Dáil debates

Wednesday, 30 September 2015

Topical Issue Debate

Home Help Service Provision

1:30 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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What have the HSE and the Government against HSE-employed home helps? There is no doubt that there has been an assault on the hours available to home helps across the country over the past number of years. A total of 1.4 million fewer hours are available now compared to 2010. From a policy point of view, it does not make sense to curtail the number of home help hours available to families that are under huge pressure and stress trying to care for a loved one at home. Home helps are an integral part of the delivery of health care, as patients transfer from an acute hospital setting to a home care setting. However, people are scrounging on a daily basis to access additional hours. They contact local public representatives, including Deputies, to beg and plead for more hours. The number of hours available is not sufficient to cater for the demand.

There is a key problem regarding HSE-employed home helps who are being blackguarded to a certain extent. People who have a contract for X hours cannot secure additional hours. I cannot understand the preference for private companies that provide home help hours. When one does the sums, it does not make economic sense to be preferential towards private companies. It must be acknowledged that HSE-employed home helps have provided a critical, integral service in our communities for many years but the notion that they must work a set number of hours and cannot access additional hours is distasteful.

I would appreciate it if the Minister of State would revisit that policy, which seems to be ingrained on the part of HSE management, to reduce, on a continual basis, HSE employed home helps and preference private companies. If there was a logical or an economic reason for doing that, one could understand it but, by any stretch of the imagination or assessment, there is no benefit gained from operating in this way. I ask the Minister of State to revisit that issue in the broader context.

There are instances where people are being provided with a half and hour of home help care. What can a person do in half an hour? There is a need for the Minister of State to fundamentally review the number of hours of home help care available across the country. Taking account of the regions, there has been an appalling assault on the hours available. Some 1.4 million fewer home help hours are being provided than was the case in 2010. We have an aging population; the demographic curve is in that direction. The stated policy is to transfer people from an acute hospital setting to a home-care setting, yet Government policy in this area leads to the opposite being the case. One of the main reasons we have overcrowded emergency departments - and bedlam and chaos in them on a continual basis - is that we cannot transfer people from an acute hospital setting back to a community-based or home-care setting. An integral element in ensuring that people can remain at home is their level of access to home help care.

In the context of the budget, I urge the Minister of State to not only review the number of home help hours available nationally but also to ensure that home helps employed by the HSE are treated fairly and with dignity and that they are not be continually blackguarded in terms of their hours being consistently reduced and priority and preference being given to private companies. It does not appear that the Minister of State can inform me as to why that is the practice, whether there is a rationale for it or whether a cost-benefit analysis has been carried out. I have been contacted by home helps whose hours have been significantly reduced from 40 to 15. Their basic original contract was for 15 hours, yet they had been working many hours in excess of that for the past number of years. However, when it came to the renewal of their home help hours or providing care for a new client, those hours have been given to private companies.

1:40 pm

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I am aware of the time constraints and the fact that the clock is ticking. The question the Deputy put down relates to the need for the Minister for Health to improve working conditions for home helps. The Deputy has moved into the broader region and I may be able to deal with that issue in a response to a supplementary question.

I thank the Deputy for raising this issue. While there will always be a need for long-term residential care for the older people in our society, it is important that those who wish to stay in their own homes and communities are supported and facilitated to do this and for as long as possible. It is also important that we support the return of those who have required acute hospital care to their homes.

In 2015, the HSE will spend €330 million on home care packages and home help services including €185 million to provide 10.3 million home help hours. These services are provided in two ways, either directly by the HSE or by private or voluntary organisations funded by the HSE. Home help services are provided mainly by staff directly employed by the HSE. However, in the greater Dublin area, Wicklow and Clare, home help services are provided by voluntary providers on behalf of the executive. The terms and conditions of home helps have been the subject of detailed consideration. A home help contract introduced for HSE employees in 2014 followed on from a lengthy consultative process on a range of issues that commenced in 2012. The discussions took place between the HSE and the unions under the auspices of both the Labour Relations Commission and the Labour Court. The annualised contract which emanated and was accepted is fundamental to both parties as it matches the actual workforce to the changing needs of the service. It also gives certainty to employees by way of guaranteed weekly minimum paid weekly minimum paid hours. Voluntary providers are funded under section 39 of the Health Act.

The HSE has in place service level agreements with these providers which set out the level of home help service to be provided for the grant to the individual organisation and which contain requirements in respect of standards of care. As the home helps employed by these section 39 organisations are not HSE employees, the HSE does not determine the salaries or other terms and conditions to apply to these staff, including pension arrangements. Accordingly, the arrangements offered by individual providers will vary. The pay and superannuation terms and conditions of the staff concerned are not subject to the control of the Department of Health and they are not classified as public servants. The granting of any pension entitlement in such circumstances is a complex matter. Access for home helps in voluntary organisations to a pension has been the subject of a number of Labour Court recommendations involving SIPTU, IMPACT and the HSE. Implementation of a Labour Court recommendation on payment of a gratuity to the home helps employed by the section 39 organisations has been hindered in recent years by the budgetary situation and is further complicated by the fact that the HSE is not the employer.

I am pleased to confirm that the issue was discussed during the recent Lansdowne Road talks and that the parties reached agreement on a process for giving formal consideration to the matter. The parties agreed to establish, in the short term, a working group to examine a number of issues, including gratuity payments for home helps. This process will now be progressed following the recent ratification of the Lansdowne Road agreement. As Minister of State with responsibility for primary care, I am committed to providing the necessary supports and assistance to allow our growing elderly population to remain in their homes and to provide good working conditions for those who can facilitate this.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I am aware that there were long, protracted discussions and negotiations in the Labour Court and the Labour Relations Commission in the context of trying to find an agreed basis for contracts for HSE-employed home helps. A home help who had X number of hours calculated on a base year - and I understand the number was roughly 80% of that - would have a set minimum contract but they would often have been given additional hours. The difficulty is that their hours in excess of the minimum contract are being pared back and given to private companies. As a result, there is a preference in the allocation of hours over and above those in the minimum contract which the HSE is obliged to honour. In case after case, home helps employed by the HSE are only being given the minimum contract hours. The contract refers to minimum weekly paid hours. There is no necessity for the HSE to deny them extra hours. Home helps across the country are still receiving the base minimum contract number of hours but they have been working extra hours in recent years. When the time comes to review their hours, those in excess of what is stated in the minimum contract are being given to private companies and the home helps hours are being reduced to the minimum. In this way, the HSE is meeting its basic obligations.

Why is there an obsession among HSE management, and as is evident in policy, to deny HSE-employed home helps extra hours when additional hours are being allocated to an individual? That seems to be the case. I have spoken to many home helps - I spoke to two of them before I came to the Chamber - and they have confirmed that is the case. They are now receiving the minimum number of hours when they would have been allocated many more hours up to now. There is a change in policy and the HSE is only meeting its obligations in terms of the minimum contract for these employees but it should not give preference to the voluntary organisations or private companies ahead of the HSE employees.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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The Deputy will be aware that when the State is the significant supplier of any service, it is necessary, under European rules, to put an element of the contract out to tender. It was not this Government which negotiated that, it was negotiated by a previous Administration. That to which I refer is what needs to happen.

The home help service funding of approximately €185 million will provide for 10.3 million home help hours in 2015, the same level of service and funding that was provided for in 2012, 2013 and 2014, respectively. In addition, we also have the home care packages. We do not have an obsession - neither does the HSE - with private companies. I understand that when people wish to remain in their own homes, this is the best possible option for them. I understand that perfectly. It is an option that we would all choose for ourselves. I reiterate that there is not an obsession.

3 o’clock

The difficulty is that, with the collapse of the economy, we had to ensure that not only did we get the best possible value - home helps are extraordinarily good value for the job they do - but we also had to ensure resources were spread as evenly as possible. It will certainly have to be kept under review because at the other end, we are putting people into long-stay residential care at a stage when, albeit in the minority of cases, they do not want to be in it and it is the more expensive option. I thank the Deputy for raising this matter which we will keep under review.

1:50 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister of State for her response.