Trevor Ó Clochartaigh (Sinn Fein)
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Cuirim fáilte roimh an Aire Stáit.

Tá mé thar a bheith buíoch di as teacht isteach agus tá mé an-sásta gur ise atá anseo chun an cheist seo a fhreagairt mar tá a fhios agam go bhfuil an-suim aici san ábhar seo. Mar is eol di, tá Bille dhá chur ag Sinn Féin os comhair an Tí eile an tseachtain seo maidir le cúramóirí baile agus na ciorruithe atá á dhéanamh; tá thart ar 1 milliún uair a chloig tarraingthe amach as an gcóras sin le 12 mhí anuas.

I am grateful that the Minister of State is here and acknowledge that she has a particular interest in this issue. Probably the best way for me to highlight the issue is to tell the Minister of State of a case brought to my attention. It involves a 92 year old woman in County Galway who is dependent on three carers in her home. Unfortunately, she is not fully compos mentis. She has a difficulty with memory loss. She gets confused about what is happening around her and so on. She is dependent on the three carers, two of whom are not with the HSE but the third is a HSE carer. Her relatives tried to put in place a system such that they could keep track of whether she had been to the bathroom, whether she had had a bath, what tablets she had taken, etc. They put in place a log book in the house such that each of the carers could make notes about what exactly had been done with the lady and what the position was when they were handing over. This appears to be fine in the case of the two non-HSE carers but it has been an issue with the HSE carer. It may simply be a blip in the system or it may be a HSE West scenario.

I have been told that this was brought to the attention of the HSE authorities. Apparently, the superintendents in charge said that the only thing that the HSE carer was obliged to do was sign a timesheet indicating the time of arrival and departure and that the carer was under no obligation to fill in any log book or record detailing the medication given, whether the person had been to the bathroom, whether she had been washed, whether there had been any incidents during the day and so on. The family are concerned because they are not in a position to be with the lady full time and they are dependent on what the carers say to them. She is getting on in years and it is important that they know whether she is being fed and so on.

Is this is HSE policy nationally? If so, can anything be done about it? It seems to raise serious questions about the continuity of care in such a setting. It is not necessarily anything to do with the cutbacks in the home care packages. One imagines it is more a procedural issue. I would be grateful if the Minister of State could provide clarification on the issue. It is a personal issue and a serious one. This incident and the personal situation may be the best way to highlight what we are trying to ascertain.

Kathleen Lynch (Cork North Central, Labour)
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This issue may become more prevalent as time goes on. It provides me with an opportunity to update the House on the matter. Government policy relating to older people is based on supporting people to live in dignity and independence in their own homes and communities for as long as possible. It is widely acknowledged that the home help service is one of the key services in community care. The service is flexible, allowing it to be targeted at those in most need. The service primarily includes the provision of personal care and essential domestic support, mainly for older people. The level of service provided depends on resources available and is provided, depending on local arrangements, by HSE staff or through the use of private or voluntary organisations.

In 2011, there were 3,273,000 home help hours provided to approximately 13,550 clients in the HSE West region. Some 2,300 clients were in receipt of a home care package at the end of 2011. At the end of August 2012, approximately 2,140,000 home help hours were provided for clients in the HSE West region. The number of people in receipt of home help services in the HSE West region at the end of August was 13,365. The vast majority of clients in receipt of services were older persons. I realise I am not answering any of the questions put by the Senator, but it is worth pointing out that the service is not only for older people but for people with disabilities and those with mental health issues. Sometimes families experiencing social difficulties receive such support as well.

There is ongoing monitoring, mainly done through the public health nursing service and by the home help co-ordinators in each area.

As part of the process of ensuring high standards of care, all home-help staff receive training in lifting and manual handling, health and safety, personal care and infection control. All home helps undergo a Garda vetting process.

On indirectly provided services, all organisations are required to sign a service level agreement with the HSE setting out standards of service expected of providers as well as monitoring arrangements, staff training and Garda vetting. The executive also provides, either directly or indirectly through voluntary or private organisations, home care packages. A home care package provides an enhanced level of community services and supports above the normal levels available from mainstream community services. These packages do not replace existing services. At end-August in HSE West, approximately 2,370 persons were in receipt of a home care package.

Following a national procurement process concluded earlier this year, approved external providers of home care packages must meet certain criteria, including requirements on quality, safety and monitoring. This procurement process is part of continuing efforts by the HSE to improve its standards overall for home care. The Government is committed to developing and implementing national standards for home support services, which will be subject to inspection by the Health Information and Quality Authority. Primary legislation and resources will be required for the introduction of a statutory regulation system for home care services. The question of possible changes to legislation, including regulation and inspection, for home care services for older persons is under consideration in the context of the need to prioritise legislation for the areas of children and disability. I trust the House will agree that we need to ensure that the highest standard of care will continue to be provided to all in a safe and secure environment. Providing quality and safe care will always remain at the heart of any service provision.

I am not certain that any of that answers the Senator's question but I have taken a note of the matter. He can understand that I would not have that level of detail and it is not right that I should have that level of details. Sometimes to have that sort of detail floating around may not be good. However, I will inquire and find out. Clearly, being able to have that handover is important. As he stated, whether there was an incident, whether the person has a cold or a temperature, or whether the person's behaviour has changed, is vitally important in terms of the person's ability to continue living in his or her own community.

Trevor Ó Clochartaigh (Sinn Fein)
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I appreciate the answer. I appreciate that perhaps I was not specific enough in the question on monitoring but the Minister of State will appreciate that it is the handover and the monitoring between carers even on a daily basis that we were looking at. I appreciate that the Minister of State will come back to me on it. I note that she spoke about implementing national standards for home support services. The suggestion might be that, when that is being looked at on a daily routine basis, part of those national standards for home support include that if there is a change in the person who is giving the care, be that because of a change of shift or whatever, part of the handover includes the handing over of notes. Apparently, it was not a one-off. The person who brought this to my attention is a reasonable person and it was happening on a continual basis, and only with a HSE employee in that scenario. If there are guidelines in place, they might need to be looked at before something serious happens. Gabhaim míle buíochas leis an Aire Stáit.

Kathleen Lynch (Cork North Central, Labour)
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There was much criticism last year about the fact that home-based services were not being inspected by HIQA. We had a choice and had to prioritise. Clearly, with all the different reports, children had to come first, and then disability services in an institutional setting. The third on that list are the home-based services, not only for older persons. When HIQA sits down to put in place the compliance standards that will be necessary in order to get a licence from it, we will see all of that and those matters will be brought to HIQA's attention.

HIQA recently completed the standards on disabilities and it will be commencing those inspections on 1 July next. We will move on from there. It takes a little time because sometimes when one puts the standards on paper and one goes out to public consultation, there are matters that people would feel were a greater priority, such as quality of life. All of that will be taken into account.

I will find out whether there is a specific bar to somebody doing that as opposed to whether he or she is asked to do it.