Fiona O'Loughlin (Kildare South, Fianna Fail)
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I assume the Minister of State, Deputy Finian McGrath, is taking this as, unfortunately, the Minister for Health is not here. I wish to raise the horrific situation in which so many patients and families in community healthcare organisation, CHO 7, an area that includes my county of Kildare and parts of west Wicklow, and CHO 8, which includes Laois, find themselves. Figures recently supplied to me show that some 6,458 older people are waiting for home care packages. According to the latest response I received to a parliamentary question, there are 724 people waiting on them in CHO 7 but when I rang the services, I was told that the same number of people were waiting for them last year so this is an ongoing issue. It is shocking. These figures are unacceptable.

There are many challenges in the health system, not all of which are about funding but come down to management and mismanagement. However, this is clearly an issue of funding. One family I have been helping applied for funding for the mother, who is 90 years of age, and was told funding would be provided after two weeks. The family was just about able to bear the financial brunt for two weeks but after those two weeks, it was told that no funding was available. Another family I know has been waiting for a home care package to bring their mother from Naas Hospital. In the meantime, she is taking up a bed that is needed for other people. I spoke to a nurse in the area today who told me about an 85 year old woman who broke her ankle three weeks ago and was allowed out of hospital last week. No care package could be provided. The woman was unable to shower, lives on her own and has been waiting two and a half weeks. It is a disgrace. We need to do far better. I will have more to say in my supplementary.

Martin Heydon (Kildare South, Fine Gael)
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I wish to raise the issue of home care packages and home support services and the significant waiting lists in the Kildare-west Wicklow-south Dublin area. As the Minister of State is aware, it is called CHO 7. I have been dealing with a number of constituents who include stroke victims, cancer sufferers, people suffering from early onset dementia, older people who need additional support and a person recovering from the removal of their colon. I have been dealing with these cases all summer. Many of these people are in Naas Hospital, other hospitals or the community awaiting these additional supports. They are taking up hospital beds they do not need. There are people on trolleys in Naas Hospital who could be in those hospital beds. The people in those beds who have these issues have applied for home care packages. The waiting list is there because the budget seems to have been eroded earlier in the year. It makes no sense. Those people want to be at home, as would we if we were sick and could be cared for at home.

Some very basic questions need to be asked. First, we must reach a situation where the very significant waiting lists in the Kildare-west Wicklow-Laois area are reduced and dealt with as soon as possible. These are real human stories that are very harrowing to deal with. However, it is also not even smart. Even if it is an accounting exercise on the part of somebody in the HSE or the Department, it is not a good use of resources. We need to support people so that they can be minded at home to free up those hospital beds for people on trolleys who need them because those beds are very expensive for people who are in them, never mind the fact that they do not need or want to be there. If we compare the Kildare area of CHO 7 with CHO 4, which covers Kerry and Cork, we can see they have similar populations of over 650,000 if we include south Dublin in our area yet CHO 4's waiting list in June 2018 was less than a quarter of that of CHO 7. Did they have the same budget to start with, were they managed differently and how has this been allowed to happen? We cannot allow this to happen in the future.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputies for raising this very important issue. I know they have a particular interest in developing services in CHO 7. The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Home care is an important part of the supports for enabling older people to remain in their own homes and communities for as long as possible and for facilitating their discharge from acute hospitals.

Since being appointed as Minister of State with responsibility for older people, Deputy Jim Daly has made improved access to home support services a key priority. Progress in this area is reflected in the additional funding made available for the winter of 2017 and 2018, the increased funding and level of activity for 2018 and the work being progressed on the development of a statutory home care scheme.

Home support services were a particular focus in budget 2018 with an additional €18.25 million allocated. 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 healthcare need. The HSE 2018 national service plan provides for over 17 million home support hours to be delivered to 50,500 people at any time. Intensive home care packages for people with more complex needs are being provided to approximately 235 people at any time delivering approximately 360,000 hours in the full year. A further 156,000 hours relating to adverse weather funding earlier this year will also be provided.

This year's home support budget for CHO 7 is about €47 million with an additional adjustment in spring of €1.4 million in view of sustained pressures in the community and to address delayed discharges in hospitals. At the end of June 2018, there were 6,683 people in receipt of home support services in the CHO 7 area.

Working within its available resources, the HSE has sought to maintain and, where possible, to 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. Despite this significant level of service provision, the demand for home support continues to grow. It is important to note that the allocation of funding for home supports across the system, though significant, is finite and services must, therefore, be delivered within the funding available. In that context, it is acknowledged that in some cases, access to the service may take longer than we would like.

However, the Minister of State, Deputy Jim Daly, is satisfied that the HSE monitors the delivery of home care on an ongoing basis to ensure that activity is maximised relative to the individual clients’ assessed care needs within the overall available resources for home support and having regard to demand throughout the year.

As part of the Estimates process, the Department is actively engaging with the Department of Public Expenditure and Reform regarding funding for services for older people in 2019, including home support services. I have listened very carefully to the issues raised by Deputy O'Loughlin in regard to the 90 year old mother who is waiting and the person who is in Naas hospital due to the discharge issue. Deputy Heydon mentioned stroke victims and also the issue of hospital beds and home care packages. Of course, these are priority issues. I will bring the points raised in the debate to the attention of the Minister.

Fiona O'Loughlin (Kildare South, Fianna Fail)
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To be honest, that answer is not worth the paper it is written on. There is nothing there that could in any way satisfy the 796 people who are on the waiting list. I outlined these specific cases. How many more cases are there across the country where people are taking up hospital beds when they just need to have a home care package in place? More funding has to be allocated for 2019 if the Government wants to see any reduction in the number of people waiting in hospitals for a home care package.

We are currently in a trolley crisis. August was the worst month on record and I heard this morning that 33 people are on trolleys in Naas hospital. Families cannot afford to put supports in place but they hate to see their relatives unable to come home due to the lack of supports. This is putting them in penury. Something has to be done to resolve the issue. Home care is a far better system for the patient and for the taxpayer when one considers the cost of keeping people in hospital. The Minister of State has to give solid answers and a solid vision for improving the current system. It is simply not good enough.

Martin Heydon (Kildare South, Fine Gael)
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I thank the Minister of State for his response but questions have to be asked. Was the initial budget for the home care package for the greater Kildare area sufficient to start with? Why is there such a disparity between our area and other areas of similar population, given waiting lists are greater in our area? I accept additional funding was given in the spring of this year as a result of Storm Emma, which affected many parts of the country, although Kildare appears to have been disproportionately affected. However, that additional money did not provide any extra home care packages for the Naas hospital area because it all went to Tallaght and St. James's hospitals. I suspect that not much money went into the community either.

That is a challenge for us and we have to learn from it. I acknowledge the role management play in Naas General Hospital, although I suspect managers were nearly punished in the spring for not having many delayed discharges and for managing as well as they possibly could. I deal with some great people who are managers in the HSE and the Department of Health. While that is great on an individual basis, the system has to be looked at and we have to learn from this situation. First, we have to ensure money goes in and that we clear the backlog of the very significant number of Kildare people who do not have access to home care packages but who need them. Then, we need to understand why this happened and ensure it does not happen again. I will keep asking these questions until I get answers because this is too serious and there are too many people affected by it.

Finian McGrath (Dublin Bay North, Independent)
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Arrangements for home care have developed over the years with a significant local focus and there is considerable variation in accessing services in different parts of the country. It is accepted there is considerable demand for home support services over and above the existing service levels, so the Deputies have hit the nail on the head with their main points.

A Programme for a Partnership Government includes a commitment to increase funding for home support services and, as I mentioned, the Department is actively engaging with the Department of Public Expenditure and Reform in regard to funding of older people's services in 2019, including home support services. The Department is actively engaging on this issue and we are listening to the concerns. My Department is currently engaged in a detailed process to determine what type of home care support scheme is best for Ireland. I am happy to say we reached an important milestone in the development of a new support scheme in June, when we published the report of the findings of the public consultation on home care. The consultation process took place last year and approximately 2,600 submissions were received. The report includes a number of interesting points made by respondents in regard to innovative new models and it is available on the Department's website. The findings will now be used to help to inform the design of the new home care scheme.

In the meantime, the Department and the HSE are continuing to improve the existing services, including in 2018 through the introduction of a single funding stream for home support services. This new approach is providing significant benefits, including making services easy to understand, streamlining the application and decision making processes and facilitating service users to move to changed levels of service as their needs change, without the need for an additional application process.

However, there is also another reality, which is that there has been a 12% growth in the overall population, a 59% growth in the population aged over 65 and a 95% growth in the population aged over 85. A classic example of what we are trying to do is that the HSE has undertaken a new tender for home care, which is expected to run from 1 September 2018 until December 2020. A list of 48 approved providers is available for the provision of home care support services across the nine CHO areas.