Colm Burke (Cork North Central, Fine Gael)
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This matter has been raised with me by families with elderly parents or relatives trying to get home care and by commercial providers of home care. They find that the number of hours being allocated and the way those are allocated means there is quite a long delay. Where someone has been looking for home care and the HSE has exhausted its efforts to find someone who has worked with the HSE to provide that, private contractors are contacted, but those contractors are finding that the person has been waiting quite a while for a decision to be made about home care provision.

I shall cite some figures. During the very difficult period of Covid, the HSE in the South/South West Hospital Group area had more than 1,800 home care providers. I understand that, once Covid ended - we were all delighted to see the end of it in real terms - more than 400 people decided not to work in the area any further. That was a drop of 400 out of 1,800 people. The HSE has worked hard to get replacement people but it has not been successful. While it has replaced some, it has not replaced all of the 400. Therefore, there is now a reduction in real terms in the number providing home care within the HSE. This has given rise to the need to go to other providers. I believe there are well over 20 providers of home care, which find themselves being contacted at a far later stage. Although we might want to get people out of hospital in a timely manner, families are reluctant to take the risk of having people come home unless they know there is a support package in place.

In fairness, all of the HSE staff in hospitals and out in communities work extremely hard, but there still seems to be a disconnect in how we can get a better co-ordination of services and deliver them in a timely manner so that people not only get the home care they require, but that it is put in place at the earliest possible date.

I wish to discuss the hours allocated. In a number of cases recently, I found that the hours allocated were not sufficient even though there were people available to provide them. When I made representations on it, it was followed through, but it should not be up to families or relatives to have to approach a public representative to have the number of hours increased. These were genuine cases. I am talking about elderly people living on their own who may not have immediate family living close to them but who need someone coming in, not just once per day but at least twice if not three times per day, to ensure they are adequately looked after in terms of meals and the care they require. It is in that context that I am raising this matter, which relates to the South/South West Hospital Group. My understanding is the private sector is contacted at a very early stage in all group areas except in the south. As a result, where the HSE does not have the staff to provide the care, there is a delay in providing it.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputy for raising what is an important issue for everyone in the House and the people we represent. A key focus of the Sláintecare reform programme is recognising, facilitating and enabling older people to age well at home and in their communities for as long as possible. Therefore, improving access to home support is a priority for the Government. Since budget 2021, we have provided approximately €230 million in additional funding for that service. The preliminary data indicates that more than 22 million hours of home support were provided in 2023, which was more than had ever been delivered and exceeded the HSE’s target for the year. While that is important, it requires good management, and the Deputy correctly highlighted some of the difficulties TDs, including me, hear about in their constituencies. It is important we have a continual focus on the management processes of these initiatives.

The HSE has reported that in Cork and Kerry, there are currently 8,293 people receiving the home support service with over 33,000 hours of support being provided. Within Cork Kerry Community Healthcare, I am told 75% of the service is provided directly by the HSE, with 25% delivered by external providers.

The Deputy's question is about the process by which the request is advised to private providers in cases where the HSE cannot provide it. I am told that the HSE advises that when a request for service is received, its priority is to identify availability to deliver that support and that a request for home support will always be sent to private providers if the HSE does not have available staff to allocate to the service. The Deputy correctly asks whether that is done within a day, a week or six weeks, because all of that is time mounting for a family with somebody who needs very specific care. I am told from follow-up queries to the Department, which I am grateful to it for, that this can happen on the same day but it typically happens within the week. The HSE provides CHO-specific lists of approved providers and asks clients to indicate first if they have a preference. If they do not, the HSE issues an email alert to all providers in that CHO and the first one to indicate availability gets the work. That is a little further clarity on this.

It is important to point out that both the HSE and private providers are currently experiencing similar recruitment and retention issues for staff. It is a priority for the Government to try to bring more people into this country to address the shortage of care workers. It is a key challenge for the Department of enterprise to make sure that can happen and indeed for the Minister, Deputy Simon Harris, with apprenticeships and bringing people into different pathways so that we can meet the needs. Efforts are continuing in Cork Kerry Community Healthcare to increase capacity by recruiting staff. Since the introduction of the current recruitment pause, derogation has been sought and granted for 49 health care assistant staff, but of course those people have to be available to be able to be hired.

I have been told this evening by the Department, and am grateful for its answers to my follow-up queries, that September 2023 figures show there were 1,495 HSE home support staff in the Cork-Kerry area in CHO 4, with 929 whole-time equivalents. I am told that is the highest of all the CHOs. That is to provide a little extra clarity to the Deputy. This is a question of management and quick responses to constituents. There is no doubt that we need to continue to rely on private providers where we are not able to meet the need in the HSE but those private providers have an obligation to respond quickly and efficiently and to make sure the care is met as soon as may be.

Colm Burke (Cork North Central, Fine Gael)
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I thank the Minister of State. I think the answer confirms what I was saying. For instance, the Minister of State talked about 25% being provided by the private sector. My understanding is that in other areas, it is far higher than 25%. The concern I have is the fact that it is confirmed that only 25% is provided by the private sector. I said to the Minister of State that three years ago, more than 1,800 people were working in the HSE providing home care. More than 400 people left for various reasons because it was a tough time for anyone providing home care during the Covid period. The Minister of State has confirmed to me that there are now only 1,495. In fact, all of the places that became vacant have not been filled, yet we are still only bringing in the private sector for 25%.

I will give one example. I have a case where someone was 90 years of age, living on their own and having to use a walking frame to move around their own house. All they got in home care was one hour per week. This issue needs to be reviewed by the HSE in the Cork-Kerry region. Can we provide additional hours by engaging with the private sector and also making sure that we can provide them in a timely manner?

Remember that the cost of a nursing home bed in the HSE is €1,800 per bed per week. When provided by the private sector in a private nursing home, it is around €1,150 per bed per week. One could provide an awful lot of home care for €1,800 per week. That is why I am saying that where people need additional hours, we should be trying to provide them so that families do not have to decide that the only option is for Mary, Michael or Pat to have to go into a nursing home. It is really important that we work towards getting the additional hours and getting support for people to keep them in their own homes for as long as possible.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I agree with the Deputy. It is important to highlight that notwithstanding that this is the highest number in all the different regions, we are still not meeting the need. While we recognise that there are recruitment challenges, both for the public and private sector, the emphasis on management of resources and management from the perspective of the user is still very important. An hour a week appears to me to be a grossly undermet need.

I stood in a constituent's house this week, looking at the care schedule for a gentleman in Carysfort Downs in Blackrock. I looked at all the different carers who were coming in. There were five or six carers every day. This man is at a period of acute need in his life. Looking at the management processes, some carers come two or three times a week, but there are five or six different people a day. One has to wonder about the management of that, given the scale of the resources being provided to the private provider. From the perspective of this gentleman's wife, the absence of continuity of care for her means she has to explain what is different every time. One wonders about the cost of this and the customer service or client focus that is being delivered. It seems curious that so many different carers are needed for a single individual and that they cannot be rostered in a way that provides the best continuity of care, the best support and the best relationship development. There are questions around the management of this. Coming to it from the perspective of the person's need is by far the most important thing.

We are struggling with a recruitment challenge. It is important that we have people in this country to be able to meet the need. If we want to have people at home for as long as possible, then we need more healthcare assistants. I am afraid this is linked to questions of migration that come up again and again. This issue is important in highlighting that with a growing population that is ageing more and more, there will be a greater need for more people in this country who will be ready and available to provide the sorts of services that the Deputy and I would like to see for our constituents.