Anne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I would like to share my time with Deputy Fitzmaurice.

Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

I need the agreement of the House for that. There is no objection. Each Deputy has two minutes.

Anne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

My question is about convalescent beds and the policy regarding University Hospital Galway and discharge. Prior to the Easter recess a letter had regrettably been sent out to nursing home providers seeking tenders for convalescent beds. This came as a shock because the letter stated that the beds had to be within a 30 km radius of University Hospital Galway. Galway is broad and diverse and not all of the nursing homes fell inside that particular commuter belt. Fair deal and convalescent care was all about the patient having choice. We have a great selection of both private and public nursing homes right throughout the county, but a good number of them are outside the 30 km belt. They feel disenfranchised by this letter, and that the patient choice was being eroded. The private providers had nursing homes built in the community. They had invested in the community and created jobs, as well as creating a choice for the patient to convalesce with their own families. That is what the families had wanted.

I need to know what the HSE policy is. I know a letter had issued in 2012 on this topic, and the letter that came out in March 2017 was quite a shock to people. They need to know where the HSE is going with this sort of policy. I know it has been withdrawn since, but in actual fact it is a comfort withdrawal. We need to know what the policy is. Are letters like this only issued in Galway or was it right across the country?

Michael Fitzmaurice (Roscommon-Galway, Independent)
Link to this: Individually | In context | Oireachtas source

The facts are that in County Galway and other counties, people who wanted to go to a nursing home close to their family or that their family would be able to visit were not given the option for convalescent beds. None of us are saying that people should be paying two prices in one and one price on the other. If the Department was using a bit of common sense it would say that people could go wherever is nearest to them, providing that they are in line with the other nursing homes in the county. There is a workable solution. It looks very unfair when a tender document says that a nursing home might be 31 km from University Hospital Galway and be excluded because it was not built inside this alleged zone.

The HSE has to think of families or elderly people who might have an elderly partner at home that might not have a way of travelling to these places. County Galway is the second biggest county in Ireland. There are other counties affected, it is not just confined to County Galway. The HSE needs to use some common sense. This is not a money saving exercise. If one is in and around Galway city a nursing home will probably be more expensive than out in the rural parts of County Galway. These people want the opportunity. Some elderly people are very aggrieved about this. Every Deputy gets phone calls, and constituents will say that they are not being allowed to go to a particular nursing home near their family and their families will not be able to visit.

We should have a bit of consideration and a bit of common sense. There are people in the HSE who go off on tangents of their own and decide to do things without telling the Minister, but at times the reigns must be pulled in. We should think of these elderly people who are trying to the best they can. They are not being awkward. What they want is a fair and level playing field, as do the nursing home providers.

Helen McEntee (Meath East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank both Deputies for raising this issue. It is important to say at the outset that the overarching policy of the Government is to support older people to live in dignity and independence in their own homes, and most importantly within their own communities, for as long as possible. This is clearly what older people want and only those in genuine need of residential care should go down that route where it is appropriate. Short-term beds, including convalescent, respite and rehabilitation beds, contribute to the provision of an integrated model of care for older people, enabling them to return home following a period of hospital care or postponing admission to long-stay residential care.

The management of resources and service planning is a matter for the HSE in the first instance. Over the past number of years different arrangements have been in place across the country in relation to the provision of convalescent care. Galway University Hospital has operated its own process in this respect for a number of years. In 2014, as part of the local community support to the Hospital and in consultation with both the HSE’s special delivery unit and national services for older people, designated short-stay services to support acute discharges were developed. Between 2014 and 2015, a total of 25 HSE short stay beds were put in place in addition to the 28 step-down beds that are provided in Clifden District Hospital. However, there remained an insufficient geographical cover, particularly for the population of north and west Galway, and a decision was taken, through the local services, to address this issue. Six private beds were commissioned at a cost of €700 per week. Only two nursing homes were prepared to provide three beds at this rate. In late 2016, the HSE decided to formally tender for these beds. Around the same time, at national level, the HSE was provided with additional funding under the winter initiative for 2016-17 to extend transitional care funding services to all acute hospitals. Some €6 million in additional funding was allocated for that. Transitional care beds support patients who have been deemed fit for discharge but may be awaiting a specific bed in a long-term care facility or some degree of convalescence prior to returning home.

As a result of the extension of this national system which would cater for patients’ needs in the area it was decided not to proceed with the local tender in Galway. Patients who require convalescence or who are awaiting funding under the nursing home support scheme can access the national transitional care fund I mentioned earlier when leaving hospital services. While every effort is made to accommodate the patient's choice they can only be placed where there are vacancies and where the nursing homes can cater for their needs and agree to their admission. The local arrangements in County Galway will expire when all six patients have vacated those beds in question and, as I have outlined, transitional care funding is now available to all acute hospitals nationally on request.

The HSE has no further plans to tender for this service, and instead the policy is to continue to provide beds under the national system that is currently operating. The aim of the Government is for people to stay in their own homes, in their own communities, and to retain their independence for as long as possible. Home care services are critical in this regard, and I remind Deputies that a public consultation will be launching this month concerning the development of the home care scheme, which will provide older people with certainty, but most importantly choice.

Anne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for her response. I take it that from the end of these six beds that there is going to be no tendering process whatsoever for it.

Choice has to be left with the patient. Do they now have to access the funds to get their convalescent care? Has that been tendered by the HSE? Have the HSE hired a new recruitment group for carrying out that tendering process for the beds, or how is that supported? How can patients access those funds?

The whole idea about convalescent care I assume is because they need 24 hour care or assistance and that there are no home care packages available to step patients down and so they have to use home care facilities. If one was to look at 168 hours required for 24-7 convalescent care in nursing homes it works out as €3.25 per hour for the Government, as opposed to €18 to €25 it would cost in a home care package.

Michael Fitzmaurice (Roscommon-Galway, Independent)
Link to this: Individually | In context | Oireachtas source

The Minister of State said that the HSE has its own autonomy in doing this.

Can the Minister of State clarify whether we have passed the stage when a Minister can say, "This is what we need to do and this is the way we are going to do it"? Many Ministers would not do some of the things we have seen done so is there a cohort in the HSE who go off on tangents of their own, only for it to come back to the Minister when it backfires? As Deputies, we also get it day in, day out. Who makes the calls on these things? Is it someone in an office who decides, while the Minister is left carrying the baby?

Helen McEntee (Meath East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

The needs of patients in Galway will continue to be catered for. At the time there was a gap and local services figured out a way to fill it, whether it was the right way or not. In the current system, one can apply and, if it is approved, funding will be received from a national pot. The problem with the previous tendering process was that there were two nursing homes and other homes were excluded, which was not a fair system. It is now much fairer and people can apply for the nursing home closest to them and which suits their needs and if there is availability, the funding is available to everybody. Galway is one of the biggest users of transitional care in the country and is very well catered for. The decision has been taken to provide a national system and a pot of funding for which people can apply. Services have used their initiative and thought outside the box and nobody would disagree that they should do that but we now need to implement things in a much fairer way. It will take time and things are not perfect but, as time progresses, a much fairer system will be in place.