Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I very much welcome the opportunity to speak on this very important motion and thank the Independent Group for bringing it forward. The motion is very wide ranging, from nursing homes to electronic health records, and it reflects the scale of the challenges we face in relation to serious problems within the health service. At present, our health service is disjointed and operating in silos. We have nine CHOs and six hospital groups, all with their own separate boundaries, management teams and budgets. This disconnected and competitive model is a far cry from a system of integrated care and it is failing patients as well as healthcare staff.

The dysfunction at the very heart of the system is addressed in Sláintecare with the introduction of regional health areas, RHAs. Although often overlooked, the importance of restructuring the HSE and combining community and hospital services within regions cannot be overstated. While I believe the Minister for Health is committed to this structural reform, I am concerned that he is ignoring some critical aspects of the regionalisation project, particularly in relation to the need to decentralise power, decision making, responsibility and accountability from the centre to the regions. It is very disappointing that the business case chosen by the Government for RHAs did not include full decentralisation and a slimming down of the very heavy command-and-control centre of the HSE because that is a huge impediment to the regions taking on the responsibility and the accountability for the provision of services and for the spending of budgets. Without full decentralisation it is difficult to see how we are to address the current centralised approach to decision making and the spending of budgets. That has to change urgently. Senior management in the new RHAs must be fully empowered to take decisions locally. Obviously those decisions must be based on national health policy but the responsibility and the accountability must lie locally. This project will only be successful if there is a legitimate devolution of power and accountability to the regions. That is why the Minister must publish the RHA implementation plan without any further delay and clearly state his intentions regarding governance and accountability.

It is also important that we review the models of care and authority in other areas of health and social care. I want to speak particularly about elder care. In terms of home care, the Minister for Health and the Minister of State, Deputy Butler, in particular must provide the funding required to progress the recommendations of the strategic workforce advisory group. That is long overdue. We are now into a five- or six-month extension of the existing tender and that is simply unacceptable. The strategic group did its work and reported last October but we have yet to see action on that. An offer was put on the table that was based on the validated costs involved in this. I do not know why the Department asked Grant Thornton to do a validation of costs and then proceeded to ignore the results.

Let us not forget that there are 6,500 older people on waiting lists for home care. That is a shocking figure. It is very hard to reach what is a very high bar for being awarded home care and yet 6,500 very vulnerable people are left in their own homes, in very urgent need of support to remain at home. Those waiting lists are persisting and have been at that level for quite some time. It is also time to be serious about the large number of delayed discharges from hospitals. At any one time there are around 600 delayed discharges. I refer to people who are ready to be discharged but for whom the necessary supports are not available, either in the form of step-down beds or home care. A very significant number of those whose discharge has been delayed are waiting for home care and that needs to be addressed.

Alongside increased funding in the medium to long term, we need to take a serious look at the home care model. We know that only 38% of home care is provided directly by the HSE and that must be increased. However, home care appears to be an afterthought for this Government. Increased provision would help to tackle our stubbornly high waiting lists. We need a new model. What we have seen over recent years is a rush to privatise and outsource services for older people, whether that is in relation to home care or nursing home care. We have seen that headlong rush to absolve the State of its responsibility to provide care for older people, whether in a residential setting or in their own homes. What is happening is that the State is shirking its responsibility to provide public services.

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