Dáil debates

Thursday, 21 November 2019

Saincheisteanna Tráthúla - Topical Issue Debate

Home Care Packages Provision

4:50 pm

Photo of Denis NaughtenDenis Naughten (Roscommon-Galway, Independent)
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I thank the Ceann Comhairle for giving me the opportunity to raise this important issue. Cathy Mahon from Lisacul, County Roscommon, occupies a rehabilitation bed in the National Rehabilitation Hospital in Dún Laoghaire, that would allow another patient to finally leave hospital. Despite the fact the 51 year old has been ready for discharge for the past six months, following excellent treatment at the hospital after a stroke that left her as a quadriplegic, no home care support has been secured, meaning she cannot return to her family home. Helen Grace has been trapped in St. Vincent's hospital in Dublin for a year while she waits for access to the same bed Cathy Mahon occupies in the National Rehabilitation Hospital. It effectively means that Cathy Mahon, through no fault of her own, is occupying the only suitable bed that would allow Helen Grace to move out of St. Vincent’s hospital.

Cathy Mahon spent months in University Hospital Galway before being transferred to the Mater Hospital in Dublin and later on to the National Rehabilitation Hospital in Dún Laoghaire, where she is today. She has been cared for in the only bed in the country that is equipped for a patient who has her level of disability and needs the support of a ventilator to help her to breathe. Cathy Mahon has made remarkable progress and was ready to be discharged in May, but only if she received an intensive home care package. However, she is still in the National Rehabilitation Hospital while awaiting a package that would include skilled home care staff and therapy. Her home is ready. Her husband is keen to have her go home. He has carried out extensive work to their small cottage to accommodate Cathy.

Helen, on the other hand, who is also quadriplegic and on a ventilator, has for the past 12 months occupied a specialised bed in St. Vincent's hospital, Dublin, waiting to be transferred to Dún Laoghaire as soon as Cathy Mahon can return home. The Mahons have made absolutely no progress in securing the necessary home care support they require to ensure Cathy can leave Dún Laoghaire and return to Lisacul in County Roscommon. By doing so, it would allow Helen Grace to move from St. Vincent's hospital to the specialised bed in Dún Laoghaire.

I know there are plans to put a second specialised bed in Dún Laoghaire. However, it is pointless having a bed there and a patient in it who does not need that level of care just because we cannot put specialist supports in place to allow her to live with as much dignity and independence as possible in her own home in Lisacul, County Roscommon. Will the Minister of State take on and progress this specific case? Will he engage with the HSE and ensure it has the funding made available to it from the national coffers to community healthcare organisation, CHO, 2 to ensure Cathy Mahon can return back to County Roscommon?

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I thank Deputy Naughten for raising these cases as well as for giving me the opportunity to outline the position on the provision of home care packages for people with disabilities being discharged from acute hospital settings. I can assure the Deputy of the Government's commitment to providing services and supports to people with disabilities that will empower them to live independent lives, provide greater independence in accessing the services they choose, as well as enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in A Programme for a Partnership Government. It is guided by two principles, namely, equality of opportunity and improving the quality of life for people with disabilities.

In 2020, more than €2 billion will be allocated to the HSE's disability service programme, an increase of 7%. This will fund the provision of a wide and complex range of services and supports to people with disabilities, including the provision of home support packages.

The HSE funds the National Rehabilitation Hospital in the region of €29 million annually under section 38 of the Health Act 2004. Services are provided through a service agreement that is reviewed annually. There are 242 patients awaiting admission to the National Rehabilitation Hospital inpatient services across its brain injury, spinal cord injury, prosthetic-amputee and paediatric programmes. Approximately 90% of referrals are generated in an acute hospital setting. There are also several delayed transfer of care patients in the spinal programme and in the brain injury programme.

Personal assistant and home support services are provided either directly by the HSE or through a range of voluntary service providers to support individuals with a disability to maximise their capacity to live full and independent lives. In 2019, the HSE will deliver 17.9 million home support hours to 53,000 people, along with intensive home care packages delivered to approximately 235 people, which comes to 360,000 hours delivered in the full year. Services are accessed through an application process or through referrals from public health nurses or other community-based staff. Resource allocation is determined by the needs of the individual, compliance with prioritisation criteria and the level of resources available.

As with every service, there is not a limitless resource available for the provision of home support services. While the resources available are substantial, they are finite. The number of hours granted is determined by other support services already provided to the person or family. While the majority of people in receipt of home care packages are aged 65 years or over, approximately 85%, a small portion of the target hours are delivered to people with disabilities that may include those suffering the effects of acquired brain injury.

In addition, in 2020 the HSE will be providing new and additional resources in terms of providing intensive in-home transitional support packages as a positive measure to support people with disabilities. Details of this measure will form part of the national service plan to be agreed for 2020. On the particular cases the Deputy raised, I will engage with the HSE and CHO 2 as well.

Photo of Denis NaughtenDenis Naughten (Roscommon-Galway, Independent)
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I acknowledge the last comment of the Minister of State. With all due respect, however, both Helen’s family and Cathy have been forced to go public. Helen is in her 70s and stuck in an inappropriate bed in St. Vincent’s hospital, Dublin, for the past 12 months. How many more people are in other hospitals throughout the country waiting to be treated in that hospital bed in St. Vincent’s? Cathy, a young woman of 51 years of age, has been stuck inappropriately in Dún Laoghaire for the past six months. The Minister of State gave the numbers of people around the country who could be treated in that specific bed but who are waiting for access to it.

I have given the Department the details of these two cases. They are already in the public domain. I am disappointed I did not get a response to the specific issues I raised, however. The Department looked for specific information from me regarding the individuals in question. I provided it with that information. With all due respect, however, the response today from the Minister of State is a generic reply to a generic issue. This is not a generic issue.

Two specialist beds have been tied up for the past 18 months.

Two women are being accommodated inappropriately in specialist beds who should not be in them. There is a young woman from County Roscommon who wants to go home. Her husband has carried out changes to their cottage in Lisacul, County Roscommon in order that she can return home and have her dignity and as much independence as possible. I plead with the Minister of State to take on this issue and come back to me with a detailed reply and commitment to provide funding to unlock the two beds for the two women mentioned and anyone else who might need them.

5:00 pm

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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Of course, I agree that the issue is not generic. I have listened very carefully to the Deputy as he outlined the two cases. To answer one of his questions, 242 patients are awaiting admission to the National Rehabilitation Hospital.

On the broader issue, the HSE funds the National Rehabilitation Hospital to a figure of approximately €29 million annually under section 38 of the Health Act 2004. Services are provided under a service level agreement which is reviewed on an annual basis. The HSE is committed to protecting the level of personal assistant and home support services available to persons with disabilities. In its 2019 national service plan the HSE's priority is to provide 1.63 million personal assistance hours for more than 2,500 people with a disability, which represents an increase of 170,000 hours on the 2018 target of 1.46 million hours. The HSE will also provide 3.08 million home care support hours for adults and children with a disability, which represents an increase of 150,000 hours on the 2018 target of 2.93 million hours.

Resource allocations are determined by the needs of individuals, compliance with prioritisation criteria and the level of resources available. Like every service, limitless resources are not available for the provision of home support services and while the resources available are substantial, they are finite. In that context, services are discretionary. The number of hours granted is also determined in the context of the other support services already provided for the person or family concerned.

There is a need for increased services. I will take on that issue. The HSE will continue to work with the agencies to explore various ways by which they can respond in line with the budget available. These are genuine cases that deserve our support. I will agree to engaging with the HSE and taking on these cases. We all accept that we have to do more to provide services for people with disabilities.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I expect we will hear more from Deputy Naughten about this matter.

Photo of Denis NaughtenDenis Naughten (Roscommon-Galway, Independent)
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By God, you will.