Cormac Devlin (Dún Laoghaire, Fianna Fail)
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628. To ask the Minister for Health the main initiatives that he has taken to develop and expand health services for older persons since 27 June 2020; the additional funding provided in successive budgets; his plans for 2023; and if he will make a statement on the matter. [62215/22]

Mary Butler (Waterford, Fianna Fail)
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Next year the overall funding available to the HSE for Older Persons will exceed €2.4 billion. This includes nearly €1.1 billion for Fair Deal. This represents an overall increase of 25% since 2020. A wide range of core services will be provided for older persons including home support, day care, community supports in partnership with voluntary groups and intermediate care as well as long-stay residential care when remaining at home is no longer feasible.

Home Support

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’. Over the last three Budgets I have secured over €200 million in additional funding for home support: a 42% increase since 2020.

Over that time, targets have increased by 5 million hours. Delivering this enhanced capacity requires substantial recruitment. This has been affected due to strategic workforce challenges. To examine, and formulate recommendations to address, these challenges, I established a cross-departmental Strategic Workforce Advisory Group in March 2022. The Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on 15 October 2022, and it presents a suite of 16 recommendations spanning the areas of areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform, and monitoring and implementation.

I have strongly endorsed all of the Advisory Group's recommendations, the implementation of which has commenced and will be closely monitored by the Department of Health against agreed timelines. At a joint press conference on 30 November 2022, the Minister of State for Business, Employment and Retail, Damien English, T.D. and I announced that, as recommended by the Advisory Group, 1,000 General Employment Permits will be made available for home support workers from January 2023. This will enable the employment within Ireland of non-EU/EEA citizens as home support workers and promises to significantly reduce the shortage of workers that we are currently experiencing.

In line with our Programme for Government commitment the continued expansion of home care hours and progressing development of a statutory scheme for the regulation and financing of home support services is a key priority in 2023.

The Department of Health is currently developing a regulatory framework for home support providers with the aim of ensuring that all service users are provided with high quality care. This will comprise of primary legislation for the licensing of home support providers, regulations for home support which will set out the minimum requirements that a provider must meet to obtain a licence, and HIQA national standards.

The Heads of Bill are currently being drafted by the Department with a view to bringing it through the Houses of the Oireachtas at the earliest opportunity. The Department is engaging with key stakeholders in relation to the legislation. A Regulatory Impact Analysis is also being progressed by the Department. The draft regulations are at an advanced stage and are informed by a public consultation which concluded on 4 August. The analysis of submissions has been carried out by the Institute of Public Health (IPH) and it demonstrates strong agreement in relation to the regulation of home support service provision. A report on the findings of the public consultation is being finalised with a view to publication in due course. Legal advice and engagement with key stakeholders (HIQA, HSE, private and voluntary providers, and service user representative groups) will assist with final revisions to regulations for providers of home support services in 2023. In addition to this, HIQA are in the process of developing standards for home care and home support services which will be the focus of a public consultation early next year.

Testing of a reformed model of service delivery for home support is in progress in four pilot sites. The evaluation phase has commenced, and a final report is expected by Q1 2023. The HSE has begun the recruitment process for 128 interRAI Care Needs Facilitators to progress the national rollout of interRAI as the standard assessment tool for care-needs in the community. Inter RAI standardised outputs will be used to determine prioritisation and levels of care required. This will facilitate effective, efficient, fair and transparent care needs assessment and planning and appropriate service delivery. The HSE is undertaking a recruitment process for a number of key posts to support and enable the establishment of a National Home Support Office. Funding is provided for 15 full time jobs including 9 Community Healthcare Organisation home support manager/coordinator posts. A Head of Service has been appointed to the new National Home support Office.

Day centres

Day centres are fundamental to the health and wellbeing 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. Approximately 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.

Meals on Wheels

Over the years the Meals on Wheels service has proven to be an important component of the community services offered to older people, particularly in rural communities. I have secured an additional €1.8m with a view to expanding the service.

Enhanced Community Care

In 2021 the HSE commenced the implementation of the Enhanced Community Care (ECC) 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. As of November 2022, 21 ICPOP teams have been established.

ALONE and the HSE Support Coordination Service

The HSE, in conjunction with ALONE, is continuing the roll out of a Support Coordination Service across the country. This supports older people to live well at home as independently, and for as long as possible, through support coordination and access to services such as but not limited to; practical supports, befriending, social prescribing, assistive technology, and also coordinate linkages to local community groups in their area. This service is being led out under the ECC Programme.

Healthy Age Friendly Homes Programme

The Healthy Age Friendly Homes Programme is an innovative partnership between the local government sector (through Age Friendly Ireland) and Sláintecare in the Department of Health that commenced at the beginning of 2021 and saw the introduction of a new person-centric, robust, support coordination service. This new initiative aims to support older people to remain living in their own homes and communities for as long as possible and reduce the rate of older people transferring to long-term residential care. The interim report of phase 1 of the Healthy Age Friendly Homes programme was published in June 2022 and details the significant progress of the programme over its first 12 months pilot phase.

I was delighted to announce in Budget 2023 that funding of €5.2 million has been allocated to roll-out the initiative nationally. Age Friendly Ireland will deliver this programme in partnership with Sláintecare. This two year pilot project represents an innovative approach by operating between housing services in local government, the health service, and community and voluntary supports. The overall objectives of the programme are to prevent early or premature admission to long term residential care; enable older people to continue living in their homes or in a home more suited to their needs; help older people to live with a sense of independence and autonomy and support older people to be and feel part of their communities.

Community Nursing Unit Programme Update

One of this Government’s key priorities is to support older people to age in place and live in dignity and independence in their own homes and communities for as long as possible. HSE Community Nursing Units (CNUs) are an essential and valued part of our social care infrastructure. For those who avail of long-term residential care, it is essential that public investment in this infrastructure is maintained at a level which supports the highest standard of care.

The CNU Programme was launched in 2016 to ensure that public community nursing units would be refurbished or replaced so that they would be fully compliant with Regulations made under the Health Act 2007 and in line with National Standards. There are currently 89 different projects at various stages and phases of development. 43 full projects are complete. Construction is underway on several more facilities, while the remainder are at various stages of appraisal, planning and/or design. On 7 December I was delighted to announce that the awarding of the contract to deliver seven Community Nursing Units (CNUs) under the HIQA compliance programme through the Public Private Partnership (CNU PPP Project). The CNU PPP Project will deliver the residential care facilities comprising of both short and long stay beds for older persons at facilities across the country. Some 530 beds will be delivered overall in sites at Ardee (50 beds), Athlone (50 beds), Clonmel (50 beds), Killarney (130 beds), Midleton (50 beds), St. Finbarr’s, Cork (105 beds), and Thomastown (95 beds).

Community Beds

A critical component of the Winter Plan 2020-2021 was the provision of sufficient Intermediate Care capacity in the community to reduce hospital admissions and facilitate timely discharges from acute settings for older persons. It included expanding Intermediate Care capacity through the addition of rehabilitation beds in public facilities, repurposed public beds and privately purchased bed capacity for transitional care. Delivery has been significantly impacted by a number of factors, including but not limited to: COVID-19 Outbreaks, Recruitment Challenges, Minor Works, HIQA Fire and Safety Works. Beds have been reprofiled to new facilities to combat challenges to service delivery and to more appropriately address client needs.

As of November 2022, 365 public Community beds have been delivered over the last two years. A further 127 beds are planned to come on stream by March 2023. At the end of 2021, 521 beds were on stream. At present 643 private short stay beds are now on stream in 34 facilities supporting discharges from Acute Hospitals and hospital avoidance in the community. A further 44 beds are scheduled meaning we should have up to 687 beds on stream by the end of 2022.

Nursing Homes Expert Panel

Throughout the pandemic, as part of the overall national response to COVID-19, there has been 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 21 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 - gov.ie/en/publication/c7f5b-covid-19-nursing-homes-expert-panel-report-implementation-oversight-team/#progress-report. Significant progress has already been made in implementing the recommendations of the Expert Panel, particularly those recommendations requiring a priority focus in the response to COVID-19, and work to progress medium and longer-term reform recommendations is on-going.

In October 2022, the Government approved the publication of the General Scheme for a Bill to provide a broader suite of enforcement tools for the Chief Inspector of HIQA and allow for the collection, sharing and publication of key date on nursing homes. Pre-legislative scrutiny has been undertaken and engagement with the Office of the Attorney General on the drafting of the provisions will commence shortly. The Patient Advocacy Service commenced a phased rollout to private nursing homes in November 2022. The findings of the first National Nursing Home Experience Survey, which is the first national survey on the experience of residents and their families of nursing home care in Ireland, were also published in November 2022. A new end-of-life palliative care programme, the Carú Programme, for the nursing home sector was also launched. This programme is a partnership between the HSE, Irish Hospice Foundation and the All Ireland Institute of Hospice and Palliative Care.

Funding is also being provided to establish regional HSE Community Support Teams for nursing homes. Recruitment is underway to replace the temporary COVID Response Teams (CRTs), which were set up as a response to COVID-19 with permanent multi-disciplinary Community Support Teams (CSTs) in each CHO.

Nursing Home Support Scheme

The Nursing Homes Support Scheme (NHSS or ‘Fair Deal’) currently supports over 22,500 residents in approx. 550 nursing homes across the State. Long-term residential care is supported through additional funding for the Nursing Homes Support Scheme (NHSS) to maintain services and manage inflationary increases. Budget 2023 saw over €40 million in additional funding for the Nursing Home Support Scheme (NHSS) which will provide for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated.

The Nursing Homes Support Scheme (Amendment) Act 2021 introduced further safeguards into the NHSS, 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.

Nursing Home Supports

The Government has provided substantial support to the private and voluntary nursing home sector over the course of the pandemic, with over €145 million in funding delivered through the Temporary Assistance Payment Scheme (TAPS). The Temporary Assistance Payment Scheme will continue to support Nursing Homes with the cost of COVID-19 outbreaks until the end of the year. Since the start of the pandemic, private and voluntary nursing homes have also received a wide range of non-financial supports, including over €72m in free PPE and oxygen,

A new €10 million scheme – the Temporary Inflation Payment Scheme - has been established to support private and voluntary nursing homes with increases in energy costs. The scheme covers 75% of year-on-year cost increases in energy and heating, up to a monthly cap of €5,250 per nursing home, over the period of July to December 2022. Nursing homes can claim three-quarters of €7,000 of vouched expenses overall.

Further work is also being undertaken to address issues in the sector on foot of the recommendations of the NTPF Pricing Review, the Value for Money review of Nursing Home costs and the report of the Strategic Workforce Advisory Group.

Inflation Package/ Cost of Living Supports for Section 39 Organisations

In recognition of the challenges being faced by the community health and social sector in delivering and maintaining key health and social care services against a backdrop of increased inflationary pressures affecting energy, heating and related costs, the Government is providing an inflation support fund in Budget 2023. A significant fund of up to €100m has been allocated to support community based voluntary organisations who are such an essential pillar in the provision of Health services across country. €10m of this has been allocated for the Temporary Inflation Payments Scheme for Nursing Homes, with the remainder to be allocated to community and voluntary providers across the health sector. The exact scope and mechanism for distributions of these funds is currently being finalised by the Department of Health and will be announced shortly. It is proposed that the inflation support fund will be administered by the HSE utilising the mechanism in place for funding eligible organisations in receipt of Service Level Arrangements and Grant Aid Agreements.

Dementia Supports

I have long been an advocate for the development of services for people with dementia and their families and this is reflected in the focused investment in dementia 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 €12.9million for dementia specific supports and services in 2021 allowed for substantial advancements in areas including:

- 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

- Access to in-home day care and support

- Dementia: Understand Together initiative

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 has brought the total number of dementia advisers to 28 nationally, plus a coordination post.

In 2022, funding of €7.3 million has been allocated for dementia services and supports to continue to improve care pathways for people with dementia across the country. This funding provides for: -

- 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

- 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

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

- A Brain health project manager to 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.

This year, the number of new home support hours allocated to people with a dementia or cognitive impairment has been raised from 5% to 11%, valued at €7.8 million.

Investment in the National Dementia Strategy will continue in 2023, with a continuing focus on diagnosis, post-diagnostic supports and care for people with dementia. The HSE intends to publish a Model of Care for dementia in Q1 2023. Some €2.1 million in additional funding will be provided for the restoration to full capacity of dementia-specific community day care services. Furthermore, the proportion of dementia-specific new home support hours will increase from 5% in 2021 to 15% in 2023, valued at €5.2 million.

National Carers' Strategy

New funding of €2 million was provided in Budget 2021 for the implementation of the National Carers’ Strategy. The funding delivers on the Programme for Government commitment to a Carers’ Guarantee by improving equity of access to supports for carers across the country. Some €1.9 million of this funding is being provided to Family Carers Ireland to improve its supports, while the remaining €100,000 is supporting an online support group operated by Care Alliance Ireland.

A Carers’ Needs Assessment is also being piloted in Community Healthcare West at present.

Commission on Care

The Government is committed to supporting healthy and positive ageing throughout the life-course as well as to ensuring that older persons can continue to live independently in their homes and communities for as long as possible. Acknowledging the disproportionately negative impact of the pandemic on older persons, the Programme for Government (2020) commits to the establishment of a commission on care that will ‘assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens’, learning the lessons from COVID-19.

Desk research has been undertaken within the Department of Health in preparation for the establishment of a commission on care. The conclusions of this initial scoping exercise, along with an outline proposal for the commission, were presented to me earlier this year. It is envisaged that the commission will support a whole-of-government approach to examining existing policies and strategies which are of relevance to supporting positive and healthy ageing. Drawing on lessons learnt internationally as well as on stakeholder engagement, it is also anticipated that the commission will make recommendations to effectively address the gaps which currently exist in the policy landscape. It is anticipated that work on the commission will commence in the new year.

In 2023, our ambitious reform programme for older persons services will continue in 2023, building on work undertaken to date and with a focus on the development of new operational models and reform for Home Support and Residential Services.