Seanad debates
Wednesday, 19 October 2005
Home Help Service: Motion.
4:00 pm
James Bannon (Fine Gael)
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I move:
"That Seanad Éireann, conscious of the valuable and mainly unrecognised work carried out by home helps, calls on the Minister for Health and Children to:
—regulate their contracts of employment;
—recognise the need for the regulation of their working hours and pay scales, under partnership agreements;
—provide home helps with adequate training;
—rectify the position of home helps in relation to the failure of the Health Service Executive to honour an agreement, stipulating that where hours have to be reduced, wages would only be reduced after two weeks or four weeks, depending on length of service; and
—substantiate her claim that there were no cutbacks in the home help service in 2004 and in 2005."
I have tabled the motion to highlight the thousands of workers employed in the home help service who have been invisible for too long. In view of the valuable contribution these unsung workers have made over many years to their local communities and the long hours they have put in on behalf of the ill, the elderly and people with disabilities whose quality of life would be bleak without their care and, conscious of the valuable and mainly unrecognised work carried out by home helps, they must be given their proper entitlements. Their contribution is a one way ticket and I intend to do everything in my power to ensure those who give so generously are rewarded and not taken for granted, as they have been by the Government over the past eight years.
It is a scandal in this post-Celtic tiger era that these essential workers remain underpaid and must work in untenable conditions. The imbalances that remain in certain sectors are a sad reflection on our society. The Minister must recognise the need for regulation of the working hours and pay scales of home helps under partnership agreements and she must also ensure the regulation of their terms of employment under the Health Service Executive. Despite continual requests to do so, the HSE has consistently failed to give home helps proper contracts of employment specifying their working hours and specialist work or provide the necessary training facilities for them.
I call on the Minister to rectify the position of home helps by addressing the failure of the HSE to honour an agreement stipulating that where hours have been reduced, wages would only be reduced after two or four weeks depending on length of service. Most important, will the Minister of State clarify the position regarding the 2 million home help hours cut in 2004? Parliamentary questions on this issue were tabled by my colleague, Deputy Twomey, in the Dáil, and followed up by my party leader, Deputy Kenny, as recently as 13 October, but the Minister has not produced data, despite her contention that the figures are incorrect. A comparison between the HSE's 2005 national service plan and a parliamentary reply on home help hours in 2004 revealed a discrepancy of 2 million hours service for the elderly. The Minister of State, Deputy Tim O'Malley, promised to supply accurate figures last July and we are still waiting. If there is no cover up, he should stop hiding and release the figures. He obviously has no grounds on which to dispute our figures. In my constituency in the midlands the figure for employed home help in 2002 was 312. This decreased to 286 in 2003 and decreased further to 261 in 2001. Nationally, the figure for 2002 was 2,534 and this was dropped to 2,304 in 2004. Last year the home help hours were reduced by 254,000 over four counties in the midlands area.
In every constituency throughout the country, evidence supports the contention that home help hours have been slashed. The Minister of State has tried to cover up Government inaction on services for the elderly over the past eight years by spinning old Government promises as new initiatives. I urge him to forget the empty promises, whichever way they are spun, and to release the figures if he feels our estimates are incorrect. That a simple question on figures should cause the Minister to go to ground is self-explanatory.
It is hardly reassuring that the HSE's 2005 national service plan is not clear on the difference between the 2004 figures and those for 2005. If the difference of 2 million is because home help services for people with disabilities are not included with those over 65 years, it should not be a problem to provide accurate figures.
The Minister should clarify the HSE's figures if this is the case. This should be easy but not if there is another explanation, namely, another botch-up by this lame duck Government. If home help services are undermined, the repercussions will be felt in our hospitals and accident and emergency units. Elderly patients who are no longer able to remain at home or to receive the specialised assistance from home helps will end up on trolleys in our already overworked and under-funded national health service.
The Years Ahead, A Policy for the Elderly, was published in 1988 and advocated that older people should be maintained with dignity and independence in their own homes and also that the care of older persons in their own community by family, neighbours and voluntary bodies should be encouraged and supported. However, the health strategy, Quality and Fairness — A Health System for You, published in 2001, acknowledges the "need to develop a comprehensive approach to meeting the needs of ageing and older people, if the problems in the care and quality of life of older people are to be addressed and increased demands over the next 20 to 30 years are to be met". At that time it recognised the need to develop a range of community support services, including the home help service.
The Government places great emphasis on community care, including home help services. It is now recognised that this service is an essential support to family and informal carers. The duties of home helps fall predominately into two categories, personal care and domestic tasks. The home help assists the elderly person in bathing and showering, dressing, feeding, assistance with toileting, personal hygiene and administration of medication, under personal care provisions. With regard to domestic tasks, the home help may assist the client in preparing and serving food, assistance with meals-on-wheels service, lighting fires, bed-making, room tidying, and essential cleaning, including hoovering. The remuneration for this service is an unbelievable sum of €8 per hour, sometimes inclusive of night time work. Home helps are the unrecognised and hidden workers, who perform an invaluable job, without adequate salary, training or security of employment.
The majority of these workers are female. Their work has been erroneously described as menial by the more belittling among us. Perhaps this is why they can be paid the minimum rate and the Government can cut their hours. Categorising their work as menial is an appalling description of the valuable contribution they make to our society. In reply to a parliamentary question on the impact of cuts in allocation to health boards the then Minister of State at the Department of Health and Children with special responsibility for services for older people, Deputy Callely, stated "the policy of the Department of Health and Children on services for older people is to maintain them in dignity and independence at home in accordance with their wishes, as expressed in many research studies; to restore to independence at home those older people who become ill or dependent; to encourage and support the care of older people in their own community by family neighbours and voluntary bodies".
This sounds familiar and, in fact, he was quoting directly from the 1988 reports, to which I referred earlier. The aims are the same but not the provisions. Despite Deputy Callely's contention that there has been a major step forward in the implementation of the home help scheme since 1999, the picture is bleak and the repercussions will resonate in every area of our already overstretched health service. It is claimed funding for the home health service has increased, from €12 million in 1997, which is the year the world began, according to Fianna Fáil. The current figure is inadequate so the increase is meaningless. It is a blatant lie to contend that services in this area have improved in the past few years. It is my contention that services for our elderly, disabled and handicapped and the treatment of home helps, both financially and in terms of security of employment and training for their role, have deteriorated drastically over the past couple of years. The losers are the most vulnerable in our country and those who seek to help them.
The bottom line is that the cost of keeping people in a nursing home, whether private or public, far exceeds the cost of supporting them in their own homes, which is the preferred option of the majority of our elderly citizens. Any cutback on hours or pay and facilities for home helps is a false economy and will come back to haunt this Government in its financial mismanagement.
The Health Service Executive has revealed that patients well enough to be cared for in their own homes are tying up hundreds of hospital beds. The shortage of home helps, nursing home care and other support services is responsible for seriously ill patients being denied life-saving hospital beds. Recently 450 patients in the eastern area alone had finished the acute phase of their treatment but were forced to remain in hospital, due to the lack of essential support services. With up to 200 patients a day waiting for hospital beds, this is farcical. Most health professionals agree that unnecessary admissions to nursing homes could be avoided or delayed by proper investment in community-based services. Some studies suggest that 16% of admissions to nursing homes are social admissions.
Elderly patients are at the mercy of a nursing home system that leaves a lot to be desired, as evidenced by the scandal at Leas Cross nursing home. This revelation, along with other investigations that have so far only scratched the surface, makes it imperative the Minister faces up to the facts and figures of the home help sector and accepts the points raised in this motion. Home helps must see a regulation of their contracts of employment. They must have recognition of their working hours and pay scale, under partnership agreements. Home helps must be provided with adequate and appropriate training. The Minister must also rectify the position of home helps in regard to the failure of the Health Service Executive to honour an agreement stipulating that where hours have to be reduced, wages would only be reduced after two or four weeks, depending on the length of service.
There is no escape for the Minister. There can be no more delay. Figures must be produced to sustain the Minister's contention that there have not been any cutbacks in the home help service in 2004 and 2005. If our claims are substantiated, another nail will be hammered into the coffin of this lame duck Government and the victims of the Minister's ineptitude will once again be the ill, the infirm and those who work quietly on their behalf. We want regulation and we want a statement on that from the Minister this evening.
Fergal Browne (Fine Gael)
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I second the motion. Our major difficulty is that the Minister and the Department of Health and Children are on record as saying one thing while the HSE is saying another. This issue was raised by Deputy Twomey, the Fine Gael spokesperson on health, in an Oireachtas health committee last July at which I was present. The Tánaiste gave a clear commitment to clarify the point and get back to Deputy Twomey but she has failed to do so. I understand that even when challenged in the Dáil last week, she failed to answer the question. That immediately indicates that there is a problem. If the matter was as clear-cut as the Tánaiste maintained in July, why has it taken three months to even acknowledge there is a problem and clarify the point?
During the recent by-election in Kildare North, I met a lady involved in the home help service who was angry because her hours had been cut, exactly as outlined by Senator Bannon. I put down a parliamentary question to ascertain the Minister's position on it but the answer I got back indicated that the hours had not been cut and there was no change in the rates of pay, etc. Having regard to what happened in July, however, I am beginning to wonder who is telling the truth. That is the nub of this issue. Who is telling the truth? Who is in charge? Has the HSE now become the NRA? Is it now dictating policy? What is the role of the Minister for Health and Children? The Minister spent the past year avoiding the hard questions by saying she was only in the job less than a year but her tactic now is to blame the HSE. When asked what she believes are awkward questions, her reply is that it is not her responsibility but that of the HSE. The problem with that charade is that members of the public are suffering, in particular the elderly and those in need of the home help service. What is happening on the ground does not match the official version of events.
I met a lady lately who suffered a brain haemorrhage in 2001. Unfortunately, she suffered a second brain haemorrhage this year. Having fought her case we finally got her two hours of home help per week. The picture is not rosy. That lady has a young baby but all we managed to get for her was two hours service per week. I have no argument with the people in Kilkenny who were providing the service. They were providing the best service they could out of a small budget and with few resources but there is a problem centrally in that the Government is not allocating adequate funding.
The Government's record on the elderly is abysmal. I will arrange to table a motion at the Joint Committee on Health and Children next week calling on the Minister to immediately refund the elderly the nursing home charge overpayments. It is scandalous that the Government was finally forced to admit, after months of questions in the Dáil, that there was a problem with the charging of nursing home patients in public beds. It rushed emergency legislation through the Houses, the Supreme Court refused to accept it and the Government had to start from scratch again. Finally, when the Minister was forced to admit she had made a mistake, she then said she would pay back the elderly in her own time, and we are talking about payments being made in 2006. I look forward to the debate in the Joint Committee on Health and Children next week when we will hear, for the first time, the Government's real policy regarding the elderly. It is despicable that people who are nearing the end of their lives — some may only have a month or two to live — are being treated in that way. They should get immediate payment.
On the question of nursing home subventions, I became aware recently of a man who goes into a nursing home for night-time care only because he is being fed through a tube. He submitted his details and all he got was a €10 in subvention. Having worked all his life and paid his taxes, that is the way the State treated him. We are fighting that case tooth and nail. There is a problem for the elderly, not just in the area of home help but in all the other areas, and I am not convinced that the Government is willing to take responsibility for it and lead from the front.
Why did the Tánaiste not clarify the point made by Deputy Twomey last July that 2 million hours had been cut from the home help service? What is she hiding? Is she not aware of the real position, which is an even scarier thought? Does she not know the answer? If that is the case, who is running the Department of Health and Children? Professor Drumm is issuing policy guidelines every day, which makes us all wonder why we are here.
This motion calls for regulation of the working hours, pay and conditions of those involved in the home help service and is worthy of acceptance. These people are working for pittance yet they provide an invaluable service. Many thousands of families greatly appreciate the work they do, often at unsociable hours as Senator Bannon pointed out. The Government should acknowledge the role they play in society and take steps to immediately rectify the wrongdoing. It is despicable that three months later, the Houses of Parliament still cannot get straight answers to straight questions.
Camillus Glynn (Fianna Fail)
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I move amendment No. 1:
To delete all words after "Seanad Éireann" and substitute the following:
"—recognises that personnel in the home help services have benefited from substantial improvement in their terms and conditions of employment under national collective agreements between health service employers and trade unions; and
—notes that funding has increased from €12 million in 1997 to €120 million this year for Home Help services in recognition of their important role in;
(i) providing support to people who require it to enable them to live in their own homes and in the community and therefore avoid the need for long-term residential care; and
(ii) providing support to their carers and their family, as appropriate."
The reference in the amendment to "increasing the funding from €12 million to €120 million" says a great deal. Senator Bannon referred to the Fianna Fáil-Progressive Democrats Government as being a lame duck. If it is a lame duck, the former rainbow Government perfected the hammer stroke.
James Bannon (Fine Gael)
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It is evident in the Senator's home town of Mullingar where a shell of a building has been left idle.
Camillus Glynn (Fianna Fail)
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——is a member of the party which let phase 2 stand idle for over a year without providing a cent to open it. Whatever about being seen, I would certainly not be heard.
The importance of the home help service cannot be over-stressed. It was designed and is working as a measure to ensure that people who want to live in their own homes, that is, the elderly, have an opportunity of doing so. Having dealt with elderly people over many years in the profession in which I worked, I am aware that most people, even though they often live in adverse circumstances, will opt to remain in their own homes. As a consequence of that desire, this Government has increased the home help allocation ten-fold in the past eight years. That indicates a clear commitment on the part of the Government and the Minister to devolve to this important section of our community that they are serious about it.
A number of services are provided by the home helps. Starting with household tasks, they do general housework duties which include lighting fires, bringing in fuel, bed making and, where proposed by the public health nurse, prepare food. They also provide shopping services for the elderly and in many cases they accompany the elderly on shopping trips. That is very important, being of therapeutic value to the elderly person. Moreover, in the past those concerned were very often cast in the role of the good neighbour. However, things have changed, and the good neighbour is not only important but must be remunerated appropriately, the reason being that many people who provide home help services are mortgage-holders. It is important that they provide such a service to bring in a few extra euros to pay the mortgage. The work therefore has a twofold benefit.
The second reason is personal care, which involves getting elderly people out of bed and dressed, washing, bathing, showering and toileting them. In certain cases, it will also involve continence care, which is extremely important. I remember when I was working with the Midland Health Board and a survey was conducted by a nurse into the level of continence or incontinence, as one might also put it. It was of great service at the time. Not only did it deal with incontinence; it also helped bring about continence in some cases.
The service also still supports young families in crisis. In families with multiple births, the home help service has stepped into the breach. Single parents are also under stress, and as everyone knows, they now account for a very large percentage of new births. Families of elderly relatives who wish to go on a break are another client group. The fact that personal care is not necessarily related to the means-tested service has tended to be ignored. Household tasks are another important service. Home help organisers and home helps in general need training, since, as I have said, the "good neighbour" aspect of the home help service has almost disappeared. Apart from being there to provide that tremendous service, people now need the money.
One issue has been relevant since 1999. There has been a tenfold increase in money provided for home help services, but there are still several questions to address regarding home help organisers. We must also examine another matter. Some home helps have gone far beyond their role in assisting old people in their homes, stepping into the breach in many areas. I say this to the Minister and to all sides of the House. The home help service is tremendous, having been improved. Further improvements are necessary. I would not be naive enough to say that it is a utopia. There is no question that the service provided is unrivalled, but it must be further developed. It is accepted that those working in it need more training, since the circumstances in which they work and make themselves available have changed. We must deal with change as it arises. I commend the amendment to the House.
Brendan Ryan (Labour)
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I cannot but wonder at the extraordinary instinct of the Government, which rushes in to amend a motion calling on the Minister to regulate the contract of employment of home helps and recognising the need to regulate their working hours. I thought that we all shared those sentiments. The motion also suggests providing home helps with adequate training. Who would want people to carry out all those tasks without proper training? It mentions rectifying their position. If the Government took issue with that, the simple solution is to say that it is not true and state the case as it sees it. However, it did not do so. Finally, the motion mentions substantiating a claim. I was listening via the monitor to two colleagues from Fine Gael. Apparently this claim has been made time and again, and now an unholy retreat is taking place, with no such substantiation available. It seems that the Government took exception to the last part, but what problem it might have with regulating the contracts of employment of home helps is beyond me.
We know that it is a difficult area. Let us first examine the numbers and the increase in funding from €12 million to €120 million. One would need to have increased the budget of the Southern Health Board 18-fold some four or five years ago to pay people the minimum wage, since they were being paid 50 pence an hour. Other health boards were being extremely generous and paying IR£3 an hour. Recognising the fact that this was not a token, pocket-money gesture to self-sacrificing people, I have never been entirely sure why health boards paid home helps such trivial sums. It is probably a commentary on the State's inherent view that the sort of person who would volunteer is a fool and therefore not to be recognised or rewarded in same way as thrusting enterprise.
At the core of our current State philosophy, which is infecting many areas of life, is the view that, if one is any good, one gets paid for it. If one is really good, one is paid a great deal more, and the better one is, the more one is paid. In the words of the Minister for Justice, Equality and Law Reform, Deputy McDowell, a good deal of inequality increases incentives. Presumably, if one pays home helps badly, one encourages them to become something else. That is the Government philosophy, articulated by the Minister and unchallenged. He said that we need inequality. A fine definition of where one has inequality is where people are prepared, with little training and considerable bureaucratic regulation, to help out elderly people and other vulnerable groups so that they can live in their own homes with dignity.
For many years, my mother had a wonderful home help. She was a reasonably bright woman, and I obviously did not take after her. She was always intrigued by the number of things that her home help was not allowed to do, such as clean a window, since standing on a chair was not covered by insurance. A succession of prohibitions entertained rather than infuriated my mother.
There was a squeeze on funding after the 2002 election, when the fraud, false promises and gloriously wasteful expenditure of the two previous years were being withdrawn. The Government, in a cynical ploy, having bought the election, dumped the promises. Bureaucrats all over the health services looked to see where it would be easiest to save money after budgets were cut. As always happens in such situations, home helps topped the list, since the service is diffused and its workers usually not organised and with limited labour rights owing to their contracts often being quite peculiar.
For many years, the trades unions took no great interest in the welfare of home helps. If my colleagues and comrades in the movement take exception to that statement, I can give them chapter and verse regarding my area. Being poorly organised and with limited rights, home helps are a terribly easy target. One was giving Mrs. Murphy four hours a week but can now give her only three. If she got six, she will now get only four. The assertion that there were no cutbacks flies in the face of the experience of every politician. Such cutbacks have put enormous numbers of families under stress because they had come to rely on particular services.
The first challenge to the Minister and the Government is to produce the evidence that no cutbacks have taken place. The second challenge is to implement a service that is as flexible as necessary. We should remember that most home helps not only work for five or ten hours per day but are often the first port of call when something goes wrong for the elderly or vulnerable people for whom they care. Most are unable, unlike senior management in the HSE, to tell a person requiring assistance at 7 p.m. that they will see them at 9 a.m. the following morning. It is only the senior managers, who are paid for the responsibility they bear, who can go home at 5 p.m. and stop worrying about the people dependent on such care.
Those who provide day-to-day care, whether nurses, hospital doctors or home helps, do not believe they have some moral right to walk away from the service they provide. That is not how they work. It is a terrible pity that their role is being demeaned by the Government's refusal to accept that their contract of employment should be regulated, recognise the need for that regulation and accept that they should be provided with training.
The claim that there have been no cutbacks cannot be accepted by anybody working in politics, excepting those in the ranks of the Department of Health and Children. This denial of the facts from the Department should come as no surprise because its connection to the realities of life becomes increasingly tenuous as one event after another unfolds. It is regrettable that the Government's amendment is worded in such terms and that it fails to address the genuine problems for those who provide the service in terms of income, training and so on. I support the Fine Gael motion.
John Minihan (Progressive Democrats)
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I welcome the Minister of State and am grateful for the opportunity to contribute to this debate. The Opposition's claim, in the introductory sentence of this motion, that a contribution to society such as that made by home help services could go "unrecognised" is beyond comprehension. Home help provides aid to older people, families in stress and difficulty, those with disabilities, other carers and hepatitis C clients who need assistance. To paraphrase a famous quote, people who do this work are a light to others, doing well and willingly the tasks at hand, namely, being aware of another's needs and doing something about it.
When home help services assist a person to remain in his or her own home and avoid the necessity of entering institutional care, they do both the individual and society a tremendous service. As already mentioned, international research suggests that the life of a person can be extended by up to two years if care is delivered in the home. I, along with he Tánaiste and the Progressive Democrats Party, not only recognise the work of home helps but salute and applaud it.
The substance of the motion deals with the nature of home help contracts, including regulation of hours, training and wages. Following the necessary abolition of the health boards at the start of this year and their replacement by the HSE, responsibility for delivering all former health board services now lies with that body. All HSE service areas, as I am aware from my dealings with the staff in the Cork region, either provide the home help service directly or make arrangements with voluntary organisations to do so. The HSE is not limited in the categories of persons it may assist at home.
The executive is dealing with a challenging and changing scenario. In terms of home help for older people, it is estimated that between 1991 and 2026, there will be a 75% increase in the number of people aged 75 and over. Such demographics provide a challenge for the HSE and home help services. Moreover, people no longer die from the same diseases as in previous generations. Chronic conditions are key causes of illness, disability and death in modern societies. Given medical advances in surgical interventions and pharmaceuticals, Irish people now live longer. However, we often live longer with disabling, chronic conditions. In addition to demographic change, therefore, the HSE and home help services must also take account of the changing nature of illness and, as a result, the nature of care.
The Opposition motion also raises the issue of training. Medical staff and care professionals must work with and care for an 85 year old in different ways than they would a person of 55 years. There are remarkable differences, in needs and responses, just as there are between children and middle aged adults.
This is a composite issue, one that will not be simplified even by the €120 million spent on home help this year. As the Tánaiste sets out, the Government commitment in this area is evident, involving a tenfold increase in funding since 1997. I will not dwell too long on the funding element, except to say that, unsurprisingly, the tenor of the Fine Gael motion is that the Government's commitment to funding and resources is the problem. That is not the reality. There has been a 200% growth in spending on health since 1997. Furthermore, spending by the Department of Social and Family Affairs has increased by 110% in the same period.
John Minihan (Progressive Democrats)
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I mentioned earlier that international research suggests the life of a person can be extended by up to two years if care is delivered in the home. There is another, perhaps more critical, element to this. It is the Government's policy to provide community-based supports to enable people to live in dignity in their own homes and communities, in accordance with their wishes, for as long as possible. It is not just about longer life but improved quality of life.
Revenue funding allocated to services for older people from 1997 to 2004 was €287 million and €15 million has been allocated to the provision of such services for 2005. In Limerick recently, the Tánaiste referred to certain parties who wish to belittle achievements by observing that " there is more to it than good numbers". Denying numbers and the facts of progress in challenging areas does not help. Denying the reality behind the numbers is simply a hindrance.
The National Economic and Social Forum held a plenary session last month to debate its draft report, Care for Older People. That report draws attention to the slow pace of implementation of policy for older people and the shift internationally to more person-centred and home-based responses. Speaking at that session, the Tánaiste observed that as many as 5,000 older people in nursing homes could be cared for in their own homes with appropriate support. We must look at this in terms of life expectancy and life quality issues. Increasing support for older people in the home, including substantial increases in home care packages and availability of home help, are uppermost in the deliberations of the Tánaiste and her Department.
The 2005 OECD Report on Care confirms Ireland's moderate relative spend, as a proportion of GDP, on such services. This aspect is often a focus of Opposition statements. Not for the first time, the nuances of the topic are overlooked or ignored by some.
Policy makers — especially those, such as HSE members, who are responsible for services — face challenges relating to demographics, the changing nature of illness, training issues and so on. The matter is more complex than the Opposition would have us believe. However, we can be sure that due to the current programme, new initiatives and the appointment of the Tánaiste as Minister for Health and Children, these challenges will be resolved. The Tánaiste does not fear hard questions but some people fear difficult decisions.
Sheila Terry (Fine Gael)
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As I presume that Senator Minihan was speaking on behalf of the Office of the Tánaiste and Minister for Health and Children and reflected her intentions on the matter, I am unsure what will remain for the Minister of State, Deputy Tim O'Malley, to say. I disagree with the tenor of the Senators' comments and his assertion that all is rosy in his garden. While I accept that the Minister, Deputy Harney, has been in office for only one year, the Government has had responsibility for this Department for a long time. In terms of responsibility, it is not a question of Ministers but of the Government.
For years, the area of home help services has been neglected. There is no doubt that this service is in a mess due to the lack of funding. I learned that from people who work in that area, including public health nurses in Dublin.
While circumstances may be better in Cork, there is a shortage of home help in Dublin. I have personal experience of the service because my father, who is 93 years old, receives two hours of home help per week and my mother-in-law, who is also 93, has received one hour per week for the past couple of years. Senator Minihan may be proud of that service and believe that it will allow two 93 year-olds to live at home but I disagree. My relatives appreciate the service and are glad of it.
John Minihan (Progressive Democrats)
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That is two hours more than my father receives.
Sheila Terry (Fine Gael)
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Is Senator Minihan's father 93? The problem in terms of not providing this service is that some people remain in hospitals unnecessarily. The Minister, Deputy Harney, has indicated that she wants to provide such a service but the Government has not acted, even though it had sufficient time to do so. That is why beds are being blocked.
Sheila Terry (Fine Gael)
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The Government has had years to provide the service.
Geraldine Feeney (Fianna Fail)
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The Senator would come in with a magic wand.
6:00 pm
Sheila Terry (Fine Gael)
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Many people would be at home if they were given the necessary care. The home help service is an integral part of this care. When services are cut or a home help person is told that no money is available to pay him or her, that person is lost. Usually, people in home help services have low incomes and need money. They cannot hang around if they do not know when they will be re-hired. It was made clear to me by a public health nurse who is familiar with the service that the loss of these valuable people is a significant problem. They have unique skills and not everybody wants to do their jobs. It is essential that they are given a contract so that they can be sure of long-term employment. Nobody should be treated in that way. Once their service is cut, they are lost because they will find more secure employment elsewhere.
Senator Minihan asserted that the situation was complex but it is not. We need to free up beds and while some patients should not be in hospitals because they need nursing home care, others could be cared for at home. The system of primary care in the community must be developed. I appreciate that the Minister, Deputy Harney, and Professor Drumm want to develop that system but we cannot continue to talk about it. Members of the Government should not tell the House that this is their intention as if they are in their first year in office. We are approaching the end of the Government's second term, yet it has not delivered on this matter.
People who work in the home help service need security and their work to be recognised and valued. While this work comes naturally to many, basic training is also needed. I am surprised that we have not been given details of the hours worked by home help carers but I have no doubt that the hours have been cut, which is disgraceful. I want the Minister of State to improve this service and look after the people who provide it.
Geraldine Feeney (Fianna Fail)
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I welcome the Minister of State and second the amendment moved by my colleague, Senator Glynn. I am pleased to have the opportunity to speak to the amendment. The €120 currently being spent represents a 1,000% increase on the £12 million that was spent in 1997. I listened to my good friend, Senator Bannon, with whom I hate to disagree because doing so can give him cause to shout, allege that the Government spins by introducing these matters as new initiatives. Regardless of the side of the Chamber on which one sits, a 1,000% increase is not spin.
Geraldine Feeney (Fianna Fail)
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I am unaware of anybody who does not want elderly family members to be cared for at home. However, sometimes that is not possible. This Government is committed to having the elderly cared for in the community and at home. As Senator Minihan noted, people are living longer and are more independent than they were in the past. They want to stay at home and the onus is on us to provide them with that option. This Government has done more for older people than any other Government in the history of this State.
Geraldine Feeney (Fianna Fail)
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Plenty of evidence exists. Senator Minihan referred to a report of the National Economic and Social Forum. The sub-committee of the forum on which I sit ——
James Bannon (Fine Gael)
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That is all the Senator is about. Sitting on committees, one after another.
Geraldine Feeney (Fianna Fail)
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—— launched that report three weeks ago. I often speak in this House about the work done on that matter. The sub-committee includes no more than three politicians, while lay people who look after the elderly comprise the remainder of its members. Those lay people would say that a lot has been done, acknowledge what has been done and the amount of the funding invested in the services for caring for the elderly, but they and I would also say that a lot more needs to be done.
Senator Minihan alluded to the Tánaiste indicating that there are 5,000 people in the low to medium category of dependencies who, with proper community supports, could be cared for in their own homes instead of in our acute hospitals. That brings me to the various pilots schemes in place. I will mention only one of them, the Slan Abhaile scheme. It is a worthwhile scheme that caters for people like those 5,000 people who can be cared for by their families or in the community. Once they are well they can be moved out of a hospital bed and looked after at home.
On the day the NESF launched its report, the Minister, Deputy Harney, said it is time for new thinking, new policies and new practices on services for our elderly citizens——
Geraldine Feeney (Fianna Fail)
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——and a key priority is supporting people to stay in their own homes and communities and moving away from the practice of placing people in residential care as a first option. The Minister said that currently we do not offer enough support to high dependency patients who want to remain at home. She is determined to change this and expects to see major increases in home care packages as the winter approaches.
I was also glad to hear the Tánaiste state on another occasion that she will examine the area of nursing home subventions. In that context, we are considering the value of €95,000 being placed on a person's home. I do not know what kind of housing one would get for €95,000 when we all know that the price of an average second-hand home in Dublin is approximately €400,000. The Minister, Deputy Harney, and the Minister for Social and Family Affairs, Deputy Brennan, are examining new initiatives to support the elderly in society.
Geraldine Feeney (Fianna Fail)
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It would be remiss of me not to comment on what Senator Browne said about the scandal of the Government's handling of the nursing home charges in respect of those over 70 years of age. He and I sat on the inquiry into that matter carried out by the Oireachtas Joint Committee on Health and Children. He was disingenuous in how he has put across his point. There was a full hearing and the facts were as recorded in the report of that committee. We did not discover a scandal but rather that the position was anything but that. The Minister of State present and the other Ministers in the Department appeared before the committee. They gave their account of the position and the facts, which were debated in this House and were catalogued in the report of that committee. I record that I do not agree with what the Senator said. I do not see where there was a charge in that context.
I have no doubt that when we debate his motion at next week's meeting of the Joint Committee on Health and Children we will all want to ensure that the people who are owed money — we are all on record, including the Chairman who spoke on this subject when it was debated in this Chamber — are paid promptly. I have no doubt the Government is committed to doing that, as it is committed to looking after the elderly in our community in terms of the good initiatives that are coming forward.
Senator Terry said that the Minister has been in Government for not one but for several years. The Government parties have been in office for several years and the good state of the economy is a testament to how the Government has acted. However, improvements cannot happen overnight. Rome was not built in a day. We disbanded the health boards. Senator Bannon was a member of a health board, several other Senators were members of health boards and they saw what was happening. The Health Service Executive has been established and we must give it space and time to be effective. We can see what initiatives it is coming up with and we must be patient. We must let it get on with its work and support it.
James Bannon (Fine Gael)
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On a point of order, the Senator referred to my having been a member of a health board.
Cyprian Brady (Fianna Fail)
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Senator Feeney without interruption.
James Bannon (Fine Gael)
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The health board of which I was a member was controlled by Fianna Fáil.
James Bannon (Fine Gael)
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For the past 20 years all the health boards were controlled by Fianna Fáil.
Geraldine Feeney (Fianna Fail)
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I do consider that health boards were ever controlled by one or other of any of the political parties. Fianna Fáil might have been in the majority——
Geraldine Feeney (Fianna Fail)
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——but I do not believe we ever controlled anything. There is a big difference.
We should not knock Professor Drumm. We should give the Health Service Executive room and time to carry out the good work that it is about to do. We need to be patient. We have 18 months to go to a general election. The Senators opposite will jump up and down plenty of times between now and then but we will wait until we see their manifesto for Government before we start talking about the real policy we all have up our sleeves.
Maurice Cummins (Fine Gael)
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I do not have a problem with the stated policy of the Minister, Deputy Harney, of keeping elderly people at home and providing adequate home help for them to enable them to be cared for outside of nursing homes, a policy with which I am sure everyone would agree. However, the Government's stated policy and practice in this area are different. As the motion states, home help hours have been cutback. That is a fact and we can give examples of such cutbacks throughout the country. Irrespective of what a Minister states, the facts are evident to everybody.
The Government's amendment is the usual type of amendment tabled to such motions citing what has been done between 1997 and 2005 — one would think that the world began in 1997.
Maurice Cummins (Fine Gael)
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Obviously it did. Perhaps for many of the consultants involved in PPARS and other projects——
Camillus Glynn (Fianna Fail)
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Especially for pensioners and the underprivileged. Others talked about what they would do, but we did it.
Maurice Cummins (Fine Gael)
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——it was payback time for them, and perhaps there was a lot more to do in that area.
We have witnessed cutbacks in home help hours. When one hears of the work home helps do, and Senator Glynn outlined that work, one realises they are the unsung heroes in the health service. If one talks to any family member with elderly parents who want to live at home, one hears that those families need a little help from the State. It is only a little help involving a home help working for a few hours a day, if possible. Senator Terry mentioned that her parents have a home help service of two hours and one hour, respectively, per week. This is contrary to what the Minister for Health and Children stated. She wants to see much more home help made available but she also said that while the Government has done a lot it has a lot more to do. How long more will we hear that?
The Government parties have been in power for the past eight years. Over the past 20 years they have been in power for almost more years than we can imagine. We still hear the same old story, cry and cnáimhseáil, that Rome was not built in a day. We heard that again today. Rome would never have been built if this Government had been in power.
Camillus Glynn (Fianna Fail)
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We have built Rome, so to speak, we are now building the rest of the Continent.
Maurice Cummins (Fine Gael)
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What we are seeing is Government by committee and by consultants. We hear all the pious words about the Government's aspirations and we cannot disagree with them, but when the people examine its practice they realise how false those promises are and how false the Government has been in regard to the care of the elderly. There can be no question about that.
The delay in the repayment of nursing home charges was mentioned. Home help is the way forward and cutbacks hit both the home helps and many families and elderly people, who the Government claims it wishes to serve and help. My colleagues have spoken extensively about other areas where the Government has failed. Despite Government claims that it has spent a considerable amount of money, this is one area where it has failed miserably.
Tim O'Malley (Limerick East, Progressive Democrats)
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I wish to begin by thanking Senators for moving this motion and for giving me this opportunity to clarify the issues raised and to make clear my unequivocal belief that the home help service is the cornerstone of public care provision for older people. The aim of the home help service is to enable people to remain at home, where appropriate, who would otherwise need to be cared for in residential care. It is an essential support to family and informal carers. Home helps form part of a wider community team and the Government is deeply aware of the important role that this service plays in supporting older people, in particular, to remain in their own homes for as long as possible.
I would also like to take the opportunity afforded by the motion to acknowledge the hard work and the commitment of carers in the home and in the voluntary sector and to say that we are making every effort to support them as much as possible. I also wish to acknowledge the valuable service provided by home helps themselves. In no way is their work unrecognised by Government — in fact there have been significant developments in the service over recent years including a major initiative to regularise the employment conditions of persons providing home help services. In a short period of time, the service has evolved from family members or neighbours providing support on a voluntary basis to today's situation where home helps, as employees, have the same statutory rights as other workers.
Home help comprises a range of services which may be provided to a single individual or to a household, including household and domestic support and emotional and personal care issues. Home helps provide a continuum of such support to clients, particularly as clients' needs change over a period of time. By its nature, it is a flexible service which responds to clients' needs and it is targeted at people who have been assessed as having high and medium dependency. As a result, the level of service required in individual cases will fluctuate from time to time. There must, of course, also be effective prioritisation within the service. Assessments are undertaken at local level and are carried out predominantly by the public health nursing service or by the voluntary service provider where arrangements have been made for the service to be provided through voluntary providers.
Most of us would prefer to remain living at home when we get older rather than going into long-stay care. No less than 28% of residents in long-stay beds are in the low to medium categories. This represents over 5,000 people and it is difficult to believe that many of these could not have been cared for at home if the right level of supports were in place. Clearly, long-term residential care will always be required in the health system but such places should be more appropriately allocated to patients with a higher dependency who can no longer be cared for in their own homes and communities. It goes without saying that community supports are needed if older people are to remain in their own homes or within their own community for as long as possible.
Internationally, other countries are putting in place community supports which give older people more control over the services delivered to them. Indeed, the experience is that families do not reduce their care-giving but rather maintain it if they see that there is some support for their more dependent relatives. The result of this in other countries is that residential care generally is not increasing and in some countries is reducing because of better home supports. It appears that we are short of the norm for home care provisions by OECD standards while we appear to be at the average for residential care. This is completely the wrong balance and must be changed. Given that people want to remain in their own homes, it is heartening to note the research that states that those who do so live on average two years longer.
Demand for home help services is increasing and this is attributable to a number of factors. One factor is demographic — our aging profile, although this is less acute than many of our European neighbours. In Ireland, our age profile means that approximately 6,000 additional people come into the over-65 bracket every year and there has been a proportionately higher percentage increase in the more dependent over-80 category.
Currently in Ireland, I believe that we can do even more to offer support to high dependency patients who want to remain at home. The Government is committed to developing the various community and home support schemes so that people and their families have a viable alternative to long-term residential care. There is no doubt that these supports will give people greater control over their own lives and will allow families to continue with their care. The Government is working to ensure that residential care should not necessarily be the first option when people need long-term care.
In a broader context, the Government is very conscious of the changing demographic profile of our population, with more people living longer lives and the consequential greater demand for services, both community-based and residential. The Mercer report on the future financing of long-term care in Ireland, which was commissioned by the Department of Social and Family Affairs, examined all issues surrounding the financing of long-term care.
Following on the publication of this report in 2003, a working group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established. The objective of this group is to identify the policy options for a financially sustainable system of long-term care for older people, including respite care, taking account of the Mercer report, the views of the consultation that was undertaken on that report and the review of the nursing home subvention scheme. This group will shortly report to the Tánaiste and Minister for Health and Children and the Minister for Social and Family Affairs.
Additional funding of €5 million was made available in the 2005 Estimates for the home help service. In September 2005, an additional €6.6 million was allocated to target services for older persons and in particular, to address the priority needs across the country with regard to home helps, bringing the total budget to approximately €120 million in 2005. This figure should be compared with the figure of £12 million, which is approximately €15 million, which was allocated to this service in 1997.
This level of funding shows the Government's commitment to the thinking and policies I set out earlier. However, we must continue to build on what we have achieved so far. We must continue and accelerate our investment in this key service if we are to meet people's real desire to stay in their own homes.
There is concern among carers generally that home help hours should not be reduced and it is clear that Senators share these concerns. I fully agree with this view, as does the Tánaiste and Government, and this concern has been made clear to the Health Service Executive. However, increased demand for the service may necessitate some minor adjustments in the provision of the home help service. Basically, this means that although a small percentage of clients may have the number of hours of home help which they receive reduced, this is counterbalanced by others receiving the service for the first time. Such decisions are made on the basis of need. In 2005, it is anticipated that around 7.5 million hours of home help services will be provided to the elderly with a further 1.5 million hours being provided for people in the disability sector and others. Funding has been provided by the Government to the Health Service Executive for this purpose. There will be no cutbacks in the hours committed to the home help programme this year.
The Government proposes to extend home based services through the introduction of home help packages. The home help system was introduced as a way of supplementing good neighbourliness and has now become a formalised support method. In general, it is provided between the hours of 9 a.m. and 5 p.m., five days a week, although there are exceptions. However, the care which people require is not limited to those hours. It is proposed that home care packages would run in conjunction with home help. Home help forms part of the home care package. It must be much more flexible and less prescriptive and capable of dealing with people late at night, overnight and at weekends, if required. If a disabled or elderly person is not capable of cooking meals, dressing himself or herself or putting himself or herself to bed, our home help and home care package must be able to facilitate support to do these things in the home.
Crucial to the effectiveness of the home help service is the staff concerned — the home helps themselves. In line with increases in investment in services in recent years, major progress has been made in enhancing the terms and conditions of employment of home helps who are employed in the health service. A collective agreement was finalised in August 2000 between the health service employers and the trade unions. This part-time home helps agreement represented a significant step in regularising the employment status of home help personnel employed by the former health boards and it is worthwhile setting out some of its components.
These included a commitment from both sides to the reorganisation and restructuring of the home help service. It noted that home helps would provide a continuum of care for clients, particularly as clients' needs change over a period. It proposed that an assessment of needs be conducted for each client, part of which would include the number of hours of home help service which would be provided to the client. This would be subject to regular review and monitoring. The agreement also noted that flexibility of service provision by home helps would be maintained. Under this national level agreement people working as home helps benefited from substantial pay increases and benefits.
The agreement regularised the pay and conditions of home helps in terms of pay, annual leave, premium pay and travel expenses. It recommended that contracts of employment be agreed between the parties and that guidelines be drawn up on the standardisation of working hours. Arising from the agreement, as and from 1 January 2001, home helps were transferred to the same pay scale which applied to non-nursing staff at that time. During the course of this process, an assimilation exercise was also agreed, which granted incremental credit to home helps, thus recognising previous service. That is not to say there are no outstanding implementation issues. However, all such issues, for example, contracts of employment, continuity of working hours and superannuation continue to be discussed between management and trade unions in accordance with normal industrial relations processes. I stress that, in overall terms, significant progress and enhancement of the terms and conditions of home helps are evident since the August 2000 agreement.
Since 2000, home helps have been included in collective agreements which apply to non-nursing support staff. Senators will be aware of the work of the public service benchmarking body, PSBB, which was established to carry out a detailed examination into jobs, pay and conditions of public servants and compared them with jobs of equal size in private sector. In tandem with this process the PSBB established a parallel process for craftworkers and non-nursing personnel, which included home helps. This is called the parallel benchmarking process.
The resulting agreement between health service employers and the trade unions — SIPTU, IMPACT and ATGWU — in regard to the support, formerly non-nursing, staff employed in the health services became known as "Recognising and Respecting the Role". This is a framework agreement for support staff in the health services which aims to contribute to the ongoing development of support staff and the services which they are responsible for providing. It sets down the modernisation and change required in the service, the achievement of which would result in pay increases for personnel.
The parallel benchmarking agreement which was concluded in late 2003 provided for three phases of pay increases to eligible personnel, including home helps as follows: phase 1, 25% from 1 December 2001; phase 2, 50% from 1 January 2004; and phase 3, 25% from 1 June 2005. Payment of the first phase in the form of a lump sum of €2000 to each whole time equivalent, or pro-rata thereof, was sanctioned for payment by the end of December 2003. This was an up-front payment.
As well as pay increases under the parallel benchmarking agreement, non nursing personnel have also benefited from the following general pay increases under Sustaining Progress and the mid term review of Part Two of Sustaining Progress: 3% from 1 January 2004, 2% from 1 July 2004, 2% from 1 December 2004 and 1.5% on 1 June 2005. Further increases of 1.5% and 2.5% fall due for consideration with effect from 1 December 2005 and 1 June 2006 respectively. Sanction to payment of all these pay increases is subject to health service performance verification group being satisfied that the employees have complied with the modernisation and change agenda for the health sector.
Under the parallel benchmarking agreement, with effect from last June pay structures were streamlined; more than 25,000 support staff, including home helps, were placed within four bands for pay purposes, a reduction from the 11 bands which had applied heretofore. Recognising and Respecting the Role also contained specific provisions on the training and development of support staff. A discrete fund of €60 million is to be spent over the five years period 2004 to 2008 on training and development and thereafter a fund of €12 million per annum is to be provided. This underlines the commitment of the Government to address the on-going training and development needs of support staff. This training is being implemented through the SKILL project, an acronym for securing knowledge intra, within, lifelong learning.
The SKlLL project is a unique training initiative which is designed to address the needs and aspirations of support staff in the health service, including home helps. Its mission statement is, "To educate, develop and train support staff in the health services to the optimum of their abilities, in order to enhance their role in the quality of service to patients". The overall objective of the SKILL project is to allow individuals to undertake a programme of training, development and education. Participants in this programme will be enabled to progress through a predetermined structured framework encompassing personal and career development, training and educational opportunities. In this way, participants will be able to acquire new knowledge and skills, and will also receive recognition for their achievement, by way of accumulating credits and accreditation of prior learning, right through to the achievement of higher level academic vocational qualifications. The training and development needs of support staff, including home helps, will be identified through consultation with all stakeholders and in particular with each category of support staff, managers and users of the service.
The SKILL. project has the following twin objectives: first, to provide opportunities for support staff in the health services to acquire the skills and knowledge necessary to enable them provide excellent levels of service in the health services, and to provide support staff with the ability and confidence to adapt to the changing environment of the health services and, second, to provide an integrated framework within which support staff in the health services can pursue personal and career development. It is envisaged that the structured framework which has been designed for the SKILL project will be supervised and monitored by a recognised college and-or learning and education accreditation organisations. In other words, the training, development and education programmes provided to participants in the project will be required to comply with the standards set by the accreditation body. The overall SKILL. project will be divided into a number of work packages to develop and deliver programmes to specific groups of support staff, for example, the creation of a programme specifically geared towards the needs of home helps.
The HSE has confirmed this evening that the amount of hours delivered by the home help service will not be cut. The Department of Health and Children is in consultation with the HSE to get full and accurate figures on the number of hours delivered by this service in recent years. It is hoped that all this information will be collated within the Department shortly and will be published. The full-time salary for those involved in home help is approximately €27,000. Part-time workers are paid on a pro rata basis.
I appreciate that the motion is important both to those involved in home help and to the people who use their services. I am very conscious of the changing demographic profile of our population. More of us are living longer with a consequential greater demand for services. Significant developments in the home help service have taken place in recent years including a major initiative to regularise the employment conditions of persons providing home help services. In a short period of time the service has evolved from family members and neighbours providing support on a voluntary basis to today's situation where home-helpers, as employees, have the same statutory rights as other workers.
The Government is determined to continue its focus on supporting care in the community for older people. The home help service is a fundamental part of this support. I acknowledge that we do not have a perfect system and that more work needs to be done if we are to give people a real choice. We are targeting those most in need while also ensuring that the home help service is available to as many people as possible. There is, therefore, a continuing need for prioritisation within the home help service. I again stress that the Government is absolutely committed to the further development of the home help service. The very substantial increase in funding over the past eight years shows that commitment in concrete terms. For my part, I will continue to work assiduously towards ensuring that the service is improved and that older people can retain their independence and their place in the wider community.
Michael McCarthy (Labour)
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I support the motion and welcome that we are debating an extremely important issue. I do not believe there is anybody who cannot attest to the wonderful service provided by many people to many homes throughout the country. The service has been developed in recent years and thankfully our economy is now sufficiently buoyant to allow us to do so. It began with the helpers being paid a pittance. The service was relatively new and money was needed for other areas in the health system. Thankfully in recent times we have seen the conditions and levels of remuneration improve. Accordingly, there is a higher rate of dependence on the service on the part of those who wish to remain in their communities for as long as possible and who are not as reliant on hospital care as others are.
It is important to make sure that the person receiving the service as the single most important individual represents the cornerstone of policy in this area. We need to ensure the standards, under which those who provide the care operate, are beyond reproach. We also need to ensure that those conditions of employment are conducive to providing a very good service and encourage people to become involved in the area.
On the question of ongoing training and development, step down services are in great demand. There is a double whammy here. If we can provide the type of support that is necessary for people to remain in their communities it is equally important to have a sufficient level of expertise for those providing the service. For instance, I know many people who have completed courses and obtained certificates in dealing with patients with Alzheimer's disease. It is important to invest in such education so that people can learn the various skills although not on a full-time basis as we have sufficient medical personnel in that regard. It is also important that those providing a service in that area have some level of knowledge and expertise. We have seen an increase in the courses available, which improves the standard of service. There are immense benefits to those who can acquire such skill and knowledge. There is also a certain amount of fulfilment in terms of the commitment those providing the home help service have to the people availing of it. It is critical to ensure that the standard of excellence exists at all times. It is therefore critical to invest in training and ongoing development of those providing the service.
The support can be monitored on various levels. There is a huge element of emotional support for people. Someone calling on a daily basis provides companionship. Too often we can forget the loneliness of those living on their own, who by and large have fended for themselves throughout their lives but are now getting on in years and have become more reliant on others for various reasons. We cannot underestimate the level of emotional support given to these people in terms of companionship to provide an ear and be there for somebody. Occasionally we overlook that very important part of the service.
I refer to the conditions under which people work. A relative of mine who worked in the service in the 1990s did so for a pittance. The Department has a much bigger budget and we have more money in the economy allowing us to provide these services. I am very glad that the level of remuneration is equated to that of a care attendant in a hospital.
Approximately two years ago budgetary constraints resulted in a reduction in the number of hours some people provided. Even when overall cutbacks in services need to be made, we cannot afford to reduce the level of home help service. We are sufficiently well covered. If overall expenditure needs to be reduced, I plead with the Minister of State to consider other areas. Vulnerable people are availing of a service and people provide a service for what in real terms is not a huge amount of money. If cutbacks need to be made this particular area should not be attacked. I recall a case of a person who was provided with care in the aftermath of having been widowed. The person had a child with a disability and the task of minding the child was particularly tough and harrowing in their new circumstances. The home help hours were reduced by approximately two hours per week. While this might not seem very much, it was a large amount of time for the person concerned and caused some trauma.
I have spoken before about care attendants in hospitals. It is critical that contracts of employment and conditions of employment given in other areas of the health service are given to home-helpers. While this occupation is registered and viewed as a stand-alone role, it should be linked in terms of conditions, including rates, hours, overtime, bonuses and all the other benefits applying to hospital posts.
I am glad to support the motion. While as we approach a general election, I presume cutbacks will not be made, if cuts ever need to be made I appeal to the Minister of State that this area should not be considered for a reduction in expenditure. It is a critical area providing an enormous service to the community. It is saving the State considerable money. If many of these people needed to go to hospital the demand on the Exchequer would be far greater.
Ann Ormonde (Fianna Fail)
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I welcome the Minister of State to the House and I welcome his report on the home help service and its importance to the wider community. I acknowledge that we are living in different times with changes in the demographic profile of the country and with people living longer. It is natural to study this subject to see how best to enhance the quality of life of the elderly population in the community.
Two weeks ago I chaired the annual general meeting of the Institute of Community Health Nurses, which represents public health nurses, which was held in Portlaoise. The main discussion centred on the necessity of a team approach. The Government is very committed to this project with an increase in funding from €12 million in 1997 to €120 million. This acknowledges and reflects the importance of the home help service to the community and the enhanced quality of life it provides to the elderly. In order to create the service and make it a substantial structure, the Minister of State has highlighted the importance of creating a proper training structure for home helps with proper conditions of employment. It is important there be no going back on this commitment.
The home help service is greatly in demand. It is a local service and home helps perform all the necessary duties associated with the care of the elderly. They can inform the elderly person of the local news and bring enjoyment to people in their latter years.
The service is not sufficiently publicised. The home help structure in some former health board areas seems to be flimsy, a fact acknowledged by the Minister of State when he referred to areas which need improvement. The service is a core area of health care and is acknowledged by the public health nurses as being a system of back-up support for their service. Elderly people do not always require nursing or medical care but they need a local person who knows them well and can judge when the elderly person requires a nurse or a doctor's care. This is a necessary network. If the system is implemented correctly now it will have a positive effect in the future by helping to keep people out of hospital or residential care and so freeing up such facilities for those who need it and also reducing the cost of residential care.
I commend the amendment as it is a subject which deserves discussion. It must be acknowledged that the service needs to be upgraded and provided with a structure. I suggest the service should be publicised more. I would not know how to go about asking for a home help if I needed one.
The Government has shown its commitment to the service and the money is being put into it. The Minister of State has said he will do more but I urge him to publicise the service and get value out of it. He is doing a lot of work and this should be acknowledged. There is no point talking in this House while nobody outside is aware of what has been said on the subject. I am with the Minister of State in this positive work and I will publicise it.
I am aware of the new skills which the Minister of State has decided are necessary and that he has benchmarked a structure. Many people would be happy to undertake this work given the conditions of employment which are proposed and given that it is work within their locality. They would be happy to provide a community service and be paid accordingly. This is a good report and I urge the Minister of State to work to improve it.
Paul Bradford (Fine Gael)
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I suspect the Minister of State, Deputy Tim O'Malley, will definitely support Senator Ormonde in the next Seanad election because that was a strong plea. We all know that child care will be one of the big issues in the next general election and the political parties are currently putting forward their views on this issue. It is an important matter which needs to be addressed. However, the same degree of political thought, attention and priority must be applied to the question of the care of the elderly. The demographic statistics are known and it must be acknowledged that care of the elderly will continue to be a significant problem. The political debate during the past five or six months has centred on the question of nursing home subventions and on where the responsibility lies in respect of nursing home charges and the repayment of moneys.
A fresh approach should be adopted towards the expansion of the home help service. The Government Members will not be supporting the motion but it has put the issue of home help on the Leinster House political agenda. Proper attention should be directed towards two aspects of the care of the elderly, the home help service and the carer's allowance. Maximum results can be obtained from minimal investment.
The Minister of State stated that €120 million is being invested and this is to be welcomed. However, if I was a cynical person I could say that was the sort of money which the Minister for Communications, Marine and Natural Resources, Deputy Noel Dempsey, last week regarded as a drop in the ocean. I hope more funding can be set aside for this programme.
A national debate on the care of the elderly is required. It must be re-emphasised that the care of the elderly should not be simply regarded as having a nursing home solution. Our aim must be to ensure that the maximum possible number of elderly people are enabled to remain in their homes and in their communities. The home help scheme and the carer's allowance scheme have been expanded and developed to a certain extent but they must receive a higher priority.
Senator Bannon raised the issue of proper contracts of employment, the regulation of working hours and the provision of adequate training for home helps. Members of the House will be familiar with the outstanding and sometimes almost hidden work done by the home helps in their own localities. Without the home help service and the carer's allowance scheme, the current long queues for geriatric and long stay beds would be even longer.
I urge the Minister of State to tackle the question of extra beds in district and geriatric hospitals. I hope it is not his intention to regard the care of the elderly as a one piece jigsaw; there are many pieces in the jigsaw, such as community and social housing and Respond housing. It is a problem with many types of solutions. The home help service has been underfunded and underrated and has never received the political attention it deserves. We are beginning to see the benefits of funding this programme more positively and more fully. In so far as the Department has been able to bring about some improvements and invest additional resources, I welcome that, but it is a question of a little bit done and a lot more to do.
In every Government statement we listen to, or endure, every figure is compared with 1997. In Cambodia, when Pol Pot took over, the year of his accession became known as year zero. Our year zero is 1997. When the Minister of State reminds us of what has been done since 1997, we reflect on the fact that he and all his political colleagues have been in office since then, which is eight long years. There has been plenty of time to make progress and while I acknowledge that a certain amount has been made, many opportunities have also been missed.
The issues of care for the elderly, home help and the carer's allowance are important. I am sorry for referring to the carer's allowance so often during a debate on home help but it is a central part of the programme for caring for the elderly. Flexibility was introduced into the carer's allowance system which has worked very well. We also need the maximum flexibility for the home help system, with regard to who can qualify to carry out the work, who is eligible for home help and so on. We need only to reflect on the cost of keeping a person in a district or geriatric hospital, which is at least €1000 per week and acknowledge that, for a tiny fraction of that cost, many people would be much more comfortable and content in their own homes, among their families, friends and communities. That is why issues such as the home help service must be kept at the top of our agenda.
A debate on child care is being embarked upon by all the political parties, following which a conclusion and unanimity may be reached. I hope that we devote the same political attention to the issue of care of the elderly and that we will put the structures in place that elderly people not only demand, but deserve. The Minister of State cannot but agree that everything sought by Senator Bannon and members on this side of the House, that is, our demands on behalf of the elderly, are reasonable and modest. I hope the Minister of State can respond appropriately and ensure that the improved financial standing of our country will result in an improved level of care for our elderly.
Terry Leyden (Fianna Fail)
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I welcome the Minister of State to the House and wish him well in his ministry. I was in the Department for some time in the past and I must compliment the Minister of State for the work he is doing there. I also welcome the former Senator, Mr. Jim Ruttle, his son Robert and several visitors from the United States of America. Mr. Ruttle had a very distinguished career in Seanad Éireann and it is nice to see him here today.
Eight golden years describes the last eight years of Fianna Fáil rule.
Terry Leyden (Fianna Fail)
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I am surprised at the motion tabled by Senator Bannon. I do not know if the Minister of State has read the motion or has been briefed on it, but it calls on the Minister for Health and Children "to regulate their contracts of employment" and to "recognise the need for the regulation of their working hours and pay scale, under partnership agreements..." Am I missing something? I have documents here that outline the home help rights and entitlements, that is, the home help rights and entitlements part-time workers collective agreement 1992, the home help agreement 2000 and the contract of employment 2004. These rights and entitlements were introduced, all items are listed, the conditions are attached, so from where is Senator Bannon coming? These documents detail the various rates of pay and travel allowances, all of which were negotiated and agreed.
I know that Senator Bannon has lost his way but it is a very poor day when this is the only motion that could be laid before this House this evening.
Paul Bradford (Fine Gael)
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That is an unfair comment. Any debate on services for the elderly in this House is not a waste of time.
Terry Leyden (Fianna Fail)
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The motion urges the Minister to regulate the contract of employment for home helpers. It is already regulated in a very positive way. When Fine Gael was last in Government, it paid home help staff £1 per hour. That was under the last coalition Government and is a fact.
Terry Leyden (Fianna Fail)
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That Government relied totally on the goodwill of the beneficiaries of the services of home help staff. When I was a member of the Western Health Board, the then Chairman, Dr. Rice, campaigned ——
Paul Bradford (Fine Gael)
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That was before the former Minister for Health and Children, Deputy Martin, sacked the Senator.
Terry Leyden (Fianna Fail)
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I would like some protection from the Chair because I need——
Terry Leyden (Fianna Fail)
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I remember at that time Dr. Rice embarked on a campaign, backed by Fianna Fáil, to increase the home help allowances and to give workers proper pay and conditions. That was achieved under a Fianna Fáil Administration.
Maurice Cummins (Fine Gael)
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It could not have been £1 then, as the Senator argued earlier.
Terry Leyden (Fianna Fail)
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In 1997, the last time that Fine Gael was in Government, £12 million was provided for home helps. This Government is now providing €120 million per annum. Does that not say everything? How could any Opposition party highlight its own deficiencies in this way? I cannot believe it. Why score an own goal at this point? It has highlighted the fact that it provided £12 million in 1997. Can the Leas-Chathaoirleach help me with a query — was that the last time that the eainbow coalition was in Government?
Paddy Burke (Fine Gael)
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I can help you, Senator Leyden, by telling you that your time has elapsed.
Terry Leyden (Fianna Fail)
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I am not accusing the Chair of being biased in any way but the point ——
James Bannon (Fine Gael)
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Senator Leyden is spinning it again. He is the Roscommon spinner.
Terry Leyden (Fianna Fail)
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If I was not hitting home so hard, my time might be extended.
Terry Leyden (Fianna Fail)
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Given the circumstances, I will conclude on this note — £12 million in 1997 and €120 million in 2005. That speaks volumes.
7:00 pm
James Bannon (Fine Gael)
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I thank the Minister for State for listening to this debate and compliment the Senators who made contributions to it, particularly those from this side of the House.
Instead of tabling an amendment to the motion, it would have been better for the Government to apologise to the public for wasting public funding. We have learned in the last week that the Government wasted €3 million on a website that never got off the ground. It wasted €150 million on the PPARs episode, which involved paying off consultants and so forth. We also heard the Minister for Communications, Marine and Natural Resources, Deputy Noel Dempsey, dismissing the sum of €150 million as a drop in the ocean in the context of the health budget. The money that was wasted by the Government would provide a large number of services for the elderly. We could be talking about a state-of-the-art home help service today were it not for the fact that the Government wasted so much money on consultants. Shame on the Government for that.
I am very annoyed and a large number of people who visited my office last weekend were disgusted at the manner in which the Government wasted this money and at the comments of Deputy Dempsey, when he argued that the money only represented 1% of spending on health. That money would have enabled us to provide care for our handicapped, respite for infirm people in their homes and other such services.
We have heard a lot of spin from the Government today and indeed, the Minister of State only added to it. Senator Feeney talked about nursing home subventions but I wish to point out that the subvention has not been increased in the last ten years.
James Bannon (Fine Gael)
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Another area, raised by Senator Glynn, who is commenting now ——
Camillus Glynn (Fianna Fail)
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That is not correct. The Senator does not have a notion of what he is talking about.
James Bannon (Fine Gael)
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Senator Glynn marched in Mullingar with me in protest at the Government's neglect of health services in the midlands ——
James Bannon (Fine Gael)
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Senator Glynn marched with me in Mullingar ——
Camillus Glynn (Fianna Fail)
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I had to give the march some semblance of respectability.
James Bannon (Fine Gael)
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He marched in protest at the Government's ——
Mary O'Rourke (Fianna Fail)
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I thought this debate was about child care, or rather, home help.
James Bannon (Fine Gael)
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Senator Leyden, in the last few minutes, insulted the elderly and home help and he should withdraw that insult.
Terry Leyden (Fianna Fail)
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It was Fine Gael I was insulting, not the elderly.
James Bannon (Fine Gael)
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The Minister failed to supply accurate figures despite promising to do so. Last July, the Tánaiste promised she would clarify the figures. When the Fine Gael spokesman, Deputy Twomey, pointed out that 2 million hours of home help were cut, the Minister said it was incorrect. However, she has failed to clarify the position in this regard.
I would like to compliment the voluntary sector on its huge input into caring for the elderly. Some home helps work very unsociable hours to deliver a service for a pittance. Community support must be enhanced. The Minister of State spoke about community support abroad and the services being provided for the elderly. He said that in some countries admissions to hospital are being reduced because of better home support. He acknowledge the neglect of the Government in this area. All the evidence suggests that home help hours have been slashed throughout the country. There has been more cover-up today by the Government in regard to the inaction on services for the elderly.
The Minister of State referred in his statement to minor adjustments. Minor adjustments to me mean cuts in services, which was admitted today.
Terry Leyden (Fianna Fail)
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The Senator's party was paying £1 an hour.
James Bannon (Fine Gael)
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The Minister of State spoke about the agreement with the unions, etc., but it has not been implemented. Agreements made with the unions have been reneged on. I know from members of unions that they are not happy with what staff who work in home help are paid.
Terry Leyden (Fianna Fail)
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The Senator's party paid them £1 an hour.
James Bannon (Fine Gael)
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It is shameful treatment. I hope, on behalf of carers, the elderly, the sick and the handicapped throughout the country that the Minister of State will take note of what has been said today and implement the policies outlined in the interests of the elderly and home helps. I am calling on the Minister of State to do so or he will not survive the next general election.
Amendment put.
The Dail Divided:
For the motion: 27 (Cyprian Brady, Michael Brennan, Peter Callanan, Brendan Daly, John Dardis, Timmy Dooley, Geraldine Feeney, Liam Fitzgerald, Camillus Glynn, Brendan Kenneally, Tony Kett, Terry Leyden, Don Lydon, Marc MacSharry, Martin Mansergh, John Minihan, Tom Morrissey, Pat Moylan, Labhrás Ó Murchú, Francis O'Brien, Mary O'Rourke, Ann Ormonde, Kieran Phelan, Eamon Scanlon, Jim Walsh, Mary White, Diarmuid Wilson)
Against the motion: 18 (James Bannon, Paul Bradford, Fergal Browne, Paul Coghlan, Noel Coonan, Maurice Cummins, Frank Feighan, Michael Finucane, Brian Hayes, Michael McCarthy, Joe McHugh, David Norris, Joe O'Toole, John Paul Phelan, Shane Ross, Brendan Ryan, Sheila Terry, Joanna Tuffy)
Tellers: Tá, Senators Minihan and Moylan; Níl, Senators Bannon and Cummins.
Amendment declared carried.
Paddy Burke (Fine Gael)
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I welcome former councillor and Senator, Jim Ruttle, to the House. When is it proposed to sit again?
Mary O'Rourke (Fianna Fail)
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At 10.30 a.m. tomorrow. The hour long debate on the sad death in Monaghan will be taken at 1.30 p.m. tomorrow following the conclusion of the agriculture debate.