Donna McGettigan (Clare, Sinn Fein)
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Recently, Home and Community Care Ireland, HCCI, published its new report and witness for home and community care throughout the State. Home and Community Care Ireland is an umbrella group for home and community care providers across Ireland. Its report is based on the latest available statistics. The report makes for grim reading, with almost 5,000 people currently waiting for home care, but what is of particular concern for me is that my constituency of Clare has a waiting list of 304, which when calculated per 1,000 people of population equates to 2.386 per 1,000 or 157% of the national county average. The lowest waiting list per 1,000 of population is Dublin, with 0.076. County Clare's waiting list is more than 3,000% higher than that.

HCCI has compiled reports on waiting lists for a few years but they were based on the total number of people on the waiting list in each county. Under that measure, Cork had the highest waiting list. This is the first report that calculates the HSE waiting list as a percentage of the population of each county. Since it is the first report of its kind, we cannot even say for sure how long this problem has persisted in County Clare. More importantly, we do not know why the waiting list is so much worse in County Clare, so that is the first question that needs to be answered. What is causing the excessive waiting lists in County Clare? If the Government does not know, what does it intend to do to research the problem and find out its causes?

These 304 are not just numbers. Behind each of them is a person who has been approved by the HSE for home care hours and yet cannot avail of this vital service to keep them in their own home for longer. Without this help, people's health can deteriorate, making them more likely to need hospital care or nursing home care. They may also face difficulties in being discharged because they cannot be sent back to their own home if the home care is not available to them. A spokesperson for HCCI said that they have heard of examples of where people have died while on the waiting list, only for their families to be later offered home care for them. This must be utterly heartbreaking for family members. They must feel like their loved one was completely let down and neglected by the State in their time of need.

The HSE issued a statement to the media in response to the HCCI report. We should not be reliant on the HSE to issue statements in the wake of a report like this about the lack of services that people have to endure to try to find out what is going on. The HSE statement may have been its best guess as to why the people of County Clare have been so neglected but a number of its assertions simply do not add up. It states that the mid-west has an ageing population and that is a contributing factor. However, other counties with higher age profiles have lower waiting lists. The Central Statistics Office gives a ratio for the number of people over 65 years of age to those under 65 in each county. County Leitrim, for example, has an age ratio of 28.4, according to the latest census data compared to a ratio of 25.1 for Clare, yet its waiting list is 1.254 and ours is 2.386. Let me be absolutely clear: the waiting list in Leitrim is far from acceptable. No one should have to wait for the care services they need.

The HSE's statement also implied that County Clare is a rural county but so is County Kerry. It has a waiting list of 0.676 per 100,000 compared to our 2.386, so ours is more than three times the waiting list of Kerry, even though both counties are rural.

The HSE is responsible for managing the waiting lists and for managing decisions to allocate home care to people in the first place, yet it seems it is not able to adequately account for the large difference between the waiting lists in each county. Even if we in County Clare does have a higher ageing population than anywhere else, and even if we have a more dispersed rural population than anywhere else, as the HSE seems to assert, it is still the job of the Government to ensure that Irish citizens have proper, full and prompt access to appropriate home care when they require it. Every Government has had access to census data for years, which was supposed to be used to plan for future needs, so why do we find ourselves in this unacceptable situation?

John Cummins (Waterford, Fine Gael)
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I thank Deputy McGettigan very much for raising this important matter, to which I am responding on behalf of the Minister for Health. Improving access to home support is a priority for the Government. The overall budget for home support in 2025 is circa €838 million. This is the largest allocation ever for home support. It is an increase of nearly €122 million on the previous year and an increase of over 70% when compared to the 2020 budget of €487 million. We are on track to exceed the target of 24 million home support hours, excluding complex home support, for this year. At the end of September, we delivered 1.3 million more hours than by the end of September 2024. We have already exceeded the year-end target to support over 60,000 people at any one time.

Under budget 2026, the HSE will be funded to increase the target to €26.7 million next year. In the Clare and Limerick integrated healthcare area, at the end of September 2024 the HSE reported that 1.034 million hours of home support had been delivered. This is 2.1% ahead of the target for the year to date, and nearly 48,000 more hours than the number of hours delivered in the same period last year, which is an increase of nearly 5%. However, although supply of home support hours has increased, the waiting list does remain persistent in some parts of the country, including County Clare. The HSE reports that, as of September 2025, the waiting list in County Clare stood at 340 people. Some 93 people are waiting for their home support package to commence, while the other 247 people were waiting for receipt of additional home support hours.

Where there are waiting lists for home support, priority is given to those in the community with acute needs and those assessed and waiting in acute hospitals who are able to return home with support.

Higher waiting lists are known to be directly related to the availability of carers in the region. The Government has recognised the importance of addressing recruitment and retention for the sector and is continuing to work to deliver on the recommendations of the strategic workforce advisory group on home carers and nursing home health care assistants.

The HSE has also reported that it is carrying out regional rolling recruitment campaigns in line with the pay and numbers strategy across the health regions. A number of initiatives are under way to focus on the recruitment and retention of HCAs to provide home support in areas where additional home support staff are required. Additionally, at a national level the HSE has developed a HCA career hub spotlight piece which highlights the role of HCAs who provide home support, the training required and the benefits associated with working for the HSE. It also offers contact details for local home support services as well as information on how to join the career hub to receive job updates.

The Minister of State with responsibility for older people and housing, Deputy O'Donnell, is fully committed to addressing waiting lists for home support, with a focus on those regions that are disproportionately affected. The Minister for Health, Deputy Carroll MacNeill, has specified that home support waiting lists must be addressed through the HSE's upcoming national service plan.

Donna McGettigan (Clare, Sinn Fein)
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It is a pity the Minister for Health is not here because, unfortunately, the Minister of State has been left to read out a response which indicates that he has not even heard what I have been saying. The answer he has read suggests that the Department has exceeded targets but we are not seeing that in County Clare. The answer does not tell us what we want to hear. While I thank HCCI for this report, which clearly identifies the problem of waiting lists for home care in various counties, we should not have to rely on a report to tell us what we should be informed of by the HSE. It is the responsibility of the Government and the HSE to bring forward solutions for this, but I am not hearing solutions. The Minister of State is saying that there are increases, but they are not being seen in County Clare. These solutions have to be rooted in a clear understanding of the sources of the problems. It is deeply concerning that the HSE cannot clearly identify the causes of the current excessive waiting times in County Clare. The suggestion that County Clare has longer waiting times because it is a rural county does not hold up when other rural counties do not have the same level of waiting lists we have. The idea that it is caused by an ageing population overlooks the fact that other counties with ageing populations have shorter waiting lists than ours. This seems to be another case of postcode lottery in terms of services. We in County Clare have inadequate services and the agencies responsible do not seem to know why.

The people of County Clare have a right to feel abandoned by the Government. The HCCI stated in its report that it relies on parliamentary questions to get access to statistics and data relating to waiting lists. We need to see transparent reporting from the HSE. Will the Government instruct the HSE to compile and report on waiting lists regularly in the same way it reports on other matters? If so, when will it do so? If not, why not? This report should serve as a wake-up call. People are being left to wait and suffer in silence and that is not acceptable. Ours is a modern society in the 21st century. This dereliction of duty by the Government cannot continue. The Government and the HSE need to formulate a plan to introduce protocols for the capturing, analysing and publicising of data related to what is clearly an inadequate home care service.

John Cummins (Waterford, Fine Gael)
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As I said in my opening statement, budget 2026 will increase the number of hours provided for home support to 26.7 million, which is significantly more than what was provided in 2025. Nonetheless, I acknowledge the points the Deputy has raised. The Minister of State with responsibility for older persons and housing, Deputy O'Donnell, is committed to ensuring that where there are gaps in provision, including in County Clare as the Deputy has pointed out, they will be addressed through the national service plan which the HSE will bring forward. There is no question that areas of rural Ireland should not be disadvantaged in terms of home support - or any other service for that matter - that is provided by the State. Where there are disproportionate waiting lists in certain parts of the country, we are committed to addressing that through the HSE service plan, which the HSE is responsible for bringing forward. It is the Government's responsibility to ensure the funding is put in place and it is the HSE's responsibility to ensure that adequate provision is provided across the country to ensure people can remain in their homes, as is their requirement, and to ensure we free up capacity within acute settings as well. I will take the points the Deputy has made back to the Minister for Health.

Aidan Farrelly (Kildare North, Social Democrats)
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I thank the Minister of State and Deputy McGettigan.