Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I welcome the opportunity to address the Chamber on the important issues raised by the Irish Women’s Parliamentary Caucus in their motion on delivery of a rights-based care economy. I acknowledge the work of the chair, Senator Fiona O'Loughlin, and deputy chair, Deputy Bacik, who put many hours of their time into driving on the caucus, and have done so for many years. I thank them for that.

The Government is committed to ensuring the rights of everybody with care needs are upheld in accordance with their needs and preferences throughout their lives. I am pleased to support the motion. We recognise the invaluable contribution that family carers make in caring for some of the most vulnerable in our society and we are committed to ensuring that carers are fully supported and empowered.

The motion covers many Departments but I will focus on older people’s health and social care services and social protection supports for carers. My colleague, the Minister, Deputy Browne, will speak later about the Government’s work to support the rights of people with disabilities.

The Government is committed to supporting older people to age in place in their communities. With its emphasis on reorientating the model of care towards primary and community care, the ongoing Sláintecare reform of our health and social care system, led by the Department of Health, aims to support people with care needs to live independently in their own homes and communities for as long as possible.

The Government has invested an additional €228 million in home support services since budget 2021. The delivery of home support hours is increasing year on year. We expect to deliver 21.5 million home support hours in 2023, increasing to 22 million hours in 2024. This is more than ever before. In addition, a minimum of 18% of new home support hours are ring-fenced for people with dementia in 2024, up from 5% in 2021. There are now over 54,000 people receiving home support services, with almost 75,000 people benefitting from the service last year. All home support hours for 2023 are fully funded, including those on the waiting list.

In terms of waiting lists, the latest figures show there are a total of 3,084 new applicants approved for funding and waiting for supports. There are 2,902 people already receiving supports but not yet receiving the maximum hours advised. This is down considerably from the start of 2020, when the total number of people waiting for home support was over 9,000, but we have a lot more to do.

In order to continue to expand the provision of home support services, we need to address workforce challenges in the sector, particularly the shortage of care workers.

We continue to advance the implementation of the 16 recommendations of the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants as an immediate priority. A progress report was published on 16 October. As recommended by the advisory group, 1,000 employment permits for non-EU or non-EEA home support workers were authorised last year and commenced in January. Approximately 330 permits have been availed of to date.

A new and improved HSE home support tender has been in place since August this year. This delivers on commitments for sectoral reform, such as payment for travel time for home support providers, paying carers the national living wage, at a minimum, and bringing legacy rates in line with the new revised rates of funding.

In response to the Deputy’s question, we have not been made aware personally or in the Department that the living wage is not being passed on to employees. That is something I am monitoring.

The triangle of supports of home care, day care and meals on wheels, including dementia-specific supports, are a key factor in supporting older people to age well in their own homes. Some 323 of our vital day centres have reopened following the Covid-19 pandemic. Earlier this year I announced increased funding for day centres and to expand the meals on wheels network, which provided an estimated 2.7 million meals across the country. The budget allocated for meals on wheels will increase by €1 million next year to €6.2 million. I thank all those involved, including all the volunteers who work across the meals on wheels sector.

An additional €2.2 million will be provided for day care services in 2024. We know that day centres are a crucial part of social care provision in our communities and an important resource for carers, providing a break from the caring role.

Regarding dementia-specific day care, in 2023 the Government allocated €2.1 million to allow dementia day care services to reopen to full capacity and I am pleased to note that the Alzheimer Society of Ireland opened its 52nd day centre recently. In budget 2024, I have secured an allocation of €500,000 to increase the provision of in-home dementia care for people who cannot or do not wish to attend in-person day care services. A further €300,000 will be provided for weekend activity clubs for people with young onset dementia. Yesterday, I met some of the committee for the Alzheimer's Christmas jumper day, and their plans for these weekend activity clubs are under way and will commence very soon.

The development of the statutory home support scheme, to which the programme for Government commits, is well under way within the Department of Health. The preparation of primary legislation for the licensing of home support providers, regulations to underpin the new licensing regime and national standards to support the ongoing quality enhancement of home support services are all in train. Importantly, the regulation of these services will help to safeguard everyone who uses the service and ensure that all service users receive a uniformly high standard of home support when they need it and wherever they may be.

As part of the development of the statutory scheme, a reformed model of service delivery for home support has been piloted across four sites. The Government is committed to the national roll-out of interRAI as the standard assessment tool for the care needs of older people, and the HSE has begun the recruitment of 128 interRAI care facilitators. A national home support office is being established and work is under way to procure a bespoke IT system. This is one of the key issues we are dealing with at the moment, the importance of having an IT system. The Government’s commitment to ensuring that citizens receive timely, high-quality, person-centred integrated care in the most appropriate setting is also reflected in the countrywide establishment of community specialist teams for older persons under the enhanced community care programme.

In the programme for Government, the Government committed to establishing a commission to examine care and supports for older people. The proposal for the commission that I and the Minister for Health brought forward was approved by the Government on 3 October this year and €1.24 million was secured in budget 2024 to support the commission’s work next year. The commission will examine the provision of health and social care services and supports for older persons and will make recommendations to the Government for their strategic development. A cross-departmental group will be established under the auspices of the commission to consider the supports for positive ageing across the lifecourse.

The work of the commission will be cognisant of the need to ensure continuity of care for persons with disabilities when they turn 65 and, more broadly, of the need to ensure that the care and support needs of older persons with disabilities are met in accordance with Ireland's obligations under the UNCRPD. The commission will be formally established in early 2024, and we are currently close to appointing a chairperson for it.

The Government recognises the invaluable contribution made by family carers to care provision in our society. We have delivered on the commitment in the programme for Government to introduce a carer's guarantee that will provide a core basket of services to carers across the country, regardless of where they live. Since 2021 we have invested €2 million each year in these services. A total of €1.9 million is being provided to Family Carers Ireland to deliver a mix of community and individual supports to a minimum of 5,000 new carers annually, including counselling and intensive supports. Some €100,000 is provided to Care Alliance Ireland, which operates a professionally-moderated online carers’ support group. A pilot of the interRAI family carer needs assessment tool has also been undertaken in HSE community healthcare west with a view to establishing a standardised mechanism for assessing carers’ needs.

Respite care is a vital resource to support older people and their carers, and this is reflected in our investment of approximately €62 million in respite beds for older people’s services each year. In addition, in June 2021 the HSE, in partnership with Family Carers Ireland, launched the home support emergency respite scheme, with funding of €600,000 to provide a total of 27,000 hours of respite care to unpaid carers who require additional emergency respite. The HSE has committed to continue providing emergency respite supports in 2024.

In the area of social protection, the main income supports to carers are expected to amount to almost €1.6 billion in 2023, of which expenditure on the carer's allowance scheme is estimated to be over €1 billion. While the carer’s allowance is means-tested, there are a range of other supports for carers provided by the Department of Social Protection that are not based on a means assessment, such as the carer’s support grant, carer’s benefit and the domiciliary care allowance. As part of budget 2024 there has been a significant improvement to payments for carers, as well as lump sum payments.

The Government is also putting in place measures to enhance State pension provision for carers who have spent more than 20 years of their lives caring for an incapacitated dependant. The legislation to give effect to this change was introduced in the Dáil on 22 November and is expected to be enacted by the end of the year.

The supports delivered through the health and social protection systems, and the planned improvements that I have outlined, all contribute to the delivery of the rights-based care to which the Government is committed.

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