John Lahart (Dublin South West, Fianna Fail)
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873. To ask the Minister for Health if he will outline the main improvements in the provision of health services for older people since 27 June 2020; and if he will make a statement on the matter. [36240/22]

Mary Butler (Waterford, Fianna Fail)
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On Monday 20th June 2022, the HSE published its 2021 Annual Report and Annual Financial Statements. The report and accounts, which is available on the HSE’s website highlight the key health and social services, including older persons services provided by the HSE in 2021 out of a budget of €21.643 billion, including funding to non-statutory agencies of €5.691bn. The 2022 HSE National Service Plan also available on HSE website sets out the type and volume of health and personal social services to be provided by the HSE this year.

The Programme for Government commits the government to ‘Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care’. In Budget 2021, I secured additional funding of €150 millionfor 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 millionadditional hours of home support or more than 25% above the 2020 target. The funding for these additional hours has been maintained for 2022.

On 27 April 2021, Government gave approval to the Minister for Health to draft a General Scheme and Heads of Bill to establish a licensing framework for home-support providers. The drafting of the Heads of a Bill is at an advanced stage and it is intended to bring this legislation through the Houses of the Oireachtas at the earliest opportunity. In tandem to this, draft regulations setting out the minimum requirements a home support provider must meet to obtain a licence are also at an advanced stage. A public consultation on these regulations is ongoing.

Testing of a reformed model of service delivery for home-support has commenced in four pilot sites. Last week, I announced the commencement of the recruitment of 128 Care Needs Facilitator posts to progress the national rollout of interRAI as the standard assessment tool for care-needs in the community. It is planned to have these posts in place by the end of Q3 2022. InterRAI standardised outputs will be used to determine prioritisation and levels of care required. A comprehensive and robust operational model for the roll-out of the interRAI has been developed which will facilitate effective, efficient, fair and transparent care needs assessment and planning and appropriate service delivery. A National Home Support Office is in the process of being established. Recruitment to posts to run this new office are at an advanced stage, and office buildings have been sourced.

I am very much aware of the strategic workforce challenges in the home support and nursing homes sector. I have 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 into the future, so that solutions can be identified and implemented. Ensuring an adequate supply of appropriately skilled healthcare support assistants and healthcare assistants is a key objective of this initiative. The Group which is currently engaging with key sectoral stakeholders is committed to providing me with a set of recommendations by September.

Day centres are fundamental to the health and well-being of our older population and play a key role in enabling older people to live independently in their own communities and the reopening of these centres are a priority for me. The re-opening of day care centres following their necessary closure in 2020 began in the second half of 2021 and continues into 2022. About 85% of Day Care Services for Older People are open and have resumed service and by the end of 2022 it is expected that 92% of Day Care Centres will have resumed the service.

In 2021 the HSE has commenced the implementation of the Enhanced Community Care programme which aims to deliver increased levels of healthcare with service delivery reoriented towards general practice, primary care, and community-based services. Work continues on the roll-out and establishment of community healthcare networks and community specialist teams for older people and for chronic disease management. The National Integrated Care Programme for Older Persons (ICPOP) forms part of the ECC Programme and seeks to ensure older people with complex care needs can access care quickly, at or near home, through care pathways specifically designed for older people and targeting Frailty, Falls, and Dementia.

The Integrated Care Programme for Older Persons (ICPOP) has worked with acute hospitals and their local community older person’s services to develop end-to end care pathways for older people with complex care needs.

A total of 30 ICPOP Community Specialist Teams will be established across the country to deliver on the Sláintecare principle of delivering care as close to people’s home as appropriate. Each Community Specialist Team will service a population on average of 150,000 across an average of 3 CHNs. The teams will be co-located together in ‘hubs’ located in or adjacent to Primary Care Centres, reflecting the shift in focus away from the acute hospital towards general practice, a primary care & community-based service model. As of May 2022, 19 of 30 Community Specialist Teams for Older Persons are now established. The full complement of 30 ICPOP teams will be established by Q3 2022

Throughout the pandemic, the overall national response to COVID-19 has had a specific and sustained focus on older persons, and in particular, those resident in nursing homes. This included the establishment of a structured nursing home support system, in line with National Public Health Emergency Team (NPHET) recommendations, to provide enhanced supports to public and private nursing homes. A comprehensive package of direct and indirect supports was established in early 2020 and many of these remain active across the country to support nursing homes on a proactive basis and to respond in the event of a COVID-19 outbreak.Furthermore, an independent COVID-19 Nursing Homes Expert Panel was established in May 2020 to examine the complex issues surrounding the management of COVID-19 in nursing homes. The Expert Panel recommendations have provided a guiding framework not only for the pandemic response in nursing homes over the last two years but also more broadly for a wide-ranging programme of improvement and reform for older persons’ care, in particular in residential care settings. Four Expert Panel Progress Reports have been published to date, the latest published on the 21st of June 2022. This progress report sets out the progress achieved across the 86 recommendations in the Nursing Homes Expert Panel’s report and outlines the plans and structures in place to continue implementation along with details of next steps and timelines. It is available here - www.gov.ie/en/publication/c7f5b-covid-19-nursing-homes-expert-panel-report-implementation-oversight-team/#progress-reports

The Nursing Homes Support Scheme (Amendment) Act 2021 introduced further safeguards into the NHSS, also known as Fair Deal, to further protect the viability and sustainability of family farms and businesses. It also introduced a change which extends the three-year cap on contributions to the sale of a personal residence, removing a disincentive against the sale of a property. My Department has also developed an amendment to reduce the rate of at which rental income is assessed under the NHSS, to remove a disincentive to the rental of vacant homes owned by residents in long-term care. This change will be enacted imminently and the legislation will be commenced once appropriate preparations have been made within the HSE to ensure it can be operated effectively and in a way that addresses concerns I have raised in relation to safeguarding, consent and capacity.

Furthermore, if residents wish to make their properties available to house refugees without charge, this will have no impact on their contributions to the scheme. It is also anticipated that the financial contribution for hosting of temporary protection beneficiaries will be exempt from means-testing under the NHSS, once the related legislation, which is currently with the Oireachtas, has been enacted.

My Department is at an advanced stage of developing a national policy on adult safeguarding specifically for the health and social care sector, the policy will cover all public, private, and voluntary settings including private nursing homes. The Department expects in the near future to announce details of a public consultation with the intention of submitting a costed policy to the Government for its approval around the end of 2022. Any required underpinning legislation will be prepared following Government approval of the new policy.

I have long been an advocate for the development of services for people with dementia and their families and this is representative in the focused investment in these supports and services in recent years. A key commitment of the Programme for Government is to continue implementing the National Dementia Strategy with an aim of improving dementia supports and services so that people living with dementia can live well for as long as possible.

Funding of €12.9millionfor dementia specific supports and services in 2021 allowed for substantial advancements in the areas of:

- Enhanced Memory Technology Resource Rooms in 9 sites across the country

- Dementia diagnostic services through a specialist regional memory clinic in Cork and four new memory assessment and support services in Mayo, Wexford, Waterford and Sligo

- Enhancement of acute care pathways for people with dementia through the recruitment of more clinical nurse specialists

- The implementation of a National Clinical Guideline on the appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia

- Increased access to in-home day care and support and

- Dementia: Understand Together initiatives

In addition, in November 2021 I officially launched an expansion of the National Dementia Advisor Service. The Dementia Adviser Service provides a key focal point to help people navigate the health and social care system, ensuring they receive the right support at the right time. I was delighted to secure funding for 11 new dementia advisers in 2021, to expand this vital service. This brought the total number of dementia advisers to 28 nationally.

In 2022, an additional €7.3million has been allocated for the continued implementation of the National Dementia Strategy which will work to continue to improve care pathways for people with dementia across the country.

Funding in 2022 will allow for substantial advancements in the areas of:

- 5 new memory assessment and support services and one new regional specialist memory clinic in Galway

- Specialist diagnostic services for people with an intellectual disability through the National Intellectual Disability Memory Service in Tallaght University Hospital

- Enhancement of memory technology resource rooms to demonstrate assistive technology options for people living with dementia

- Implementation of a dementia minimum dataset across all care settings to standardise data collection and reporting

- 6 dementia assistant director of nursing posts (one in each hospital group) to improve quality and safety of care for people with dementia

- 4 additional dementia clinical nurse specialists to improve care pathways in acute care settings

- Undertake the third wave of the Irish National Audit of Dementia in acute hospitals

- Promote brain health and reduce the prevalence and delay the onset of dementia through collaboration with clinical programmes, the understand together campaign and dementia risk reduction group through the provision of a brain health project manager

In addition to the €7.3m for dementia services outlined above, the proportion of new home support hours ringfenced for people with dementia will more than double from 5% in 2021 to 11% in 2022.

Taken together, this will represent 15 million euro of investment dedicated to dementia specific supports and services in 2022, on top of the €12.9m of additional funding in 2021.