Niamh Smyth (Cavan-Monaghan, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The restrictions on new applications for home help services are appalling. This regressive decision will have knock-on negative consequences for families, carers and the wider health service. On the one hand, we have the Government saying it will facilitate people growing old in their own home and, on the other, it is restricting the means to do so.

It is important to remember we have an ageing population. Over the next 30 years, the number of people in Ireland over the age of 65 will double and the number over the age of 85 will quadruple. Despite the increasing life expectancy, chronic illness is on the rise and, therefore, people will need to be cared for in their home to take the pressure off acute hospital services. Real progress in meeting the challenge on home care must be made. It is the preferred option for older people and well acknowledged that the care based around the home is vital for keeping people active in their communities, which in turn has enormous health benefits.

I can cite to the Minister of State particular personal experiences of people in my own constituency and I am sure he has encountered similar experiences himself. People are under enormous pressure because, quite rightly, they are being allocated home help hours because of physical and chronic illness, but they are not being allocated a person or a worker to provide that service to them. We know that providing a service to people in their home costs the State a fraction of what it costs to have them in a nursing home. Not only is it the proper thing to do, the ethical thing to do and the most economic thing to do, it is the common sense thing to do.

We know there are extraordinary people working as home help carers and providers. However, they are put to the pin of their collar and are expected to do the impossible. They are expected to be at a house to provide a service to an older person, perhaps only for 15 minutes - to get them up, get them dressed, get them their breakfast and then to move on to the next person. As we know, older people and people who are ill may not be able to move at the pace of an able-bodied or well person. However, the home care service they are being provided with is for 15 minutes, or perhaps half an hour in the best-case scenario.

I recently attended a meeting of Family Carers Ireland and I have spoken at length on this before in the House. We heard from the families affected by these lengthy delays in having a home care service provided in their homes. It is putting them under enormous pressure, physically, emotionally and mentally. They are under great strain in their own homes, not only to provide care for their sick or elderly loved ones, be it a parent, sibling or otherwise, but they are being given false promises that they have been allocated home help when the HSE cannot provide it because it does not have the services or the personnel in place to do it.

The HSE Service Plan 2019 pledged that 17.9 million home support hours would be delivered this year. However, it has been reported that this service is largely closed to new applicants until next November, which is appalling. As I said, I could cite numerous instances in which services are not being provided. One gentleman who is terminally ill not only had his home help hours reduced but following his committal to hospital for a short time he could not go home because his reduced home help hours had been withdrawn, which meant he was taking up an acute bed in a hospital when he could have been at home. These are the types of scenarios with which we are faced every day in our clinics. I look forward to hearing the Minister of State's response on the matter.

Finian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for raising this issue, which I am taking on behalf of the Minister of State, Deputy Jim Daly. There has been much speculation and media attention in recent weeks asserting that there may have been a cut in the funding available for home care. This is not the case and I am glad to have the opportunity to clarify the position.

Home supports enable older people to remain in their own homes and communities and they facilitate discharges from hospital. The Government has made improved access to home support services a priority. Progress is reflected in the additional funding made available in recent years with the budget growing from €306 million in 2015 to almost €446 million in 2019. In 2018, the total budget for the service was €416.8 million, providing 17.5 million hours. This year the HSE intends to provide over 18.2 million home support hours, including intensive home care packages, to over 53,000 people. In 2019, almost €30 million has been added to the home support budget and 800,000 more hours of support will be provided compared to the 2018 target.

Throughout the winter period additional home support was provided supporting early hospital discharge and preventing hospital admission. Almost 1,100 clients nationally were approved for new home supports and 857 packages had commenced by the end of March 2019. Preliminary information for end of April indicates that 52,571 people were in receipt of home support hours. Between January and April approximately 5.8 million hours were delivered, with 5,761 new clients commencing the service. Despite this significant level of provision, demand for home support continues to grow and 6,310 people have been assessed and are awaiting either new or additional services. People on the waiting list are reviewed as funding becomes available to ensure that individual cases continue to be dealt with on a priority basis within the available resources.

The allocation of funding for home supports, though significant, is finite and services must be delivered within the funding available. The level of service provision must be in line with the HSE's budget, delivery plan and the national service plan. To achieve this, the HSE must ensure that the total number of hours provided does not exceed the targeted level of 18.26 million hours. While this may impact on its ability to provide new or additional hours, it is in line with normal prudent management of the budget. It is not correct to say that no new clients will be allocated home supports for the next five months. The allocation of new hours will be based on clients' needs and the resources available.

I acknowledge that in some cases access to the service may take longer than we would like. However, the HSE has assured the Department that people on the waiting list are reviewed as funding becomes available to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front line staff who know and understand the clients’ needs and who undertake regular reviews of those care needs to ensure that the services being provided remain appropriate.

While the existing home support service is delivering crucial support to many people across the country, it needs to be improved to better meet the changing needs of our citizens. The Department of Health is currently developing plans for a new statutory scheme and system of regulation for home support services. The Sláintecare implementation strategy commits to the introduction of the new scheme in 2021.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Minister of State read out some staggering figures. However, a HSE spokesperson has said the opposite to what is in the response of the Minister of State, Deputy Jim Daly. The spokesperson said: "while the budget increased in 2019, that increase will not allow us to deliver an overall increase in the number of hours of care delivered because the cost of delivering the service has increased". The spokesperson continued:

In order to balance budget 2019 there will be a reduction in the level of new hours provided compared to early in 2019. This will continue until early November.

Those are the words of the HSE spokesperson which flies in the face of the response read by the Minister of State, Deputy McGrath, on behalf of the Minister of State, Deputy Daly.

As we know, there has been a significant increase in the numbers waiting for home support, from 4,481 waiting for public home help and a home care package in 2016 to 6,283 in March 2019. In my constituency of Cavan-Monaghan there are 253 people waiting, which is significant. I draw the attention of the Minister of State to the fact that many in need of home care help only receive it on a Monday to Friday basis, and they are the lucky ones. Clearly, this is inadequate in terms of health and social needs in terms of not operating outside a 9 a.m. to 5 p.m., Monday to Friday service. The result is many people end up being prisoners in their homes, and often their beds, with no quality of life. It is beyond time for the HSE to wake up and respond to people's real needs. It should not be a 9 a.m. to 5 p.m., Monday to Friday, service. We need a Monday to Monday service, including over the summer holidays. We all know of families left high and dry when their home support worker goes on holidays, while acknowledging that support workers have to go on holidays.

The HSE is saying the opposite to everything the Minister of State, Deputy Daly, has said to the Minister of State, Deputy McGrath.

Finian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source

I take on board the Deputy's points and I will bring her concerns to the attention of the Minister of State, Deputy Daly. I agree with her point regarding service provision on a Monday to Friday basis. I accept there is an obvious need to provide high quality and flexible services that not only best meet the needs of individual clients but also reduce the pressures elsewhere on the health system. There is no dispute there.

The social care services, including home care, day care and respite, are important components in enabling people to remain living at home and participating in their local communities. They also provide valuable support to carers. The Department and the HSE are continuing to improve existing services. Last year, a single funding stream for home support services brought together the funding for home help and standard home care packages. This provides significant benefits, including making the services easier to understand, streamlining the application and decision-making process and facilitating service users to move to changed levels of service as their assessed needs change without the need for an additional application process.

While the existing service is delivering crucial support across the country it is recognised that home support services need to be augmented to better meet the changing needs of our citizens. The Department is currently engaged in a detailed process to develop a new stand-alone statutory scheme for the financing and regulation of home support services. As I mentioned earlier, this scheme is a key action under the Sláintecare implementation strategy, along with improving and developing supports in the community.

I will bring back the very important points raised by Deputy Smith to the Minister of State, Deputy Daly.