Dáil debates

Wednesday, 12 July 2017

Topical Issue Debate

Home Care Packages Provision

4:10 pm

Photo of Frank O'RourkeFrank O'Rourke (Kildare North, Fianna Fail)
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I welcome the opportunity to discuss home care packages, home help hours and dementia care at home with the Minister. The purpose of these supports is to maintain someone in the surroundings they are most comfortable in at a particular age in life when they might be suffering from a particular illness or sickness. It exists in order that such people can be comfortable, happy and content in the surroundings they are most familiar with. When home care packages work well and the scheme is in place, we can see the positives and the advantages they bring, but there are problems. We need to identify those problems and we need to deal with them comprehensively. Otherwise the home care packages will not meet the necessary requirements of the end user. Ultimately that can have a detrimental effect on everyone involved.

There is a problem with the application and assessment process at the moment and I am going to highlight certain examples. When the assessment is being carried out by the home care package team, my understanding is that the level of dialogue with all the stakeholders is not taking place to the extent that it should. One of my constituents is holding up a bed in a hospital because different experts and medical professionals have recommended that that person needs 21 hours of home care support to help support the family and friends in the home. Currently, only 13 hours are allocated. There is a lack of connection and dialogue between the relevant stakeholders to put the appropriate home care package in place for that person. That is not a recommendation from me or from the family. The people who are qualified to do this should be engaging with each other in order that the best package available is put in place to help that person in their home environment. That person is in hospital holding up a hospital bed which others cannot access, and in the meantime the person cannot be at home in the environment in which they are most comfortable. That is a problem, a disconnect, and something that needs to be addressed and dealt with during the application and assessment process. This is causing a problem.

There is another problem with the delivery of service by service providers, where some are to provide the service to provide to the end user but it is not being provided. I met the HSE recently about another case. Seven showers per week were allocated to a particular person. Everyone thought it was happening. Three months later the family contacted me to ask why it was not happening, and it was during that meeting I found out that while the showers had been allocated, the family did not know it had been put in place and the end user was not getting the service. That is another issue of communication and disconnect and a lack of follow through. The real loser here is the end user. There is no follow-up with the service provider to see if it is carrying out the work. There should be follow-up with the HSE when the service is allocated to check in with the end user and make sure that the service is in place, if the person is happy with it and if the service provider is carrying out the service to the highest standards.

In another case involving a change in service provider, a lady who is severely disabled has not had a shower in eight weeks. She has had a bed bath, but has not had a shower in eight weeks. One service provider reckoned the environment was okay to carry out the work and another service provider said that it was not okay. The user is caught in the middle. There is a serious problem of disconnect, and a lack of engagement and consultation. The problem is that the end user is suffering, and that is the issue that needs to be addressed and discussed in this debate.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I thank the Deputy for raising this issue. The overarching policy of the Government is to support older people to live in dignity and independence in their homes and communities for as long as possible. Home care is an increasingly important part of the supports for enabling older people to remain in their homes and communities for as long as possible and for facilitating their discharge from acute hospitals. The HSE has operational responsibility for planning, managing and delivering home and other community-based services for older people. Services are provided on the basis of assessed health care need and there is no means testing. The HSE, working within its available resources, has sought to maintain and, where possible, expand the range and volume of services available to support people to remain in their own homes, to prevent early admission to long-term residential care and to support people to return home following an acute hospital admission. The demand for the home help service and for additional supports through the home care package scheme continues to grow in parallel with the increasing numbers of older people. Many more of our older people with complex care needs are now being maintained at home, leading to increased demand for additional levels of service and for services outside of core hours of Monday to Friday.

The overall funding for services for older people in 2017 is €765 million. This includes about €373 million for the direct provision of home care. The HSE’s national service plan provides for a target of 10.57 million home help hours, 16,750 home care packages and 190 intensive home care packages for clients with highly complex needs. The HSE has progressed a range of measures to improve home care provision overall, to standardise services nationally and to promote quality and safety. National guidelines setting out standard procedures for providers of home supports were introduced in 2011. A procurement framework for home care services came into effect in 2012. This requires service providers to meet defined minimum standards applied to services procured by the HSE. The tender arrangements are reviewed regularly and the current arrangements which commenced on 1 September 2016 will run for a period of two years. The Deputy will be aware that arrangements for home care have developed over the years with a significant local focus, and there is considerable variation in access to services in different parts of the country. There is a need for a uniform approach to assessment of need, and the HSE is in the process of introducing a single assessment tool across home care. The single assessment tool is a comprehensive IT-based assessment used to ensure that every person being assessed for support services has access to a standard and thorough assessment, regardless of where they live or who is doing the assessment.

Home care is monitored on an ongoing basis, to ensure that activity is maximised relative to individual clients’ assessed care needs and within the overall available resources for home care and having regard to demand throughout the year. Arrangements for home care have developed over the years with a significant local focus, and there is considerable variation in access to services in different parts of the country.

The programme for partnership Government includes commitments to increase funding for home support services, to improve these supports, to introduce a uniform home care service in order that all recipients can receive a quality support, seven days per week where possible, and to review the management, operation and funding of national home help services.

I assure the House that the Government is committed to promoting care in the community for older people in order that they can continue to live in their homes for as long as possible. On 6 July, the Minister for Health, Deputy Harris, and I announced the opening of a public consultation on home care services. The purpose of this is to allow all those who have views on this topic to have their say, including older people themselves, their families, and health care workers. The Department wants to find out what people think about current home care services and would also like to hear the public’s views on what the future scheme should look like. I strongly urge all those with an interest in home care services to make a submission to the consultation.

I would appreciate it if Deputy O'Rourke would clarify one point. When he talks about the services that have been allocated and not delivered, is he talking about private home care services or is it the HSE which is in charge? I am concerned about that.

Photo of Frank O'RourkeFrank O'Rourke (Kildare North, Fianna Fail)
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I do not doubt the Minister of State's commitment. I want to highlight the issues to get better delivery. The issues I am speaking about involve both the HSE and private companies. The HSE is ultimately responsible. I am concerned that there is no follow through to ensure there is a delivery of service. That is the problem. We cannot have accountability without that follow through. If people are aware that they are accountable for having a service delivered and checks and balances are carried out to ensure the end user is getting the service that was awarded, it is only then we can ensure an improvement. The only person who is important and relevant here is the end user. We will not have an improvement if people believe there is no consequence for inaction and that the issue can simply be fudged. That is the problem. All the cases I highlighted to the Minister of State are individual cases where there are problems with the delivery of service, including with the assessment and with appropriate home care packages being put in place, agreement among the clinical and medical people, and the delivery of that service. In the programme for Government it was identified that this is an area the Minister of State wants to improve

Despite the additional funding in several cases it has not improved over the past six to 12 months.

The Minister of State might need to consider the direct funding model if there is a problem in delivering the service and the family or end user is suffering. They may need direct funding to put the service in place that best suits the needs of their loved one, their time and flexibility. That works well in other places. The end user needs to be listened to because it is not a case of one size fits all.

4:20 pm

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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The Deputy's points are very interesting. His latter point is a kind of money follows the user approach so that the user can employ his or her home care with the same budget.

I encourage the Deputy to encourage his constituents to avail of the public consultation because this is the first time the Department has assessed what is happening nationally. While the objective is to bring about a better universal scheme that is accessible to all with equity and fairness at its heart it also gives us the chance to examine the existing scheme. There is no consistent national regulation of the current scheme. It would be deeply troubling if resources are being allocated and paid for but not delivered. That is a management issue that I need to take up with the Health Service Executive, HSE, to ensure that people are getting at the very least the limited resources allocated to them. People are not satisfied with the resources being allocated but they should at least get full value for what has been allocated to them. If the Deputy has details of any particular case I would be very interested in following it up to see whether it is private home care or HSE care and what we can learn from that.

The Deputy mentioned dementia. I met with the Oireachtas Joint Committee on Health this morning which is working actively in this area and that ties in with supporting people with dementia in the home and having a dementia liaison person to assist them. There is a lot to be done in this area and I am confident we can make progress working together.

I intend to lead that from the front for as long as I am in this office to get a scheme up and down the country. It could take up to two years to get the kind of scheme I want to see which gives everybody access to the home help they need but that is not a reason for us to take our eye off the ball in the intervening two years to ensure we do have full accountability for the existing service. While it may not be perfect we have to ensure it is the best it can be.