Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I move amendment No. 1:

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

“recognises:

- the invaluable work carried out by homecare support assistants;

- that the Home Support Service is a core service for older people and is highly valued by service users, their families and by the Health Service Executive (HSE), providing supports which assist older people to live independently in their own homes for longer and enabling large numbers of people to return home following acute hospital admission, who otherwise would remain in hospital or would be admitted to long stay residential care;

- that the core stated objective of this Government is to promote care in the community so that older people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible;

- that the Oireachtas Committee on the Future of Healthcare Sláintecare Report supports a significant shift in our model of care to one that is focussed on prevention and early intervention, which will provide the majority of care in the community, and the Government’s Sláintecare Implementation Strategy sets out an ambitious programme of reform to deliver this vision;

- that over the past number of years, improving access to home support has been a priority for the Government, as reflected in the increases in the home support budget which has grown from a base of €306 million in 2015 to about €446 million in 2019, representing about a 45 per cent increase in the annual budget for this service;

- that the 2019 HSE National Service Plan provides for 17.9 million home support hours to be delivered to over 53,000 people at any time, and the Intensive Home Care Packages to be delivered to approximately 235 people at any time, delivering a further approximately 360,000 hours; and

- that despite this significant level of provision, demand for home support continues to grow;

notes:

- that the HSE reviews people on the waiting list, as funding becomes available, to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front line staff who know and understand the clients’ needs, and who undertake regular reviews of those care needs to ensure that the services being provided remain appropriate;

- that the allocation of funding for home supports, though significant, is finite and services must be delivered within the funding available and in line with the HSE’s budget, delivery plan and the National Service Plan;

- that the HSE has confirmed that there are no cuts to the Home Support Service and that the HSE will meet its service plans target to deliver 18.2 million hours this year;

- that all Community Health Organisations are working to ensure the best use of available funding to support the greatest number of people requiring homecare services;

- that following a Labour Court recommendation in 2014, the HSE implemented new contracts for its directly employed homecare staff, providing each worker with a guaranteed minimum number of hours per week and a guaranteed income each week with actual work assignments, managed in a reasonable way to meet the needs of clients over the course of 12 months, and that this new contract was regarded by staff, unions and management as a positive development for HSE employed staff;

- the future demographic projections and their implications for future service provision;

- that while the existing homecare service is delivering crucial support to many people across the country, it needs to be improved to better meet the changing needs of our citizens;

- that the Programme for a Partnership Government signals the Government’s intention to improve homecare services and to introduce a uniform homecare service; and

- that the Minister for Health has committed to establishing a new stand-alone statutory scheme and system of regulation for homecare services; and

confirms that:

- there are no cuts to the Home Support Service, the HSE will meet the service levels set out in its 2019 National Service Plan this year, the allocation of new hours will continue to be based on clients’ needs and the resources available, and hours that become available will continue to be reallocated within the increased budget provided in 2019;

- a review of existing home support services will be commissioned that will, amongst other things, examine:- the policies and procedures currently in operation at national, regional and local levels pertaining to the administration of services;

- the quantum of services provided by the HSE (through direct service provision), voluntary providers and private providers, and the coordination of these services within this ‘mixed economy of welfare’ at national, regional and local levels;

- the ratio of care workers to service users at national, regional and local levels, and whether the supply of appropriate skilled staff is adequate to meet current and projected demand for home support; and

- the current funding of the Home Support Service, including analysis of the distribution of the budget for home support services at regional and local levels, the calculation of the unit cost of home support services, the proportion of the funding allocated to direct service provision by the HSE, the methodology for the allocation of funding to service providers through the HSE’s tendering processes, and how this relates to the funding of direct service provision by the HSE; and

- a new statutory scheme and new system of regulation for home support, informed by international and national evidence and stakeholders’ engagement, will be developed that will:

- improve access to home support services that people need in an equitable, affordable and sustainable way, ensuring that the system operates in a consistent and fair manner across the country; and

- ensure that the public can be confident that the services provided are of a high standard and will bring Ireland in line with best international practice.

I thank colleagues for their contributions so far in this debate. I am well aware of many cases such as those they have highlighted. I absolutely agree that the home support service is a core service for older people and is highly valued by service users, their families and the Health Service Executive. In line with Government policy, it provides supports that assist older people to live independently in their own homes for longer and enables large numbers of people to return home following acute hospital admission who otherwise would remain in hospital or would be admitted to long-stay residential care.

Many more of our older people with complex care needs are now being supported at home, leading to increased demand for additional levels of service, and for services outside the core hours of Monday to Friday. It is crucial that we develop home support services that are flexible and best support the needs of service users. This contributes to our work towards providing a more viable alternative to nursing home care for a greater number of people.

The home help service was a feature of the Irish health service for more than 40 years, having evolved from what was a "friendly neighbour" service to the professional service it is today. The home care package, HCP, scheme was introduced nationally in 2006 and both evolved over the years such that the distinction between the two became less and less significant.

With the approval of the Department of Health, the HSE moved to a single funded home support service in 2018, combining the home help service and the HCP scheme into a single service - the home support service for older people. The HSE has implemented a single approach across the system to streamline services, and their delivery, to make the service easier to understand and to reduce the complexity of the application process for clients. This has also been done with a view to the development of a statutory home support scheme, which is under development.

Intensive home care packages for people with more complex needs, mainly dementia, were introduced in recent years and these are administered at national level.

There has been much speculation and media attention in recent weeks that there may have been a cut in the funding available for home support or a reduction in the number of hours support to be provided this year. This is not the case, and I am glad to have the opportunity to further clarify the position.

My colleague, the Minister of State with responsibility for mental health and older people, Deputy Jim Daly, recently outlined to this House the priority the Government has placed on improved access to home support services. This is clearly reflected in the ongoing additional investment made in recent years with the budget growing from €306 million in 2015 to almost €446 million in 2019. That is about a 45% increase in the annual budget for home support.

In 2015, the estimated home support hours target, inclusive of home help hours, home care packages and intensive home care packages, was 15.12 million hours. In 2019, the HSE commits to provide 18.26 million home support hours, including intensive home care packages, an increase of 3.14 million hours.

To deliver these hours this year approximately €30 million has been added to the home support budget. When one looks at the year-on-year targets, this means that this year’s national service plan targets to deliver approximately 800,000 more hours than the original 2018 target.

The final reported activity for home care in 2018 was just over 17.5 million hours, which accounts for an additional investment in home support made during 2018, including in the context of adverse weather. This year’s targets and allocation take into consideration 2018 activity, including the carryover of increased activity resulting from adverse weather investment and increased costs. These cost impacts include the revised contract for health care support assistants and costs associated with the 2018 tender for indirect or non-HSE care provision, which equates to approximately €19 million.

Throughout the winter period, additional home support was provided supporting early hospital discharge and preventing hospital admission. Almost 1,100 clients were approved for new home support hours nationally and 857 packages had commenced by the end of March 2019.

The service is not demand led and is therefore operated in line with agreed budgetary limits and targets, as set out in the HSE national service plan.

Preliminary activity data reflect the period to the end of April 2019. The number of people in receipt of home support at any time will vary according to the value of the individual home supports approved and as clients cease and new clients with different needs are approved and commenced. By 30 April 2019, more than 5.6 million hours of home support had been provided and 52,329 people were in receipt of the service, with 5,761 new clients commencing this year.

Services allocated to new clients, and additional hours are provided to existing clients, are dependant on the number of additional hours approved and funded each year; the hours that become available through recycling, and the value of that service that becomes available for recycling; and the value of the service required by the new or existing client.

To achieve compliance with its funding allocation, the HSE must ensure that the value of the total number of hours provided does not exceed the budget. This means that the HSE must manage its service delivery over the course of the year to align with the total funding available. It has a responsibility to ensure that activity is planned to anticipate critical demand pressures, most particularly emergency pressures in the initial and latter parts of the year. The significant roll-out of packages in the first quarter of the year reflects these requirements, with the HSE now managing the recycling of hours in line with normal prudent management of its budget, as it does every year.

It is not correct to say that no new clients will be allocated home supports for the next five months. The allocation of new hours will be based on clients’ needs and the resources available. The recycling of hours is ongoing in line with budgetary management.

I acknowledge, and I listened to the debate tonight, that in some cases access to the service may take longer than we would like. Despite the significant level of provision, demand for home support hours continues to grow and, at the end of April, 6,310 people had been assessed and are waiting for new or additional services. However, the HSE has assured the Department that people on the waiting list are reviewed, as funding becomes available, to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front-line staff who know and understand the clients’ needs, and who undertake regular reviews of those care needs to ensure the services being provided remain appropriate. The HSE has a responsibility to ensure that activity is planned to anticipate critical demand pressures, most particularly during the winter period.

As noted, home support is recognised by all of us as an important service. On 20 June, my colleague, the Minister of State, Deputy Daly, convened a meeting with HSE management and community healthcare organisations, CHO, representatives to discuss the issue of home support. He was assured that all community healthcare organisations are working to ensure the best use of available funding to support the greatest number of people requiring home care services. There is no freeze on home support and the HSE will deliver on its service plan targets.

While the existing home support service is delivering crucial support to many people across the country, the Government fully accepts that it needs to be further improved to better meet the changing needs of our citizens. The development of a new, stand-alone statutory scheme and system of regulation for home support services is a long-standing objective of the Government.

This is currently progressing in line with the Sláintecare implementation strategy which commits to the introduction of the new scheme in 2021. It is intended that the new statutory scheme will improve access to adult home support services on an affordable and sustainable basis while the introduction of a system of regulation will ensure public confidence in these services. The new scheme will be designed to support carers and will complement and integrate effectively with other health and social care services.

Building on a review of the home care systems in four EU countries, which was published in April 2017, the Department is engaged in a review of the policy goals, objectives and guiding principles of adult home support service provision in ten countries. This review will assist in identifying international good practices, the learning from which will be incorporated into the new statutory scheme in Ireland.

I welcome the continued strong engagement of service users, their families and health and community care professions and stakeholder organisations and look forward to further dialogue throughout the process of developing the new scheme.

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