Helen McEntee (Meath East, Fine Gael) | Oireachtas source

I thank Senator Burke for highlighting this important issue. Nobody would question the work the Senator has done to date in this area. He has been working on the Bill for some time. Home care is an increasingly important part of the supports that we offer to older people, and will continue to increase in importance into the future. In that context, it behoves us to consider how home care should be provided and regulated. The Senator has mentioned a number of the issues dealt with in the Law Reform Commission report. This 2011 report highlighted the imbalance between residential and home care. The number of people aged over 65 will double in the coming years while the number of people aged over 80 will treble. Currently, 11 people a day are being diagnosed with dementia and that figure will only increase. We need to continue to focus on the fact that getting older should never be seen as a burden on society and we need to continue to address the imbalance.

It has long been Government policy to help older people and others to stay in their homes and communities for as long as possible, with long-term nursing care being seen as a last resort only after home care and other community-based supports have been fully utilised. Under the Government, that emphasis is being strengthened. People want to stay at home with the environment, possessions and friends built up over a lifetime and that are most familiar to them, and this is entirely understandable. I also attended a party last year for a lady who was 100 years young and still living on her own and I want that to continue to happen. Accordingly, the programme for partnership Government includes commitments to increase funding for home support services, to improve these supports, to introduce a uniform home care service so all recipients can receive a quality support, seven days per week, where possible, and to review the management, operation and funding of national home-help services.

I am pleased that overall funding for services for older people will increase to €765 million in 2017, which is an increase of €82 million since the HSE's 2016 service plan. This has focused on additional funding for home care, in particular, and is aimed at allowing people to continue to live in their own homes and at facilitating discharge of older people from acute hospitals. During 2016, the number of home care packages will have increased by 1,000 from 15,450 to 16.450 and the HSE will provide more than 10.5 million home help hours. Home care funding has increased by €41 million over the initial 2016 provision, and this will be augmented in 2017 with a further €27 million. I will work hard to ensure we continue in this direction in future years. I understand it is not enough and it is not the figure we need but we need to build on it. The dementia home care packages, in particular, will need to be delivered throughout the lifetime of that programme but we need to reach a stage where there is proper regulation, a proper structure and a proper framework to provide support to people in their homes whether they have dementia, a disability, or simply need care.It is estimated that approximately 20% of the over 65 population receives some form of community-based support service annually from the State. Traditionally, home care was viewed as providing a lower level of support than residential care, and not as an alternative to it. Increasingly, however, it is considered possible to support many people at home who would previously have gone into residential care. This requires an increase in the amount and intensity of home care, and more effective integration with other supports including nursing, therapies and other primary care services. We want and have to develop home care services to provide a more viable alternative to nursing home care for a greater number of people.

Home care services are provided on the basis of assessed health care need and there is no means testing or personal contribution towards the costs involved. Other HSE provided or HSE funded services include day care, meals-on-wheels and respite care. These are services we must protect. People are cared for at home under a wide variety of arrangements, both formal and informal. The HSE provides services directly and through service agreements with private and voluntary sector providers. Informal care provided by family and friends plays a significant and invaluable role in providing care to older people. Furthermore, many families choose to supplement the level of care provided by, or on behalf of, the HSE with additional privately procured home care. It is estimated that home care provided or funded by the HSE accounts for only around 30% of the total market, with the balance being privately procured and paid for by individuals and families. That is quite a low percentage.

Arrangements for home care provision have developed over the years with a significant local focus and while the HSE is incrementally developing a more consistent and coherent system, some legacy issues are still being worked through. Unlike the nursing homes support scheme, which is evenly applied across the country and is centrally managed in a unified way, there remains more variation than we would want to see in home care arrangements. For example, access to services can vary from place to place and at different times of the year. We have all experienced and had difficulties with that in our constituencies.

It is clear, therefore, that there are issues to be addressed and that there does seem to be a case for a more structured and perhaps schematic approach to home care than has applied up to now. Work to prepare for the development of a more formalised system is already in train, and the Department of Health has already asked the Health Research Board to carry out an evidence review of international approaches to the regulation and financing of home care services. This review will describe approaches to the regulation of home care services in other jurisdictions including the legislative framework, registration processes, inspection regime, staff assessment and training requirements, and national standards. It will examine the approach to financing of these services as well as eligibility requirements and entitlements for publically funded services, and who bears the cost of regulation. Finally, it will review evaluations and assessments of the international approaches in terms of their effectiveness and costing issues.

The review will be presented to the Department of Health before the end of December and will be used as a basis to develop policy proposals in 2017 for the regulation and funding of home care services. In terms of quality assurance in the home care sector, a significant step was taken in 2012 when the HSE introduced a single procurement framework for external providers. This included quality standards in terms of governance and accountability, person-centred care, complaints management, training and qualifications. Providers are monitored through service level agreements with the HSE and are required to provide a range of information on the services they provide. From 1 September 2016, all new home care packages approved by the HSE will be provided by organisations that have been approved by the HSE following a detailed tender process. The 32 approved providers appointed under this process meet a required level of quality based on consistent national standards. I agree with Senator Nash and others about the need for a clear professional pathway for carers. That would be an important step in ensuring the development of this profession and that those who provide the service feel valued and feel that their work is of worth. Most carers provide amazing care. The importance of regulating the sector, however, is not in dispute.

I share Senator Burke’s concerns about the potential risks involved in delivering services on a one-to-one basis in the homes of some of the most vulnerable people in our society. However, there are characteristics particular to home care which make its regulation less straightforward than residential care, and we need to think through the implications of any new system in a careful and measured way. Of its nature, home care is less uniform than residential care, and includes a wide variety of formal and informal arrangements. Unlike the residential sector, family carers are a very significant part of the home care landscape, and we need to ensure that any new system of regulation does not have unintended consequences for them or for other informal carers. Defining the margins between informal and formal service provision needs thorough assessment.

It is clear that there are considerable differences between the residential and home care contexts, and regulation needs to be designed for home care in a bespoke way that recognises its particular characteristics. Regulation is necessary, and we are all agreed on that, but a significant amount of detailed preparation needs to be done in addition to that already done before final decisions are taken on its form. For example, there are legal difficulties with the Bill proposed by Senator Burke in that it seeks to include home care providers within the current regulatory arrangements by extending the definition of "designated centre” in the Health Act 2007 to include them. However, home care services are not delivered in any one centre but at different locations and in people's homes. Legal advice obtained by the Department confirms that a separate legal instrument will be required to establish a regulatory regime for these providers.

Work on developing an appropriate regulatory system is already well under way I have arranged that it shortly be given further impetus by the establishment of a new unit in the older persons services function of the Department which can focus on it to the level required. I accordingly propose that Second Stage of the Bill be read again in 12 months’ time and I look forward to engaging further on this critical issue with the Senator and with this House as our work progresses. We are all on the same page in respect of this issue. We all want the same results and it is important that we work together to make sure the final result is the best it can possibly be to ensure we realise this vision.