoring cheap political points. She has always found that to be beneath her. I commend and acknowledge her approach in this regard.

We all share the common objective in what is being said today in the debate on the motion. As Minister of State with responsibility for this area, not only do I agree with the motion but I welcome it. Moreover, I welcome the opportunity for us to debate the issues and to share views from all sides of the House. This allows us to increase the focus on the issue. Collectively, we all want to ensure our people are cared for as they get older. Our elderly people represent our most treasured possession and we want to ensure they get to live and age well in society. We want to ensure the very best of facilities for them.

We are all committed to Government policy, which is to allow people to age in their own home and to continue to live as well as they can there. The policy is to provide as many supports as we can to people to live in their own homes.

We have several challenges facing us in the demographics as Ireland catches up with the rest of the EU demographically. Our population is growing older, with the number of people over the age of 65 years set to double and the number of people over 85 years set to treble in the next 20 years. While this will prove something of a challenge, it will also prove an extraordinary opportunity for us as a society to radically change how we approach the care of our elderly. It will allow the inter-generational aspect come to the fore more at a time when our younger people are more and more obsessed with screens and lack of social interaction and so on. This represents an extraordinary challenge for us but also an opportunity to tap into the wisdom, wit, company and friendship of our elderly and young people. We can realise the challenge by working together. We must embrace other challenges that are coming down the tracks and we must look at other opportunities when it comes to care. One such challenge is what is at the heart of this motion, namely, providing home care for the elderly population.

People will know the statistics. Last year, the HSE provided 17 million home help hours. Deputy Curran and others are tenacious in seeking this information. They will know all of these figures by heart. Anyway, it is no harm to put them on the record and to put them into focus. Sometimes we say there is no service there. As politicians we do not have people coming into our offices telling us when they get the service and what they are getting. Rather, we come across people who do not get the service. A total of 17 million hours were provided by the HSE last year. The budget in 2015 was €306 million and it is now at €420 million. That indicates a significant increase in the budget over that period. Of course, that is not enough. I have accepted that every time I have spoken on the matter in the Dáil, including during Questions on Promised Legislation. I acknowledge that it is not enough and that we need more. Yet 52,000 families have benefitted from home care delivery. It is important to acknowledge the good work of the HSE and to acknowledge where the HSE is delivering and providing an exceptional service as well as acknowledging the individuals who are providing the service.

Certainly, I am not shy in wanting to share in the ambition of the party opposite to increase and improve on this delivery and to ensure that we can allocate the maximum possible amount of resources available to us to ensure we continue in this regard.

We are keenly aware and acknowledge that in some cases access to the service may take longer than we would like. However, the HSE monitors the delivery of home care on an ongoing basis to ensure that activity is maximised relative to individual clients' assessed care needs within the overall available resources.

Following the recent budget announcement, the HSE and officials from the Department of Health are in the process of developing and agreeing the HSE national service plan 2019. The plan will set out in detail the type and quantum of services to be delivered in 2019, including services for older people.

In the context of winter planning there has been a sustained focus in recent years on reducing delayed discharges and enabling patients to be discharged from acute hospitals sooner. The HSE is currently finalising its winter plan in conjunction with the Department of Health to provide the most effective response to the challenges to unscheduled care provision in the coming months. The plan will contain a range of measures across hospitals, primary care and community care settings to manage critical demand pressures during winter to ensure the system is working at full capacity throughout busy periods.

As part of budget 2019 an additional €10 million has been made available to the HSE for the winter period for home supports and other supports to minimise delays in people getting home from hospital, with a focus on those in the over 75 age group. My Department immediately sanctioned the release of €5 million of this additional funding to support the deployment of social and primary care measures to enable patients to return from hospital to their home or community with the supports they need. The funding will support an additional 300 home support packages, additional aids and appliances and additional transitional care in the run up to Christmas. The expected impact of these measures will be considered in the context of the broader winter plan.

The HSE has committed to prioritising the full-year cost of these measures in the national service plan for 2019 and to including additional measures in early 2019. These will include an additional 250 home supports packages. This means that in the months ahead an additional 550 home support packages will be made available. Importantly, these measures are being actively operationalised.

Deputy Troy referred to Deputy O'Dea's Private Members' Bill. As Members will be aware, we launched a consultation last year to find out what people would like to see in a home care scheme to be set out in statute and underpinned by statute. The idea is that it would be demand-led like the fair deal scheme. Anyone who wants to go into nursing home care is guaranteed that the funding would be available. Thankfully, it has been available for several years now and people have to wait no more than three weeks for an application to be processed. We have the same ambition for home care. We have begun the journey. The Sláintecare implementation strategy sets a target of 2021 for introduction of the new statutory scheme. We hope that in 2020 we will have an outline of how the scheme will look. However, it will take a further 12 to 18 months before we can get to where we need to be to design the policy in full. Much work has to be undertaken behind the scenes to ensure the availability of staff to respond to the needs of such a scheme. The scheme will introduce clear rules on the services for which individuals are eligible and on how decisions are made on allocating services. For that reason, developing a new statutory scheme will be an important step in ensuring the system operates in a consistent and fair manner for all those who need home support services.

It is important to note that a significant amount of detailed work remains to be carried out before final decisions are taken on the form of home support scheme and the system of regulation of these services.

It is important that people are supported and encouraged to live independently in a supportive environment for as long as possible and to plan for this. The Department of Health and the Department of Housing, Planning and Local Government are working together on developing a policy framework by which Government can facilitate and promote a variety of housing options, including housing with care for older people. The Minister of State at the Department of Housing, Planning and Local Government, Deputy English, and I held an expert conference yesterday on housing for older people. The conference provided the opportunity to hear from experts in housing, health and social care services. It was an opportunity to inform those present on the development of an appropriate policy framework to respond to the challenges and opportunities ahead. The Department of Health and the HSE are participating in a demonstrator project in partnership with Department of Housing, Planning and Local Government, Dublin City Council and the Irish Council for Social Housing. A site in Inchicore has been identified for development of a housing with support model under the Rebuilding Ireland plan, which will deliver 52 homes and is due for completion in 2020.

One important aspect of the home care debate is that we provide real and meaningful alternatives for people who want to move, to downsize or to live in supported environments. These people want a real alternative rather than simply the choice between their own home and a nursing home. There is a mid-way place where people can go to supported housing developments with on-site supports. There are some wonderful examples throughout the country. Many of the Deputies opposite and on this side of the House will be familiar with them. Often I quote the example of Kilmaley in west Clare, where there are 24 units for elderly people. One person is on duty 24 hours per day, seven days per week to provide whatever assistance is necessary to the people there. More important, in 20 years of these 24 units being in place only one person has ever gone from the supported housing unit to a nursing home. Only one person there has ever graduated to a nursing home. Anyone who has had end of life experiences or who has died has either died on-site or in an acute setting. We can be far more ambitious. That is a part of the solution. It is not the whole solution but it is another part of the debate.

We are developing a new statutory care scheme. It will be 2021 before it will be brought in. This comes under the implementation of the Sláintecare strategy. As resources become available we will continue to enhance and improve on the available resources to maximise the amount of home help we can provide to people. We understand the benefits for the acute setting. We understand the advantages of taking people out of hospital, which is the least safe place for elderly people to be when they do not need to be there. We certainly support the motion from the party opposite.

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