Frank O'Rourke (Kildare North, Fianna Fail)
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I am delighted to be given the opportunity to speak today on the issue of home care packages. As with all Members of the House, health is a constant issue at my weekly clinics. Access to vital health services is a challenge, waiting lists are increasing and securing home care is a constant struggle for many older people. Most of us like to think that when the time comes, we will have the means to care for ill or aging family members who, given the choice, would rather be in their own homes than in a hospital or nursing home. This is where the home care package comes in. The package consists of a range of services provided by the HSE to facilitate the care of older people in their own homes. Whether it is therapy, home help, respite, transport to and from medical appointments, or day-care services, the package aims to make it easier for people to remain independent for as long as possible.

The HSE has a core provision of €324 million for home supports in 2016 and its national service plan for the year provides for a target of 10.4 million home help hours, 15,450 home care packages, 130 intensive home care packages for clients with very complex needs and a further 80 packages for clients with dementia. While I welcome this provision, the unfortunate reality is that accessing these services on the ground can be a very frustrating and protracted process. The suspension of home help hours and home care packages in February of this year has had a major impact and the effects are still being felt. On a system-wide basis, the cuts have ended up costing dearly, both financially and in terms of patient health. Increased pressure has been placed on an already creaking system through delayed discharges from hospitals and more people have being re-admitted to hospital due to inadequate supports in the community and home. Respite care is another issue. Good home care provision ideally supports both a medical and social model of care whereby both the carer and the cared-for person are supported physically with therapy, respite and home help and psychologically. It should allow the carer time to get a much needed break. Again, I have been contacted by a number of constituents this week alone who expressed their dismay that the provision of respite care at Maynooth community care centre had been reduced to two beds for the entire area. I am awaiting clarification of this via a parliamentary question I have submitted but it appears the centre is no longer allowed to use primary care beds for respite. This appears to be totally at variance with Government policy and with the commitment given in the programme for Government to increase funding for home care packages and home help every year.

Older people prefer to live in their own homes and this can be assisted by providing home care packages or home care hours and making their physical environment more suitable for their needs. However, there was a decrease of 83,346 home help hours in Kildare between 2010 and 2015. I hope the recent announcement by the Minister for Health of the Government's approval of a Revised Estimate for the Department of Health means there will be increased resources for home care services. I ask the Minister of State to be more specific on this funding. Does she agree that at minimum 2.2 million extra hours of home help and a further 3,500 home care packages for older people are required? Is that a target the Government will commit to meeting?

I also raise the issue of intensive home care packages, especially for people with dementia. Most people living with dementia and their families want to provide for their care at home. Can we step up the provision of intensive home care packages to achieve this? There is now an urgent need for the Minister for Health to deliver, as a priority, the projected increase in funding for home care packages as included in the programme for Government.

Helen McEntee (Meath East, Fine Gael)
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I thank the Deputy for raising this issue, which we know is extremely important from the questions which were asked during Question Time. Our population is ageing rapidly. Advances in health care are leading to a dramatic rise in our older population. Each year, the total number of persons over the age of 65 grows by approximately 20,000. We can see what the figures will be in the coming years. There is now a stronger emphasis on home care and other community services which provide 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. Older people have consistently said that they want to stay in their own homes and communities for as long as possible and the Government is committed to facilitating this. As Minister of State with responsibility for older people, I am committed to facilitating this as much as possible. Home care services are key to achieving this and the strengthening of home care services is an objective to which the Government is committed. The HSE provides a range of community-based services aimed at ensuring that older people receive safe, timely and appropriate care and treatment at the lowest level of complexity and as close to home as possible. The HSE's national service plan for 2016 provides for a target of 10.4 million home help hours to support approximately 47,800 people. It also provides for 15,450 home care packages and 130 intensive home care packages for clients with complex needs. A further 60 clients with dementia will be supported with co-funding from Atlantic Philanthropies under the Irish national dementia strategy.

Notwithstanding the significant improvements in the overall economic position that we have seen in recent times, pressures continue to apply across the health service. Services are being stretched by demands from more people and for more hours at times outside core hours, in the evenings and at weekends, all of which costs more. The Government has been able to respond to this demand by providing an extra €40 million for home care services in 2016. As I told the Deputy's colleague, the HSE is engaging with local community health organisations, CHOs, to establish how that funding can best be divided and spent. Those most in need must receive it first. I hope this will happen as quickly as possible. If the Deputy wishes to keep in touch, I will be in regular contact with the HSE to determine when that funding will be passed down. The targets for 2016 will be reviewed in the light of the provision of these additional resources.

There is always more that could be done in these crucial areas, but this represents a step in the right direction. I am delighted that the Government has been able to respond to the increased demand for services by providing additional funds. The allocation of these funds in the most appropriate way is a priority for the HSE. Prudent management of available resources is needed as demand for services increases. The HSE will continue to work to apply the available resources to target those in the greatest need most effectively and provide the best possible contribution to the system as a whole.

There is no doubt that home care services need more resources than are available. For this reason, the programme for Government commits to increasing funding for home care packages and home help services year on year in the coming period. I cannot give the Deputy an exact figure, but I will seek as much funding as it is physically possible to increase the figures he outlined.

Respite care services are of the utmost importance, not just for the individual who needs care but also for carers who are among the most important people in our society, something we might not recognise enough. Sometimes, respite care provision is the only break they get. We must see an increase in funding in line with that for home care packages.

On the issue of dementia, the Minister, Deputy Simon Harris, and I have met the Alzheimer Society of Ireland. I have met it several times independently. We are working with it on how we can increase funding and provide specific dementia care packages for dementia sufferers.

Frank O'Rourke (Kildare North, Fianna Fail)
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I thank the Minister of State for her reply. I do not doubt her commitment to making improvements where they are needed badly, particularly for the elderly. She is aware of the difficulty in this regard, from the response to one of my colleagues, that what is happening on the ground is different from what is being reported within departmental or other official circles. Given her offer, I would welcome the opportunity to meet her outside the Chamber to discuss this matter in detail. There is a problem with the service provider and the service user.

We are discussing the issue of hours, but I could give the Minister of State a list of 44 cases. She could give me as many, as could other Deputies. In Kildare North applicants have received approval for a home help service, but HSE officials have called to their homes in the past week to take the service away from them. I am not in the Chamber to play theatre with the Minister of State. I do not believe in engaging in such opportune politics for the optics. I believe in working hard for the people who elected me, representing them to the best of my ability and seeking the services they need.

An elderly lady who is partially sighted has received no home help service since February or March. Recently, she was told that she would not receive such a service unless she paid for it herself. An elderly man was meant to come home from hospital, but he was transferred to a hospital in Dublin on Friday because a home care package had not been approved for him, even though one had been identified and charted for him by his consultant. In the National Rehabilitation Hospital in Dún Laoghaire the medical profession has as difficult a job to do as anywhere else and there is a waiting list. I spoke to a constituent on Friday evening who, despite waiting, could not be discharged because a home care package had not been approved. I am aware of a couple in their 70s and the woman has dementia, is incontinent and needs to be showered daily, as recommended by the medical professionals. After she has her shower on Friday at 10 a.m., she will not have another until Monday at 7 p.m. The man gets two three-hour breaks on Monday and Thursday nights. He receives a home help service for approximately two hours to do household chores. Last week two HSE officials arrived like the Mafia and took them from him. He has lost a service for two and three quarters hours.

We need to have this issue addressed. These are the real issues and I need the Minister of State's help.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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The Deputy is over time.

Frank O'Rourke (Kildare North, Fianna Fail)
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I need the Acting Chairman's forbearance.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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No. I have given the Deputy-----

Frank O'Rourke (Kildare North, Fianna Fail)
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Please, will the Minister of State help us to correct these issues? It is a scandal.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Will the Deputy, please, allow the Minister of State to reply?

Frank O'Rourke (Kildare North, Fianna Fail)
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The people concerned have contributed to the State and need to be looked after.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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The Deputy has made his point.

Helen McEntee (Meath East, Fine Gael)
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This is a priority for me. There is a major flaw in the system, in that significant amounts of money are being used to keep people in hospital and acute units when we know that the financial benefits to the HSE and the Department in keeping them at home are considerable. There are also the physical benefits. When people are surrounded by their families and involved in their communities, naturally they get better and live longer and happier lives. As the Deputy rightly put it, trying to flip the manner in which funding is directed is a mammoth task. Unfortunately, one cannot just whip money from acute or hospital services. One must play a steady game by increasing funding in one direction while gradually decreasing it in another when it is no longer needed. That is when we will start to see a change. The five to ten-year plan for health is the way forward. We must invest over a long period. In the meantime, the priority is to continue increasing the finances for home help services, home care and intensive care packages. I am working on this issue with the advocacy and support groups, carers and hospitals. I will also work on it with the Deputy and ask for his and the support of every Deputy, as this is an important issue. The number of people aged 65 years and over will double in the coming years, while the number aged 80 years and over will quadruple. We will face a major problem if we do not address the issue now.