Dáil debates
Wednesday, 23 June 2010
Health Services
10:00 pm
Margaret Conlon (Cavan-Monaghan, Fianna Fail)
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I am pleased to have the opportunity to bring to the attention of the House a matter which is of serious concern for constituents in my constituency, namely the provision of day services at the Darley Health Centre in Cootehill. I have had numerous calls about this from concerned persons and from Councillors McCarey, Igoe and Smith in Cootehill.
I, with my Oireachtas colleagues, attended a public meeting in Cootehill on Monday night last where we heard at first hand the concerns of the service users and their families. There were 300 people present, which shows the seriousness with which they took the matter, and they highlighted clearly the benefits which the senior citizens receive from attending the day centre, as it currently exists.
The Darley Health Centre opened its doors to the senior citizens in November 2006 and it continues to provide what is concerned by health professionals and service users and their families to be a service of excellence. Is that not what we all are looking for? I look forward to witnessing this for myself on Friday when I visit the centre, and I would wonder how many local area managers have taken the time out to visit this wonderful facility.
The confusion results from a proposal to look at how day services are delivered in counties Cavan and Monaghan. I believe there has been misinformation or, at best, inaccurate information. This fed the rumour mill and, suddenly, the word was spread that the services are closing on 1 September.
When I contacted the HSE, it confirmed this was not the case. I accept the HSE's statement in good faith, but the services will not be provided in their current form.
Once again, the HSE has been reactive rather than proactive. I am led to believe that service users and service providers were given different information on the same night. This is unacceptable and has led to the current confusion. The users and their families need certainty and clarity. Surely they are entitled to these. I accept that the HSE is considering the introduction of enhanced services at Cootehill, which is certainly deserving of additional services like occupational therapy, physiotherapy, speech and language therapy and so on. As a town, it has potential for delivering these services to the people of counties Cavan and Monaghan, but this does not mean the current day services must move.
For those who use the service, the words of praise were high. For many, the social interaction was as important, if not more so, as the other services provided. Many spoke of the benefit of meeting their friends. For many, it was their only opportunity to meet people on a weekly basis. Moving the service and its users to other rural locations would not work. The service would be fragmented and the same quality would not be provided. The Darley unit might become unsustainable. The other units would not be in a position to provide the same level or quality of service with the same expertise.
I watched the recent programme on the treatment of Alzheimer's patients. Many such patients avail of this service. The programme was emotional, but it made clear how any change in routine or venue would have significant consequences for patients. Are we not to put the patients first? If we learned anything from the programme, it was that services of excellence should remain where they are. This is the case in respect of Cootehill.
We need a proper consultation process with service users at its heart. They should continue to receive the same excellent service, which is delivering good outcomes. If it is not broken, it does not need fixing. I would be critical of many other aspects of health care provision and service delivery and action is required in respect of them, so let the HSE focus on fixing them instead of causing confusion, anxiety and worry for elderly people. I do not want the HSE to use this as a reason to prevent the acquisition of new services in Cootehill. The services can be located in the new premises.
The complete breakdown in communication must be remedied with immediate effect. It is unfair to all stakeholders, including those providing the new premises. They have invested time and money and adapted the premises to suit the HSE, but they have been treated unfairly. It is time for honest, frank and open communication between all stakeholders. Only then will a satisfactory solution be found. I look forward to the Minister of State's reply.
John Moloney (Laois-Offaly, Fianna Fail)
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I am taking this debate in the absence of the Minister for Health and Children, Deputy Harney.
The Government's overriding policy is to support older people to live in dignity and independence in their homes and communities for as long as possible. Where this is not an option for whatever reason, the HSE supports access to quality long-term residential care, as appropriate. In accordance with this approach, a priority of the Government in recent years has been to develop a range of community-based supports, such as home help, home care packages and day-respite care. Between 2006 and 2010, additional investment of more than â¬200 million was provided to the HSE to develop such community supports for older people. Without these initiatives, many older people would experience inappropriate admission to acute hospitals or would be admitted to residential care earlier than might be required.
The HSE service plan for 2010, approved by the Minister in February, commits the executive to providing agreed levels of service nationally for these key community support areas. The plan includes day-respite care, often available through various day care facilities or as part of a home care package. Such services can be delivered directly by the HSE or in partnership with local voluntary or private providers.
Broadly speaking, the level of community supports for older people in 2010 is in line with the 2009 provision. This includes an increase in the number of home care packages available due to additional funding of â¬10 million provided in the last budget for this specific purpose. The key activity targets contained in this year's HSE service plan are almost 12 million home help hours to approximately 54,000 people, an increased home care package provision from 8,700 recipients at any one time in 2009 to 9,600 in 2010 and a total of 21,300 day care places, estimated to cater for up to 80,000 people. While this last target is slightly down from a comparable figure of 21,600 places in last year's service plan, the respite-day care levels agreed would generally be compensated for in 2010 within the overall home care supports component of the plan. It should be noted that any changes to these national target commitments, as part of the agreed HSE service plan for this year, would need to be notified to the Department of Health and Children.
Other important initiatives are also being undertaken at a strategic level to improve community-based services for older people. Arising from an evaluation of home care packages published by the Department in December, the HSE is progressing various improvements in home care provision. The Department accepts the need for a more standardised approach to home care generally, whether by public or private provision. It is worth nothing that, this year, the HSE intends to finalise standardised access and operational guidelines for the delivery of home care packages, adopt a voluntary code of quality guidelines for home care support services for older people, progress a procurement framework for home care services and introduce procedural guidelines for the home help service to standardise access to and allocation of home help hours.
As the Deputy is aware, the HSE has operational responsibility for the delivery of health and social services nationally. She will appreciate that all developments relating to older people, including day care services at individual centres such as Cootehill, must be addressed in light of the current economic and budgetary pressures. The executive has been asked to rigorously examine how existing funding might be reconfigured or reallocated to ensure maximum service provision is achieved. This requires a stringent ongoing review of the application of the resources currently available.
The HSE recognises the challenges ahead in meeting the increased volume and complexity of need within our ageing population while also attempting to address the demand for integrated, co-ordinated and appropriate services based on the principle of maintaining older people at home for as long as possible. From this perspective in the Cavan-Monaghan area, the HSE is examining options to bring additional services into Cootehill for the benefit of people in the town and surrounding areas.
The local health manager established a strategic planning group for services for older persons in counties Cavan and Monaghan in March 2010 to consider, among other matters, the manner in which day care services for older people are being delivered across both counties. As a result, there may be some changes in the method of service provision. There are different possibilities with regard to the future provision of these services, each of which is being explored and negotiated currently. In the case of day care services for older people, it is the aim of the executive that older people requiring this service would access it as close to their homes as possible and within their communities. Day care services are provided at the Darley Centre to older people from Cootehill town and the surrounding community. The majority of older people attend weekly or bi-weekly on a rotational basis. I understand many users of the day care service in Cootehill also currently access other local day care services. There is capacity to increase this option to them.
An information session was held on 25 May, led by the general manager and key HSE personnel, to inform the current service provider and the voluntary organisations representing the local views of the older people of the proposed review of the day care services. A decision has been taken that the existing older people will continue to be provided with the same frequency of day care services, whether at the Darley Centre or a different facility. It was emphasised that it should not mean a reduction in service for any person currently attending day care in the Darley Centre. Every effort will be made by the HSE locally to meet the needs of each individual in the best way.
The timeline for bringing the new and changed day care service into operation is by the end of the first quarter of 2011. The HSE will continue to work with local services and people from Cootehill in developing new services. It is a matter for the executive to manage this service, bearing in mind all relevant factors, such as overall resources, local circumstances or evolving service priorities.