Seanad debates
Wednesday, 13 July 2022
Nithe i dtosach suíonna - Commencement Matters
Home Help Service
10:00 am
Robbie Gallagher (Fianna Fail)
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I welcome the Minister of State and thank him for taking the time to be here. It has been widely accepted for some time that older people are happier, and live longer, in their own homes. Home care packages are essential in supporting older people to continue to live within their communities. As we know, however, the home care sector is beset by a staffing crisis. Close to 5,000 people are waiting to be provided with a carer in their home. In the constituency where I live, Cavan-Monaghan, more than 250 people are waiting for home care packages, about 50 are waiting for first-time packages and more than 200 for additional hours, some of whom have been waiting for more than 12 months.
The demand is clear in the HSE's service plan, which states that the HSE expects to deliver 23.67 million home care hours this year, up by more than 2 million on the 2021 figure. Home care packages have improved but, unfortunately, there is no one to deliver them. Fears are increasing that older people may be forced into residential care sooner than they would like or left to languish in hospital because they cannot go home as there is no home care package in place for them. Age Action has called for a radical shift in how home care is managed because the delays are putting people at risk of harm. Older people may be forced to move into residential care sooner than they want or may be stuck in hospitals unable to be discharged. They may suffer consequences for their physical and mental health and their independence. Access to home care has, traditionally, been affected by funding issues but, thankfully, that is no longer the case. Just 286 people were waiting on funding for home care at the end of 2006, whereas just before the pandemic, that figure stood at 9,000, according to Department of Health data. The very significant increase in the budget is to be welcomed. Additional money had to be found for home care packages and I, along with my party in opposition, am delighted that is now the case.
The problem, however, has moved to being one of staffing. Low pay and erratic hours for carers are key issues. It can be difficult work and we as a nation owe these workers deep gratitude for the work they do. A Government workforce advisory group has been working on the recruitment crisis in home care and nursing homes and it is clear some radical thinking is required. In the past, home care was provided by the family, but family life has changed and it is now very difficult to do that. Nevertheless, families may be able to work with the HSE to find solutions. There may be a way for families to subcontract the work at local and family level, allowing, for example, a number of family members to work as a team to provide care and support to an older family member. Indeed, a similar scheme has been rolled out in Australia and the UK, where it is referred to as the consumer-directed home care scheme, which allocates a certain degree of funding to the families to spend on whatever care they deem fit. There is much merit in such a scheme because it would give families more freedom by providing carers with more financial support. With the appropriate training and oversight, the home care provided would be an added benefit to families and their connections with one another.
The advisory group may come up with other solutions and possibilities, but it needs to move quickly as the current circumstances will have knock-on effects not just for older people needing home care but also in the wider health service, in both the short and medium term.It is clear that something needs to be done sooner rather than later.
Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for raising this important issue. The Government is committed to the development of improved community-based services, shifting care to the home and offering greater choice for older people. In budget 2021 the Government allocated additional funding of €150 million for home support to progress the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and to provide 5 million additional hours of home support. The funding secured in budget 2021 to provide the additional 5 million hours has been maintained for 2022. In 2021 some 20.4 million hours were provided to over 55,000 people, around 2.9 million more hours compared to 2020, which represents an increase of 17%. In 2022, our aim is to provide 23.67 million hours of home support. At the end of May preliminary data showed that 55,392 people were receiving home support, and over 8.7 million hours of home support have been delivered this year to date, around 9% more hours than was provided for the same period last year. The preliminary data also show that significant inroads have been achieved in reducing waiting lists for funding approval for new or additional services, from over 7,800 in January 2020 to 348 in May 2022. This reduction has been achieved through a combination of validation of the waiting list and availability of additional funding to address those waiting.
However, there can be a lag between funding approval and the actual delivery of home support hours. Certain geographical areas that are experiencing increased pressures due to staff availability are particularly affected. At the end of May 4,720 people who had been assessed and approved for home support were waiting for a carer to be assigned to them. In January 2020, approximately 1,300 people were in this category. Despite the increase, it is important to note that the total number of people waiting for home support across both categories has reduced from over 9,000 at the start of 2020 to 5,068 at the end of May 2022.
The Government is very aware of the strategic workforce challenges in the home support and nursing home sector. I see it on the ground, as does the Senator. That is why he is raising this issue. The HSE continues to advertise on an ongoing basis throughout the region for health care support assistants and to recruit as many suitable candidates as possible. Due to the nature of the role, this recruitment is normally conducted at a very local level. In her ongoing engagements with the chief officers, the Minister of State, Deputy Butler, has recommended that they consider a renewed focus in advertising these positions locally. In addition, approved private home support providers continue to recruit home support workers. The Minister of State has established a cross-departmental strategic workforce advisory group to examine issues such as recruitment, retention, training, pay and conditions, and the career development of front-line carers in home support and nursing homes. I am working with the Minister of State on the issue. She is very much on top of it and is working extremely hard to resolve the issue.
Ensuring an adequate supply of appropriately skilled healthcare support assistants and healthcare assistants is a key objective of the advisory group initiative. The group has met five times since March and is currently working with key sectoral stakeholders in a structured programme of ongoing consultative engagements to further explore the issues and identify approaches to respond to the strategic workforce challenges. The group provides a forum for agreement on strategic approaches to address sectoral workforce challenges and will submit a report for the Minister of State's consideration by September 2022. The report will outline the group's key findings and recommendations.
Robbie Gallagher (Fianna Fail)
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I thank the Minister of State for his comprehensive response. I commend our carers the length and breadth of the country on the work they do. We are deeply indebted to them. I acknowledge the huge effort being put into resolving this issue by the Minister of State, Deputy Butler. I recognise that. I welcome the fact that the advisory group will conclude its work and publish its recommendations in September, which is only a few months away. Now that the hours have been allocated, it is vitally important that we recruit the people to carry out that work. The model of allocating funds to families directly to spend as they see fit is key. The recruitment of workers is a challenge across the entire economy, as the Minister of State is aware. It is key that the money is allocated to the families who are best placed to provide the care. If the families cannot provide the care themselves, they might know others in their communities who can do it. It is a key component in trying to resolve the staffing crisis.
Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Gallagher for highlighting this most important issue. As I said, we see this issue in all of our constituencies. The number of home support hours provided in communities is increasing in line with enhanced investment. Delivering this enhanced capacity requires substantial recruitment. The recruitment process has been affected by the strategic workforce challenges in the home support sector. Therefore, it is our ongoing objective to meet the continued increased demand. The Minister of State, Deputy Butler, has established an advisory group to examine the relevant issues, including the obstacles to recruiting carers, and to make recommendations. The group, which is engaging with key stakeholders, will publish its report in September. I look forward to its publication. In addition, work to progress the development of a new statutory scheme for the financing and regulation of home support services continues. Taking place in the broader context of the Sláintecare reforms, the work encompasses the development of the regulatory framework for the new scheme, the examination of options for the financing model for the scheme, and the development of a reformed model of service delivery. I thank the Senator again for raising this important issue.