Thomas Pringle (Donegal, Independent)
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31. To ask the Minister for Health his plans to introduce a home care scheme along the lines of the nursing home support scheme; when the consultation will start; when he expects to have a scheme in place; and if he will make a statement on the matter. [4859/17]

Thomas Pringle (Donegal, Independent)
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This question relates to the recent announcement that the Minister intends to start a public consultation on the development of a home care scheme along the lines of the nursing home support scheme. I would like to hear further views on it.

Helen McEntee (Meath East, Fine Gael)
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It is Government policy that long-term nursing home care should be a last resort and we want to develop home care services to provide a more viable alternative to nursing home care for a greater number of people. Traditionally, home care was viewed as providing a lower level of support than residential care and not as an alternative to it. Increasingly, however, it is considered possible to support many people to continue to live at home who would previously have gone into residential care. That is clear when we consider the length of stay of people in nursing homes, which has changed from around six or seven to two years. People are entering nursing homes much later in life, possibly with more complex needs. This requires an increase in the amount and intensity of home care, and more effective integration with other supports including nursing, therapies and other primary care services.

Arrangements for home care have developed over the years with a significant local focus and, unfortunately, there is considerable variation in access to services in different parts of the country. The services people in Meath receive may be different to those living in Donegal. The HSE is incrementally developing a more consistent and coherent system of service provision. The service plan for this year sets a target of 10.57 million home help hours to support 49,000 people, including 16,750 home care packages and 190 intensive home care packages.

It is my view and that of the Government that we need a stand-alone funding scheme designed for home care that recognises its particular characteristics together with regulation of home care services.

A significant amount of detailed preparation needs to be done, and is currently under way, before final decisions are taken on the form of a home care scheme and the regulation of these services.

Last year, the Department commissioned the Health Research Board to carry out an evidence review of international approaches to the regulation and financing of home care services. The four countries examined were The Netherlands, Scotland, Germany and Sweden. The reason they were chosen was because of the type of framework they have and what it is that we are looking to apply here. The report is going through its final stages of being peer reviewed and will be published shortly. The Department is also undertaking a mapping exercise of current service provision nationally. This will take into account the scale and diversity of services funded by the HSE. This work will be used to identify major policy options for a new statutory home care scheme around the areas of regulation, financing, assessment and eligibility.

Once this is completed, a public consultation will be launched to allow stakeholders, including older people themselves, their families and healthcare workers, to express their views regarding a new home care scheme. It is my hope and intention that the consultation will be launched in May of this year.

Thomas Pringle (Donegal, Independent)
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I thank the Minister of State for her response. I wonder about her figures on the length of stay of those in nursing homes. ALONE's figures are that 35.4% of those in long-stay beds have low to medium care requirements, which is a huge proportion of those in nursing homes. This is a huge cost to the State. They could be cared for at home and, in many cases, would wish to be cared for at home. It seems that there has been a huge growth since 2004 in the number of low dependency residents in nursing homes. This is bad public policy and bad for the residents themselves.

It is vitally important that home care would be supported more fully. As the Minister of State stated, more than 4%, or nearly twice the national average, of people in my county of Donegal are cared for at home. Families need the additional support to ensure they can do this. It is also far more cost effective than the nursing home support scheme. It is therefore vitally important that we would have this scheme.

I welcome the fact that the consultation will start in May but I press on the Minister of State that it should not be a consultation to replace what is already in place in terms of home help hours and home care packages.

Helen McEntee (Meath East, Fine Gael)
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As we develop a new scheme, it is important to continue to invest and see our funding increase and the Government has committed to continue its investment. This year, we will see €30 million of the €40 million announced for the winter initiative go into our home care packages, with an additional €10 million on top of that. The nursing home support scheme, which took seven years to devise and has a budget of more than €930 million, is a scheme for residential care. We need to ensure that those who are entering the nursing home support scheme cannot be cared for or provided with that support at home. The difficulty we face is that the demand far outweighs our ability to provide the support at home. There is an urgency to it, but it is important that we do this right. Some 70% of home care is currently provided through an informal arrangement, with private providers and family members, which is why the public consultation is so important. The other 30% is provided through the HSE.

Thomas Pringle (Donegal, Independent)
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The reason the nursing home support scheme is oversubscribed is probably the lack of availability of home care packages. It is a little haphazard. Currently families struggle to get increased levels of support that would enable them to keep their elderly at home. Many would take that decision. I do not think that County Donegal, with 4% of its elderly people being cared for at home, is that unusual. If the supports were available, we would see far higher levels of home care throughout the country. I welcome the fact that the Minister of State is starting the consultation. I hope that it will not take seven years to develop the scheme and that the scheme that is developed will facilitate families and the elderly and not simply push them into the hands of private operators.

Helen McEntee (Meath East, Fine Gael)
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As Minister of State with responsibility for older people, I stress that my priority and the priority of the Government is to ensure that older people can remain with the people that they love and in their homes and communities for as long as possible. The difficulty we currently face is that there is no statutory scheme. There is no framework for the provision of home help. While it has been developed over the years, it is very much on a county-by-county basis. It is therefore important that we provide a framework and ensure that it is sustainable, equitable and regulated in an appropriate manner. This will take time but I am also conscious that it cannot go on for seven years. We certainly will not allow that to happen.