Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I pay tribute to home support workers and the contribution they make to society. They provide medical care, support and much more. As all Deputies know, they are a lifeline for older people, vulnerable persons and those who want to live safely and securely at home among family, friends and community.

It is important to remember that we are an ageing nation and we should celebrate that we are living longer, can spend more time with our families and friends, contribute to society in our retirement years and get involved in our communities. However, there are warning signs and we are not heeding them. We are not planning for the fact that over the next 30 years, the number of people in Ireland aged over 65 years will double and the number of people aged over 85 years will quadruple. People want to live at home for as long as possible with the correct wraparound supports. Home care support packages enable them to do that. For some older people, the home care support worker might be the only person they see all day.

The home help crisis is hitting the most vulnerable hardest. I acknowledge that the Minister of State, Deputy Finian McGrath, accepted the need to further improve the system. It is cruel that so many people are waiting for home help hours to be allocated. The latest HSE figures reveal that 6,310 people were on waiting lists for home help services at the end of April. Currently, 53,000 people receive home care supports but figures show that one in ten of those who need supports are waiting to receive them. Some of them have serious issues. In recent years, the number of people waiting for home help hours has increased significantly, despite significant increases in available hours.

The recently announced restriction on new applications for home help services is appalling. This regressive decision will have many knock-on negative consequences for families, carers and the wider health services. The Government says on the one hand that it will facilitate people to grow old in their own homes while, on the other hand, it restricts the means to do so.

The HSE service plan 2019 pledged that 17.9 million home support hours would be delivered this year. It has been reported that the service has been largely closed to new applicants until November. I accept the Minister of State's assurance that it is not correct that no new clients will be allocated home supports for the next five months, the allocation of hours will be based on clients' needs and the resources available and the recycling of hours is ongoing in line with budgetary management. Unfortunately, this was contradicted by a HSE spokesperson who stated that the budget increase of 2019 would not allow the HSE to increase the number of hours of care delivered because the cost of delivering hours had increased. The spokesperson noted that to balance the budget for 2019, there will be a reduction in the number of new hours as opposed to existing hours provided compared with early 2019 and that this will continue until early November. The Minister of State's assurance that the number of hours will not be affected is contradicted by the statement from the HSE.

On the number of home care hours allocated, the final reported activity for home care in 2018 was slightly more than 17.5 million hours. In the first quarter of this year, 4,215,754 home support hours were provided. If this figure is repeated in every quarter, provision will fall approximately 1 million hours short of target in 2019. That is very worrying because hours cannot be front-loaded at the beginning of the year. People who need home support and are lucky enough to get it require the service on 365 days of the year.

As demand for services continues to grow and waiting lists become a feature, we are being told on the ground that home support will be closed to new applicants until November, notwithstanding that the Minister of State argues differently. Some restrictions on access will place extra pressure on acute hospital services and aggravate the problem of delayed discharges. We learned that 206,000 bed days were lost last year due to delayed discharges. This has caused great pressure on emergency departments. Given the ageing population, the announcement by the HSE before Christmas 2018 that it would extend home support to an additional 550 people in 2019 was extraordinary.

Will home care packages be recycled? It is important that the Minister of State clarifies the position. In some community healthcare organisation, CHO, areas, no one is waiting for the home support service while other areas are performing badly in this regard. Why is the good practice in some CHO areas not reflected in the poor performing areas? Is this a case of bad management, a lack of funding or mismanagement of funding or is it that some people who need a service for, say, seven hours per week are receiving only one hour of service and are being classified as having their needs met? We need to tease out that issue.

The Fianna Fáil Party amendment is broadly supportive of the amendment tabled by Sinn Féin and would strengthen it. I recognise the introduction of a new five over seven day roster. The last time we debated this issue, I noted that the new roster is not supported by adequate information technology systems and this is causing difficulties, as the Minister of State acknowledged. I also recognise the recent agreement reached on travel expenses for home care support workers. However, a guarantee is needed that it will not impact on delivery of the additional 800,000 home support hours pledged in the 2019 service plan. We have been led to believe that funding must come from the existing hours allocated, which will be difficult.

Most important, as our amendment provides, individual need, not geography or postcode and certainly not funding, must be the decisive determinant of care. The patient must come first at all times. Families across Ireland are angry, worn out and under pressure. Any move to reduce home help hours cannot and will not be tolerated.

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