Terence Flanagan (Dublin North East, Independent)
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I thank the Minister, Deputy Varadkar, for attending. The lack of respite care is an important issue. I am raising the matter on behalf of carers throughout Dublin and in other parts of the country who are currently having difficulty gaining access to respite care beds for their loved ones.

The HSE has advised that the north Dublin city area has not had a respite bed available for persons under the age of 65 since the start of January 2015. As a result of this bed shortage, carers are not getting the one or two week break they need. As the Minister knows, they provide an invaluable service not only for their loved ones, but also for the State, as they are doing work that saves the State billions of euro each year. Many family carers provide full-time care, 24 hours a day and seven days a week. Their loved one is dependent on them but, unfortunately, the carers have no legal entitlement to days off or any type of break from this very demanding job. Respite care is essential for these carers and for the thousands of people throughout the country who provide temporary care and relief for those who provide caring duties.

Respite care also helps to reduce pressure on other areas of the health service such as acute hospitals, and this problem is having an effect on Beaumont Hospital in my constituency, as the Minister is aware. In addition, primary care centres must be rolled out to deal with the overcrowding in hospitals. What is the Minister doing about the unacceptable waiting lists that currently exist for carers waiting to have a loved one get respite care? Can he comment on the shortage of respite care beds? What action is he taking to increase the supply? Will he also comment on the average waiting time for those waiting for care?

Lucinda Creighton (Dublin South East, Independent)
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I thank the Minister for attending for this Topical Issue. Like Deputy Flanagan, I have encountered a significant amount of distress among carers not only in my constituency, but throughout the greater south Dublin area. Everybody knows the value we attach to respite care. It is very important for carers that they have an opportunity to break from routine. It is also very important for their dependants, particularly in the case of children with intellectual disabilities and so forth, to have the opportunity to express their independence and to go to a different environment.

I have met with a group of parents who live in the south Dublin area, all of whom care for adult children with intellectual disabilities. In 2012 and 2013 they were in receipt of 20 days respite per year. That figure has now reduced to 12 nights respite per year. In some instances carers do not receive any respite at all. It appears to be quite random and ad hoc, and is causing a large amount of distress. There are also instances where respite care has been arranged and agreed. Due to the changes in staffing the notice period is now much longer than it was previously, so the respite care might be arranged weeks if not months in advance. However, due to emergency residential care requests, the respite care might be cancelled at short notice or at the last minute, even on the afternoon or evening it was due to begin. That makes it difficult for families to plan and for carers to provide the type of care that is required by their dependants.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Deputies Flanagan and Creighton for raising this issue. I am replying on behalf of the Minister of State, Deputy Kathleen Lynch.

A key objective of the Government's health policy is to support people to live in dignity and independence in their own homes and communities for as long as possible. Carers are vital to the achievement of this objective and are considered the backbone of care provision in Ireland. A break from caring can lessen the psychological and emotional stress they experience and can help carers to continue to provide the support that they give.

Respite services for adults and children with disabilities are provided in a variety of settings, depending on the needs of the family and available resources. In 2015, some 5,274 people with a disability are expected to avail of residential centre based respite services, utilising 190,003 bed nights. In addition, between 2,000 and 2,500 persons avail of non-centre based respite services such as holiday residential placement, occasional respite with a host family, overnight respite in the home, and summer camps. The provision of residential respite services for people with a disability has come under increased pressure in the past couple of years. Any available development funding has focused mostly on the provision of day places for pupils graduating from school, rehabilitative training programmes or emergency residential placements. The need for increased respite facilities is acknowledged and the HSE continues to work with agencies to explore various ways of responding to their needs.

For older people's services, respite may be provided via an enhanced home care package for the period of respite or in public or private nursing home beds.

Respite beds may also be contracted by the HSE in private nursing homes. There are about 1,860 short-stay public beds, including "step up-step down" care, rehab and respite care, which are used in a flexible manner to meet local needs at any given time. They are interchangeable for use depending on demand. It is acknowledged that a higher level of respite care is required across the greater Dublin area. Some €8 million of the additional €25 million allocated in 2015 will provide 115 additional transitional care beds for discharges from acute hospitals, including the opening of Mount Carmel later in the year. Some €5 million has been allocated for the provision of additional home care packages targeted on a needs basis to individuals who are discharged from Dublin hospitals. This will assist in allowing individuals to return and to remain at home and support the carers in the provision of in-home services. This is in addition to the €315 million that has been provided nationally for home support services. This stronger emphasis on home care and other community services provides a greater range of options to avoid admission to acute hospitals, support early discharges and, where appropriate, rehabilitate and re-able patients after periods of particular difficulty.

The funding that is available for services must be balanced across all of the various service areas in a way that achieves the best possible outcomes for the greatest number of service users and prioritises areas of greatest need as far as possible. The demand for services has increased in recent years and we need to ensure that home care supports are as easily accessible as possible in order that as many older people as possible can be supported at home. The shortage of respite care was one of the issues raised by the carers' representatives at the annual carers' forum, which was hosted by the Department of Social Protection on Tuesday. I assure the Deputies that my Department and the HSE will follow up on this issue.

Terence Flanagan (Dublin North East, Independent)
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I thank the Minister for his response. I know he has a huge volume of work on his desk, but will he prioritise this issue? Carers are being taken for granted. When one considers what is involved, they really do need their breaks. They are necessary for them to be able to continue to look after loved ones. This issue has been raised by many constituents, but particularly by service users of Prosper Fingal and St. Michael's House. One constituent was informed by St. Michael's House that although it recognised that more respite care is needed, it does not have the funding to provide that service. At the end of December last year, the HSE advised that a restrictive budget has meant that it has had to reduce respite care services. More beds are needed and they need to be freed up on a more regular basis in order that the service is spread among more families.

Will the Minister outline some of the issues raised at the annual carers' forum, what progress has been made and what plans he will put in place around them? Is there any update on the national carers' strategy? Further, will the Minister speak to his colleague, the Tánaiste and Minister for Social Protection, and ask her to look at the respite care grant? It has been reduced, sadly, in recent years, from €1,700 to €1,375. This is scandalous. These people need to be looked after properly. It is to be hoped that the Minister will do this.

Lucinda Creighton (Dublin South East, Independent)
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I thank the Minister for his reply. I do not wish to repeat what Deputy Flanagan has said. I would be interested to hear some feedback on the carers' forum which was hosted on Tuesday. I would also like to have more of an insight into what the Minister believes is required, in terms of bed numbers and capital expenditure, to deal with the backlog for respite care which exists not just in Dublin but throughout the country. What would be the ideal?

Leo Varadkar (Dublin West, Fine Gael)
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The carers' forum is operated by the Department of Social Protection and the HSE takes part in it, for obvious reasons, but the Department of Health does not operate it. The same applies to the carers' strategy, which is led by the Tánaiste and Minister for Social Protection. It would be wrong of me, therefore, to give an update or a report on it, given that I was not present and it falls within the responsibility of the Department of Social Protection.

Terence Flanagan (Dublin North East, Independent)
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Will the Minister inquire about it?

Leo Varadkar (Dublin West, Fine Gael)
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I am sure all sorts of issues relating to domiciliary care and respite care grants and so on were raised. I would expect that to be the case.

I am aware of one or two cases of people in my constituency who have not been able to get respite care. It often happens because emergency residential care is required for someone else. That, I suppose, is the nature of these things. There are always competing financial demands. Also, where there is a social or personal care help need, it is often given to people who at that particular point in time need it a little bit more. I will seek a report from the HSE on it and I will ask what additional measures could be put in place to ensure we have adequate respite facilities for carers. We want to be able to support them in what they do. The fact that they do what they do reduces the need or the potential need for long-term residential care.