Dáil debates

Tuesday, 26 March 2019

Saincheisteanna Tráthúla - Topical Issue Debate

Home Care Packages Provision

6:55 pm

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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There is a serious crisis in the area in which I live for people suffering disability who are trying to live at home and maintain a living standard in their own home with due and proper care. There are nine community healthcare organisation, CHO, areas in the country. I live in County Louth and represent part of County Meath. My community healthcare organisation area also includes part of the midlands. I had a constituent who, because of their disability, was entitled to 56 hours home support per week. For days, they would lie bedridden with nobody to care for them or go in and out. The other family member was away working during these hours. The answer we were given as to why there was nobody to do the work, even though 56 hours had been granted, was that the only hours which could be allocated are recouped from existing service users and recycled. In other words, somebody would have to die before that person could get the hours they needed. It is not the only such case in this area. At least three other cases have been brought to my attention where a person needed a significant number of home support hours and could not get them until another party died. That is absolutely unacceptable, particularly in these days when, as the Minister of State knows and which I welcome, more money than ever is available to allow people to have home help.

I refer the Minister of State to the spending review of 2018 entitled, Trends in public Social Care Service Provision and Expenditure for Older Persons. Figure 9 on page 17 of that report is exceptionally clear. It shows that of the nine community health areas, CHO 8, which covers Louth, Meath and the midlands, has a ratio of home care expenditure and percentage of population aged over 75 that is 30% less than is expected. There is a significant underspend in Louth, Meath and the midlands in respect of home care. These are figures produced by the Department of Public Expenditure and Reform based on census data from the year 2016. It is absolutely unacceptable. I acknowledge and support the Government policy of a statutory right to home care packages. I support people's right to have care in their homes, the right not to be forced into nursing homes against their will and the right to independent living as best they can. However, it is not happening in my constituency.

I would also bring another case to the Minister of State's attention. I refer to a child of six who has a rare syndrome, Pallister-Killian syndrome. After they passed the age of five, 18 months ago, they passed from the care of the Jack and Jill Children's Foundation into State services. For 18 months they have been granted home care hours but there is nobody to provide that service whom the HSE will pay. This person lives in the County Meath part of my constituency and the services providers there cannot provide a qualified person. There is somebody who is qualified for the Jack and Jill services, who can provide the services professionally but the HSE will not pay them. That is a shame and a disgrace. The family is in deep distress. They have asked me to bring the matter to the Minister of State for reply this evening.

7:00 pm

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for raising this important issue and giving me the opportunity to outline the position on the provision of home care packages for people with disabilities. I can assure him of the Government’s commitment to providing services and supports for people with disabilities, which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. The commitment is outlined in A Programme for a Partnership Government and guided by the principles of equality of opportunity and improving the quality of life for people with disabilities. This year €1.9 billion has been allocated for the HSE’s disability service programme, which represents an increase of 7.5% on the allocation for last year. It will fund the provision of a wide and complex range of services and supports for people with disabilities, including the provision of home support packages. HSE disability services constantly review all allocated hours to ensure a fair and equitable distribution of resources in an effort to meet emerging needs. The review of the current allocation is ongoing and every effort is being made to meet demand within the current available resources.

The HSE is also working to improving quality of life for people with disabilities through the provision of home support hours. In its national service plan for 2018 the executive’s priority was to provide 2.93 million home support hours for over 7,400 people with a disability. The actual number of home support hours provided in 2018 was higher; over 3 million hours were provided for over 8,000 people with a disability. This reflects the responsive nature of the service and takes account of the fluctuation in assessed need over time, as the needs of individual people change. This year the HSE is committed to maximising the provision of health and social care services, including home support services, within available resources. In its national service plan for 2019 the HSE expects to deliver over 3.08 million home support hours to over 8,000 people with a disability. This represents an increase of 150,000 hours on the last year’s target.

We are committed to providing services and supports for people with disabilities which will empower them to live independent lives. The goal is to help as many people as we can. This is a positive development, on which we can build in years to come.

On the individual matter raised by the Deputy, I am sure he will understand my reluctance to speak in any great detail in the House about the specifics of any one case, given the personal nature and circumstances of the matter. However, I am aware that a multi-disciplinary team meeting was held on 11 March to discuss the current waiting list in the County Meath disability service, with a view to the prioritisation and allocation of resource hours which became available this week. Subsequently, the individual concerned was allocated 42 hours a week. She will remain on the waiting list to be allocated the additional 14 hours. The Deputy can be assured that I will take a special interest in the case.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I thank the Minister of State for his reply, but I regret that I do not accept the principle he is enunciating. He is saying more and more money is being spent, but that is not the case in the CHO 8 area. Funding only became available when people died; I have received a letter from the HSE to that effect. They have been called "recycled hours", meaning that they have been reallocated on someone's death. While I agree and acknowledge that more money is being spent than ever before, it is not being spent in this area and I want the Minister of State to investigate the reason for this. I have spoken to officials in the HSE who are also very concerned. Why is it the case that the service in CHO 8 has not received an increase in allocation? Why is there no money available? People are coming to my office and I have to fight for their rights. What about the poor child, aged six years, who cannot receive the 18 hours he has been granted? That is unacceptable in our society. I acknowledge the work the Minister of State is doing and the €20 million in extra funding he is providing to keep people out of hospital and in their homes, but we are not going far enough. As a Government, we have to do a lot more in providing disability services for people who need care and want to stay at home. They are being placed in appalling situations, including the lady I described. The request was not made yesterday or the day before but last year when she was in a wheelchair, not bedridden like she is now. The quality of care she needed and it was agreed to provided was denied to her. Her human rights were denied. Someone somewhere has a policy and is enforcing a rule in an area at the beginning of a financial year in which more money than ever before has been provided to make sure a service is available.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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This is a very important issue and we have to understand exactly what has happened. The topic affects many people throughout the country. The home support service provides domestic or personal care inputs on a weekly basis. Temporary relief is offered to the carer by way of providing a trained, reliable care attendant to look after the needs of the person with a disability. The service provides support for parents which enables them to spend quality time with other siblings in the family. It also supports the individual with the disability in the context of his or her care plan, with particular attention being paid to the personal needs of the individual. Home supports can be provided through a dedicated home support service or the generic home health service. They can be an alternative to residential care where support for the individuals in daily living can avoid the need for a full-time residential service. I assure the House that I will do everything in my power to ensure these services will be protected and I hope increased over time in order that more individuals can be supported.

On the specific case raised by the Deputy, the HSE endeavours to use the funding and hours available in the most effective ways possible. The Government's ongoing priority is to safeguard vulnerable people in the care of the health service. We are spending €1.9 billion on disability services in 2019, which represents an increase of 7.5%. I recently announced an extra €10 million in funding for respite care houses throughout the country. Some ten new houses have been completed to date and another two will be completed in the next couple of months. One of the first things the Government did after being forming was to restore the carer's grant of €1,700 per family to 101,000 families.

There are issues we have to resolve and I give a commitment that I will follow up on the case highlighted by the Deputy.