Victor Boyhan (Independent)
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Our final matter is in the name of Senator Lombard. It relates to the HSE home support services in the Cork region.

Tim Lombard (Fine Gael)
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I thank the Acting Chair. The Minister of State, Deputy Butler, is more than welcome. It is always a pleasure to have her before us. Her Cork roots always come out in the responses. In that context, I am looking forward to her response.

There is a need for the Minister for Health to review the recent changes that have been made with regard to home support services in Cork county. In April, a number of significant changes to those services were introduced. Under the traditional model, home support was given to a family or an individual on the basis of need and a home support worker worked with the family or individual involved on a permanent basis. Links were built through the community off the back of this. We knew exactly who the home support workers were. They came at a certain time of the day and became part of the family and the set-up. They worked very well with clients. There has been a change to the rostering system, however, which means that because of a ruling agreed between the Department and the workers, the latter are now operating on the basis of a rotational system. This means that families and individuals do not have the same support workers coming their homes on a continuous basis.

In my part of the world, people who would traditionally have had two calls a day, one in the morning and one in the afternoon, are only being visited once a day, usually in the evening. This does not suit the families involved. The knock-on effect is that, unfortunately, the quality of the service is not the same. There is great frustration within some families, in particular about how the service is operating. As stated, the rostering system was changed on foot of an agreement between the HSE and staff representatives. However, the clients were never informed.They were never a part of this change in process. They were never asked for their opinion or view but were just told there had been a change. I had a client on to me who is over 100 years of age. She lives independently beside her son's house. She had previously had a call in the morning and another in the afternoon and was now being offered a mid-afternoon call. This lady is 102 and a wonderful person, if I may say so. The family fought for major changes and eventually the HSE did make a change but that is the kind of upset I am trying to avoid. I have other clients on to me who have traditionally got two calls a day but who are now down to one call every three days, if they are lucky. The home support service, which is key, has been diminished.

The home support packages are unique. They help people to live in their own settings with their family for longer. They are a unique part of ensuring the promotion of the community aspect, which does a great deal for our State. I am genuinely concerned about how these new proposals were brought forward, about how the rosters work and about the service being provided on the ground. When this agreement was made, the actual clients were not involved. The clients, the patients and people who use these support services, had no input and they are not happy. The implication is that they do not see the same person or that the person does not come at the same time. They traditionally got two calls, often in the mid-afternoon and the morning. They knew the person who would come and built up a relationship. Unfortunately, that has now gone. We need a review. Does the Department propose to carry out a review of these new rostering set-ups in which the clients would be involved because they are not very happy with what is currently being proposed?

Mary Butler (Waterford, Fianna Fail)
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I thank the Senator very much for raising this issue. It is not the first time I have heard about it. I was in Bessborough on Saturday and two councillors raised it with me. I was in Bessborough in Cork city for the opening of the first ever dementia lodge for people with early onset dementia to support them and their families. I was spoken to by two councillors and have also heard about the issue from two other people. I have been looking into it to find out what the situation is.

As the Senator will know, there is no bigger advocate for home care than me. There is a triangle of supports to support older people to age in their own homes. This consists of home care, day care and meals on wheels. Today, some 56,000 people the length and breadth of the country are receiving home care. In 2024, the overall home care budget has risen to approximately €730 million. This represents an additional €235 million put in place since budget 2021. Last year, we broke all records and delivered 22.1 million hours, an increase from 17.9 million within the lifetime of this Government. That is an increase of 4.2 million hours. It is the right thing to do, as I know the Senator will wholeheartedly agree.

The HSE reports that there were 7,599 people receiving home support services in the CHO 4 area at the end of March. There were 506 clients on a waiting list for additional hours and 842 were waiting for a new service to commence. It is important to note that those services had been funded. It is not a funding issue. The HSE has advised that priority is given to those in the community who have acute needs and to those assessed and waiting in acute hospitals who are unable to return home without supports.

I am committed to improving the way in which the HSE delivers its services across the country and there are a number of important initiatives in place to ensure this. The HSE is examining how it delivers home support and how technology can best be used to support it. The HSE is in the process of procuring a new ICT system that will improve its ability to ensure that services are allocated fairly and efficiently.

The HSE is also in the process of rolling out a rostering system across the country. I do not want anybody on a waiting list. We are trying to use the best people available to deliver home care in their own areas. I know that concerns have been raised in the CHO 4 area, where people have experienced changes in how their home support is being delivered as a result of this system being implemented. The aim of the home support service is to deliver support that enables the HSE's clients to live safely and independently at home. The HSE will always endeavour to facilitate a client’s wishes and personal preferences, where possible. However, the contract of employment contains a requirement for staff to be rostered.We have to roster staff. We have to have people working seven days over seven. We just cannot have people working five days over seven. This has been agreed nationally following engagement between staff representative groups and the HSE. Healthcare assistants now operate in teams working to set roster arrangement over a four-week period.

In the delivery of service and the implementation of rostering, the HSE recognises the care needs of its clients and endeavours to minimise disruption to service and undue stress while these new arrangements are introduced. The HSE has kept these teams, where possible, to a cohort of four staff members. Therefore, if a person is receiving home care seven days per week, it is not possible for the same person to deliver that morning and evening seven days per week. That person needs time off as well. With a cohort of four people, the client should only be seeing those people over the course of the whole week. I am really disappointed to hear that the Senator has experience of people who had two calls previously reduced down to one call. That was never the purpose of this. I am disappointed to hear about a 102-year-old lady living who is at home on her own beside her son. I could not support people who had two calls previously now only getting one call. I will come back in the next piece.

Tim Lombard (Fine Gael)
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There are two issues, the first of which is that when the rostering was changed, there were talks between the HSE and the staff. The clients were not involved. That was a failure. The clients should have been involved regarding this issue.

The timing of when the calls are made is becoming a major issue. People were traditionally getting a call in either the morning or evening and they knew the time. Now, it could be any time in the day. It is not suiting the clients themselves. The clients or patients, these wonderful people who are living independently, were used to having the same person call. A bond was built up. They knew their needs and there was no, "Hello, who are you?" That breakdown is becoming a big issue in the public domain about how we need to sort this out. The community aspect is wrong. That is a huge issue for us.

There have been, and I have evidence of this, changes in rosters with the result that people are not getting the same service they were getting previously. That is a major issue on the ground. I personally believe we need to review this. The old system worked better. The system that is in place at the moment is not serving the community. I urge that we take a review of what happened since last April because it is not working on the ground.

Mary Butler (Waterford, Fianna Fail)
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There were challenges with the old system in that when a person rang in sick on a particular day, often a client was left without somebody. That was one of the reasons the HSE has been working over the last two years on this particular new rota, which has been working across many areas. It was rolled out in west Waterford. We had teething at issues at the start, but that has certainly improved. There are always going to be teething issues. The roster system has been in place in parts of the service for more than two years. Following the initial transition to this new arrangement, clients have found that they are still in receipt of quality home care. The HSE is working as best it can. The Senator must remember that the HSE also outsources a lot of its work to private providers. It is working as much as possible to ensure a client's current healthcare assistant continues to deliver some of his or her support, while equally ensuring the remainder of his or her service is delivered by similarly qualified and professional home support staff. However, I understand where the Senator is coming from, especially if somebody, for example, might have early stage dementia and is familiar with one particular person. I can talk to the Senator offline about some of the things we are doing to try to sort out this issue.

Victor Boyhan (Independent)
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I thank the Minister of State for her time here this morning.