Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Minister of State, Deputy Helen McEntee, for coming to the House to answer my issue.

In an ideal world most of us would like to think that when the time comes, we would have the means to care for ageing family members who, if given the choice, would prefer to remain in their own home rather than be placed in a hospital or nursing home. There is a crisis in the provision of home care packages across the country. Hours and packages have been cruelly cut for those in society who are most vulnerable. I refer to my constituency, Roscommon-Galway, where I hear about this problem in every clinic. Rather than knock the Government, I will provide the Minister of State with some examples and I am sure she will see exactly from where I am coming.

I was approached recently by a family in my constituency clinic. They are caring at home for their mother who is terminally ill with cancer. They asked for more hours as her condition had worsened. We asked for a review of the case to gain more hours to help the family. When the review took place, despite desperately needing the hours already allocated, the family actually lost some of them.

I am aware of another sad case. A wife is looking after her husband who needs two people with him at all times owing to his very serious condition. She and her daughter lovingly provide 24-hour care for their loved one. They had been allocated a carer for four hours on a Wednesday in order that one of them could go shopping, collect a pension payment and prescriptions and carry out other jobs in the local town. These hours are no longer available to the family who have been left without help or a respite care service.

The figures may indicate that there has been an increase in the number of hours available in some areas - that may be the case - but I assure the Minister of State that the number of families who are looking for an allocation of hours has increased dramatically owing to overcrowding in hospitals and the cost of nursing home care. In most cases, as has been proved beyond doubt, families want to look after a person in the comfort of his or her own home. This saves the State a significant amount of money in the long term. However, the way families and patients seeking home care packages are being treated is a disgrace. I cannot see the logic in removing home care hours from families who are trying to do their best for their loved ones. The lack of hours of is causing further congestion in hospitals and means that vital beds are being taken up by patients who could be cared for in their homes if there was a comprehensive home care package in place when leaving hospital. It does not make sense that the number of home care packages is being are being cut and hours are not being allocated to other families in desperate need of help in caring for their loved ones. As the Minister of State knows, there is a problem with overcrowding in hospitals. One very quick and ideal solution would be to extend the number of home care packages available and provide support for families to look after their loved ones in the comfort of their own homes.

I recently became aware of another case in which a wife, a full-time carer for her husband, had become extremely ill. She had a stroke and has been in intensive care in hospital for a number of weeks. I was amazed to hear that the HSE services operating in the area only allocated one hour to enable somebody to look after a very sick man, even though his wife had been caring for him full-time. The system does not make sense. I plead with the Minister of State to take on board what I am saying and offer some hope and comfort to many genuine people who are in very serious difficulties because of the cutbacks.

Helen McEntee (Meath East, Fine Gael)
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I thank the Deputy for raising an issue which is raised continually in the House because of its importance. We know that it is one that needs to be addressed.

We all share the same common objective, namely, improving the quality of life for older people. It is not just older people who need support and services; people who are sick or those with disabilities also need help. The funding available for services for older people stands at almost €740 million this year. It is used to provide a range of services across the community and is focused on ensuring older people have timely access to and are provided with appropriate care and treatment at the lowest level of complexity and as close to home as possible. Home care services are critical in supporting older people to remain in their homes and communities and maintain their independence for as long as possible, which is better for them. As we know, they are happier when they are in their own home.

It also makes sense, as the Deputy has pointed out, to avoid admissions to acute hospitals. Further, many people can be supported at home at a far lower cost than that of residential care. We also know that home care services need to be put in place where residential care is not possible as well.

The HSE’s national service plan for 2016 originally provided for a target of 10.4 million home help hours to support about 47,800 people. It provided for 15,450 home care packages and approximately 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 national dementia strategy. This matched levels of provision in 2015. However, and I know the Deputy understands this, services are being stretched by demands from more people with the number increasing weekly and for more hours in the evenings and at weekends, all of which unfortunately cost more. This means that even maintaining services at last year's level would have resulted in service delivery failure this year, which is why we responded by providing an extra €40 million.

While we are saying it is an additional €40 million, it does not necessarily mean there will be additional services and supports. It is to maintain last year's level. This brings the overall budget for home help and home care packages to approximately €339 million, which is not enough, but our A Programme for a Partnership Government commits to increasing that funding year on year. With that funding, the HSE will now provide an additional or extra 133,000 home help hours and 350 home care packages this year. In addition the HSE’s winter initiative plan provides for an extra 950 home care packages with 50 packages coming on stream each week over the winter initiative period.

Community Health Organisation 2, which includes Roscommon, Galway and Mayo, is prioritising home care services to those who are currently in a hospital or in a community hospital step down facility. The HSE is providing a significant level of service for the area and it is projected that the HSE will deliver 1,193 home care packages and about 1.32 million home help hours by the end of the year. I will try to get more of an update in the coming weeks, but last week there were six people registered as requiring home care services waiting to be discharged within Community Health Organisation 2. The applications for all six are being processed by HSE community services at this time.

It is important to emphasise that management currently has a difficulty in that it has to be prudent with resources as demand for the service increases, but it will continue to work to apply available resources to target those with the greatest need most effectively. I do not like to hear that home help hours are being taken away from those who need them. While we most certainly have a difficulty with allocating additional hours as a result of the increase in demand, I do not agree with taking away hours and supports from people who clearly need them and who have been availing of them until now. Without going into the detail now, perhaps we could examine the particular cases raised by the Deputy.

There is no doubt that the resources available for home care are less than we need to meet demand and, for that reason, the programme for Government commits to increasing this year on year. The additional funding this year is €40 million. I hope to increase that further next year.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Gabhaim mo bhuíochas leis an Aire Stáit for what was quite a detailed response. I know she speaks from the heart when she speaks on the issue. She is correct in terms of what she noted in the last 30 seconds of her time on the taking away of hours from people. I spoke of neighbours down the road whose families I know so well and whose hours are being taken away. The multidisciplinary teams make decisions on the number of hours families are entitled to but after four, five or six months, when someone is very ill, there seems to be a higher authority that is deciding to take away three, four or five of the hours.

A few things need to be done. Home care should be a statutory entitlement and not a discretionary one, although I know this all comes down to funding. Second, phase 2 of the carers' strategy needs to be properly funded and resourced and I am sure the Minister of State agrees. The next problem is that HIQA is closing down facilities but not replacing them with other facilities. If a nursing home is closed down in an area and it is not replaced, this will cause problems. Families, as a result, are not able to get respite for their loved ones, which is causing another problem because it is causing an awful lot of stress for family carers. I also wish to mention long-term care for adults with disabilities who have been cared for at home for most of their lives by their loved ones. Parents move on but their one worry is who will look after their child who has a disability. No facilities are available for those families. We must address that issue. Finally, the home care package is offering only 30 minutes to families, which is not sufficient to carry out safe care. The Minister of State knows that it takes a lot longer to do things when dealing with older people and people with disabilities. The amount of time being offered is very limited. I ask the Minister of State to take those points on board.

Helen McEntee (Meath East, Fine Gael)
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I am most certainly taking everything on board. The Deputy will appreciate that, because it is not demand-led, home care is very much confined to the funding available, which is not enough. On the implementation of a statutory scheme, we need to review the management, operation and funding of home care, which is currently under way. During the course of the year, the Health Research Board was asked to conduct research into how home care is rolled out, the model used and its funding in comparable jurisdictions such as Scotland, Germany and Denmark. A pre-review was given to the Department in the past two weeks or so and we hope that it will be finalised by the end of the year. The review will influence where we go with this and we hope to get working on it early next year. The nursing home support scheme took up on seven years to put together. Obviously, we are not looking at such a timeframe, but a much shorter one. However, this is an extremely complex issue and one that we need to get right.

In the meantime, what is most important is that those who need supports and services receive them. The promise is to increase funding year on year. While being prudent with our resources, we need to ensure we are working with people and not taking away supports from those who already have them. We also need to look outside the Department of Health, something the Department is currently doing. For instance, with the national positive ageing strategy we are not just looking at help and home help hours but at supports such as transport supports that we can provide within the community. All these things help people stay within their homes for longer and give them a better quality of life. This way, they may not need additional home help or supports. The next stage of the national positive ageing strategy will begin early in the new year and will involve engagement from across the board, including community organisations, and not just the Departments. I hope to update the Dáil shortly on the matter.