Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this important issue.

At present there is a crisis relating to home help provision in County Roscommon. Emergency cases are being denied home help hours due to a ban on the recruitment of home help staff by the Health Service Executive, HSE, though it has no difficulty in recruiting additional home help managers. The crisis has also been caused by a HSE management directive issued in the past week that states home help hours for needy patients are not to be increased and new clients are not to be provided with a home help service. In addition, the HSE has instructed that home help staff, even if sanctioned, cannot be appointed unless they go through a formal, 12-week recruitment process. So much for dealing with emergency and vulnerable cases.

This is extremely frustrating as there is plenty of money available to provide home help hours because less money has been spent in the first two months of this year than was provided for in the service plan. So much for the Minister for Health and Children's commitment that there would be the same level of service in 2008 as 2007.

A similar situation has arisen with the much sought after home care packages due to the same policy direction. For an individual to avail of such a package a person currently in receipt of such a package must pass away. Why should families be forced to monitor the death notices to see whether they will receive a service? This is a national disgrace.

The Government-supported HSE policy is having a disastrous impact on the quality of life of the elderly and disabled and their families. John is 80 years of age and is in an acute hospital bed but medical staff can do no more for him. He requires care 24 hours a day and seven days a week. He is doubly incontinent, 6 ft., 4 ins. tall and is completely bed-bound. He wants to spend his final days in his own home and will rely on his only child, who has three young children between four and seven years of age, to provide the necessary care. He has no other support. The HSE is prepared to give over €350 per week for a nursing home but it is not prepared to sanction even one hour per week to help this man live with dignity in his own home. So much for the Minister for Health and Children's commitment to a fair deal for the elderly.

Mary suffers from Parkinson's disease, has three young children and is in receipt of home help hours. She cannot peel potatoes for her children's dinner yet she cares for her father-in-law. All she wants is home help for one night each week to allow her one decent night's sleep.

Bridie has just been released from hospital and has been granted four hours home help per day but the individual who is to provide that help has only one hour free each day. As a result, Bridie is using her State old-age pension to provide private home help.

The HSE is not using its full budget in County Roscommon and other counties; the money is there and that is not the problem. The problem lies in the policy direction issued by the HSE with the Government's blessing. We have been told time after time in this House that the Government has nothing to do with the day-to-day running of the health service but deals with policy issues. This is a policy issue that is having a direct impact on the elderly and the most vulnerable people in my county and throughout the country. The situation is very frustrating because funding is available. The HSE can appoint managers to supervise the existing home help staff but cannot provide home help staff for much-needed emergency services in my community and throughout the country.

Máire Hoctor (Tipperary North, Fianna Fail)
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I will be taking the Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's commitment to services for older people generally and, in particular, to the importance attached to developing home help services locally.

Government policy on older people is to support people to live in dignity and independence in their own homes and communities for as long as possible. When this is not feasible, the health service supports access to quality long-term residential care, where this is appropriate. This policy approach is renewed and developed in the latest partnership agreement, Towards 2016.

The Government's objective of continued development of community-based services for older persons is reflected in the funding given to the system in recent times and I am glad the Deputy acknowledged this. In the budgets of 2006 and 2007 over €400 million was provided to enhance service developments across the sector. Of this, just over €190 million was for community-based services over the two years.

Arising from budget 2008, a full-year package of €22 million has been allocated for new services for older people. This gives a total funding of over €422 million for new services for older people over the past three years.

Regarding the specific area of home help services, an additional €33 million was given in 2006, which funded an extra 1.75 million home help hours. This was augmented by a further €18 million in 2007 that resulted in 780,000 extra hours coming on-stream.

In 2007 the highlights of community-based services for older persons provided by the HSE nationally included the following: over 12.3 million home help hours; nearly 55,000 people had availed of home help services by the end of the year; over 4,000 home care packages assisted some 10,500 clients during the course of the year and these packages included an important home help element in many cases; and the use of over 21,000 day centre and respite places.

The new funding package of €22 million provided in the recent budget is designed to enhance important community initiatives, including €4.6 million additional expenditure by the HSE for 200,000 extra home help hours this year. The HSE expects to provide about 11.98 million home help hours nationally in 2008.

The new services coming on-stream will improve the service delivery thresholds that the Government already had in place. In this context, nearly €56 million has been provided in the last three years for new home help services, thus expanding the service nationally by nearly 2.75 million hours over this period.

As the Deputy is aware the Health Service Executive has the responsibility for the management and delivery of health and personal social services, including the operational details relating to home help for the Roscommon area.

The HSE has provided the following information. The total number of clients in receipt of home help services in County Roscommon in January was 808, while the number of new applications for the month was 108. The total number of home help hours provided for this period was 19,990. With regard to the most recent local demand, the HSE indicates that 14 clients are waiting to start the service and 25 existing clients await increased hours.

Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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They will be left waiting.

Máire Hoctor (Tipperary North, Fianna Fail)
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This situation is being addressed by the HSE in the context of the ongoing delivery of the service to individual clients.

It is clear from the measures I have outlined that the Government has made considerable improvements nationally to home help provision and other community-based services for older people generally. It is our intention that such services, including the home help initiative, will be improved incrementally in the coming years, in line with Government policies envisaged for the sector. There is no doubt that demand can at times exceed service resources and that this problem can manifest itself in particular at local level. However, it is a matter for the HSE to deliver services both nationally and locally in the context of its evolving priorities and overall resources.