Fergus O'Dowd (Louth, Fine Gael)
Link to this: Individually | In context | Oireachtas source

340. To ask the Minister for Health to provide on update on the Programme for Government commitment on the target of community services assigning a case manager for older people with chronic conditions to assist them with accessing the care they need, since the establishment of the current Government; and if he will make a statement on the matter. [33313/23]

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Ireland’s population is ageing rapidly, and for the most part, our older population clearly indicates their preference to age in place, in their own homes, for as long as possible. One of the Government's key priorities, as outlined in the Programme for Government, is to support older people to live in dignity and independence in their own homes and communities for as long as possible. This is in line with the Sláintecare vision for receiving the right care, in the right place, and the right time.

The Government remains committed to supporting older people to age in place at home, in their communities, with access to wraparound supports, including day care and dementia-specific day care services, Meals on Wheels, and home care services.

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.

The ECC programme will ensure maximum impact for citizens in avoiding hospital admission as far as possible through initiatives that will see care delivered within the community, at or near a person’s home, where appropriate.

ECC funding will support the ambitious, programmatic, and integrated approach to the development of the primary and community care sector which, amongst other initiatives, includes the development of primary care teams within 96 Community Healthcare Networks across the country, alongside 30 Community Specialist Teams for Older People, 30 Community Specialist Teams for Chronic Disease, and national coverage for Community Intervention Teams.

As part of the ECC programme, the Integrated Care Programme for Older Persons (ICPOP) aims to shift the delivery of care away from acute hospitals towards a community based, planned and co-ordinated care model which is closely aligned to Primary Care and Acute sector partners.

The objective of the programme is to improve the quality of life for older people by providing access to integrated care and support that is planned around their needs and choices. The programme seeks to ensure that 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. 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.

Each Community Specialist Team will service a population on average of 150,000 across an average of 3 Community Healthcare Networks (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 acute hospitals towards general practice, primary care, and a community-based service model.

As of April 2023, 23 ICPOP teams have been established across the country. It is envisaged that the full complement of 30 ICPOP teams will be established by Q4 2023.

In line with HSE national guidance, each Community Specialist Team (CST) provides for case management. Case Management is a complex function that involves organising and coordinating care. It forms a cornerstone of a new way of working that proactively identifies and delivers secondary care in the community for older adults with complex needs and long-term conditions such as frailty. Whilst case management has a broad function, care coordination at a minimum involves proactively supporting patients to access services, avoid duplication, and optimises outcomes.

A case management function involves collaborative and multi-disciplinary approaches to organising and coordinating care for the individual. It typically comprises of a case finding, needs assessment, care planning, care coordination and case closure. Each member of the CST Older People team, irrespective of discipline, undertakes a care co-ordination function. The case management function with CSTs for Older People is based on Comprehensive Assessment. As well as undertaking comprehensive assessment, CSTs team members will case manage care until outcomes are optimised.

This will include teams agreeing with other care provides (primary and secondary care) how meeting care needs are shared. The needs of people with complex care needs requires proactive care co-ordination, with Multi-Disciplinary Team members sharing that function (referred to as assertive case management). The clinical management of people attending the service is focused on being person-centred and may include enhanced management/interventions in people’s own homes or in other community settings.

Fergus O'Dowd (Louth, Fine Gael)
Link to this: Individually | In context | Oireachtas source

341. To ask the Minister for Health to provide on update on the Programme for Government commitment on the development of the role of advanced nurse practitioners in older person services and chronic disease management, since the establishment of the current Government; and if he will make a statement on the matter. [33314/23]

Stephen Donnelly (Wicklow, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

As the Deputy points out there is a Programme for Government commitment to develop the role of advanced nurse practitioners in older person services and chronic disease management.

Advanced Nurse / Midwife Practitioners (ANMPs) provide complete episodes of care and timely access to healthcare and earlier interventions. Creating a critical mass of advanced practitioners will contribute effectively and efficiently to addressing population health needs and has demonstrated improved patient experience, reduced waiting times and reduced admissions to hospitals. ANMPs contribute to service reform by providing the right care, at the right time, and in the right place.

Government has invested heavily in Advanced Practice for Nurses and Midwives, particularly since the publication of the Policy on the Development of Graduate to Advanced Nursing and Midwifery Practice for Nurses and Midwives(Department of Health, 2019). The role of ANMPs and the allocation of ANMPs across the various service areas is aligned with policy priorities. This includes Chronic Disease Management and Older Persons Services.

In 2020, 52 new ANP posts were created. Of these, 12 were allocated to Older Persons Services and a further 16 to Chronic Disease Management. In November 2021, I decided to increase the number of nurses and midwives practicing at an advanced level across the health service from 2% of the workforce to 3%, a 50% increase.

In 2022, I allocated €11m to the HSE to recruit 149 ANMPs, of which 12 ANPs were allocated to Chronic Disease Management and 15 to Integrated Care Programme for Older Persons.

In 2023, I announced the creation of a further 80 ANMP posts. The HSE is now in the process of allocating and recruiting for these posts. 27 are being allocated to Chronic Disease Management, 10 are being allocated to Older Persons. The table below sets out the total number of new ANP posts allocated to Older Persons Services and Chronic Disease Management since 2020.

New ANP posts since 2020 for Older Persons Services and Chronic Disease Management

These numbers will be added to when the allocated 37 posts for 2023 take up post in September 2023.