Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for being here. This Topical Issue matter is practically self-explanatory. For the past number of weeks I have been making representations on behalf of some constituents of mine on the matter of home help hours and so on. In fairness the Department has come back and sanctioned hours and stuff but the issue is that we do not have staff to fill those hours.

This takes me on to particular incidents and I spent two and a half hours being bounced around Departments yesterday while trying to find somebody who is accountable or responsible or who makes the decisions when it comes to elderly care in the home. I was talking to a family who has a parent in their 90s and they have been told that the number of incontinence pants they use on their parents have been reduced to two per day. I found that highly insulting and degrading for this family and my fear is if it is happening to one family is it happening to others? I did not want to raise it as a Topical Issue matter because of the fact that it is nice to pick up a phone and tell someone this is wrong and ask to get it sorted out. However, as I said I was stonewalled all day yesterday trying to get a response on this.

I have details on this horrible individual case that I will supply to the Minister of State but I want to highlight the fact that somebody from outside this House will have picked this up this evening. Hopefully whoever is responsible for making these decisions can reverse them. We are in here and people are under the perception that we are in the protection of the Chamber or whatever. We all go home and if we are lucky enough to have parents we look forward to seeing them. Surely when you come to the latter stages of your life people would have respect and empathy for these elderly people. I cannot figure out how this individual or collective body has made a decision to cut the likes of a basic necessity and limit it over a possible cost.

I know the Minister of State will not be able to give me a direct answer but I want to make her aware of this. All of us here are expected to know everything that is going on in our constituencies and in the country but we do not. The Minister of State needs to be informed about it and that is why I am informing her that I am afraid because another family asked me not to complain. That makes it even more serious because they are doing it through fear now. If there is fear of cutting back the number of incontinence pants for our elderly then our system is going backwards. I wanted to raise this with the Minister of State so that hopefully the powers that be who are responsible for these moves will reverse it. Hopefully this precedent will never be set again.

Anne Rabbitte (Galway East, Fianna Fail)
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I assume it is a constituent who came to the Deputy so I can only assume he is talking in the context of community healthcare organisation, CHO 4. On behalf of the Minister for Health I thank the Deputy for raising this important matter.

The Health Service Executive provides a wide range of medical aids under the community funded schemes to eligible persons, as set out in the Health Act 1970, free of charge following assessment by a relevant health professional. The HSE oversees the provision and supply of incontinence wear products for eligible persons across Ireland. Provision is based on an appropriate clinical assessment and a determination of the most appropriate products that will meet the individual's needs. These assessments are supported by national guidelines and other educational tools that are available to healthcare staff working throughout the country.

The HSE operates a home delivery service which provides incontinence wear products to more than 70,000 individuals living in their homes. This is a person-centred delivery system, which allows the individual or their carer to vary both the time of delivery and the amount of product delivered, according to their specific needs. It is also possible to alter the location for a particular delivery should the need arise. In the past, individuals have at times been provided with too much or too little product, which is not optimal for the individual person or their families, and the system now in place helps to ensure that these issues are now at a minimum. In addition, the HSE has a bulk delivery system in place for community nursing units and other residential care settings. This also operates on the basis of a regular delivery schedule with a facility to adjust both the amount and timing of the delivery. The HSE also utilises the service provided by public health nurses and continence nurse advisers to assess individual patient needs in order to ensure that the supply of incontinence wear products is appropriate.

As part of the national service improvement programme for the community funded schemes, the HSE has completed and implemented national guidelines in respect of incontinence wear products. Governance arrangements have been strengthened through the implementation of an integrated electronic management system to support the ordering, supply and distribution of incontinence wear products across all healthcare settings, including the home delivery service. The provision of clinically appropriate incontinence wear products to eligible persons is operated by each CHO under a national tender arrangement. The HSE views the appropriate provision of incontinence wear products to eligible persons based on need as a success of the improvement programme. In circumstances where a person does not hold full eligibility, such as a holder of a medical card or a long-term illness scheme card, reimbursement support for incontinence wear products is provided under the drug payment scheme, DPS. While there is no set limit on the quantity, the DPS claim must be supported by a valid prescription for such products.

It is unfortunate that the Deputy had to raise this on the floor of the Dáil but what I see here is that there is no limiting but that it is based on clinical need and assessment. When there is a clinical need assessment done, reducing the amount that is available to two per day does not seem appropriate. Perhaps it is something that needs to be taken up with the public health nurse.

Pat Buckley (Cork East, Sinn Fein)
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I know where the Minister of State is coming from. While I was listening to her I was thinking we should not be bringing these cases up because people have responsibilities and they are in jobs to provide these services. In her response the Minister of State mentioned the DPS. While there is no limit set a valid prescription is a cost to people, which is a separate issue. I refer to the idea of there being "too much or too little product". When it is causing that much stress to a family and they have to go to their Dáil Deputy, who tries all the angles to go through the HSE to try to get this solved and it ends up being discussed in the Dáil, then there has to be a breakdown somewhere. My wife always kills me when I make the following point but is it not better to be looking at it than looking for it? While we are sitting here that family does not have the answers. I will be talking to them afterwards and I will tell them it will hopefully be addressed now.

I know where the Minister of State’s response is coming from and it mentions: "too much or too little product, which is not optimal for the individual person or their families". We talk about carers and they are the individuals who have been involved for the longest length of time so to me they are the experts. If you are dealing with the district health nurse and saying that two, five or ten items is not enough then surely that should be taken on trust. People are not hoarding these products to sell them. I appreciate the Minister of State's response and she is right that I should not be raising this matter here. I am just afraid that if a precedent is being set here and if families and their loved ones are suffering because of the lack of a simple necessity. This could not be taken away from a child for example. I spoke to a mother very recently and I mentioned something about this and she said she did not know how many nappies she was going to use on her child that day. There should be a common sense approach to this and there should be trust between families and the health system.

Anne Rabbitte (Galway East, Fianna Fail)
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I agree there should be common sense shown in the approach to this issue. There is a middle ground that needs to be achieved, which is called neither "maximum" nor "minimum" but is just common sense. I reiterate that the service provided by the HSE operates on a person-centred, person-specific basis to fulfil patients' clinically determined needs. I assure the House there is no rationing of these products, which are provided to people as they need them. That is important when people are making telephone calls or trying to reassure families. There is no limit set out and no rationing taking place.

The HSE operates a flexible home delivery service, which currently provides incontinence wear products to more than 70,000 people. It also operates a bulk delivery system to community nursing homes and residential care settings. This is to ensure each person receives incontinence wear products as he or she needs them. The improved provision of incontinence wear products to eligible persons nationwide is rightly viewed by the HSE as one of the indications that the national service improvement programme can deliver. The reimbursement support for incontinence wear products available under the drug payment scheme ensures all persons, including those who do not have full eligibility, can avail of such products as they need them.