Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I thank Senator Colm Burke for raising this matter. He has been pushing for reform of the health services and has been supportive of my portfolio.

The HSE has sought to maintain, and where possible to expand, the range and volume of services available to support people to remain in their own homes, to prevent early admission to long-term residential care and to support people to return home following an acute hospital admission.

Home support services were a particular area of focus in budget 2018, with an additional €18.25 million allocated to them. The resources available in 2018 bring the total budget for the direct provision of services to €408 million. The HSE's national service plan provides for a target of some 17.094 million home support hours to 50,500 people. Home support services are provided either directly by the HSE or through voluntary and private providers. Service provision is identified through a needs assessment undertaken by a HSE professional for the purposes of identifying the person's needs and suitable service which will support the person to continue to live in his or her own home as independently as possible. The average cost per hour paid by the HSE to service providers encompasses all costs relating to service delivery, including the employee's salary, paid leave, employer's PRSI, travel, administration, training, etc. All providers who meet the HSE standards incur costs in addition to the direct cost of the salary of the worker. Such costs are essential to the operation of the service to the required standards.

In the absence of regulation of the sector, the HSE has put in place formal arrangements with external providers to deliver publicly funded home supports to the standards and requirements of the HSE.The HSE has, therefore, tendered on a number of occasions for providers of home support services so as to create an "approved provider" list in each of its geographic areas. The criteria to be successful at tender includes adherence to a level of standard of service provision as well as cost of provision of the service. In general, costs to the HSE per hour will range between €20 and €25, inclusive of pay and overheads, and will also depend on when the individual service is being provided. The utilisation of external providers delivers essential additional service capacity across the system without which many older people would not be able to remain at home.

The costs of delivery of service has increased due to general cost increases and to increased delivery of non-core hours of service at weekends, bank holidays and late evenings together with the costs of delivering an increasingly skilled workforce caring for older people with higher levels of dependency who would otherwise require long-stay residential care. The HSE has implemented increased contract hours for its directly employed staff in 2014 and is now in the process of offering improved contract hours in 2018.

In conclusion, it should be noted that the Department is developing a new statutory scheme for the financing and regulation of home support care services. This will be an important step in ensuring that the system operates in a consistent and fair manner for all those who need home care services.