Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I move amendment No. 2:

To delete all words after "Dáil Éireann" and substitute the following: recognises:

— the invaluable work carried out by Health Care 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);

— 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, since 2020, an additional €207 million has been provided for home support;

— that next year the overall home care budget will be in excess of €700 million, and this will go towards progressing the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and delivering about 24 million hours of home care in 2023; and

— that home support hours are increasing, in line with enhanced investment, and in 2021 some 20.4 million hours were provided to over 55,000 people, which is about 2.9 million more hours compared to 2020, an increase of 17 per cent, and at the end of September 2022, 16.08 million home support hours have been delivered to 56,490 clients in the community. This is about 2 per cent more than the expected activity and 4 per cent more than the same period last year, and the number of hours of home support provision nationally has increased from 17.55 million hours in 2020 to 20.46 million hours in 2021, in tandem with increased investment;

notes that:

— the Irish Government's strategic policy goal is to deliver a new model of integrated, older persons health and social care services, across the care continuum, supporting older people to remain living independently in their own homes and communities for longer, in line with the Sláintecare vision for receiving the right care in the right place and the right time;

— the interRAI assessment will be used to determine the allocation of care depending on the need of an individual and the phased rollout of the interRAI assessment tool for home support has commenced across four pilot areas, and this will be accelerated with the recruitment of 128 interRAI care needs facilitators which is underway and these outputs and the evaluation of the pilot sites for testing of a reformed model of service for the delivery of home support evaluation will be critical to the development of the new home-support scheme;

— the HSE monitors data on Delayed Transfers of Care (DTOC) on a daily, weekly and monthly basis so they can target these patients as early as possible and take appropriate steps to identify suitable post discharge support which will then facilitate their discharge and patients are added and removed from the list on a daily basis;

— as of 1st November, 2022, the HSE reported there were 594 DTOCs of which 103 people were waiting on home supports;

— the HSE National Service Plan 2022 sets a priority action to maintaining, at a minimum of 40 per cent, the proportion of public / private provision of support hours so that the balance is reflected in each area over time. Any increases reflect the workforce requirements of the expected statutory home support scheme. In line with these commitments, the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants' calls for 'a significant increase in the proportion of home support hours and packages provided directly by the HSE' and recommends that 'targets determined by the HSE on a national level should be set out in the National Service Plan 2023' (recommendation No. 11);

— there are currently 21 Integrated Care Programme for Older Persons (ICPOP) teams in place across the country and all Community Health Organisations (CHOs) have at least one team in place, the recruitment for the remaining teams is ongoing and it is planned to have the full complement of 30 ICPOP teams established by Q1 2023;

— the Programme for Government: Our Shared Future commits the Government to 'Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care', and the Department of Health is currently developing a regulatory framework for home-support providers with the aim of ensuring that all service-users are provided with high-quality care that will comprise of (i) primary legislation for the licensing of home support providers, (ii) regulations for home support which will set out the minimum requirements that a provider must meet to obtain a licence, and (iii) Acute and Community Healthcare Services (HIQA) national standards, the Heads of Bill are currently being drafted by the Department with a view to bringing it through the Houses of the Oireachtas at the earliest opportunity, and HIQA are developing standards for home care and home support services which will go out for public consultation early in 2023;

— the Government is committed to supporting healthy and positive ageing throughout the life-course as well as to ensuring that older persons can continue to live independently in their homes and communities for as long as possible. At present, this objective is supported by the National Positive Ageing Strategy (2013), which provides a blueprint for whole-of-Government policymaking and service-delivery in partnership with the community and voluntary sector. Acknowledging the disproportionately negative impact of the Covid-19 pandemic on older persons, the Programme for Government: Our Shared Future commits to the establishment of a commission on care that will 'assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens', learning the lessons from Covid -19 and an initial scoping exercise for the commission on care has been undertaken, it is envisaged that the commission on care will support a whole-of-Government and whole-of-society approach to examining existing policies and strategies which support positive ageing and that it will effectively address the gaps which currently exist in the policy-landscape and it is anticipated that the commission will be established in 2023;

— the Health and Social Care workforce planning and ensuring an appropriate pipeline of suitably qualified healthcare professionals in Ireland is a top priority for the Government, and the Department of Health has commenced a programme of work to deliver a Health and Social Care Workforce Planning Strategy and Action Plan, and a Planning Projection Model, and this work is being undertaken with the support of the European Commission under the auspices of their Technical Support Instrument which will provide the technical expertise to deliver this project and is due to be completed in Autumn 2023; and

— addressing the shortage of care-workers in Ireland is an urgent priority for the Government. To this end, the cross-departmental Strategic Workforce Advisory Group was established in March 2022 to examine, and formulate recommendations to address, the challenges in front-line carer roles in the home-support and long-term residential care sectors. The Group was chaired by the Department of Health and comprised representatives from seven government departments, the HSE, HIQA and SOLAS. Working closely with key stakeholders, the Group examined the recruitment, retention, training, career-development, and pay and conditions of front-line carers. The Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on 15th October, 2022, providing an overview of the work of the Group and its key findings, the report presents a suite of 16 recommendations spanning the areas of areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform, and monitoring and implementation. All of the recommendations have been strongly endorsed by Minister Butler, and work to implement the recommendations has commenced; and

further recognises that:

— the General Scheme of a Health (Amendment) Bill to amend the 2007 Health Act was published in October 2022. This legislation will enhance and modernise the powers of the Chief Inspector of Social Services in HIQA and will provide for the mandatory reporting of key operational data by nursing homes. The General Scheme has been referred to the Oireachtas Health Committee for pre-legislative scrutiny and the Department of Health is engaging with the Office of the Attorney General is relation to the drafting of the Bill;

— the Heads of Licensing of Professional Home Support Providers Bill are currently being drafted by the Department with a view to bringing it through the Houses of the Oireachtas at the earliest opportunity. Regulations are at an advanced stage. The Department has completed a public consultation on the draft regulations which concluded on 4 August. The report on the submissions for the public consultation is currently being compiled by the Institute of Public Health (IPH);

— adult safeguarding has been included in Section 10 of the draft regulations for the licensing of Home Support Providers;

— the HSE will recruit key posts to enable the establishment of a National Home Support Office. Funding is provided for 15 full-time jobs;

— the HSE has acknowledged the importance of a fit for purpose IT system for the delivery of Home Care across all CHOs and are finalising the details. The HSE and Department of Health are jointly working on the structures and systems to enable the creation of the Regional Health Areas and the National Home Support Office will be included as part of this;

— a key recommendation of the Health Service Capacity Review 2018 is the shift of care out of acute hospitals into the community and closer to a person's home, where safely possible. In pursuit of this goal, the HSE commenced the implementation of the Enhanced Community Care programme in 2021. The Enhanced Community Care (ECC) Programme is a strategic reform programme in line with Sláintecare proposals which seeks to deliver new and enhanced services and support the move toward a more community-centric model of healthcare. The ECC programme represents the most significant expansion in Primary Care in the last two decades, with overall recruitment to the ECC targeted at approximately 3,500 WTE, and this Government allocating significant funding to deliver this expansion;

— improving access to home support has been a priority for Government. The Government is working to ensure that People with Disabilities are enabled to live an independent life of their own choosing, like any other person, in line with the disability reform policy - 'transforming lives' and the HSE has consistently, year. on year, increased the number of hours of PA Services delivered to people with a disability. The National Service Plan 2022 outlines the HSE's commitment to deliver 1.7 million hours of PA services to 2,587 people this year. This reflects an additional 120,000 hours of PA services in 2022 to expand and enhance supports for people to live self-directed lives in their own communities;

— the Healthy Age Friendly Homes Programme, an innovative partnership between the local government sector (Age Friendly Ireland) and Sláintecare, commenced in 2021 and saw the introduction of a new person-centric, robust, support co-ordination service. It was announced in Budget 2023 that funding of €5.2 million has been allocated to roll-out the initiative nationally;

— under Housing for All – a new housing plan for Ireland, a review in relation the Housing Adaptation Grants for Older People and People with a Disability Scheme is currently underway. Grant limits and income thresholds are being considered as part of this process;

— the tender process for home support is underway. The HSE is responsible for procuring home support services. Established procurement protocols apply to this process; and

— the recommendations made in the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants includes recommendations on terms and conditions for workers.

I am delighted to see the Ceann Comhairle back in the Chair and I wish him all the very best. I thank the Deputies for raising this important issue. I am pleased to have the opportunity to speak about the substantial progress under way on supporting people to receive care in their homes as well as the wider home care sector. We know that for most people home is the preferred location for care. The home support service is therefore an essential service for thousands of people across the country. It is highly valued by service users and their families because it enables older people to live independently and with dignity in their own homes for longer. It also enables many older people to return home following acute hospital admission who otherwise would remain there or would be admitted to long-term residential care. For these reasons, improving access to this service is a Government priority.

Many of my colleagues on the other side of the House spoke about what is not being delivered. I will speak about what is being delivered. Home support hours in communities are increasing in line with enhanced investment. We provide more hours of home support to more people than ever before. In 2021 we provided 20.4 million hours to more than 55,000 people, an increase of 17% compared to 2020. As of the end of September, more than 16 million home support hours have already been delivered this year to more than 56,000 people in the community. This is more than 6% more hours than delivered by this time last year. Are there difficulties? Yes there are because more people than ever before are being referred for home care. We have had an increase of 6% already this year and an increase last year of 17%.

I want to speak about delayed transference of care because there has been a lot of talk about this. The HSE monitors data on delayed transfers of care on a daily, weekly and monthly basis so it can target these patients as early as possible and take appropriate steps to identify suitable post-discharge support, which will then facilitate discharge. Patients are added and removed from the list on a daily basis. As of 1 November 2022, the HSE reported there were 594 delayed transfers of care, of which 103 people - not 1,000 - were waiting on home supports.

I was particularly pleased to announce in budget 2023 that the proportion of new home support hours allocated to people with dementia will increase by 4%. This will bring the dementia-specific proportion of new home support hours up from 5% in 2021 to 15% in 2023, valued at €5.2 million. These improvements have been facilitated by increased Government funding. We have provided an additional €200 million for home support since 2021. Next year the overall budget will be in excess of €700 million. What is frustrating for me as Minister of State is that I have a budget and I could provide funding for the 6,000 people waiting today but we do not have the staff. I have the budget and I want to get this message out. This will go towards progressing the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and delivering about 24 million hours of home care in 2023.

The delivery of this service is not without its challenges. Delivering this enhanced capacity requires substantial recruitment. Addressing the strategic workforce challenges in the home support sector is an urgent issue and for this reason, as Deputy Cullinane referred to, in March I established the cross-departmental strategic workforce advisory group. It set out to examine and, most importantly, to propose solutions to the challenges in front-line carer roles in the home support and long-term residential care sectors. The group was chaired by the Department of Health and comprised representatives from seven Departments, the HSE, HIQA and SOLAS. Working closely with key stakeholders, the group worked together to examine the recruitment, retention, training, career development and pay and conditions of front-line carers. The contribution of stakeholders through meetings and facilitated workshops was invaluable, ensuring that deliberations were fully informed by those who provide care every day in the public, private and voluntary sectors.

The report of the strategic workforce advisory group on home carers and nursing home healthcare assistants was published on 15 October 2022. The report presents a suite of 16 recommendations spanning the areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform, and monitoring and implementation. I will mention three key recommendations on which we are already moving. Somebody providing home care has to be paid a minimum of the living wage of €12.90. We will be announcing very shortly that the critical skills list will be recruiting beyond the EU. Travel expenses should be paid to anyone providing home care. I have strongly endorsed the recommendations and implementation commenced immediately. This will be closely monitored on an ongoing basis to ensure that the recommendations are enacted in full in a timely manner. I anticipate that the implementation of the recommendations will have a lasting, positive impact.

When I took on this role two and a quarter years ago, 9,000 people were waiting for home care, and we managed to reduce that figure to 4,000, as Deputy Tully said. Unfortunately, that figure has grown again because, since Covid, more people are looking for home care than there were before and the cases are more complex. In dealing with waiting lists, one has to prioritise the most complex cases and end-of-life care. That is why it can be challenging. It pains me to see the numbers increase.

Deputy Mythen mentioned Wexford. It was I who put in train the special review for Wexford, where there is the highest number of people waiting for home care in the whole country. I will follow up on that expert report and see what the recommendations are. However, it is quite challenging. I thank home care support assistants for the invaluable work they carry out, and I know everybody is in agreement with us in that regard.

When I took up this position two and a quarter years ago, the split between private and public home care was 50:50, but because we increased home care provision by more than 2 million hours, we had to move to the private sector. The private sector has an agreement with the HSE whereby the average payment is €27 per hour. However, I cannot control the amount the private sector pays its workers. That is why I have recommended the minimum payment in the tender that will be introduced in the new year should be €12.90, which is the living wage rate, plus mileage. That would go a long way to support and encourage other people to work in the home care sector.

Health and social care workforce planning and ensuring an appropriate pipeline of suitably qualified healthcare professionals in Ireland is a top priority for the Government. The Department of Health has commenced a programme of work to deliver a health and social care workforce planning strategy and action plan, as well as a planning projection model. This work is being undertaken with the support of the European Commission under the auspices of the technical support instrument, which will provide the technical expertise to deliver this project. The work is due to be completed in autumn 2023.

Under the integrated care programme for older persons, ICPOP, community specialist teams provide access to multidisciplinary assessments that ultimately enable older people to remain living at home for as long as possible. The teams specifically target those at risk from falls, frailty and dementia. They seek to ensure that older people can access care at, or near, their homes through care pathways specifically designed for them. There are currently 21 ICPOP teams in place across the country and all community healthcare organisations have at least one team. Recruitment for the remaining teams is ongoing. With continued positive recruitment, I expect the full complement of 30 ICPOP teams will be in place by early 2023.

The Government is committed to supporting healthy and positive ageing throughout the life course. Acknowledging the disproportionately negative impact of the Covid-19 pandemic on older people, the programme for Government commits to the establishment of a commission on care that will assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens. An initial scoping exercise for the commission on care has been undertaken. It is envisaged the commission on care will support a whole-of-government and whole-of-society approach to examining existing policies and strategies that support positive ageing and it will effectively address the gaps in the policy landscape.

The healthy age-friendly homes programme, an innovative partnership between the local government sector and Sláintecare, commenced in 2021, and it saw the introduction of a new person-centric and robust support co-ordination service. In budget 2023, I announced funding of €5.2 million to be allocated to the roll-out of the initiative nationally. In addition, under Housing for All - a New Housing Plan for Ireland, a review of the housing adaptation grants for older people and people with a disability scheme is under way. Grant limits and income thresholds are being considered as part of this process.

Once again, I thank the Deputy for tabling the motion. I agree with many parts of it, several of which are currently in train. I know we agree on nearly 90% of the motion. There were a couple of other elements in the motion and the Deputy knows the reason I could not accept it, and that is why I tabled the amendment. I thank him for raising this issue. It is important that we have speaking time on home care, which supports 56,000 people per day.

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