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

I thank the Deputies for the opportunity to speak about services for older people. I agree wholeheartedly with the Deputies in highlighting this issue because, despite the significant level of increased investment in service provision, demand for home support continues to grow. I also agree with many of the sentiments expressed in the motion, which in several ways reflect work that is well under way in the Department of Health.

We all share the common objective of improving quality of life for older people. There is an obvious need to provide high-quality and flexible services that not only best meet the needs of individual clients, but also reduce pressures elsewhere on the health system. Social care services, including home care, day care and respite, are important components in enabling people to remain living at home and participating in their local communities. They also provide valuable supports to carers, an important topic to be discussed in the House tomorrow.

The Government’s overarching policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. The 2019 national service plan provides an overall financial allocation of €862 million for older person services, of which €446 million is provided for home supports. A Programme for a Partnership Government signalled the Government’s intention to improve home care services and to introduce a uniform home care service. I have committed to establishing a new stand-alone statutory scheme and system of regulation for home support services.

The Committee on the Future of Healthcare's Sláintecare report supports a significant shift in our model of care to one focused on prevention and early intervention and which will provide the majority of care in the community. The Government’s Sláintecare implementation strategy sets out an ambitious programme of reform to deliver this vision. The Department of Health’s 2018 health service capacity review 2018 and the 2017 report commissioned from the ESRI, Projections of Demand for Healthcare in Ireland, 2015-2030, are key research reports which provide an evidence base to inform investment and policy decisions in the future, including regarding home and community supports. The evidence base provided by these reports is being considered for the future planning, design and delivery of services, including the delivery of reform through the implementation of Sláintecare.

The development of the statutory home care scheme is a complex process which will build on the HSE's continual enhancement of existing service provision and on emerging good practice, both nationally and internationally, across the current system of health and social care delivery. The new scheme will improve access to the home support services that people need in an equitable, affordable and sustainable way, ensuring the system operates in a consistent and fair manner across the country. The model of financing to ensure the sustainability of the scheme will be considered in detail as part of the policy analysis and development process.

The new system of regulation for home support will ensure the public can be confident the services provided are of a high standard and will bring Ireland in line with best international practice. We plan to undertake a comprehensive review of existing services to assist in informing the development of the new scheme. 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 will assist in identifying international good practices.

Work is also being progressed on a review of the management, operation and funding of current home care services, another programme for Government commitment. This will provide a baseline for the design of an effective, sustainable service as part of the development of a statutory home care scheme. The review is expected to be concluded in the fourth quarter of 2019.

A standardised single assessment tool, SAT, is a core requirement for the successful planning and modelling of care services, particularly in the context of a shift to community models of care. The roll-out of SAT is a key priority in 2019. The procurement of a new system is well under way and expected to roll out later this year. The Department will work with the HSE to ensure this tool is fully embedded in the assessment of need for older persons, including for home support services.

I fully agree home support staff play a vital role in improving the health and well-being of our older population by supporting and looking after them at home which is usually their preferred environment. As part of the ongoing measures to improve current services, following a Labour Court recommendation in 2014, the HSE implemented new contracts for its directly employed home support staff. These contracts provided 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. This new contract was regarded by staff, unions and management as a positive development for HSE employed home support staff.

More recently, in 2017, the HSE engaged with SIPTU under a Workplace Relations Commission conciliation to review current home support staff contracts. The aim was to ensure contracted arrangements reflect the needs of the service, to maximise contracted hours for HSE directly employed staff and to take further steps towards professionalising the home support service.

The agreement, under the auspices of the Workplace Relations Commission, will, among other things, provide for an increase in contracted hours for over 90% of home support staff if they choose to accept the HSE offers, a change of title from home help worker to health care support assistant to better reflect the nature of the services being provided, and the introduction of rostered arrangements to give staff greater certainty regarding their hours of attendance with travel time factored into these arrangements.

While I and the Government agree in principle with many of the points made in the motion, it is not possible to offer full support. The motion includes calls on the Government that would likely have a significant immediate financial impact. I am concerned the capacity to deliver some of the actions may not be deliverable in the short term. The Government has a responsibility to manage, in a prudent way, the budgetary space in which we operate and must plan investment and expenditure accordingly.

It is noted, in particular, that several items in the motion relate to policy matters currently being examined by the Department of Health in the context of the development of a sustainable statutory home support scheme. It is important significant policy decisions are undertaken following a considered policy analysis and development process, including engagement with stakeholders, review of national and international evidence, as well as economic analysis and appraisal. This process, including the configuration, content, delivery and financing of a statutory home support scheme is well under way. The Sláintecare implementation strategy commits to the introduction of the scheme in 2021.

Traditionally, home support was viewed as providing a lower level of support than residential care, and not as an alternative to it. Increasingly, it is considered possible to support many people at home who might previously have gone into residential care. This requires an increase in the amount and intensity of home support, along with more effective integration with other services and supports. We want to develop home support services. We are working to provide a more viable alternative to nursing home care for a greater number of people.

The significant work packages contained within Sláintecare provide the framework for the redesign of services to ensure that more care is provided at the right time, by the right people, in the right place. Maximising future home care provision will require increased investment coupled, crucially, with reform and the introduction of a statutory home support scheme, sustainable financing models, and the broader shift to the provision of care in community settings.

I assure the House that all CHOs are working to ensure the best use of available funding to support the greatest number of people requiring home care services. As I stated on the previous occasion on which the House debated this topic, I have met senior HSE staff and CHO representatives. They provided reassurances that there is no freeze on home support and indicated that the HSE will deliver on its service plan commitments in respect of home support. In delivering on these commitments, the HSE has a responsibility to ensure that activity is planned in order to anticipate critical demand pressures, most particularly emergency pressures in the initial and latter parts of the year.

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