Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank all Deputies who contributed to this important debate today. I welcome the opportunity to make the closing remarks to it. I have taken notes and will pass individual requests back. The suggestions made and the issues raised will be borne in mind as the winter plan is implemented.

I was disappointed that not one Member today welcomed the fact that €830,000 will be spent on ten dementia advisers. I sat on the opposite side of the House for the past four and a half years and I championed the appointment of dementia advisers every week. Up to last year, there were eight dementia advisers in the whole country, meaning getting one could be a postcode lottery. We finally made the breakthrough last year and we managed to get ten more in the budget. To get another ten in the winter plan means we now have 28. The optimum number according to the Alzheimer Society of Ireland is 33. I fought doggedly for the €830,000 to get ten extra dementia advisers. I cannot believe I have been in the Chamber for the past 75 minutes but not one Member mentioned it. Up to 11 people are diagnosed with dementia every day. I chaired the all-party committee on dementia for the past four and a half years. It was a committee at which politics was left at the door. It had members from every single party and none. We all worked together to raise awareness.

As stated by many Members, as well as the Minister for Health, Deputy Donnelly, this winter will be challenging for our health and social care services. It is like a perfect storm. We are heading into the winter. We do not know what is coming. We could have the winter vomiting bug and the winter 'flu. We will have all our usual challenges with capacity, overcrowding and trolley numbers. Coupled with all that, we have Covid.

Last week, I was delighted to launch the HSE winter plan with €600 million funding, 20 times more than what the plan is normally. It is an adequate plan. As I have said many times, the devil is in the detail, however. We will work as hard as we can to ensure those supports are put in place.

We are dealing with a global pandemic which has disrupted the level and the delivery of healthcare since March, while placing significantly increased demands on healthcare staff. I wish to pay tribute to all our healthcare staff and carers who have made such efforts to provide care in such difficult circumstances. I also wish to remember all those, including healthcare workers, who have passed away as a result of Covid-19.

I agree with the sentiments expressed by Members that we need reform. That is why the winter plan is designed in line with Sláintecare principles. We need investment and reform. I take on board the point made by Deputy Joan Collins about the €600 million funding. We need to see more of that if we want to implement Sláintecare.

The €600 million investment in the winter plan represents a significant commitment from the Government which will allow us to commence the process of pivoting care and the required resources towards home and community care. As Minister with responsibility for mental health and older people, I am particularly pleased with the emphasis placed on supports for older people and those groups at greater risk in this plan. This is essential. Older people are more likely to be admitted to an acute hospital following a visit to an emergency department. They are more likely to experience a wait on a hospital trolley. Accordingly, I welcome the additional 47 community specialist teams to support older people and those with chronic disease to stay at home, the 13 additional community assessment hubs, the additional community beds which will allow faster egress from hospital and provide care closer to people’s homes.

This was piloted in University Hospital Waterford last year. Normally, the hospital would have between 20 and 25 beds for people who would be termed as late discharge. A consultant would have deemed them as fit to go home but, unfortunately, there was no place for them to go. Capacity was bought in a nursing home at a cost of €1,000 per bed as against an acute hospital charge of between €6,500 and €7,000 per week. Some of these patients needed respite, others were waiting on home care support packages or on fair deal. They were able to transfer to a nursing home for two to four weeks care, depending on what they needed. Up to 530 of these community beds will be rolled out across the country which should free up capacity in the acute hospital settings.

I especially welcome the 4.76 million additional home care hours which will allow people to remain in their own homes. I welcome the commitment to provide aids and appliances to an additional 5,500 people. Such simple initiatives can make all the difference to an older person. We need to keep our older people at home, safe and secure, with the correct wrap-around supports. There are always waiting lists for those who require home care. However, these extra 4.7 million home care hours should make a big difference. Obviously, there are people on a waiting list or whose needs might have changed during Covid. We want to make sure that the support goes into the home and that somebody does not have to go to an emergency department and wait on a trolley.

It is important to mention nursing homes and the important role they and their staff have played in the care of our most vulnerable older people before the pandemic and, especially, in the last few difficult months. The pandemic bore down very hard on our older people. Unfortunately, 54% of all deaths to date have occurred in the nursing home sector. Our nursing homes are where many of our older people call home and it is critical that we continue our supports to that sector. Our plans for winter will be enhanced by the extension of the temporary assistance payment scheme, which will continue to provide funding to private and voluntary nursing homes and to residential care homes to ensure they are prepared for Covid-19 so they are safe for older people who are transferring out of the hospital system. Enhancements in rehabilitation and home care will also help to ensure that our older people can be cared for in the community, thereby easing the pressure on capacity in nursing homes and providing an alternative care pathway when leaving hospital settings.

I want to touch on mental health because it has been raised by almost every Deputy in the House and it forms a very important part of my remit as Minister. The winter plan, with a focus on those actions which will have an impact on winter, and specifically trolleys, is part of the larger strategic plan which the Government asked the HSE to develop for health service delivery to the end of 2021 in the context of the pandemic. I intend to seek, as part of this strategic plan in the Estimates process, additional resources to implement a number of the short-term recommendations of the mental health policy, Sharing the Vision. It is important for everyone who has spoken today to note that the 4.7 million hours which will be added to the existing 19 million hours that are already there will not differentiate whether one is older or has dementia, a disability or a mental health issue. The carer will not stop at the door and say they are only looking after older people. Those hours are there for everyone: those with mental health issues, those with disability issues, those who are vulnerable, those with dementia and the older generation. It is important to get the point out tonight that those hours are for anybody who needs support in their home. For everyone who has said there was nothing in it for mental health or people with disabilities, those hours will not differentiate. When the carer goes in the front door, he or she will not differentiate whether one has a mental health or disability issue.

The winter plan is about people. It enables patients to be seen in the community and to remain in their own homes. This is the Sláintecare principle of the right care, in the right place, at the right time. However, we have a growing and an ageing population. This Government accepts that we need more acute beds in our hospital system to provide acute care to this growing population. This plan provides for a range of additional beds in acute, sub-acute and community settings along with arrangements to work with private hospitals to deal with urgent cases and waiting lists. I was struck when Deputy Harkin mentioned the four extra ICU beds going to Sligo. Each extra ICU bed needs six nurses and is at a cost of €750,000, so I am delighted Sligo is getting extra capacity. It is great to hear. These additional acute beds and measures to move care to the community will allow hospitals to operate more efficiently and reduce the number of patients receiving care on hospital trolleys.

Finally, I encourage everyone to do their bit to keep themselves healthy this winter by eating well, exercising, getting the flu vaccine, washing their hands, keeping their distance, limiting the number of people they are meeting and following public health guidance. I also encourage everyone to seek medical help if they think they need it. We are doing everything possible to keep our health settings safe for patients and staff.

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