Wednesday, 29 May 2013
Home Help Service Provision
I welcome the Minister of State, Deputy Alex White. The first matter is in the name of Senator John Kelly. Senator Denis O'Donovan has tabled a similar matter and the Senators have agreed that the two matters can be discussed together.
I thank the Minister of State for taking this Adjournment matter concerning home helps and home help hours. It is a matter close to my heart because it is one of common sense. If people are provided with a sufficient number of home help hours at minimal cost, they will be kept out of expensive institutions.
Senators Denis Landy and John Whelan and I have been vocal on this issue for a long time. We are vocal on behalf of those who were deprived of home help hours in 2012. We are also vocal on behalf of the home helps who have been before the Labour Court on 12 occasions in the past 12 months over their contracts not being honoured. They are not being given the hours which they have been contracted to do, which is a major issue. A contract is an agreement between two sides and one half of that agreement is not being honoured.
I expressed my dissatisfaction with the home help cuts made in 2012. I made representations on the issue before the last budget and received assurances that this decision would be reversed. It was mentioned in the budget announcement that the decision had been reversed and the figure of €7 million was restored to the home help budget. However, nobody I know who had their home help hours cut in 2012 has had them restored. I have viewed the HSE service plans in various counties in my neck of the woods and they reflect the same number of home help hours post the cuts in 2012. Nothing has changed.
It is obvious that either one of two things has happened. Either the announcement was not honoured and the money was not given back to the HSE, or the HSE received the money and spent it elsewhere. I would like to have clarity on that issue.
I will not go over the ground Senator John Kelly has eloquently and fairly covered. I have raised this issue previously. Irrespective of what side of the House one is on, the home help hours provided for elderly people, whether in towns or remote areas such as the area from where I come, represent very good value for money. Senator John Kelly alluded to the cost that would be involved if the State were to provide care for elderly people. I compiled a report on the issue when I was a Member of the Dáil and found that the cost to the State of such provision would be eight or nine times greater than the cost of enabling people to be cared for in their own homes. We would all like to see people being cared for in their own homes, if at all possible.
More than one year ago I dealt with the case of a 99 year old woman who had been taken to Bantry Hospital. Her son who was in his 70s who had been caring for her had cancer. He begged me to try to get the hospital to provide a long-stay bed for his mother because he was not in a fit condition to care for her. The consultant geriatrician at the hospital, a very professional man, interviewed her, did the arithmetic and she was sent home. She had never been in hospital in her life, except for these few days. The consultant said he had talked to the woman and even though she was totally blind, she was fully corpus mentis and had told him that she wanted to go home because that was where she was comfortable living. She fell short of reaching her 100 hundred birthday by a few months, but did not die as a result of the state of her health during those few days in hospital.
Geriatricians and the health experts say that in so far as it is possible to do so, it is best to care for people at home, yet because of the system in place and the cutbacks made, in some instances, home helps have only a half an hour to spend with the people being cared for. One home help has told me that she boils the kettle and makes a cup of tea for the person concerned and that some of the people to whom she calls have to be showered and brought to the toilet. Is she to leave the house after 30 minutes, similar to the time limit imposed on speakers by the Cathaoirleach from time to time, signalled by the sound of the bell, and leave the person concerned sitting on the toilet who would be unable to get up off it unaided?
There is a case to be made for home help provision for those who need the service and whom we are neglecting through these mealy-mouthed cutbacks. A case can also be made, as Senator John Kelly said, for the home helps who are providing the service, some of whom are very experienced, skillful and have been doing this work for a long time. They are being treated abominably.
That is my tuppence worth. We should work together to try to solve this problem This is not a party political issue but a national one, about which I am deeply concerned.
I welcome the Minister of State and thank him for taking this matter. Senators John Kelly and Denis O'Donovan have outlined the position which was clearly stated in previous discussions by our colleague, Senator John Whelan.
There are 535,000 people in Ireland over 65 years of age, which represents an increase of 12% since the 2006 census. The CSO has showed that between now and 2036, 15,000 more people will need home help care. The use of Exchequer funding for the provision of the home help service, undoubtedly, represents good value for money, in providing a service in people's homes, thus preventing them from having to go into nursing homes which would impose a further cost on the State. Everybody agrees with this.
The issue we are trying to get to the bottom of, as Senators John Kelly and Denis O'Donovan have outlined, is that there was a cut of €8 million in the last quarter of 2012 and that money was to be restored in the 2013 budget. The evidence available to me, through my constitutency, my constituency office and the people with whom I deal on a daily basis, shows that the hours removed have not been restored. Reassessments were made in early 2013. People who were in need of home help hours in 2012 are now being told that they are not in need of them in 2013. The people concerned are a year older and more infirm, yet a decision has been made that the hours do not need to be restored. Clearly, there is some trick of the loop when we are being told in various reports, to which Senator John Kelly alluded, that at regional level hours are being restored. Perhaps they are, but they are not being restored to the people from whom they were removed in 2012. They have the same health problems and are now a year older, but they are not receiving the samen umber of home help hours. It is falling on families who are hard pressed as it is to provide a service for their elderly mother or father on a private basis. They are unable to do this and are coming to us. I want to know from the Minister of State what is happening about this issue. That is the crux of matter. In anticipation of his reply, I thank him for coming to the House to deal with it.
I thanks Senators John Kelly, Denis O'Donovan and Denis Landy for addressing this issue.
The cornerstone of Government policy remains supporting all services for vulnerable older people, including assisting them to live at home and in their communities for as long as possible. The home help service is a core community service supporting, principally, older people to remain in their own homes, preventing admission to acute services, delaying or preventing admission to continuing residential care and facilitating early discharge from the acute sector to the community. The Health Service Executive has responsibility for the delivery of services such as mainstream home help, enhanced home care packages, meals on wheels and day or respite care services. The volume and types of health service to be delivered within the available funding for 2013 have been set out in the HSE's national service plan. My colleague, the Minister for Health, Deputy James Reilly, approved and laid a copy of the plan before both Houses earlier this year. The HSE has a statutory responsibility to live within the budget voted by the Oireachtas.
This year the HSE has committed to maintaining community supports such as home help and home care packages at the levels planned for in 2012. This means that 10,870people will be in receipt of home care packages and that 10.3 millionhours of home help service will be provided, with 50,000 people receiving the service.
Our commitment to restore home help hours to 2012 levels has been delivered. The HSE service plan for 2013 provides €392 millionfor community based services for older people.
The target for home help hours in the HSE's 2012 plan was set at 10.7 million hours. This target was incorrect. During the period 2012 to 2013 a data problem was uncovered in one HSE region which had resulted in the figures being overstated. Put simply, for a period of time in one HSE region, service figures counted all of the members of a family instead of the individual in receipt of the service in the household. This inflated the 2012 figure but this error has now been corrected.
The correct original national target, therefore, for 2012 should have been 10.3 million hours. This is the target now also set for 2013. Home help hours targets have been profiled in order to focus service delivery on the times of peak demand within each region. Activity data is being monitored to ensure that the agreed targets are met relative to the agreed profiling and by year end. The HSE has delivered over 2.2 million home help hours for the first quarter of 2013. I understand that the information requested by Senator Kelly was supplied to him earlier this week.
I acknowledge that this involves a reduction of around 7% in hours nationally, from some 11.1 million hours delivered in 2011, to the current target of 10.3 million hours for 2013. However due to service efficiencies in this area, the number of people in receipt of home help service will only be reduced by 2%. It is important also to note that the HSE works to ensure that the impact of this reduction is minimised by ensuring that services are provided in the first instance for direct patient care. Decisions in relation to the provision of home help hours continue to be based on an assessment of individual needs.
There is no doubt that these are challenging times for the health services overall, including maintaining home care services in line with evolving resource pressures. The demand for these, which are highly regarded by those who receive the service, continues to grow as the population of older people expands and as many more older people with complex care needs are maintained at home. Notwithstanding this difficult financial environment we should not lose sight of the fact that just over €390 million is being provided this year for community services for older people and that about 100,000 older people will be receiving various community-based supports during 2013.
In the reply I received from the HSE there is reference to what I call a cut but which the HSE refers to as a technical adjustment. The HSE is more or less saying that a mistake was made. However, I received figures from the HSE about the number of clients in receipt of home help in the first quarter of 2011 showing 51,735 people in receipt of home help hours.
That number has dropped to 45,000 in the first quarter of this year. Therefore, 6,000 fewer people are in receipt of home help hours now. This does not answer the question about the people who were in receipt of home help hours in 2012 whose hours were cut and not restored. I am not satisfied that the HSE response to my question deals with the situation I am trying to portray. I will leave it with the Minister of State.
I note the Minister of State's response and I thank him for coming to the House. He indicates there has been just a 2% decrease. However, the age profile of our society is going the other way in my view there should be an increase of 2% or 3% rather than a decrease. I ask the Minister of State to convey to the Minister, Deputy Reilly, that in my view, when the pressure is on the HSE budgets the home help service is the easy picking. Most of the people in receipt of home help cannot speak for themselves and they are depending on us to raise the issue here. It is appalling that there should be any cuts whatsoever in this area. I am disappointed with the response.
It is very disappointing that any services have to be reduced. The financial background is the basis on which services have been reduced, unfortunately, not just in this very important area but across the board. I agree with Senator O'Donovan's general sentiment and also with his point that the age profile has to be taken into account. There is a continuing need in that regard. If greater provision could be made or could have been made it would have been done. We are simply operating under the constraints that are well known. I regard it as a priority area and the Senator has a right to raise it in the House and to keep up the pressure for the reasons Senator O'Donovan and Senator Kelly have adverted to. In respect of the precise figures given to Senator Kelly during the week, I cannot comment in detail, other than to say that the information I have given to the House this evening is correct. As to whether individuals should have a change in their position I repeat that these decisions are made on the basis of the assessment of individual needs and that is how it is approached.