Gerard C. Connolly
Question:8 Mr. Connolly asked the Minister for Health his views on whether the availability and remuneration for persons giving home help services are sufficient to attract enough such persons to meet the demand. [4576/95]
Ceisteanna — Questions. Oral Answers. - Home Help Scheme.
Joe Walsh
Question:19 Mr. J. Walsh asked the Minister for Health the plans, if any, he has to improve and extend the home help scheme. [3352/95]
Liam Aylward
Question:81 Mr. Aylward asked the Minister for Health if he will have arrangements made to have the home help scheme extended. [4651/95]
(Limerick East): I propose to take Questions Nos. 8, 19 and 81 together. Under section 61 of the Health Act, 1970, health boards may make arrangements to assist in the maintenance at home of persons who but for the provision of such a service would require to be maintained otherwise than at home. This section empowers, without obliging, health boards to provide support services such as home help, laundry and meals.
At present there are 11,215 part time and 126 full time home helps employed throughout the country. As the part time home help service originated with the concept of the good neighbour, the level of payment to home helps reflects the voluntary ethos of the service. The rate of remuneration varies considerably throughout the country. In all boards the rates are determined by the requirements and type of task undertaken in individual cases.
My Department is considering, in consultation with the chief executive officers of the health boards, a number of aspects of the home help scheme, including the overall organisation of the service and the variations from board to board.
Do the rates under the scheme differ among health boards? We have heard that a rate of £1 per hour is paid under the scheme. Does the Minister consider that rate is sufficient and will it induce people into the scheme? Has he made any provision in his budgetary estimates for that service?
(Limerick East): The rates under the scheme vary. Stated remuneration rates would not attract people into the scheme. Under the scheme there was an element of expenses in lieu of good neighbourliness and people helping on that basis. In the Eastern Health Board the rates per hour under the scheme are between £2 and £4, £2.50 in the Midland Health Board, £2.60 in the Mid-Western Health Board, £1.45 in the North-Eastern Health board, £2.61 in the North-Western Health Board and £2 in the SouthEastern Health Board, £1.40 in the Southern Health Board and £1 in the Western Health Board. There is a big variation in the rate per hour under the scheme.
On checking on the origins of the policy on home help, I discovered that the home help service was based on a circular letter in the first instance and because of that individual health boards decided to provide the service. There is not, in effect, a national home help service, there are individual health board services stemming from that central decision which was notified a long time ago. I asked my Department to consult with the chief executive officers of the health boards to see if the service can be put on a better footing. A working group has recently reported to the chief executive officers on this. There are regular meetings between senior officials of my Department and the chief executive officers and I have asked them to discuss this at their next meeting. Progress will be made.
I understand what Deputies are saying.There are difficulties but the service is a very good one. Without imposing some mandatory service on individual health boards I would like standardisation and a review of what is happening in order that the service can be more effective. That process has now commenced.I would take the advice of any Deputy on any side of the House, especially those who have health board experience, in reorganising the service.
Does the Minister think those who provide the service in rural areas should get more than those in urban areas?
(Limerick East): The needs are as great in urban areas as in rural areas. Sometimes we look at a rural area and say people are isolated and far apart. Elderly people, who are the main beneficiaries of the scheme, can be isolated in the middle of a city. They can be isolated in a terrace of houses because nobody calls in and nobody helps. Many of the houses on the terrace may be rented. It is quite normal to find an isolated elderly person in an urban community so I would not weight it in that direction.
That does not take into account the distance which home helps have to travel in rural areas. That should be taken into consideration also.
(Limerick East): The Deputy's comments will be noted and taken into account in the review of the system. If people have a specific view they would like to put they should do so in writing and it will be taken into account as the review will be carried out during the next six months. The experience of Deputies from different parts of the country would be valuable in any assessment of this scheme.
Do the figures available to the Minister suggest a correlation between the rates of payment and the number of people participating in the scheme in each health board area? Will he consider giving a target date by which to rationalise the entire scheme?
(Limerick East): No, I have not seen any figures to suggest such a correlation. The service cost £14 million in 1993 and it involved 10,041 home helps. It is a relatively small sum of money for a national scheme but involves a huge number of people. Those home helps assisted about 17,000 clients. The assistance is mainly cooking, cleaning etc. Some of the home helps are trained nurses who would carry out minor medical procedures such as dressings but always under the supervision of the public health nurse. There is a range of circumstances which differ. It will not be possible to have a smooth national scheme where the same rules, regulations and procedures apply everywhere as the divergences are too wide. This is not simply a question of divergences in the payment rate per hour, there are other divergences as well. If one were to equalise the payment rates per hour by upping the payments the service would still be in need of a serious examination to achieve the objectives I have suggested.
I am pleased the Minister has indicated he is reviewing the service. Given the importance of the service provided by home helps, will he agree that there may well be a strong correlation between the rates of pay and the fact that the vast majority of the home helps are women? Will he agree there is a danger that the State could exploit the good neighbourliness of women and their natural kindness to help their neighbours by paying such a low rate of remuneration?
(Limerick East): We will examine all those issues in the context of the review.
I welcome the Minister's reply stating that he is interested in taking on board Members' views and that a working group will report. The position in the Western Health Board area is dire. The rate since 1990 has been £1 per hour. There is a national variation on average of about 300 per cent in the rate paid by other health boards as against the Western Health Board which has the highest percentage of elderly people deserving of the service. The rate of £1 per hour is equivalent to about half the rate paid to babysitters looking after children in their homes. Is the Minister aware of a practice in some health board areas whereby old age pensioners who are the recipients of the service are asked on a voluntary basis, but in the main comply with the request, to contribute towards the hourly rate of the home help? There is no home help in Ireland who will work for £1 per hour. Accordingly, the old age pensioner is asked to contribute on a cooperative basis an additional £1 or £1.50 to avail of the service two or three hours per day or twice a week, as the case may be, when home helps visit to carry out the essential duties referred to. Elderly people who depend on social welfare allowances are asked to contribute additional resources. I ask the Minister to take those views on board.
(Limerick East): I will take the Deputy's views into account. Neither the Minister for Health nor the Department of Health sets the rates; the rates are set by the health boards. Why do we have health boards if every problem comes to the Department of Health? Deputies who are members of health boards have a role to play. If the rate of £1 per hour in the Western Health Board is resulting in the collapse of the home help scheme the primary responsibility rests with the members of the health board. That is what local democracy is about.