Seanad debates

Tuesday, 19 June 2018

Commencement Matters

Home Care Packages

2:30 pm

Photo of Paul CoghlanPaul Coghlan (Fine Gael)
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The Minister of State, Deputy John Paul Phelan, is very welcome.

Photo of Michelle MulherinMichelle Mulherin (Fine Gael)
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A Leas-Chathaoirligh, thank you for selecting this important matter. The Minister of State is welcome. I know he will not be surprised when I say I would be happier if the line Minister, either the Minister for Health or the Minister of State with responsibility for this issue, was here but I have no doubt he will relay to them the seriousness of this situation. Basically, I am asking that the Minister for Health immediately require the HSE and the CHO area 2 to address and make right the delays that have been experienced by people who have been approved home care packages, but to date have not received them.

A far as I can ascertain, this is going on since May. Quite a number of families and constituents have been in contact with me who are a terrible situation. What has happened is that people have been approved as needing home care and needing the support to live in their homes. They have been sent a letter saying they have been approved, but that they are on a waiting list. That is not much good to somebody who is in a hospital, taking up a bed and who is fit to be discharged. That is the case in Ballina, Swinford and Belmullet district hospitals, which to a greater or lesser extent operate as step-down facilities for Mayo University Hospital, which is an acute hospital. That is adding to delays in patients being discharged from Mayo University Hospital and is at great expense to the State.

We gave a commitment to people, and it is aspiration of our Government, that those who want to stay at home should be supported in their bid to do so. That is not happening here and it is unacceptable. How long will these patients have to wait with a letter in their hand? How long will they have to be taking up hospital beds or are we directing them into nursing homes? That would appear to be the only other option, that they go into a nursing home. Hard-pressed families are trying to cope with a situation where it has been clearly identified that help is needed.

We are half way through the year. How can the budget be spent? How can they be told there are no resources when we are only half way though the year? If nothing else, I would like a clear answer to the following question. How has the budget for CHO area 2 been spent? It is being divided between Mayo, Roscommon and Galway. What is the priority? What home care packages are being provided and when will more resources be given? How is the HSE managing the situation?

I raise this matter as a last resort. I have been raising cases since the beginning of May on behalf of individuals who are stuck and are in terrible situations. It is not on as far as I am concerned.

This is not the first time this has happened. It happened about a year or 18 months ago. What was revealed at that time was that the money was being spent on University Hospital Galway, UHG. Nobody needs to be a genius to know that UHG is in the news every other day for its trolley count. Priority is being given to shifting patients off trolleys and moving them on from beds within UHG to the detriment of Mayo patients. Mayo has one of the most aged populations in the country. Our aged and older people need care. This is not on and I would like to get some answers today about what the HSE is not providing. I would like somebody in the HSE to be held to account for what is going on.I am a public representative. Public representatives should be entitled to information in a timely manner so at least constituents can know some answers are being given within a system. I have no confidence in the way things are being conducted at the moment in the area I live in.

Photo of John Paul PhelanJohn Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I thank Senator Mulherin for raising the matter. The Minister of State, Deputy Daly, was unavailable hence my presence here. It is a serious issue.

The overarching policy of the Government is to support older people to live in dignity and independence in their homes and communities for as long as possible. Home care is an increasingly important part of the supports for enabling older people to remain at home and for facilitating their discharge from acute hospitals. The HSE has operational responsibility for planning, managing and delivering home and other community-based services for older people. Services are provided on the basis of assessed healthcare need. This year the HSE has moved to a single home support service combining home help and home care packages into a single service, the home support services for older people.

Home support services were a particular focus of budget 2018. An additional €18.25 million was allocated. The resources available in 2018 bring the total budget for the direct provision of services to €418 million. The HSE's national service plan provides for a target of €17.094 million home support hours to 50,500 people. A further initiative saw 324 people being provided with home support services following this winter's adverse weather conditions.

The demand for home supports continues to grow in parallel with the increasing number of older people. Many more of our older people with complex care needs are now being maintained at home, leading to increased demand for additional levels of service and for services outside of core hours Monday to Friday.

Arrangements for home care have developed over the years with a significant local focus and there is considerable variation in access to services in different parts of the country. It is also accepted there is considerable demand for home support services over and above existing service levels.

Since 2016, home support in CHO area 2 has been allocated based on prioritised needs of assessed applicants. Since the introduction of the prioritisation system, Mayo has had an increased budget with a corresponding reduction in other parts of the CHO area, particularly in Galway. In March 2018, the last month for which figures are available, Mayo had an over-expenditure of 4.2% on its budget.

The overall budget for CHO area 2 in 2018 is €43.2 million, an increase on both 2016 and 2017. The budget is broken down as follows: Galway, which has 52% of clients has a 56% share of the budget; Mayo has 30% of clients and 29% of the budget; and Roscommon has 18% of clients and 15% of the budget.

As I have said, the demand for home support continues to exceed supply. Those with the highest priority have home support implemented, while those on a lower priority are put on a waiting list. Ongoing measures to maximise the available budget, together with financial support for winter access measures have resulted in additional funding availability. Consequently, a process began in late-April to allocate home support to those on the waiting list.

Those responsible in CHO area 2 are conscious of the significant number of applicants on the home support waiting list. The waiting list includes both those waiting on new services and those awaiting additional hours, with approximately one third awaiting additional hours and two thirds awaiting a new service. When care was offered to those on the waiting list, approximately one third declined the offer. CHO area 2 has, therefore, commenced a process to validate the waiting list. It is envisaged that this process, together with the release of hours from the available budget, will see a noticeable reduction in waiting lists, including in County Mayo, over the coming months.

Photo of Michelle MulherinMichelle Mulherin (Fine Gael)
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I ask that the HSE in CHO area 2 is made to answer public representatives who contact them in a timely manner. I do not think six to eight weeks is satisfactory, especially when there is still no answer for people. It is wrong. How will this be addressed? If we have people in a district hospital step-down facility or in an acute facility in Mayo general hospital, how much more is it costing the State? How will this be addressed? I do not think what the Minister of State has said addressed it. Is the idea that when somebody dies people on the waiting list will take over that person's hours? In the case of Mayo an awful lot of the clients and people who have been approved are older people. I understand people other than older people require home care packages.People in recovery from conditions, illnesses or accidents may also need this help. We are pushing these older people into nursing homes at extra expense. I know we have our hospitals, but then we have people on trolleys. Something needs to be done and I think much more digging needs to be done. The HSE would want to pull up its socks and start dealing with public representatives.

Photo of John Paul PhelanJohn Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I will certainly ask the Minister of State, Deputy Jim Daly, about it. The Senator is right. Members of the public who come to any politician deserve to know what the situation is when they are on a list like that. Across CHO areas there is a wide variation in responsiveness. It is not acceptable that people would wait for eight weeks. I will bring that in the strongest terms to the Minister of State, Deputy Jim Daly.

The issue with the list in CHO area 2 seems to be that circumstances have changed substantially, maybe because the list has been in existence for such a period of time. The initial work on the validation process would indicate that the list will be shortened as a result. In addition, the HSE maintains the release of hours from the available budget will see a noticeable reduction in the coming months in County Mayo.

I will certainly bring back the Senator's issue about timely answers.