Tom Hayes (Tipperary South, Fine Gael)
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I thank the Ceann Comhairle for selecting this important issue for discussion. Home help services have been of enormous benefit to the many people throughout the State who avail of them. These worthwhile schemes allow elderly people to remain in their homes, surrounded by their family, friends and community, thus enjoying a better quality of life.

Some months ago, it came to my attention that the Health Service Executive was experiencing difficulties in providing home help services to all in need of them. In some areas, no funding is available for new applicants, regardless of their level of need. In other areas, staff can only provide home help to a new applicant when an existing patient no longer needs them. In other words, staff are obliged to wait until one person dies before "recycling" home help hours. In recent weeks, it has become clear that instances of cutting people's hours and placing applicants on long waiting lists have become increasingly prevalent throughout the State. The many cases in my own constituency are undoubtedly replicated elsewhere.

For example, I was recently made aware of a shocking situation where an 83 year old man who is suffering from cancer, diabetes, and other complications was, upon his release from hospital, granted a mere one hour per day of assistance in the form of home help. His family were pleased to receive even this much but they are under enormous pressure and in a very stressful situation. I have come across cases where desperately needed hours of home help were drastically cut and where seriously ill people were put on waiting lists for home help. Families are coming under severe pressure as a result of this shortfall in home help services.

There has been a catalogue of decisions in recent months where the needs of older and more vulnerable people in our society were trampled by the Government. The Health Service Executive and the Department of Health and Children should not erode by stealth the essential provision of home help for people who are seriously ill. Will the Minister clarify the current situation? I reiterate how invaluable these services are to people who wish to remain in their homes. Given the large increases in unemployment, many people are now available to work with older people. An emergency plan should be drawn up to ensure older people receive the assistance they need to enjoy the best possible quality of life. Unemployed people should be allowed to register for some type of short-term scheme whereby they would assist elderly people in their homes. This would relieve pressure on the nursing home subvention scheme and the health service in general while also providing employment in local communities. If we do not look after older people, we cannot be proud of our society. I urge the Government to introduce the type of emergency plan to which I referred.

Éamon Ó Cuív (Galway West, Fianna Fail)
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Ba mhaith liom buíochas a ghabháil leis an Teachta as ucht na ceiste seo a thógáil. Beidh me in ann anois an fíorscéal a chur ar chuntas na Dála. I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's continued commitment to services for older people generally and, in particular, to the important area of home care.

Government policy in regard to the elderly is to support 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 this is appropriate. This policy approach is renewed and developed in the partnership agreement, Towards 2016. The home help service, delivered by or on behalf of the Health Service Executive, is a community service enabling people who otherwise might need to be cared for in long-term residential care to remain at home, where appropriate.

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

The home care package scheme is a relatively new scheme that has been developed in recent years throughout the State. A package comprises a number of community-based services and supports, provided in a planned way to meet the needs of an older person. The person will have significant medical, nursing or therapy requirements and may be recently discharged from hospital or at risk of being admitted to hospital if these needs are not met in a planned way.

The development of these services nationally in the period 2006 to 2008 reflects the prioritisation and significant investment by the Government in recent years. This involved the allocation of €211 million in revenue funding, including €55.6 million in development funding. Some 10.8 million hours were provided in 2006; 11.78 million in 2007; 11.96 million in 2008; and an estimated 11.98 million will be provided in 2009. The numbers benefiting increased from 41,400 to 54,500 from 2006 to 2008, an increase of 13,100 people.

Community-based services for older people have also been augmented in the period 2006 to 2008 by the development of home care packages. This involved the provision of €55 million in each of the years 2006 and 2007, with a further €10 million provided in 2008. This gives a total of €120 million in development funding in this three-year period. More than 4,600 packages were provided by the Health Service Executive in 2008, with some 8,700 people in receipt of a package at any one time and some 11,500 people benefiting during the course of last year.

The Health Service Executive service plan for 2009 aims to deliver the same quantity and quality of home help and home care package services as delivered in 2008. The capacity of the executive to provide approved levels of home help and home care package services continues to be reviewed in the context of overall resources available. It is incumbent on each local health manager to ensure that both home help and home care packages are delivered within allocated budgets. This requires a stringent ongoing review of the application of resources. As with every service, the Deputy will appreciate that there are not limitless resources available for the provision of home help and home care packages.

Levels of services for home help and home care packages for existing clients are reviewed regularly and, as a result, the service in individual cases may increase, decrease or remain the same, based on the assessed needs of the individual. Professional staff on the front line who are aware of local circumstances undertake individual client assessments and services are targeted at those with a high level of dependency, in accordance with assessed need.

An individual assessment is undertaken in the case of new clients for home help or home care packages. The requirements will vary from case to case and may subsequently change over time. An example would be a person discharged from an acute hospital who may require a package for a period following discharge until he or she regained independence. In this case, the level of service provided on discharge is kept under review and when the person is in a position to live more independently, the elements of a home care package may be adjusted in line with changed care needs.

It is particularly relevant, in the context of the issue raised by the Deputy, to highlight that the Department of Health and Children has recently commenced an independent evaluation of the home care package initiative and a report on this, which will help inform future policy and service direction, is expected to be completed around mid-year.

It is clear that the Government has made considerable improvements in recent years to enhance home care provision generally across the country. There is no doubt that demand can at times exceed service resources. It is a matter for the HSE, however, 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.