Dáil debates
Tuesday, 14 June 2022
Saincheisteanna Tráthúla - Topical Issue Debate
Home Help Service
10:50 pm
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I welcome the opportunity to make a few points on this issue. In the context of a previous matter, another Deputy appealed to the Minister of State to make work permits available to people who are prepared to join the workforce in Ireland as carers because there is such a shortage of staff in this area. I would support that as something which may help to address the problem. We are reaping the rewards of a very short-sighted approach taken some ten to 12 years ago, when financial challenges were to the forefront and when the HSE, in effect, changed its strategy of recruiting home help workers into its permanent staff and instead farmed the service out to private agencies. This led to a growth in such agencies, which are being paid X and are paying the carers who provide the service Y. We are seeing a mass exodus of staff from the private agencies offering home help care. While the HSE is beginning to try to recruit in order to ensure that we have appropriate staff numbers, there is a crisis in the here and now.
I offer one example of a dependent person needing home help provision who will not recover. In this instance, it is not a rehabilitation situation; it is about the provision of care to end of life. This individual has a very generous package of 42 hours per week, but only 26 of those hours can be delivered because of the shortage of staff prepared to do the work and who are available, either through agencies or from the HSE. This person's situation is indicative of an emergency that will lead to an exponential growth in the numbers attending hospitals unnecessarily, in the delays for discharge and in demands for nursing home beds. All of this, in turn, will put our entire health service into chaos.
While I am conscious that public pay talks will be commencing soon, we cannot wait two years for agreement. We need to be prepared to pay home carers an appropriate level of remuneration and expenses consistent with the astronomical rises in fuel and other expenses relevant to this area. This is not something that can wait for reviews, sub-committees, consultants' reports or anything like that. Somebody has to take the bull by the horns and take action now because, otherwise, it will cost too much in terms of the spin-off problems that will arise in our wider health service. We must increase the pay rates and remuneration for home care staff and ensure that they receive adequate expenses to look after the people who are rehabilitating at home and, in line with our national policy, those who are in the twilight of their lives and require full-time care at home.
In fairness to the Minister of State, Deputy Butler, she is making all the hours available. The problem is we are not paying the correct rates to get the job done. There is a superficial granting of hours, as in the case of the poor patient to whom I referred. That individual has been given 42 hours but, in reality, only 26 can be delivered. This is unsustainable. I would like to see us dealing with this crisis with the same gusto, can-do attitude and speed with which we were prepared to take measures in the management of the Covid crisis and, indeed, in welcoming our Ukrainian friends who have been running for their lives.
Damien English (Meath West, Fine Gael)
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I thank the Deputy for raising this very important issue, which affects many people, and their families, who are in need of home care throughout the country. It is an issue that has been discussed a great deal in this House with the Taoiseach, the Tánaiste and the Minister of State, Deputy Butler, who has been addressing it in a number of ways. The Minister of State could not be here tonight and has asked me to take the matter on her behalf. I certainly will convey the Deputy's clear message to her.
The Government is very much committed to the development of improved community-based services, shifting care to the home and offering greater choice for older people to be able to remain at home for as long as possible. We want to ensure the people who need that care can receive it, including the person to whom the Deputy referred, for whom more than 40 hours was approved. In budget 2021, the Minister of State secured additional funding of €150 million for home support 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 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 approximately 2.9 million more hours, or an increase of 17%, compared with 2020. That increase was needed because, as the Deputy noted, demand is up. Preliminary activity data currently available show that in the period to the end of April 2022, some 6.9 million home support hours were delivered nationally to just under 55,000 people.
Significant inroads have been achieved in reducing waiting lists for funding approval for new or additional service from more than 7,800 in January 2020 to 302 in April 2022. This reduction has been achieved through a combination of validation of the waiting lists and availability of additional funding to address those waiting. However, there can be a lag between funding approval and the delivery of home support hours. Certain geographical areas that are experiencing increased pressures due to staff availability are particularly affected. At the end of April, provisional information shows there were 5,344 people for whom funding for home support had been approved and who were waiting for a carer to be assigned. It is important to note that the total number of people waiting for home support has reduced from more than 9,000 at the start of 2020.
Supporting egress from acute hospitals is a key priority of the Government, and each community healthcare organisation area has dedicated staff working closely with the hospitals. As of 7 June, 531 patients nationally were waiting to be discharged from hospital. A total of 96 patients were waiting to be discharged home with home supports, with 59 waiting on a carer to become available. Transitional care funding continues to be in place on a demand-led basis to support patients discharging from acute hospital to long-stay care and for patients who require convalescence care before returning home.
The HSE continues to advertise on an ongoing basis throughout the country 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 local level. In addition, approved private home support providers continue to recruit home support workers. The Minister of State is very much aware of the strategic workforce challenges in the home support and nursing homes sector. In recent weeks, she has had meetings with the HSE to discuss the potential of a renewed focus on advertising these positions locally. There is a renewed effort to recruit the staff to provide the care. She has also 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, with a view to ensuring that solutions can be identified and implemented.
It is also expected that the pay and conditions for these workers will be examined. The Deputy asked that these facets be examined. He also said an urgent decision was needed, but this work now looks like it will be due to complete early in September, with recommendations being provided. The Minister of State, Deputy Butler, wishes to achieve the goal of ensuring there is an adequate supply of appropriately-skilled healthcare support assistants. That is a key aim of this initiative. Hopefully, therefore, the report and this work will bring some success in September.
I also engaged with the Minister of State regarding the permanent option. We made changes in April 2021 to the healthcare assistant role in nursing home settings, but not in home settings. This aspect is one that can be reappraised in the next review, which will commence soon. A major part of the focus, however, must be on the terms and conditions and what contracts are on offer. I refer to them being full time, because the terms are generally concerned with those types of contracts.
11:00 pm
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Unfortunately, we are doing exactly what I said we should not do, in respect of having a group for this, a chat about that, an expert group on the other and a cross-departmental team on something else. The reality is that this is a problem now. When we get to early autumn and into winter, it is going to be a much worse problem. We must pay home carers more money and remunerate them for adequate expenses, especially given the astronomical rise in costs. If we do not do that, then we will have a major problem in our hospitals, nursing homes, etc., later this year. It will be much worse. It is already bad, but it will be much worse then.
My point is that when we want to and when we are under the glare of the international spotlight regarding our reactions, which we all welcome in respect of helping our Ukrainian friends, we can pay thousands of euro every week to house people and to ensure they are looked after. Indeed, if the Secretary General of the Department of Health needs an extra €80,000, we can do that overnight as well. It is as clear as the nose on my face why there is a recruitment problem in this area. Let us address it, look after people who are rehabilitating and in the twilight of their lives and keep the pressure off our hospitals and nursing homes. They are already under pressure. The Minister of State will bring what I am saying back to the Minister of State, Deputy Butler. I understand she is otherwise engaged this evening. I very much hope, however, instead of there being the usual administrative merry-go-round, which we tend to embrace and then say something has been dealt with, that we can use the same can-do, let-us-get-it-done attitude as we did when dealing with Covid-19 and the Ukrainian refugee crisis. I do not see the same level of urgency and the same can-do attitude manifested when it comes to looking after our own and I would like to see it in this instance.
Damien English (Meath West, Fine Gael)
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I thank Deputy MacSharry again. He is asking a fair question regarding whether we can get some quicker decision-making on this matter as well. It is not just an issue concerning pay and conditions, but the Deputy has identified these aspects as the main reason. Part of the work the Minister of State, Deputy Butler, is doing involves trying to determine these reasons. It also includes travel arrangements, the hours on offer in respect of full-time versus part-time work and the unsocial nature of those hours. It is also difficult work and a difficult service to provide. Not everyone is fit to do the work of a carer or a healthcare assistant in a home or nursing home. It is only certain individuals who can do it. The Deputy raised the point that these people need to be well paid and looked after. I will certainly bring the Deputy's points back to the Minister of State. She is determined to resolve this issue. I will also bring back the suggestions made by Deputy MacSharry. We must try to get some urgency in addressing this matter. I thank the Deputy.