Michael Moynihan (Cork North West, Fianna Fail)
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I thank the Ceann Comhairle for the opportunity to raise the matter of home help services. In my region of Cork and Kerry, we have had a major issue with getting home help for people. This has manifested itself in a number of ways for people coming out of acute hospitals and going home. They are not able to return home unless some form of home care is provided for them for a number of hours. Going back three, four or five years ago, we may have raised the question of home help but the problem then was that there was no funding for it. There has been a large increase in funding but it has not led to an increase in the amount of home help hours available for patients and families.

Policies have changed over years to provide people with support and facilities within communities so they can live for the longest possible period in their homes. Every family benefits enormously from home help services and my family is no different; the practitioners of home help involved with my family's care are second to none. They have been absolutely excellent. Every family is seeking home care, but some people have been waiting a long number of weeks, leading to a delay in discharge from an acute hospital, which causes more problems for the health services. Any cost-benefit analysis of the home care packages or home help services indicates it is extremely good value for money. It is a win-win for everybody.

How are we getting from a position where funding is available to ensuring there is a service on the ground? That is about delivery of service, and it is very important we get to the bottom of that. I have spoken on a daily and weekly basis with the people who provide home care assistance, and they do excellent work. Some have told me they are contracted for 15 or 16 hours and would gladly take more but they are not getting them.

What is causing the blockage in the system? If new staff cannot be recruited to provide the care, why does the Government not look at the home care assistance that is already in place to see whether additional hours can be accommodated? Some of the providers have told me they would be delighted to provide more hours. In some instances, where families are trying to expedite the process, they are looking to people locally who are already working as home care assistants and might be able to provide the service. However, they are being told that although the local providers would love to take on the additional work, they are given only a certain number of hours and do not have the capacity to offer any more.

The HSE needs to look at what the stumbling blocks are in terms of delivering this service, which is vitally important and gives huge value for money. Keeping people in their own homes is the most important issue and it can be done by managing the home care assistance scheme in an imaginative way and ensuring there is delivery for people locally.

Roderic O'Gorman (Dublin West, Green Party)
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I thank the Deputy for raising this important matter, to which I am responding on behalf of the Minister of State, Deputy Butler. The Government is committed to the development of improved community-based services, shifting care to the home and offering greater choice for older people. In budget 2021, the Minister of State secured additional funding of €150 million to progress the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and to provide 5 million additional hours of home support. The funding secured in budget 2021 to provide those additional 5 million hours has been maintained for 2022. In 2021, some 20.4 million hours were provided to more than 55,000 people. This is an increase of some 2.9 million hours, or 17%, compared with 2020.

Significant inroads have been achieved in reducing waiting lists for funding approval for new or additional services, from more than 7,800 in January 2020 to 286 in March 2022. This has been achieved through a combination of validation of the waiting list and availability of additional funds to deal with those waiting for care. However, there can be a lag between funding approval and the delivery of home support hours. Certain geographical areas have experienced increased pressures due to staff availability. At the end of March, there were 5,458 people assessed and waiting for a carer to become available. In January 2020, there were approximately 1,300 people in this category. Despite the increase, it is important to note that the total number of people waiting for home support across both categories has reduced from over 9,000 at the start of 2020 to 5,744 at the end of March. At the end of April, 1,553 people in north Cork were receiving home support. During the first four months of this year, almost 130,000 hours of home support were delivered in the area.

The HSE is acutely aware that there are staff resource issues across both direct and indirect provision of home support in north Cork and other areas. Provisional data show that at the end of April, there were 113 people waiting for a carer to provide a new or additional service. At that time, nobody was waiting for funding approval. The HSE continues to advertise on an ongoing basis throughout the region for healthcare support assistants and to recruit as many suitable candidates as possible. Due to the nature of the role, this recruitment is normally conducted at a very localised level. The HSE recently completed a substantial recruitment campaign for healthcare support assistants and successful candidates are currently completing final clearances prior to being assigned to their locations. A total of 13 of these new staff are due to take up positions in the north Cork area this month and will be allocated to clients currently wait-listed for home support. In addition, approved private home support providers continue to recruit home support workers.

The Minister of State, Deputy Butler, is very aware of the strategic workforce challenges in the home support and nursing homes sector. She has established a cross-departmental strategic workforce advisory group to examine issues such as recruitment, retention, training, and the career development of front-line carers in home support and nursing homes into the future in order that solutions can be identified and implemented. It is also expected that pay and conditions for workers will be examined. The group, which is currently engaging with key sectoral stakeholders, is committed to providing the Minister of State with a set of recommendations by September.

Michael Moynihan (Cork North West, Fianna Fail)
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I would like to bring a particular case to the attention of the Minister of State, Deputy Butler, the Department of Health and the HSE. I know of a situation where a member of a family became seriously in February this year. The family looked for care to be provided two or three nights a week. Three nights were allocated because family members were travelling long distances from where they were living to provide the care, day and night, for the person who is ill. The family got a commitment in writing from the HSE to the provision of care three nights per week, but that approval was subsequently withdrawn. It is completely unacceptable that this should happen to families that are trying to make the right decisions for their loved ones. A little bit of help from the State can go a long way for people in this situation.

Public health nurses right across the region have contacted me to say how frustrating it is for them to do an assessment and make a recommendation for home help hours for patients who they clearly see need that service, only for the application to go back into the system and the outcome to be that no service is provided. The Minister, Deputy O'Gorman, indicated that a cross-departmental working group has been established to examine this issue. Data should be available from within the service as to whether all staff are satisfied with the hours they are getting and whether there is any extra capacity. The first thing on everybody's mind must be to try to keep people in their homes for as long as possible. That is best for everyone.

The reality is that the service locally is grinding to a halt. The Minister indicated that the working group will bring forward recommendations by September, but that is some three months away and we will be facing into winter by then. There should be an urgency applied to this matter. The problems in the service have been ticking along for some time. As I said, in the case of the family to which I referred, the provision of three nights was approved in February before being withdrawn completely at the end of March without ever having been provided. This is totally unacceptable. We need to see a real urgency to address this issue because it will become a major problem over the coming weeks and months.

Roderic O'Gorman (Dublin West, Green Party)
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I completely understand the frustration felt by the public health nurses to whom the Deputy spoke, the frustration and anger, probably, of the family he referred to for whom support was withdrawn, and his own frustration and anger in dealing with these situations. I know the Minister of State, Deputy Butler, sees the urgency of the situation. She met the chief officer of community healthcare organisation, CHO, 9 last week to discuss the issue of home care provision. There is a renewed focus on the advertising of care roles on local radio and social media. It is important to note that funding is not an issue here. The funding is provided; the difficulty is with the process of getting people into those roles.

The number of home support hours in communities is increasing, in line with the enhanced investment the Minister of State has secured. Delivering this enhanced capacity requires substantial recruitment, which has been affected by the strategic workforce challenges in the home support sector. Efforts are ongoing to meet the continuing increased demand. As I said, the Minister of State has established an advisory group, which is looking to identify and remove the specific obstacles to recruitment in order that we can use the money that has been secured to deliver extra staff and additional hours of care to families. In addition, work to progress the development of the new statutory scheme for the financing and regulation of home support services is continuing within the broader context of Sláintecare reform. This work encompasses the development of the regulatory framework for the new scheme, examination of the options for the financing model for the scheme and the development of a reformed model for service delivery.

I will, of course, raise the Deputy's specific concerns with the Minister of State. I thank him for highlighting them in the House today.