Áine Brady (Kildare North, Fianna Fail)

The overriding policy of the Government is to support older people to live with dignity and independence in their own homes and communities for as long as possible. Where this is not an option for whatever reason, the HSE supports access to quality long-term residential care, as appropriate. In accordance with this approach, a priority of the Government in recent years has been to develop a range of community-based supports such as home help and home care packages, as well as day or respite care. Between 2006 and 2010 additional investment of over €200 million was provided for the HSE to develop such community supports for older people. Without these initiatives, many older people would experience inappropriate admission to acute hospitals or be admitted to residential care earlier than might be required. The HSE service plan for 2010, approved by the Minister for Health and Children in February, commits the HSE to providing agreed levels of service nationally in these key community support areas. The plan includes day or respite care which is often available through various day care facilities or as part of a home care package. Such services can be delivered either directly by the HSE or in partnership with local voluntary or private providers.

Broadly, the level of community supports for older people in 2010 is in line with the 2009 provision. This includes an increase in the number of home care packages available owing to additional funding of €10 million given in the last budget for this purpose. The key activity targets contained in this year's HSE service plan are: almost 12 million home help hours in respect of around 54,500 people; increased home care package provision from 8,700 recipients at any one time in 2009 to 9,600 in 2010; and a total of 21,300 day care places which it is estimated will cater for up to 80,000 people. While this target is slightly down from a comparable figure of 21,600 places in the service plan last year, the respite or day care levels agreed will be generally compensated for in 2010 within the overall home care supports component of the plan. It should be noted that any changes to these national target commitments, as part of the agreed HSE service plan for this year, would have to be notified to the Department.

Other important initiatives are also being taken at a strategic level to improve community based services for older people. Arising from an evaluation of home care packages published by the Department in December 2009, the HSE is progressing various improvements in home care provision. The Department accepts the need for a more standardised approach to home care generally, whether by way of public or private provision. This year the HSE intends to finalise standardised access and operational guidelines for the delivery of home care packages; adopt a voluntary code of quality guidelines for home care support services for older people; progress a procurement framework for home care services; and introduce procedural guidelines for the home help service to standardise access to and allocation of home help hours.

As the Senator is aware, the HSE has operational responsibility for the delivery of health and social services nationally. He will appreciate that all developments relating to older people, including day care services at individual centres such as the centre in Cootehill, have to be addressed in the light of the current economic and budgetary pressures. The HSE has been asked to make a rigorous examination of how existing funding might be reconfigured or reallocated to ensure maximum service provision is achieved. This requires a stringent ongoing review of the application of the resources available. The HSE recognises the challenges ahead in meeting the increased volume and complexity of need within our ageing population, while also attempting to address the demand for integrated, co-ordinated and appropriate services based on the principle of maintaining older people at home for as long as possible. From this perspective, in the Cavan and Monaghan area it is considering options to provide additional services in Cootehill for the benefit of people in the town and surrounding areas.

The local health manager established a strategic planning group for services for older people in Cavan and Monaghan in March to examine, amongst other matters, the manner in which day care services for older people are being delivered across all of Cavan and Monaghan. As a result, there may be changes in the method of service provision. There are possibilities with regard to the future provision of these services, each of which is being explored and negotiated. In the case of day care services for older people, it is the aim of the HSE that older people requiring this service will access it as close to their own home as possible and within their own community.

Day care services are provided at the Darley Health Centre for older people from Cootehill town and the surrounding community. The majority of older people attend weekly or biweekly on a rotational basis. I understand many users of the day care service in Cootehill also access other local day care services and that there is capacity to increase this option. An information session was held on 25 May led by the general manager and key HSE personnel to inform the current service provider and the voluntary organisations representing the local views of older people of the proposed review of day care services. A decision has been taken that existing users will continue to be provided with the same frequency of day care services, whether at the Darley Health Centre or a different facility. It was emphasised that this should not mean a reduction of services for any person attending day care services in the Darley Health Centre.

Every effort will be made by the HSE locally to best meet the needs of each individual. The timeline for bringing the new and changed day care service into operation is the end of the first quarter of 2011. The HSE will continue to work with local services and people from Cootehill in developing new services. It is a matter for the HSE to manage this service, bearing in mind all relevant factors such as overall resources, local circumstances and evolving service priorities.