Alan Kelly (Tipperary, Labour) | Oireachtas source

I welcome the Minister of State. This is a topic I have spoken directly to the Minister about on many occasions. I have spoken about it ad nauseam here and in committee as well. This topic is a major part of sorting out many of the issues and problems in our healthcare system. The Labour Party will be supporting this motion, which tallies well with the motion my party will be putting forward tomorrow night regarding carers. The two motions go hand in glove. I acknowledge that. We ended up in a debate on this issue because of reports in the media. I know the Minister of State is well aware of that. I refer to a document sent to the Department with options for savings of €500 million. I know that the new chief executive office of the HSE is under pressure regarding budgets etc.

This option was one of many, I presume. We will find out when the full document is published, one way or the other. The Minister of State might publish it or it might come out some other way. This was an option that I understand was rejected or not even considered. That is fair enough. In real life, however, there was concern about this. In real life as well, issues arose because of this. There also seem to be issues arising in some of the CHOs but not in all of them. I have spoken to representatives from many different CHOs as well as many people who work in them and deal with services. There are different experiences in different CHOs. I ask the Minister of State to examine this issue from a budgetary point of view. I will come back to this point.

I listened to the other Minister speaking about this topic earlier. One phrase jumped straight out at me. That was when he stated that this is not demand led. That is the problem. It should be demand led. The issue here is that provision should not be based on a budget every year. That is the real problem. We know where the demographics are going. I do not expect the Minster of State to be able to quantify the numbers exactly each year but the numbers of people over 65 and over 80 is changing dramatically. This service, therefore, has to be demand led.Ironically, making it demand led will allow us to save a fortune. We will then be able to reinvest that money into the health service in many other ways.

There has also been frequent mention here regarding the difference between home help hours, €150 to €170, versus more than €1,000 for a nursing home and €5,000 to €6,000 for acute care. The strange thing is that we have CHOs being put in a position whereby they have to meet their budgets but there are people in beds in the same corresponding acute area network. I know the Minister of State knows this because he has a report on delayed discharges that he and I have read. The Minister of State has taken an active interest in this area. It is bizarre and perverse that it makes more sense for those in a CHO area to want those patients in an acute setting to be left in those beds. That costs taxpayers five times more than if they were going into elderly care for a while, into recuperation or whatever. The fact that packages cannot be put forward is crazy. It is a perverse situation and changes in this area will actually allow money to be saved.

It is an issue that is going to have to be addressed. I, with some colleagues here, sat through 11 months of working on Sláintecare. This whole area needs to be flipped. It needs to be demand led, proper packages need to be provided and all them need to be orientated towards those who need them. The beds taken up in acute care need to be freed up and the pressure eased. People need to be able to stay in their homes. There are issues concerning how we do that. The significant nut that has to be cracked is the issue of workers. There are not enough of them. Why is that? Despite the continued increase in pay of and continued investment in directly-employed workers, when it comes to non-directly employed workers, their conditions are not good enough. That has to change. We need a recruitment plan and a training plan which is set out for five to ten years. We also need a registered employment agreement for workers in this area to create a standard and to provide pay and conditions to help workers and ensure that they want to work in this area. I know there are people who want to work in this area. They will not, however, because of the craziness of going out for half an hour here and there and having to travel long distances between clients. That is an insane system. This whole service needs to be packaged up and dealt with.

The manner in which the CHOs are currently individually dealing with the three types of packages, home help hours, homecare packages and intense homecare packages, is also insane. It is exceptionally difficult to get intense homecare packages. Conversely, the fact that they are not being put in place is costing the State a fortune. Do we have the skills, resources and the volume of people to be able to go in and be able to carry out those packages? We do not. It gets worse depending on which CHO we look at the statistics from. It is crazy that some CHOs have waiting lists of 300 and 400 people. In other areas, nobody is on a waiting list. The Minister of State's colleague stated earlier that that was based on prioritisation. That is not prioritisation. Those waiting lists are based on what side of a line someone is born on. A person could be a top priority in one area but one mile over the road he or she could number 150 out of 350. This whole system and the way in which it is managed needs to be examined.

There also needs to be an examination of the manner in which allocation amounts are given. Like everyone else here I had dealt with this issue for a long time. I dealt with a couple who lived over the road from me and who have recently passed away.They were allocated 20 hours in total because they were high dependency. They never got more than eight hours. If they did get eight hours, their family members were thrilled. That was because there was never ever going to be a situation where that couple was going to get the full 20 hours. That is not right. By the way, those eight hours only came about after they were fought for, in fairness to those who delivered it.

Hand in glove with this issue is the matter of carers. Due to the way in which we have let this system go, carers pick up the slack. That issue is going to heighten over the coming years. Corresponding with the need to change the whole system governing home help hours - changing it to make it demand led, investing in people for the future of the system, changing the criteria as to how people are being serviced, ensuring we do not promote delayed discharges in acute beds and joining up the thinking between the CHOs and the acute networks - we also need to invest more in carers. That starts with getting rid of the means test for the carer's allowance.

We also need to invest more in carers, which starts with getting rid of the means test for the carer's allowance.

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