Catherine Byrne (Dublin South Central, Fine Gael)
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I thank the Minister for being in the Chamber to take this Topical Issue matter. I know and understand only too well the needs of older people in our families and communities. As I said last night, our senior citizens have been the backbone of our communities and they deserve our support when they get older. Therefore, I wish to highlight the issue of home help and the need to support further the services in our communities. There is considerable demand for these services throughout the country in every village and town. At present, the services are under great strain. While many of our senior citizens are healthy and able-bodied, some need a little help to get through the day, wash, feed, go to the shops and other small chores. Some have more acute needs but they deserve to be able to live at home, if they so choose, with the support of their local health team and home help services to be near family, friends and neighbours.

Home help is not only about sitting down and having a cup of tea, although that part is sometimes as important as any other part. It is also about enabling elderly people to keep their independence and live in dignity at home for as long as they can. I recognise the value of home help and home carers who can be a lifeline to many elderly people. However, in some areas people are being told that no more hours are available. In my area around Inchicore and Ballyfermot, home help service is at a standstill. Currently, a total of 90 people are on the waiting list and it cannot accommodate anyone else. What happens to these people? Many of them end up back in hospital and that is not really necessary. They would be better off staying at home with a small number of hours of home help.

I have also encountered a problem involving one of my constituents. A private company has been contracted to provide the service to the HSE. The company often sends a different staff member every day. This can be upsetting for an older person who may be unfamiliar with the staff member. The staff member may not be a familiar face or someone the elderly person believes she can trust. This lady has half an hour to get up in the morning, get washed, dressed and fed. The lady in question is rather infirm at the moment.

I realise the Government is aware of the needs of older people and I commend the Minister of State, Deputy Kathleen Lynch, and the Minister for Health on the work they have been doing. I acknowledge the services provided by the HSE as well. At present, more than 10 million hours of home help services are being provided through the support of 50,000 people. However, we need to invest in home help services to help take the pressure off our hospitals and long-term care services.

Although their hours have been cut, our home help workers continue to meet people in the evenings and go back to ensure the people they work with are all right. Many of the home help people I know personally have started to use money out of their own pocket to upskill themselves and improve the way they care for older people. Many older people want to say at home for as long as they can. Often they are afraid of going into hospital or nursing homes. That is where the home help service can really be a lifeline and take the pressure off all our front-line services.

I wish to make another point about the fair deal scheme. There is great demand for places, especially in the greater Dublin area. I know one group of family members who recently contacted 27 nursing homes on behalf of their elderly mother but only three of the homes would put the person on the waiting list. This situation is urgent and needs to be addressed.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy for raising this issue. I am taking this debate on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch, who is on Government business elsewhere.

While there will always be a need for long-term residential care, older people have consistently said they want to stay in their homes and communities for as long as possible, and the Government is committed to facilitating this. The review of the nursing homes support scheme, to be published next week, will include consideration of the need for continued development of home and community-based services alongside continued support for residential care. The HSE already provides significant levels of home supports. The executive will expend approximately €330 million this year on home-based supports. The HSE's national service plan for 2015 provides a target of 10.3 million hours of home help with a budget of approximately €185 million. This matches the 2014 budget for this area.

In addition to the mainstream home help service, which provides assistance with personal care, such as washing, dressing and essential domestic chores, the home care package scheme provides assistance for those with more complex care needs. As well as helping with the essential tasks of daily living, a home care package may include community nursing, therapy services, aids and appliances and respite care. The 2015 service plan provides for €135 million for home care packages to support 13,600 people at any one time. This represents an increase on 2014, when €130 million was provided to support 13,200 clients. As part of a measure introduced in 2014, a further €10 million has been made available to provide intensive home care packages for up to 190 people at any given time. These people would otherwise have to remain in acute hospital or long-stay residential care settings. This initiative could help to keep up to 250 people with complex care needs at home for longer.

The HSE is progressing a range of measures to improve home care provision overall, standardise services nationally and promote quality and safety. Providers are monitored through service level agreements with the HSE. These are supervised through regular local operational meetings and review of care plans.

The HSE is currently undertaking a full review of home care services with a view to improving services generally. This includes the preparation of national quality guidelines which will apply to all home support services, including those procured by the HSE from external providers.

Notwithstanding the significant improvements in the overall economic position that we have seen in recent times, significant pressures continue to apply across the health service and finding the resources to develop home care services in the way I would like continues to be a real challenge. However, there is no doubt that supports delivered in the home and in other community settings will play an ever-increasing part in supporting our older people, and I will ensure home-based services are given adequate priority when it comes to allocating available resources across services for next year.

Catherine Byrne (Dublin South Central, Fine Gael)
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There is nothing I disagree with in that. I am all about promoting equality and safety. I know the Minister understands the challenges facing us, especially those facing elderly people. Our elderly population is increasing as well. I was at the Joint Committee on Health and Children this morning where we met representatives from the Alzheimer Society of Ireland. The lady who spoke, Caitriona Crowe, is from the south Tipperary dementia pilot project and she explained what they were doing. Among the figures she gave was that there are approximately 54,700 people with dementia throughout the country. The figure is growing all the time.

There is an understanding that if people stay at home, they live longer, they are more comfortable in their home space and more comfortable when surrounded by people they know. Most of the home care teams in my area are made up of people who have worked in the area for a long time and they know the residents. However, we are a far cry from the 90 clients I have in Ballyfermot and Inchicore who are waiting for some home help hours. To me, they are the important people.

It is the small things that matter to most people when their parents get older. The way the home help service has been run down through the years has raised questions and it has been difficult to manage at times. I believe the services are coming to a better understanding of what it is about. I have no problem with anyone having a cup of tea and talking to someone, but not for two hours, something that happened in the past. Thankfully, that does not happen now and we have really committed people.

The Government is pouring vast sums of money into these services across the board. However, I still have 90 clients in the Ballyfermot and Inchicore areas who need these services. That is why I am speaking up today. I believe there is a small group of people in every community throughout the country who need a little extra. It may not involve a significant amount of money when it is calculated, but it matters a great deal to those people who cannot even secure an hour or two of home help in a week.

Leo Varadkar (Dublin West, Fine Gael)
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I cannot dispute what the Deputy is saying.

Although there have not been cuts affecting home care or home help packages in the past couple of years and despite a small increase benefiting home care packages, our difficulty is that we have an ageing population that is getting bigger all the time. Our objective is to allow people to stay at home for as long as possible. This is not only their desire and in their interests, but it is also less expensive than residential care. I am conscious of this and will specifically ask my officials and the HSE for a note on what is happening in Ballyfermot and Inchicore to determine whether the problem is particularly bad there by comparison with other areas. I will undertake to examine the position.

I take the Deputy's point on some of the private providers not providing for continuity of care and sending different staff every day, which is not desirable. Irrespective of whether the recipient is old or young, it is best for him or her to see the same staff all the time. We could potentially write into future contracts a requirement that changes not happen all the time. It may be necessary sometimes, however, if staff are sick, for example.

Thanks to the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, an additional €44 million was provided for the fair deal scheme this year. This has reduced the waiting time to four weeks from 11 or 12 last year. Notwithstanding this, in certain parts of the country, including parts of Dublin, the south east and the north east, there is a shortage of nursing homes. As with the housing crisis, there were years in which there was no private or public investment. That is now changing and quite a few nursing homes are under construction or in the planning process. They are very much needed. It is only when they open that people will start to see a freeing up. In Dublin and the north east, in particular, there is a shortage of nursing home spaces, but there is to be a supply.