Dáil debates

Wednesday, 21 June 2017

Other Questions

Home Help Service Provision

5:30 pm

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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51. To ask the Minister for Health the reason behind the 19% reduction in the number of home help hours in Dublin West in the period January to April 2017 relative to the same period in 2016. [29085/17]

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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What is the reason behind the 19% reduction in the number of home help hours in Dublin West in the period between January and April 2017 relative to the same period in 2016? The Minister referred to trends, demographics and ad hocplanning. In the past 12 months the increase in the number last year has been reversed. There has been a significant decrease this year. That contradicts Government policy which is that the threshold should remain the same or increase. It deserves an explanation.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I thank the Deputy for raising this important matter. Home supports provision is a key mechanism in enabling older people to remain in their own homes and communities for as long as possible and facilitating their discharge from acute hospitals. The HSE's national service plan for 2016 originally provided for a target of 10.4 million home help hours and 15,450 home care packages. However, the numbers of patients who had completed their acute treatment but required home care in order to be discharged were very high in the early part of the year. Without additional funding, this rate of hospital discharges could not have been sustained and the allocations for the rest of the year would have had to be reduced. The Government responded to this challenge by providing an additional €40 million for home care services in 2016. Further resources were provided through the winter initiative, in particular, additional home care packages and an increase in the number of approvals for transitional care beds.

This year's national service plan provides for a target of 10.57 million home help hours, 16,750home care packagesand190intensive home care packages for clients with complex needs. While the January to April data for home help hours are lower than for the corresponding period in 2016, of more significance is that the HSE target for this year is to provide approximately 200,000 home help hours in Dublin West, an increase of 20% on the number of hours delivered in 2016. A total of 509 people were in receipt of home care packages in Dublin West in April 2017, an increase of 8% on the expected target of 470. This represents an increase of 19% on the number in receipt of a package at the end of 2016.

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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I wish the Minister of State well in his role. He has a challenging few months ahead, given the ageing demographic. It is fundamental that we move away from the national picture he has outlined. Despite the changing statistics in Dublin West to which he referred, we know from the raw figures that there has been a 20% reduction in provision year-on-year. That is despite the ageing demographic and all of the challenges mentioned by previous speakers. The core issue concerns HSE management. Area managers are incentivised to balance their budgets and not to increase the provision of home care packages. There is a rigid threshold which is not about service delivery but about meeting budgetary targets. From a health service perspective, we need to move the management incentive away from an inhumane, rigid ceiling for different aspects of community-based health care and deliver for the individual. That should be the reward for the manager. Various area managers in Dublin West have been promoted on the back of cuts in the numbers of home care packages and community services, which have resulted in people being put into hospitals and nursing homes, resulting in a greater cost to the State. They have been rewarded for this flaw in the Government's health policy.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I appreciate the Deputy's comments. There is no point in us arguing over and back about the statistics. As the Minister alluded to previously, the number of hours has increased year-on-year, but there is also increased demand, which has resulted in a reduction in the number of available hours. There are too many disparities geographically, with greater availability in some places. We have to get to grips with this. I would like the service to be put on a statutory footing similar to the fair deal scheme. We spend €373 million on home help provision, which is a large budget. We can continue to increase it, but we need to put the service on a statutory footing with a level playing field. I agree with the Deputy that we need to make sure everybody can access the service because it represents better value for money and, more importantly, a better quality of life for elderly people who wish to remain in their own homes.

Photo of Jack ChambersJack Chambers (Dublin West, Fianna Fail)
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I agree that it is important that we keep people in their own homes and maintain a community-based focus in health care, but we need to be careful about a statutory package. We saw what happened with the Tory policy in the United Kingdom on a dementia tax. It is fundamental that the Minister of State avoid imposing another tax obligation or levy on people's homes through a statutory scheme. That would scare the living daylights out of people who want to stay in their own homes. We will have to see what the Minister of State proposes in his scheme. Caring for people in their own homes and ensuring they took their prescriptions delivered through the primary care or hospital system would save the State money. The State should fund such a service and not impose a levy on the family home or the individual. It should be willing to care for them in their own homes because that will keep them out of the hospital system or nursing homes, which are costly alternatives. It is important that we incentivise the scheme by making it free for people and not examine it on a cost basis.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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We are saying the same thing. There is no argument from us. The Deputy's party colleague, Deputy Willie O'Dea, proposed a similar statute to the one we are discussing.

We all want to get there. Obviously, there is a cost and we have to deal with the reality that if we go with a demand-led scheme, we cannot have a limitless budget because the budget has to be allocated year-on-year with a certain amount of money. It is a difficult challenge for us to get it right but I think we all want the same thing. I thank the Deputy for his interest.