Christopher O'Sullivan (Cork South West, Fianna Fail)
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I will speak about some of the difficulties that people are having in accessing home care supports in west Cork, but in doing that I must first acknowledge the incredible work being done in this whole area by the Minister of State, Deputy Butler, since she became the Minister of State. Year on year the Minister of State, Deputy Butler, has secured and allocated more funding for home care supports, and has done more than any other Minister previously in securing that level of support. The Minister of State began the process and has revolutionised nursing home care and I know she will do the same for home care. That said, the Minister of State has also acknowledged the unprecedented level of demand for home care support services in the State. The Minister of State has acknowledged this and it is what I want to speak about today.

It is surely time that the HSE becomes accountable for this and that it starts showing some results and some value for money for the money and the funding that the Minister of State has secured for the sector. This applies right throughout the healthcare sector. The HSE and the management structures within the HSE need to start showing that value for money and return for taxpayers' funding that goes into that service. For example, in 2019 the funding for the HSE was some €16 billion. This has increased to €23 billion. It is about a 40% increase yet we are not seeing that value for money and we are not seeing the return in increased services. This has certainly played out in previous weeks. I am aware that we have had unprecedented levels of viruses, which has also been the situation throughout Europe but we have seen situations here where we have had record numbers of people on trolleys and people awaiting care.

The whole point of home help, home support and home care is to take people, elderly people, and dependent patients, out of those acute services. It underlines the importance of a functioning home support service. Far too often, unfortunately, and certainly in my area in west Cork, that is not the case. There are numerous examples I could give to the Minister of State but I will focus on one example. I thank the family that has given me permission to give it as an example. I will not use the names. The man has dementia, stage IV cancer, and Parkinson's disease. A good few months ago back in September he fell and broke his hip. He went to the hospital and was operated on. He was ready to be discharged from hospital a number of weeks later but he could not be discharged because the level of required home support services was not there to assist him. The requirement was that he would have two home carers in the morning, two in the afternoon, and two in the evening. The best that he could be offered at the time when the HSE went out to tender for it, was 2 a.m. or 1 p.m. This was very quickly withdrawn because one of the home care workers was no longer available. The HSE, of course, gave the response that there were issues with recruitment and issues with securing staff. While this may very well be the case, the upshot is that a family wanted to bring their father and family member home and spend time with him - however long that gentleman has left - and they wanted to spend as much time with him at home as possible. They could not do it because the appropriate level of home care and home supports services was not there. We need to see that change. The Minister of State has put the funding in place. She has resourced it and the HSE now needs to step up to the mark to ensure that this level of support is provided for families who desperately, desperately need it.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy O'Sullivan for raising this very important issue, and for giving me an opportunity to address it.

Since budget 2021, I have secured an additional €207 million in funding for home support. This year, the overall home support budget will be more than €700 million. I am probably the first Minister of State that has ever stood here who has the capacity to provide every home care hour that is needed in the country, but I do not have the staff to deliver it. This funding will enable the HSE 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. This will fund nearly 24 million hours.

The dementia-specific proportion of the new home support hours increased from 5% in 2021, 11% last year, and this year in 2023 I will have 15% that is dementia specific. The delivery of home support hours in communities is increasing, in line with enhanced investment. Older people want to age well at home. There are three things that can mean an older person can age well at home: home care supports; access to day-care centres; and meals on wheels. These three are the triangle that means people can age well at home.

As of November 2022, 56,429 people were in receipt of the service. At the moment we have approximately 56,500 people who receive home care every day. There were 3,240 new applicants funded and waiting for supports, and 2,819 people were already receiving supports but not the maximum hours advised, such as the gentleman the Deputy spoke about. Seven people were assessed and waiting on funding. Whereas previously people were waiting on funding, that is not the case anymore. Last year, up until the end of November, we delivered 19 million hours of home supports. I expect this to land some place in and around 21 million hours. Specifically in the context of Cork and Kerry CHO 4, we have seen an increase in those waiting in that area. Between January and November last year, preliminary data show that more than two million hours had been provided in Cork to more than 7,000 clients. At the end of November the waiting list in Cork stood at 429 people waiting on additional hours - so they had some form of supports but not the full package that was recommended - and 589 were new applicants. We have seen unprecedented demand for new home care supports. As I have said, 589 were new applicants.

Last year, I established a strategic workforce advisory group which came back to me with 16 recommendations. I accepted all these recommendations as quickly as I could. As of 1 January 2023, and working with my colleague, the former Minister of State, Deputy English, I have secured 1,000 employment permits which will allow home care workers from non-EU-EEA countries the opportunity to work in Ireland. This is an immediate intervention to support the sector. We did that previously for the nursing home sector and at the last count we had 2,500 people who came in on permits. I would be very hopeful that in the next month or two, we will see people who would be prepared to come in here. The average person provides interventions to about six people a day. If we could get 500 or 600 people in, it would almost clear the waiting list. In conjunction with wider sectoral reforms which are in train, implementation of the group's recommendations will have a real and lasting impact on addressing our workforce challenges.

Christopher O'Sullivan (Cork South West, Fianna Fail)
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The Minister of State quoted a lot of the facts and figures. She has secured €700 million in funding this year for home care. There is an unprecedented provision of hours. She also mentioned the statutory scheme of 24 million hours. I spoke about her revolutionising the sector and I think that will happen. Of course, we have to give this time to settle in. We have to look at the circumstances now. I appreciate the efforts that are being made in recruiting non-EU workers to take up those positions and clear the backlogs. That is very welcome. We have to look at workers within Ireland as well and consider why we are struggling to recruit staff and fill those positions. Do we need to look at the working conditions? These are incredible people in our community who love their work. They love doing what they do. They love the help and support they give people but clearly we do not seem to be doing enough to recruit people into that profession. It is certainly something that needs to be looked at. I am very heartened to hear of the efforts being made in recruiting non-EU workers into Ireland to clear that backlog. It is a very important step and something I hope will make a difference.

However, that is not to lose sight of the main reason I am raising this issue. As with the example I have given, it is for the family who want to be reunited with their loved one. They want to see him discharged from hospital for what they thought would have been a routine procedure but he has been in there since September. This is all about ensuring that those families are reunited and can be together in the home. I want the Minister of State to take that example and hopefully we can see a difference made for that family.

Mary Butler (Waterford, Fianna Fail)
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I am committed to supporting people to age in place at home in their communities with the wrap-around supports, including the dementia-specific day care services, meals on wheels and home care. In order to bolster staff resources and reduce waiting times for allocation of service, Cork-Kerry community healthcare advertises on an ongoing basis for healthcare support assistants throughout the region. It has a rolling campaign ongoing at the moment. The rates of pay are quite attractive. The HSE rates start at €16.49 an hour, plus mileage. I have to say that we have been challenged to try to sell home care as a viable career opportunity. The private providers are also actively endeavouring to recruit additional staff resources. Given the nature of this role, this recruitment is normally conducted at a very local level, which is important, across the region. One of the recommendations of the strategic workforce advisory group is also that those private providers would have to pay a minimum of the living wage and they would also have to include mileage. That new tender is being worked out at the moment.

I understand the point the Deputy makes about the gentleman in question whose family wanted to bring him home but did not have sufficient home care. Many of the Deputies in the House will be able to relate to that case. From Monday to Friday, we are okay but a lot of the challenges are at the weekends and in rural areas. That is why it is important that, if we can at all, trying to recruit people at a local level is vital. In addition, patients regularly discharge directly home from the acute setting with home support. Where patients are on the delayed transfer of care list because it is proving difficult to secure appropriate home supports, they can be offered a transitional care bed in a residential care facility. Last December just gone, we used that facility 1,000 times and in the first week of this year it was used 289 times. Home care is one of the issues I am trying hard to resolve. When I was appointed, there were over 9,000 people waiting for home care. Today, there are 3,200 people waiting and 2,800 with a partial home care package. I am hopeful that we will see some new people coming into the country who might be able to provide some support for us.