Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this matter.

I seldom personalise any issue in the Dáil, but I raise this matter on that basis to show clearly the situation on the ground as far as home help is concerned in the constituency of Cavan-Monaghan. I do it in light of the fact that the Minister for Health and Children, Deputy Mary Harney, is explaining that the closure of the two wards in Monaghan hospital will not cause any problem because there are good home help services and packages available. There is supposed to be an effort to encourage people to stay in their homes for as long as possible, yet here is a specific issue concerning a lady who received seven hours of home help in 2003, which was subsequently reduced to four hours. On 28 January 2009 she got a letter to say it was being reduced to two hours.

With all due respects, what support can an 83 year old woman get from a home help over two hours per week? If she only takes her into town as the sole outing of the week, that will take up most of the two hours, regardless of the need to keep the house clean and tidy and whatever other supports she needs. The woman no longer goes to her place of worship, but tries to visit the town once a week. If she does not, the home help has to do it for her.

This is an example of how home help is being delivered, in reality, in the present situation. We are being lectured by the Minister as regards how many home help hours are available throughout the country and so on, but when it comes down to the individual, that is when it really hurts. I have another note here from someone in Belturbet, at the other end of the constituency from the woman in Carrickmacross, where a 79 year old lady had her home help reduced from 1.5 hours per week to three-quarters of an hour. This is really coming down to the level of a joke. If we want to encourage people to remain in their homes, there should be realistic periods of time allocated for home help.

To return to the example of the first lady, she does not have a family member, relation or anybody else available to her. She is completely dependent on the home help and the goodness of her neighbours. Imagine what it would cost the State if this citizen could no longer stay in her own home owing to the lack of home help. Imagine what subvention top-up and all the rest would have to be paid to a nursing home. I ask the Minister of State to reconsider this case and the whole home help situation.

I was told the other day by the Minister's representative, Professor Brendan Drumm, that a number of top level personnel would be appointed to the Monaghan region to organise and look after the home help situation there. However, if the people on the front line, the home help staff and home carers, are not available or not being employed, what is the use, because that is where the patients get the service? I ask the Minister of State to please ensure that this lady has her four hours of home help restored.

I know I am taking a risk in raising this in the Dáil. The services may see my intervention as an effort to bypass them. However, I raise this solely as an example of what has been happening all over the area. The Belturbet case has nothing to do with this, but that is an example where 1.5 hours has been reduced to three-quarters of an hour. What benefit can home help of three-quarters of an hour be to a 79 year old, living on her own in Belturbet? I urge the Minister of State to treat the situation seriously. We have never had as many people unemployed as there are today. Surely, it would be better to employ people as home help or home carers rather than giving them dole, with nothing to show for it.

Jimmy Devins (Sligo-North Leitrim, Fianna Fail)
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I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

I thank Deputy Crawford for raising this issue, as it provides me with an opportunity to reaffirm the Government's continued commitment to providing services for older people generally and, in particular, the important area of the home help service. Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care, where appropriate. This policy approach is renewed and developed in the partnership agreement Towards 2016.

The Government's objective of continuing to develop community based services for older persons is reflected in the funding given to the system in recent times. The total additional funding allocated for such services was in excess of €210 million in the three year period 2006-08, inclusive, of which €55 million was specifically earmarked for the expansion of the home help service. The new funding was both to enhance existing services such as home help and meals-on-wheels and to widen the range of services available to older people through, for example, the introduction of home care packages. Home help is the backbone of community based services and includes a range of essential supports that make all the difference to the quality of life of each recipient. In 2006 almost 11 million home help hours were provided by the HSE. The executive estimates that it will make available nearly 12 million hours this year, benefiting over 54,000 people nationally.

It is important in the context of the issue raised to point out that the home help service has also seen increased professionalisation in recent years with the implementation of the national home help agreement. This has resulted in greater flexibility in service delivery and improved consistency and service quality through measures such as training to the benefit of service users.

The home help service is reviewed regularly at local level by the HSE which has operational responsibility for individual cases. Professional staff on the front line who are aware of local circumstances undertake individual client assessments. Services are targeted at clients with a high level of dependency and in accordance with their assessed need. In such instances the level of service in individual cases may increase, decrease or remain the same, based on the assessed need of the individual.

In the context of the issues raised by the Deputy, I understand the person in question recently had a review of her circumstances which resulted in a reduction of her service provision after taking account of various factors such as the recent review and the need to assist others locally waiting for a home help service. It is open to any individual or person working on his or her behalf such as a GP to request that the situation be reviewed by the HSE should circumstances change. The Deputy will appreciate that the HSE collates statistics as a matter of routine in respect of the Cavan-Monaghan local health office. The executive has indicated that in this local health office area some 2,800 clients benefited from the home help service in 2007 and that approximately 3,100 clients received a service in 2008.

It is clear that the Government has made considerable improvements in recent years to enhance home help provision generally across the country, including the Cavan-Monaghan area. There is no doubt that at times demand can exceed service resources. However, it is a matter for the HSE to deliver services, both nationally and locally, in the context of Government priorities and its overall resources and taking account of the individual circumstances of each case.