Michael Moynihan (Cork North West, Fianna Fail)
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I thank the Ceann Comhairle for allowing me the opportunity to raise this issue. The home care package is a service that has been a lifeline to many families throughout the length and breadth of the country. My family benefited enormously from it in times past. The work done by the care assistants who dedicate their lives to the care of others in their own home is invaluable, as is the care they give and their dedication.

6 o’clock

It would be remiss of me not to say that at the outset. At present, we face a crisis in home care and the delivery of home care services. No more than any other Deputies from all sides of this House, my constituency office is getting calls daily from people trying to get home care packages or to find home help services available for loved ones. Due to advancing years, they may want to get an increase in the hours. The home help and home care services undoubtedly have provided an enormous service to the State over the years, have been hugely beneficial and have saved the State an enormous amount of money by keeping people in their own homes for as long as possible. However, we now have a major issue. We came through the winter and many families have been scraping together to try to put together a package. We have worked with some families to try to build a package with private care and so forth because they want to keep their loved ones at home for as long as is humanly possible and are trying to do that. We have been told time out of number by the HSE and the powers that be that there is a shortage of staff. This did not happen today or yesterday, but goes back a number of months.

The issue I want to raise today is what the State, the Government, the Minister and the HSE are doing to recruit more people into this area and to make the job of care assistant in the community more attractive. We have seen instances where the HSE has been contracting out hours to private companies to try to get cover but even that is proving difficult. Some of the senior HSE people are exhausted from trying to provide cover or get home help services. The HSE is then looking at the home help services in existence and is going out through the powers that be to see if they can reduce the hours for some people to spread the service more thinly on the ground. That is totally unacceptable because in some of the cases I have, families need more help for their loved one, not having it reduced because of a shortage of staff. The Government needs to be innovative about getting more people involved. The position of care assistant needs to be an attractive position and new people must be attracted into it to make sure. As we go on, it is fundamental and hugely important, given the aging population, that the home care and home help services are enhanced and strengthened because that is the only way we will be able to keep people in their own homes for as long as is possible.

Niall Collins (Limerick County, Fianna Fail)
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I thank Deputy Michael Moynihan for raising this issue and I am responding on behalf of the Minister for Health, Deputy Stephen Donnelly.

Improving access to home support is a priority for the Government. Since budget 2021, the Government has provided an additional €207 million in funding for home support to the Department of Health. This year, the overall home support budget will be more than €700 million. This 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. It also will fund nearly 24 million hours of home support this year. The dementia-specific proportion of new home support hours will increase from 5% in 2021 to 15% in 2023. The delivery of a high-quality consistent home support service is a key priority for the Cork and Kerry community healthcare organisation, CHO 4, focusing on keeping people well in their homes and communities for as long as possible, in line with enhanced investment.

As of November 2022, the latest available preliminary data show in excess of €19 million hours of home support had been delivered nationally in the year to date. Within the CHO 4 area, the home support service delivered more than 2 million hours from January to November in 2022 to over 7,000 clients. At the end of November there were 56,429 people in receipt of this service nationally. There were 3,240 new applicants funded and waiting for supports while 2,819 people already were receiving supports, albeit not for the maximum hours advised. The HSE has advised us that as of the end of December, 109 people were awaiting home support in north Cork. There are strategic workforce challenges in this sector that have immediate and longer-term implications. Current difficulties in recruiting healthcare workers are already affecting the level of service provision. This has the potential to be exacerbated over time due to an aging demographic. The Government has commenced a number of initiatives to address these challenges. Last year, the Minister of State at the Department of Health with special responsibility for mental health and older people, Deputy Butler, established a strategic workforce advisory group to address the challenges of recruitment and retention of home carers and nursing home healthcare assistants. The Government has published its findings and the implementation of the advisory group's recommendations has commenced. Since January 2023, the Minister of State, Deputy Butler has also secured 1,000 employment permits, which will allow home care workers from non-EU and non-EEA countries the opportunity to work in Ireland. This is an immediate intervention to support the sector. In conjunction with wider sectoral reforms that are in train, implementation of the group's recommendations will have a real and lasting impact on addressing our workforce challenges.

The HSE has advised the Department of Health that more people than ever before are being referred for home care. Consequently, delivery of this service is not without its challenges. Cork-Kerry community healthcare is acutely aware that there are staff resource issues across both direct and indirect provision of home support in Cork and other areas. In order to bolster staff resources and reduce waiting times for the allocation of service, Cork-Kerry community healthcare advertises on an ongoing basis for health care support assistants throughout the region in an effort to recruit as many suitable candidates as possible. Approved 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 and is ongoing across the region. The HSE has also advised that a good working relationship has been established between local hospitals and the community. Patients are regularly discharged directly home from acute settings with home support. Patients can also be offered a transitional care bed in a residential care facility until a carer can be assigned.

Michael Moynihan (Cork North West, Fianna Fail)
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I thank the Minister of State. There are a number of issues. There are 109 people waiting for services. Is there a policy to reduce the amount of home help hours to existing people, referred to in the document as clients, so as to spread the service more thinly because of the shortage of home care assistants? Strategically, in the Minister of State's own Department of Further and Higher Education, Research, Innovation and Science, should there not be an incentive put in place to recruit people to the home care assistants courses that are offered in many of the colleges throughout the country? The Minister of State mentioned permits being brought in to help with the service and that is very welcome but there are an awful lot of people who could be recruited. Has there been co-ordination between the HSE and the Department of Further and Higher Education, Research, Innovation and Science, to see if a new course can be created into which people could be recruited or equally, into the existing healthcare assistant course? If we do not do something at a fundamental level, we will be back here again. I have to say, from the evidence we are getting, we see some people who are well into their 80s and maybe older and there is talk of them surviving on less hours because of the shortage. We have to stamp that out because we cannot be reducing any services that are there. In some cases we have people who are in acute hospitals or in transition beds and they are waiting. They are fit to go home and would go home if there was a home care package available. That again is contributing to the issues across the hospital services.

I refer to the issue of spreading the services we have more thinly on the ground and what is being done to recruit more people at the bottom end and to make the package for a healthcare assistant more attractive.

Niall Collins (Limerick County, Fianna Fail)
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I thank the Deputy for his contribution. There is no policy to reduce hours. and end-of-life care is always a priority for the Government. The Government remains committed to supporting people to age in place at home in their communities with access to wraparound supports, including day care and dementia-specific day care services, meals on wheels and home care.

As I mentioned earlier, delivering this enhanced capacity for support requires substantial recruitment and significant work is under way to address the strategic workforce challenges in this regard. The HSE also continues to advertise on an ongoing basis for healthcare support assistants and recruits as many suitable candidates as possible. The Department of Health is continuing to develop a regulatory framework for providers, which will comprise primary legislation for the licensing of providers and secondary legislation in the form of regulations and HIQA national standards. The HSE has begun the recruitment process for 128 interRAI care needs facilitators to progress the national roll-out of interRAI as a standard assessment tool for care needs in the community to determine prioritisation and levels of care required. The HSE is also progressing the recruitment of several key posts to support the establishment of the national home support office.

I was also recently involved in a Zoom call with the Minister for Health and the Taoiseach, and Oireachtas members from the mid-west region. This came on the back of the issue in the region. The specific issue raised by the Deputy also came up as part of that discussion and the point was correctly made that an employment regulation order is also needed for people who work as home carers. This key element is lacking in making this a viable career and option for people to go into work where they will have certainty in this regard. This point was also made on that call with the Minister and the Taoiseach and they were both accepting of it because we have done similar in the child care setting, where, as the Deputy will be aware, an employment regulation order was recently issued to give certainty to people working in that sector. The Deputy asked a specific question about my Department in this regard. It is the intention, and the Higher Education Authority has sought expressions of interest from our higher education institutions, to put on additional courses to train home care assistants and allied health professionals in this area.