asked the Minister for Health the plans he has to deal with the problems of those caring for incapacitated persons at home which were highlighted in a recent study.
Ceisteanna—Questions. Oral Answers. - Care of Incapacitated at Home.
7.
I presume that the Deputy is referring to the working party on health and welfare services for the elderly whose report "The Years Ahead — A Policy for the Elderly" was published last year.
"The Years Ahead" makes several recommendations to increase support for carers, including that they be entitled to claim social assistance in their own right. I have taken this issue up with my colleague, the Minister for Social Welfare. Other recommendations of the report to support carers will be implemented as resources permit.
I did not understand from the Minister's reply whether he is happy with the progress that has been made in welfare services for the elderly in the community care area as he did not say anything about that. There has been a very low uptake of the home help and prescribed relative's allowance, although the Minister for Social Welfare indicated today that he will pay the prescribed relative's allowance to the carer which is certainly a welcome change. Would the Minister indicate if he is satisfied with the community care programme for the aged and whether he has immediate plans to improve the situation?
Yes. In my reply I answered the question asked by the Deputy but the Deputy is now broadening the question. Certainly, we have plans to improve the facilities for the care of the elderly. I would point out that the community care services are very good.
There is no uptake.
There is a whole range of services available to the elderly and there have been improvements in many services, for example, the public health nursing service, the home help service, etc. However, with regard to the specific question, one area where good work is being done all the time, but where further work needs to be done, is the provision of respite care, so that those carers who wish to avail of a few weeks' holiday or if there is a crisis can avail of accommodation that would be available or help to look after the elderly. Such schemes are working successfully in St. Mary's Hospital, Phoenix Park, in Blanchardstown Hospital and in Baggot Street Hospital. I would like to see this scheme extended, and we have written to the health boards asking them to consider how that particular scheme could be extended as a matter of urgency.
The Minister has stated that he has plans for the implementation of a policy for the elderly. When does he intend to implement the plans? May I ask about the home help scheme? Would the Minister agree that because of cutbacks this service is totally inflexible and it is nearly impossible to get a home help from the health boards? Has the Minister any plans for the training of home helps as is proposed in the policy for the elderly? Further, would he not agree that it is a highly cost effective service rather than institutionalising elderly people and that it is highly desirable from the community point of view?
I have outlined what we are doing in terms of support for carers to develop and extend the respite care service, which is available in a number of areas. I am glad to say that a great deal of progress has been made in this regard. On the broader question raised by Deputy Stagg, ideally an elderly person should be able to live out their lives in their own home, and there are support services available to ensure this happens where it is possible and practicable. Families have an obligation towards their elderly parents. Indeed, we can be very proud of the way families look after their own elderly.
The community also has a role to play in ensuring that the elderly can live in their community, for example, the old person's dwelling scheme, hostels and small homes in their own community are available. It is only when these facilities for one reason or another are unsuited to the elderly person that they should have to go into permanent residential care. That is the direction we are moving. I might also add that the change in the general medical service scheme will allow the general practitioner to participate more actively in the team concept of the delivery of primary care and in my view this will be of benefit to the commuity, and to the elderly in particular.
In view of the apparent lack of urgency with which the Minister seems to be dealing with this matter; was he surprised to find that less than 2 per cent of the 66,000 carers were able to have home help, that less than 10 per cent were getting any nursing help and that less than 9 per cent overall were getting a reasonable level of support services? Does he not regard that as a serious indictment of the community care services available to cares in the home? Would he accept that it would cost approximately £350 million to substitute for this care if it had to be provided through State funding? In view of that would the Minister not bring forward more specific plans than those he has indicated here today to do something definite within a specific time?
I am satisfied that the community care services are available to those who need them. Of the 66,000 carers, they do not all need public health nurses in to help them.
It is clear from the report that more than 2 per cent need home help.
The service is available to those who need it. I am concerned that, particularly in the larger urban areas, the inner city for example, there is accessibility to services that are available. This is something that needs to be addressed so as to ensure that people have access to the services available when they need them. The public health nursing service and the home help service is available in each community care area of the health board.
I am worried lest the Minister might inadvertently mislead the House because what he is describing is simply not in accordance with the facts. Would the Minister agree that the schemes he is describing are skeletal and so thin on the ground that most people who need the services simply cannot get them? That includes the home help service, the nursing service and other community services. Would the Minister agree that the reason for that is that the Minister did not provide the money to the health boards to expand the community care services when he cut back on institutional care?
We are having an element of repetition. The Deputy has already made that point.
We have 55,000 people working in the health services, caring for 3.5 million people. I am satisfied that there are sufficient personnel. I would point out to Deputy Stagg that while there has been a reduction in the institutional services available, but not impinging on the high level of hospital care available, there has been an increase in the proportion of the health budget that is going to community care.
I have a specific question——
A brief question, please.
There is one main recommendation and that is the request for an integrated plan to be developed for providing a service to carers. Does the Minister accept that there will be an integrated plan for this need?
Yes. The two areas in the report on which we would like to work immediately relate to carers and to voluntary organisations. There are very good recommendations in the report. We have sent a copy of it to the eight health boards and are awaiting their response.
We will see an integrated plan.
Question No. 8.