Bríd Smith (Dublin South Central, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

7. To ask the Minister for Health his plans to expand the provision of home care services that are provided directly by State bodies; if future funding will continue to be disproportionately directed to private home care providers; and if he will make a statement on the matter. [40921/17]

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for her question. Home care services are provided on the basis of assessed health care need and there is currently no means testing. The HSE-funded home help service is delivered predominantly by HSE staff or, in a minority of cases, private and not-for-profit providers. Home care provided as part of the home care package scheme is delivered by HSE home help staff or by arrangements with not-for-profit and private providers who have been selected through a tender process as approved providers.

I assure the Deputy that the Government is committed to promoting care in the community for older people so that they can continue to live in their own homes for as long as possible. We propose to establish a statutory home care scheme along with a system of regulation for home care services. On 6 July, the Minister and I announced the opening of a public consultation in this regard. I urge all of those with an interest in home care services to make a submission to the consultation.

The consultation is an important step in informing the development of a statutory scheme for home care, which will introduce clear rules on what services individuals are eligible for and how decisions are made on allocating services. The new scheme will ensure that home care services operate in a consistent and fair manner for those who need them and help to improve access in an affordable and sustainable way. It is also envisaged that a common system of regulation will be introduced for all providers, be they public, not-for-profit or private.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for outlining the situation and informing us of the consultation process, but his response did not answer my question on the Government's plans to expand the scheme via public operators as opposed to the private sector. Everyone has had experience at some level, be it through family or friends, of someone who has had a stroke or suffered from dementia going into hospital only to return home with all of the problems that go with that. It is difficult to obtain the support and home help hours that are required.

Back when people in my community were much younger, many of my neighbours got extra hours of work providing home help. They got a few bob from the health board to help someone have a shower, clean up, get the pension, buy food, etc. This and the previous Government have cut 1.5 million hours from that system and driven everything towards the private operators. That is why, when I turn on the radio, I hear ads about how wonderful Home Instead Senior Care is; it is all being privatised.

The proliferation of advertisements relating to the treatment of our old people and those suffering from strokes and dementia is shocking. It is something we pay for through the public purse. We would not do it to cancer patients. There are advertisements for VHI and BUPA but we do not have advertisements on television telling people to come to us if they suffer from cancer and that we care about the victims of that disease. The State is giving up on the people who need to be kept at home. Their distress is palpable because they are either being left waiting in hospital for home care or are at home not getting adequate care.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I will be very brief. The Deputy has raised a number of issues. We all acknowledge that there is unmet demand in the home care system. There are 10.5 million home help hours in the system this year. We are spending €373 million on it. We would love to double it in the morning if that was possible. However, it cannot be done overnight. There is a commitment in the programme for Government to try to increase that budget. I cannot announce the budget here; I am not in a position to do so.

The argument about private versus public is a slightly different issue introduced by the Deputy. Health care has been provided on a public and private basis in all areas, whether it is in acute care or nursing home care where about 80% of our people are being cared for in private nursing homes. There is no intent on the part of the Department or the Government to privatise home care and the provision of home help hours. In the vast majority of cases, such care is provided by HSE staff. Where possible, it is always done by the HSE. Where we have a shortfall and have to rely on private interests rather than let people go without, we will use the private services. We do not look down our nose at any particular service or consider one to be better than the other. We want to have a statutory regulatory scheme. The consultation is out at the moment to ensure that both public and private services are regulated in full.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

I will submit a series of questions to the Minister of State to check his facts to the effect that, in the majority of cases, the service is provided publicly by HSE staff. I dispute that contention and would like to see the figures that support it. Our experience is that more and more people are being treated as though there was an inheritance tax on their health when they get old because they have to seek private care providers to look after them and to come in and fill in the hours that are not available from the home help service. Some of my neighbours who deliver home help are told to go in and - in 15 minutes - clean up, get the messages, wash a person, get him or her out of bed, provide breakfast and then get out again. We cannot treat human beings in that way. Pressure is increasing for those who need care to go to the private operators. They are advertising enthusiastically and non-stop in respect of their services because the public service is letting people down. I am not eulogising the previous home help service but, by and large, it was far superior to what is available to people now. At least it was available to them and they did not have to root into their pensions, etc., and suffer a selective inheritance tax on their health.

Pat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

In accordance with Standing Orders, I call Deputy Louise O'Reilly.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The average cost per hour of a home help is €23.20 according to the Department of Public Expenditure and Reform. In the not-for-profit and directly-employed home care arena, we would get that hour for approximately €17 so what is pushing up the price is the private home care providers. Deputy Bríd Smith is right: people in global multinational corporations can afford to pay for prime-time advertising space on radio and television because they are getting money from the State and making a massive profit. Prior to being elected, I represented home helps. We concluded a deal on their hours in order to put a bit of a floor on it and ensure that they had some continuity. This is not being utilised to the greatest possible extent. There are home helps directly employed and working for the not-for-profit organisations who cannot access additional hours. We could remove the barrier on those organisations providing extra hours where clients might have a few bob to supplement it themselves. The Government put a stop to that and I would like to see it come back and for more emphasis to be put on directly employed and not-for-profit home care. I will put it to the Minister of State in terms he might understand - it is the best value for money for the public purse.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

There are two separate issues. If I am correct, what Deputy Bríd Smith is referring to is the need for people to engage with private providers as opposed to the HSE using private companies.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

No, I asked the Minister of State his plans to expand the provision of home care services directly from the State, not from the private operators.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

To answer the Deputy's question, 63% of the hours are provided directly by the HSE and the remainder are provided between not-for-profit organisations and private providers.

Yesterday, the Minister discussed the issue Deputy O'Reilly raised. It was raised at the Joint Committee on Health and the Minister has undertaken to go back to his officials and examine the position regarding the provision of private home care hours and the value for money attached to it.