Adjournment Debate

Care of the Elderly

Deputy Catherine Byrne

I thank the Ceann Comhairle for allowing my matter be raised on the Adjournment this evening. I want to raise three points about the home help service in Ballyfermot and Inchicore, namely, the importance of the service to the local community, the effects of the proposed cuts on the elderly and the status of the employees, which is very unclear. None of them know where they stand regarding their employment. What will the forthcoming review of the service mean? What will the cuts mean, especially for the elderly, and for the many people in home help services who care for the elderly?

There has been major confusion among elderly people and the home help staff in Inchicore and Ballyfermot during the past few weeks. There is continuing concern about the cuts in the service and the effect they will have on local communities. A letter addressed to the clients and staff of the services was issued by the home help service on 26 March stating that due to the cuts in funding imposed by the Health Service Executive, cuts would be made to the service on 6 April. Naturally, that caused huge upset, confusion and concern. Although the statement in this letter was later retracted, doubts remain over the service and its continued support through the HSE.

I am concerned that the cuts to the service will mean a reduction in home help hours and services for elderly people who rely greatly on their home helps. This service is invaluable for our elderly. From a daily home-based task to providing simple companionship for a person who is on his or her own, home helps are a real lifeline to the many elderly in our community. If their hours are cut, many vulnerable elderly people will be left alone and will be unable to do simple tasks for themselves such as washing, ironing or even making a cup of tea or taking their medication. I know this from my experience of caring for my mother when she was very ill and the daily tasks I did to help her through her daily life.

Workers in home help services are hard-working and work more than their allocated hours; on many occasions they return to check on many elderly people. They often call to see the elderly people for whom they care in their free time to check that they are okay. In many cases they have formed a real bond and this becomes a companionship. Many lonely people find it a great help to have such company in the evening time.

Home helps are not very well paid, as we all know, and they save the State money in the long run. Hospitals in this city are overcrowded. If home help hours are cut, many elderly people will have to leave their homes and communities and move to hospitals and nursing homes that are already overcrowded. Is this really what we want? With a little help, many elderly people can live a full life in the comfort of their own homes. In this way they retain their independence and feel happy and secure in their familiar surroundings.

More than 60 people are on the waiting list for a home help in Inchicore alone. It does not make sense to anyone to cut this service, least of all for those people who are on the waiting list for a home help. Home helps find themselves in a state of limbo. On one hand, they are being told they work in a limited company, however, they recently had take a take a pay cut, and thus have had to pay for their gains under benchmarking, which indicates they are considered public sector workers. If the service is funded by the HSE, why can the Minister of State not confirm by whom home helps are employed? Some people have been working in this service for 30 years and yet they do not have a contract or benefits. An arrangement was signed by the HSE in 2007 but to date the employees have not received a contract. They have heard that the service is to be privatised and understandably they are very concerned about this.

I ask the Minister of State to clarify what will happen to the home help service in Inchicore and Ballyfermot and to its clients and staff. We need to reassure the many elderly people living in Inchicore and Ballyfermot that they are not just a number but that they are cared for. Not everyone can be a home help. It takes a very special kind of person to be one, somebody who cares, understands and, above all, takes the time to sit and listen to the many elderly people in our communities on a daily basis.

Minister of State at the Department of the Health and Children (Deputy Áine Brady)

I thank Deputy Byrne for raising this matter. It provides me with an opportunity to update the House on Government policy on community services for older people.

The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care where this is appropriate. Notwithstanding the significant overall economic pressures facing the country, we have continued to prioritise services for older people, as reflected in the additional funding of €10 million provided in the last budget to expand home care packages nationally. These packages often contain a significant home-help component, at individual recipient level.

In the HSE national service plan for 2010, approved by the Minister for Health and Children earlier this year, the HSE has undertaken to provide almost 12 million home help hours to 54,500 people, more than 5,000 home care packages to some 9,600 people, and 21,300 day care places, which we estimate cater for up to 80,000 people. Between 2006 and 2010, an additional sum of more than €200 million was provided to the HSE to develop community based services for older people.

Other important initiatives are also being undertaken at a strategic level. Arising from an Evaluation of Home Care Packages, published by the Department of Health and Children in December last, the HSE established a task group to progress this year various improvements in home care provision, including the allocation of home help hours to clients.

The Deputy will appreciate that all developments in the area of home care have to be addressed in the light of the current economic and budgetary pressures. The HSE has been asked to make a rigorous examination of how existing funding might be reconfigured or re-allocated to ensure maximum service provision is achieved. This requires a stringent ongoing review of the application of the resources currently available.

The HSE has operational responsibility for the delivery of health and social services. It is therefore incumbent on the executive to review, as appropriate, the home help service in Inchicore-Ballyfermot in the context of overall service priorities for Dublin West or the wider region. I understand that in 2009 the Inchicore-Ballyfermot Home Help Service received in the region of €2 million in funding. As with most other organisations being funded by the HSE, this service was written to earlier this year and was requested to operate in a more efficient manner. It is expected that after these efficiencies have been agreed, this home help service will provide in 2010 substantially the same level of service as heretofore.

Unfortunately, due to the current industrial action, this is the most up-to-date information available to me. I regret that I do not have any more information at present but if the Deputy wishes to raise this matter again once the current industrial action has ceased, I will have the matter re-examined.

Miners Compensation

Deputy Noel J. Coonan

I am glad the Minister has joined us because this is an important matter. During a presentation made by the National Coalminers Group at a recent meeting of a joint committee two issues emerged. One was that the occupational injuries benefit scheme is too restrictive a scheme for the miners; it does not address their needs because the list of prescribed illnesses is too tight. For example, pneumoconiosus is acceptable but COPD — chronic obstructive pulmonary disease — tinnitus and asthma are not. As these are the main conditions suffered by the miners, the scheme is too restrictive for them.

The other issue that emerged is the high variance of diagnosis between the experts. A case study undertaken under Professor Fitzgerald at St. Vincent's Hospital diagnosed a person with disabilities of 80% whereas the Department of Social Protection's doctors or experts decided it was only 20%. In today's money, that means a €750 per month loss to the miners. In fact, one can say openly and clearly that the Department of Social Protection is discriminating against miners and is not capable of addressing their needs.

The Department of Communications, Energy and Natural Resources wants to wash its hands of this matter. As a recent example, when I put down a Priority Question on the issue, the Ceann Comhairle's office ruled it out of order, stating the Minister had no responsibility in this matter. The Minister has a serious responsibility because the licences are in his gift and, under the Mines and Quarries Act 1965, he has a duty of care to the people who work in quarries and mines to provide adequate ventilation and to protect them from overexposure to dust.

That duty of care is not being exercised. In fact, cowboys were allowed to operate the mines without due respect to the health and safety or general well-being of the miners. The consequences have been dire. The mortality rate of miners is much higher than that of the ordinary individual; they are dying at an alarming rate, with 50 deaths in the past year.

What is the solution sought by the National Coalminers Group? They want the establishment of a redress board, which would be of benefit not only to the miners but also to the State in that there would no admission of liability on the part of the State, it would be limited to a very limited group of approximately 350 claimants, including miners and their widows, it would be ring-fenced by terms of reference established by the State and a finite amount of compensation would be clearly identified for the 350 people.

The most reasonable solution is to provide a lump sum to the miners because an increase in social welfare is no good to a dying man whereas a lump sum can at least improve his general well-being and economic situation. That is what we ask of the Minister today.

Deputy Frank Feighan

I thank Deputy Coonan for sharing time. It is time the Government established a redress board to provide compensation for the National Coalminers Group and acknowledge the contribution the miners have made to this country. In my area of Arigna, which covers counties Roscommon, Leitrim and Sligo, the survivors and widows have been forgotten. I ask the Minister for Social Protection, with the Departments of Health and Children and Communications, Energy and Natural Resources to come up with a package to acknowledge and recognise what these people have done. They have been forgotten for far too long. I ask the Minister, Deputy Ó Cuív, to work with the various Departments to come up with some form of redress or compensation.

Minister for Social Protection (Deputy Éamon Ó Cuív)

Ba mhaith liom buíochas a ghabháil leis na Teachtaí as ucht an deis seo a thabhairt dom cur síos a dhéanamh ar an gceist seo. I thank the Deputies for raising the issue. I am aware that the National Coalminers Group was in Leinster House today seeking to advance its campaign for a scheme of compensation in respect of the illnesses miners have acquired as a result of working in coalmines. In this regard, I was pleased to facilitate my colleague, Deputy Aylward, in arranging for an official of my Department, together with officials from the Department of Communications, Energy and Natural Resources and the Department of Health and Children, to meet earlier today with a delegation from the group to hear their concerns at first hand.

As the Deputy will be aware, the primary role of my Department in regard to this issue relates to the provisions of the occupational injuries scheme and specifically to the disablement pension payable under that scheme. The occupational injuries scheme is a compensation payment for loss of faculty arising out of or in the course of insurable employment. The legislation governing the occupational injuries scheme provides entitlement to benefit for persons suffering from certain prescribed diseases which are listed in the legislation and where those persons have contracted that disease in the course of their employment.

Employment under a contract of service as a miner is insurable for occupational injuries benefit under the Social Welfare Acts. Miners who are unable to work due to an accident arising from their employment may be entitled to occupational injury benefit for the first 26 weeks of their claims. If their incapacity extends beyond that period, they may receive illness benefit or invalidity pension, subject to meeting the qualifying conditions for these payments.

Miners may be entitled to disablement benefit if they suffer a loss of physical or mental faculty as a result of an accident at work or a disease prescribed in legislation that they contracted at work. Medical assessments are undertaken in all such cases to determine the degree of disablement, which is calculated by comparison of the state of health of the applicant with a person of the same age and gender. Miners who contracted the prescribed disease pneumoconiosis are entitled to disablement benefit. While I appreciate the position in which the miners concerned now find themselves, I am obliged to reiterate that a compensation package specifically for former miners would be outside the remit of the occupational injuries benefit scheme of my Department.

The issue debated here has been the subject of several parliamentary inquiries from a number of Deputies and has been aired most recently at the Joint Committee on Communications, Energy and Natural Resources. In the course of that meeting and again at the meeting held with the group earlier today, it was argued that the list of prescribed diseases under the occupational injuries scheme should be extended, and reference was made in particular to chronic obstructive pulmonary disease, COPD, in this regard. My Department has considered whether COPD should be added to the list of prescribed diseases but has been advised that COPD is a common clinical condition and one of the leading causes of death after heart disease, cancer and stroke. It is not a condition that is specifically linked to a particular occupation and it is not possible to establish a causal link between coal mining, or any other occupation, and the experience of COPD. Smoking is by far the most common cause of COPD.

Deputy Noel J. Coonan

Professor Fitzgerald would not agree with the Minister.

Deputy Éamon Ó Cuív

I take the Deputy's point. However, one of the problems in life is that it is possible to find professors who will say totally different things. I will certainly consider——

Deputy Noel J. Coonan

He is a very reputable man.

Deputy Éamon Ó Cuív

I am not saying he is not reputable. The Deputy will find reputable people with wildly differing views.

My Department has been advised that no EU state, other than the UK, includes COPD in their schemes equivalent to the occupational injuries benefit scheme. The position in the UK is that their equivalent of our occupational injuries benefit may be paid to coal miners who have worked underground for at least 20 years and who are diagnosed as having definite pneumoconiosis, with considerable lung function loss. The effect of prescribing COPD or chronic bronchitis and emphysema, CBE, was not to confer entitlement to people who did not already qualify for the UK equivalent of occupational injuries benefit but, rather, to enable a higher rate of payment to be made to some sufferers in certain circumstances.

In this country, the position is that where miners develop pneumoconiosis as a result of their occupation, then occupational injuries benefit is awarded. Persons claiming occupational injuries benefit in cases of pneumoconiosis are referred to a consultant respiratory physician in the first instance for an examination and report. This examination consists of a clinical assessment and pulmonary function testing. The latter is a standardised test that will establish the extent of lung malfunction irrespective of the specific medical condition giving rise to that malfunction. Disablement benefit is awarded on the basis of the consultant's objective report, including the pulmonary function test results. If COPD is present in some of these cases, the disablement award will reflect this. Given this background, it was concluded that it would not be appropriate to specify COPD for the purposes of occupational injuries benefit.

Concerns were also expressed at perceived inconsistencies in the nature of the medical assessments undertaken of the medical conditions affecting the miners under the occupational injuries scheme. I will ensure they are brought to the attention of the medical advisors in my Department.

I also undertake to obtain a report of today's meeting. As a Minister I have sympathy for anybody suffering from an occupational disease or injury, where this can be established. The reality is however that one cannot allow a situation to develop whereby, for example, people with the same condition as a result of smoking, could also make a claim of occupational injury. Therein lies the challenge. I will seek a detailed report of today's meeting. This is not a simple issue but I will treat it with the utmost seriousness. I must stress that the situation is as outlined this evening and will remain so. I will undertake to obtain a full report of what was said at today's meeting to see if anything therein might make a difference.

Dáil Éireann debate -
Wednesday, 5 May 2010