Thursday, 16 September 2021
Ábhair Shaincheisteanna Tráthúla - Topical Issue Matters
Home Care Packages
I am again raising an issue that I put to the Minister of State, Deputy Rabbitte, on the floor of the House some 12 months ago. It relates to the provisions that are being made by the HSE, together with the education sector, to recruit staff, and whether there is consultation and communication in that regard. I refer to the home care support packages that are not being delivered. The hours are there but the staff are not. I am incredulous that when people contact the HSE, the service provider will say it can give them 21 hours but it does not have anyone to deliver the care.
On 10 August, I had to resort to writing to the Minister, as follows:
Dear Minister, I am contacting you today with what I am sure you will agree are two very urgent and upsetting situations. For me, it is incredibly regrettable that I have to seek intervention directly from the Minister and your Department in both these instances as, for me, such cases as I am representing today should be afforded the immediate delivery of approved hours without excuse or delay. [I will not use the individuals' full names, only initials.]
BW has muscular dystrophy, is incapacitated and a full-time wheelchair user. BW's full-time carer is presently in hospital recovering from major surgery, which has resulted in an emergency situation where BW is now in urgent need of assistance in her home place. BW cannot toilet herself [and] she cannot attend to her own personal hygiene or prepare any meals. She is presently assisted by her sisters, who are both unwell and unable to provide BW with the care she needs. Both BW herself and her sisters have attempted to engage with the PHN [the public health nurse] as well as making direct contact with older persons' services, just to be fed with lame excuses and no resolutions. This lady is an urgent and emergency case, which is being passed from one person to the next, with zero interventions or solutions to providing approved care hours.
I wrote that letter on 10 August. Today is 16 September and it took three weeks for action to be taken.
The other case I wrote to the Minister about concerns a person with the initials PS. I wrote as follows:
PS has a terminal diagnosis which is no longer receptive to treatment. All treatment has now stopped and PS is now seeking to return to her home for comfort measures. Also, a referral has been made to the palliative care team in Wexford to allow PS home. Home care hours are required to assist the family with PS's care. I am sure you will understand that time is not on the side of PS or her family and they are now extremely anxious to get her home. This is an incredibly upsetting and traumatic situation for PS and her husband and family, who now simply want her home to spend what short time is left in the comfort and love of her own home and family. However, she is being denied returning to her own home as approved care hours cannot be delivered due to staff shortages.
These are just two cases. I could go on providing more; the reality is I have instances almost in treble digits of where home care packages are not being delivered. The hours are there but the staff are not there to deliver them. Can somebody, please, tell me what is going on? Do we have the money? I attended a meeting of the Committee of Public Accounts today at which HSE representatives were in attendance to account for having spent €81 million - "spent" is a very conservative word - on ventilators we did not receive. How many carers would €81 million train and provide for the people of Ireland who have paid tax all their lives and are trying to get home to die in peace? I want my question answered and I do not want to have to stand up in the Chamber again to ask it.
I thank the Deputy for raising this matter. I recognise that it is a very complex issue. I know from personal experience that trying to get carers is a difficulty. It is a key priority of the Government to enable more people to engage in services that allow them to remain independent and to live in their own homes with dignity and independence for as long as possible. In order to advance this, the Government is committed to establishing a new statutory scheme for the financing and regulation of home support.
In July, the Minister of State with responsibility for mental health and older people, Deputy Butler, announced the selection of a number of sites for a new home support pilot project. This pilot will deliver an additional 230,000 hours of home support over a six-month period and will test a reformed model of service delivery for home support. The Community Healthcare Network, CHN, sites selected for the pilot are Tuam, Athenry, Loughrea, Bandon. Kinsale, Carrigaline, Ballyfermot, Palmerstown and east Westmeath. The pilot will underpin the development of the statutory scheme for home support services. A national home support office will be established to support the testing of the reformed model of service delivery. In addition, approximately 130 posts have been funded for the national roll-out of the interRAl Ireland assessment system, which the home support pilot will test as the standard assessment tool for care needs. In parallel, work is ongoing by the Department to make progress with other aspects of the scheme, including the development of a regulatory framework and the examination of options for the financing model.
While this new home support scheme is under development, the Government is prioritising improving access to home support services. An additional €150 million was made available for home support for older people in budget 2021. The national service plan set a target to provide 24 million hours of home support. This is an ambitious target that will increase provision by 5 million hours, or more than 25% above the 2020 target.
The Covid-19 pandemic has led to unprecedented challenges across our health services, nowhere more than in older persons' services. While there have been challenges in the delivery of home support hours, particularly during the third wave of the pandemic, significant progress has also been made. Preliminary data indicate that at the end of July 2021, more than 11.4 million home support hours had been provided to 53,732 people. This means that 1.5 million more hours were provided compared with the same period in 2020 and the number of people waiting for approval of funding for a new or additional service has greatly reduced.
The Department, the HSE and the Minister of State, Deputy Butler, are committed to ensuring that we continue to allocate additional home support hours where they will be most effective coming into the winter period. There has been a sustained focus in recent years on reducing delayed transfers of care and enabling patients to be discharged from hospital sooner. As of 14 September, there were 468 cases of delayed transfer of care. There were 93 people categorised as waiting for a home support service, of whom 57 were approved for funding and waiting for carer availability. The HSE will continue to work towards increasing home support provision. However, challenges remain in regard to capacity and efforts are ongoing to recruit staff across both direct and indirect provision.
The Department of Health is committed to working across Government and with relevant stakeholders to ameliorate these issues. The programme for Government committed to establishing a workforce planning expert unit to work with the education sectors, regulators and professional bodies to improve the availability of health professionals and reform their training to support integrated care across the health services. I take on board the cases the Deputy outlined, involving individuals she referred to as BW and PS, and the letter she wrote in that regard. Their cases are harrowing and I hope we will be able to address those issues in the coming weeks and months. However, there is an issue with both retaining and recruiting staff.
I thank the Minister of State for his reply but I have to say it is more spin. This Government is going to spin itself out of existence. There is not a word about delivery in his reply. He talked about challenges. The challenge here seems to be to rein in the HSE in some shape or form such that money can be spent where it is required. We cannot accept that €81 million just got thrown into the atmosphere without any cognisance of what that means for people's health.
It means we do not recruit healthcare workers and pay them appropriately in order that they are enticed into the sector. I cannot have Departments deciding whether a 73-year-old man who ends up paraplegic as a result of an accident is an older person or a disability case, because that is what happened when I wrote to the Department. One came back and said it was not it, it was the other Department. That took another week, just for issues like that to be ascertained. It is outrageous. I am sorry to be going off on one here, but this is deeply frustrating for families in very vulnerable positions. Let us imagine the trauma of having one's 73-year-old husband and a father turned into a paraplegic as a result of an accident and not being able to come home from hospital for the want of two carers coming in for 45 minutes in the morning and for 45 minutes in the evening. Does that sound like too much to ask for a 73-year-old farmer who paid his tax all his life, whose wife wants to be the primary carer, to take him home and deliver the care he deserves? The co-ordinator says there can be one carer for 45 minutes once a day, five days a week, not seven, and they will be left to their own devices for the other two days even though his wife is also 73 years of age. This cannot go on. This is why I am so against what is going on here for the past eight weeks, that we voted on last night. The real work that needs to be done is just going unnoticed.
I take on board what the Deputy says and I will bring back her exact views to the Minister. The Government did improve access to home support services as a priority. Last year we did provide €150 million for these services. The Covid-19 pandemic has highlighted the importance of supporting the most vulnerable in society to be cared for in their own homes for as long as possible. It is of the utmost importance that all individuals accessing home support are provided with a high quality level of care which is safe and person-centred.
The statutory home support scheme is a key enabler to providing more alternatives to nursing home care and a wider opportunity for people to live fuller more independent lives. The scheme will provide for the financing and regulation of home support services in order to provide equitable access to high quality services based on a person’s assessed care needs. The system of regulation will ensure public confidence in the service provided, as well as safeguarding service users.
The sector probably needs a lot more pay. Such increases will be part of the Minister's deliberations on the budget. It is very difficult to attract people into the sector and I agree that they probably need more reimbursement. The funding is there, and I hope that all the stakeholders will be able to work to try to attract people because it is a very difficult job, but it is also necessary to keep people in their own homes away from the front-line services.
The Department of Health is examining the potential demand and costs of introducing this scheme. Following that, work will be undertaken to examine the associated workforce requirements for the introduction of such a scheme. I understand officials from the Department will engage with all the relevant stakeholders and the other sectors as required. It is an issue we hear about as politicians across the country, and we need to address it.