Home Help and Home Care Services: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Caoimhghín Ó Caoláin on Tuesday, 16 October 2012:
That Dáil Éireann:
- recognising the right of older people to live in dignity and independence, and to age well, in their own homes and communities and for as long as possible;
- knowing that 91 per cent of older people rely on the State pension and related supports to protect them against risk of poverty;
- understanding that home help and home care packages are vital, not only to enhancing the quality of life of older people and supporting their preferred wishes, but also to reducing pressures elsewhere in the health care system, including acute hospital services;
- commending the work of home helps, home care providers and carers who care for the needs of our older people and those in infirmity;
- acknowledging that the demand for these services, and for additional supports such as meals-on-wheels, day and respite care, will continue and will increase as the demographics and complex needs of older people change;
- accepting that the Government, despite the economic challenges, must maintain and improve, by all means possible, the social fabric of Irish society, caring for and cherishing people with disabilities, their families and others in need;
- condemning the recent Government decision to cut up to €1.7 million in funding for home care packages and approximately €8 million in funding for home help hours between now and this year’s end, equating to some 450,000 hours of support for those in need, and which, further to cuts implemented in January, will see almost 1 million hours of home help hours withdrawn over these 12 months; and
- recognising the devastating impact these cuts will have on the quality of life and general well-being of those affected;
calls on the Government to:
- immediately reverse the cuts to home help hours and home care packages and to return funding to pre-budget 2012 levels;
- maintain, develop and enhance home care front line services and to guarantee continued reliable access to community care for older people; and
- draft, publish and implement a national positive ageing strategy before December 2013.
Debate resumed on amendment No. 2:
To delete all words after “Dáil Éireann” and substitute the following:
"acknowledges:
— the Health Service Executive, HSE, community based supports currently in place for older people, including vulnerable older people; and
— the imperative to maximise service delivery in all relevant respects in line with current or expected overall resource availability;
recognises the significant existing investment of, for example, in the region of €320 million this year for home help and home care packages and overall for the wide range of HSE health and personal social services generally, including mainstream home help, enhanced home care packages, meals-on-wheels and day or respite care, which meet the preferred wishes of many vulnerable older people and help reduce pressures elsewhere in the wider health system;
notes the complex and multi-disciplinary nature of such services, including the partnership by the HSE with non-statutory agencies to complement its overall funded provision;
welcomes progress by the Government so far, to consolidate and improve the planning and delivery of such services, including maximising the use of limited resources while promoting quality, safety and equity for both providers and care recipients alike;
acknowledges various quality related initiatives led by the HSE, including developing new guidelines and a new procurement framework for its home care services;
welcomes the recent publication by this Government of the national carers’ strategy, which reinforces the Government’s recognition of, and commitment to, all those caring in whatever capacity for vulnerable people;
welcomes progress by the Government to advance the long awaited national positive ageing strategy, now being finalised, to enhance a more strategic and co-ordinated approach to the well-being of older people and the intention of the Minister for Health to bring a draft of the completed strategy to Cabinet before the end of the year;
acknowledges that it is best practice to keep home help and other services for older people under review, so that such assistance is in keeping with their individual requirements, as assessed by the local health team, which may increase as well as diminish;
and commits to keeping the position in relation to home help and home care packages under review for the remainder of the year, and that anyone who has been assessed as needing a service will have that service provided."
- (Minister of State at the Department of Health, Deputy Kathleen Lynch).
I propose to share time with Deputies Thomas Pringle, Luke 'Ming' Flanagan and Tom Fleming. The Government has talked continuously about health care reform and its determination to reform the public health service. Some of us believe reform is, for the most part, a euphemism for cuts and austerity. There is no clearer example of where this is the case than what the Government is doing to home helps and home care packages. It is despicable to cut more than 1 million home help hours to the elderly and the disabled, some of our most vulnerable citizens. One cannot call it reform because it is just cuts. Every one of the hours cut will degrade the quality of life of our most vulnerable citizens. It will mean more suffering, more loneliness and more isolation. For many people, it will mean an accelerated move to death. It is despicable, unacceptable and there is no justification for it. The Government should reverse the cuts. It should find the money elsewhere and leave the elderly and the disabled alone.
Given the move to take personal assistants from some of our most disabled citizens, the fact I have heard from parents of some of the most severely disabled children who have had respite hours taken from them, and the cutting of home help hours, I seriously ask what the Government has against the elderly and the disabled. This is not a rhetorical point. The Government seems to be relentlessly targeting them, which is appalling and should stop. I appeal to the Government to reverse the cuts and make it clear that no further cuts will be visited upon this area. I shudder to think what €700 million of further cuts to the health service in the December budget will look like in light of what this has meant for some of our most vulnerable citizens.
Apart from the awfulness of the cuts, I question the economic logic behind them. The Government seeks to outsource these services to private companies, replacing not-for-profit home help providers with for-profit home help providers. An woman in her 80s from Greystones phoned me to explain that she is on a waiting list for public home help services. She is paying €26 an hour to a private home help provider. Public home help providers receive between €12 and €14 per hour. Where is the difference going? It is going into the pockets of private companies, like Comfort Keepers. These are the subsidiaries of multinationals and they see the needs of our elderly and disabled citizens as an opportunity to make money. Setting aside ideological differences in the House, it is unacceptable that the support and health care necessary for our elderly, disabled and sick citizens should be dependent on whether someone can make money from it. It does not make sense from the point of view of the public finances. I urge the Government to lay off home help services and I urge it to protect the not-for-profit home help services and the low paid women workers who work in those services and provide community care.
The Government should stop the drive to put people on the clock. The Taoiseach denied home help workers were being put on the clock but they are. It is dehumanising and is degrading the service. If the Government does not stop, there will be public outcry. The home helps who came into the Dáil and who were on the streets are not going away. They will fight and continue their campaign. The Government should lay off them and back off on these cuts.
I welcome the opportunity to contribute. I agree with Deputy Boyd Barrett in respect of the cuts. It is the worst kind of cutback when home helps are being targeted in this way. The Taoiseach referred to saving only €8 million out of €200 million spent on home help services every year. It means much more to people in their daily lives. Over the past week or two, I have been contacted by a number of elderly people, including a 91 year-old man who will lose the two half hour periods of home help he receives every week. He lives on his own and wants to continue to do so. The service has been withdrawn to save €8 million and to cut 450,000 hours of home help support. A family, in which the mother suffers from Alzheimer's, is struggling to keep her out of a nursing home because they want to keep in her home environment. The HSE has cut the hour provided on a Saturday to help put the mother to bed. These cuts are taking place throughout the country. The HSE dresses it up by saying the same number of people receive a service based on medical need and by saying that 50,000 people receive the service. This is the reality of what such cuts are inflicting on people. I agree with the argument on privatisation, which is coming. We have it in Donegal and every other county. Privatisation is nonsensical and short-sighted in a budgetary sense. Keeping people at home saves money in the long run.
It is difficult to work out what the Government is trying to achieve. This week, we read that one in ten people in the country cannot feed themselves. Now that the Government has achieved that, it wants to try to get older people to die a little younger so that it can save more money. My father does not want to go into a home. I do not know anyone of that age who wants to go into a home if it can be avoided. These cuts will create a situation where people must go into institutionalised care. One does not need to be a genius to work out that people are better off in their homes. It is difficult to make the argument because I thought the Government agreed with it. I thought the Government agreed because one cannot argue against it. On many subjects, one is told one cannot do it because the country is bankrupt and does not have the money. On this subject, the Government does not have that argument. If these people cannot be taken care of in their homes, it will cost much more to take care of them in a place where they will be less happy. Trying to apply logic to the situation does not work. Why is the Government doing this when it will cost more and make old people miserable? I thought the Government agreed with fairness, but it does not.
The upgrading of the home help service over the past ten years has probably been the most significant development in health services in this country. Home help staff in the 21st century are highly trained, dedicated and proficient in delivering excellent quality of care and assistance to thousands of vulnerable people who wish to live in their homes, their own environment and in the local community. As regards value for money, the cost and benefit ratio is not matched in any other sector in the delivery of health services in this country. Recent developments highlight the expanding role they play into the future, with fewer patients in hospitals, shorter hospital stays and the increasing focus on community care.
The total health spend for this year is in the region of €13 billion. The recent decision to reduce funding to the home health service by €8 million for the last quarter of 2012 equates to a loss of approximately 450,000 hours. This is devastating, on top of the half a million hours cut when the HSE service plan was announced. Compared to the €13 billion, this is nitpicking.
This dramatic reduction is an indictment of the reckless policy of the HSE and the Department of Health of targeting the most vulnerable in our society and causing undue hardship and stress to people. I am sure all public representatives are aware of people whose home help service has been totally discontinued, causing them considerable unease, unrest and inconvenience.
Hundreds of people have had their hours seriously cut. Some people report that their hours have been so reduced that their home help can only rush in, stay for 20 minutes and rush out again. These people are now worried that they may lose their home help altogether.
The reduction in home care packages is also causing serious problems.
I call Deputy Patrick O'Donovan, who is sharing time with Deputies Regina Doherty, Tom Barry, Martin Heydon, Liam Twomey and Gerald Nash.
I welcome the opportunity to speak on this motion and I acknowledge the presence of the Minister of State, Deputy Alex White.
Previous speakers have mentioned the regulation of home care provision. Until recently, the provision of residential care in institutions was not regulated or inspected. It took a scandal, unearthed by "Prime Time Investigates" to establish the Health Information and Quality Authority, HIQA, and for minimum standards to be introduced.
The Law Reform Commission report, Legal Aspects of Professional Home Care, recommended that HIQA be given additional regulatory and inspection powers to ensure that appropriate legal standards are in place for undertakings providing professional home care, that is, that the State would provide a set of minimum standards, supervised by HIQA, to ensure that private home care providers which are outside the loop of the HSE are doing the right thing. I have mentioned this issue three of four times in the House. I have a personal involvement in the matter. Families who are dependent on home care providers, whether commercial or publicly funded, want to know that someone who is looking after an elderly relative or semi-independent adult, because this issue does not only affect old people, is properly trained and has the necessary skills, that an inspection regime is in place, that there are consequences if things go wrong and that these things can be examined on a renewable and continual basis. That is not the case at present.
The Programme for Government 2010-2016 commits the Government, in principle, to introducing legislation for this matter. However, we recently saw another "Prime Time Investigates" exposé of this issue. Given that we will shortly hold a referendum to enshrine the rights of the child in the Constitution for the first time, it is important that we introduce legislation to ensure that people who are in receipt of home care services, whether home help hours or packages provided privately and funded through the HSE, are guaranteed a minimum standard assured by HIQA so that action can be taken, if necessary.
Recently, the Minister for Health visited St. Ita's community hospital in my constituency and enunciated the importance of maintaining people in their home environment. This is critical. To achieve this, multidisciplinary services must be provided. The services of a physiotherapist and occupational therapist are essential. The home help is often the person on whom all of this hinges. It is often the home help who makes the telephone call and arranges to have the public health nurse come and change bandages, and so on. The home help is often the last line of defence.
Home helps need legislative protection to ensure that the standard they are working to is enshrined in law and that they have the protection of the law, as professional providers who are entrusted by the community to look after people. I quote from the Law Reform Commission report of 30 June 2012, to which I referred earlier. It states:
The main beneficiaries of the proposed new HIQA regulation will be those over 65. The proposed system should apply to professional home care provided to any adult over 18 in their own home. There should be a specific register of professional home carers which would set out the specific requirements in relation to the registration and monitoring of professional home carers.
In 2012, it is not too much to ask that a service provided and funded by the State would be covered by regulation. I implore the Minister of State, as a matter of urgency, to bring such legislation forward.
I welcome the opportunity to speak on this matter.
The prospect of change is always worrying, especially when it concerns one's health. The fair deal package is now widely accepted as a good deal for many people. I know many people who are using it. After initial worries, people are now largely happy with it.
We need to look at the issue of financing home care. Perhaps we should consider a system along the lines of the fair deal scheme. Instead of considering a person's assets over a period of three years they could be assessed over 15 years. This would allow a contribution to the State as well as a recognition that a person needs and gets the best home care possible. Farmers had an issue with the fair deal scheme because, as well as the primary residence the farm asset was also taken into consideration. This was a little unfair but it is something that can be looked at down the road.
We need innovative solutions for funding the measures we need. We are all against cuts in services, but where can savings be made? We need to assist the people who deserve our care the most.
The parents of disabled children are worried by the prospect of changes in services. We need to consider these children on a whole-of-life basis. We need a plan for these children, from birth to the very end, to take the worry from their parents. We cannot have a system where children are managed for a few years but there is nothing for them later on. Organisations such as the Cope Foundation in Mallow and St. Joseph's Foundation in Charleville are remarkable. We must help these organisations because they are doing an extraordinary job. Ordinary people who are living ordinary lives are dealing with situations that are incredibly taxing with an extraordinary attitude. One would not realise what they are dealing with because they get on with life. It is important that we recognise these people and help them as best we can.
We must not forget the people who are out of work.
They have many skills and can, perhaps, retrain in the area of home care. JobBridge and other such schemes might be handy in this regard as well. In addition, we must try to encourage people in communities once again to visit their elderly neighbours, even if it is just to call in and ask if there is anything they can do for them. Over the last number of years people were so busy and consumed with all that was happening they forgot to spend a little time looking after their neighbourhood. Thankfully, rural areas are getting better again in this regard.
We must examine how we can fund home care and care for the most vulnerable. We must consider a whole of life approach for those who are most vulnerable. How we manage to do that will define us as a Government.
The opening statement in the Private Members' motion refers to the rights of older people to live in dignity and independence and to age well in their own homes and communities for as long as possible. That is something all of us endorse.
This year, 2012, is the European year for active ageing and solidarity between generations. Together with other member states, the Government has celebrated and promoted positive and active ageing. Currently, Ireland has just above 500,000 people aged 65 years or older, but by 2021 that number is expected to be approximately 775,000. That is an increase of 55% in just 11 years. However, Ireland is one of only two countries of the 34 countries in the Organisation for Economic Co-operation and Development, OECD, that have dedicated Ministers to support policy decisions relating to older people's issues. When this Government took office the fine Minister of State, Deputy Kathleen Lynch, was given that ministerial responsibility.
This Government is committed to bringing greater coherence to Government planning, policy and service delivery for older people. We are at a very important juncture in terms of future policies and services for older people. Currently, we have the lowest proportion of population aged 65 years and older in the EU, but this will change and now is the time to get our house in order. The expected demographic changes will bring significant challenges but also great opportunities. These challenges can be met successfully and the opportunities fully exploited by planning ahead now, just as we must plan for any change.
The national positive ageing strategy is being developed within the constraints posed by the current fiscal situation. It sets out the strategic direction for future policies, programmes and services for older people. It sets out to establish a common framework for the development of operational plans by Departments and to clarify their objectives relating to older people. It will also involve the development of ongoing mechanisms designed to monitor progress and to identify challenges facing older people in future. A key objective of Government policy has been to support older people to live at home in their communities for as long as possible. This option, the preferred choice of most older people, has been maximised through enhancing the range of HSE services such as home help, home care packages and day and respite care. In addition, the Department, in consultation with the HSE, is currently preparing proposals to ensure that access to community services is provided on a nationally consistent and equitable basis having regard to each person's care needs and means.
The purpose of the national positive ageing strategy is to identify the provisions that must be made and the plans that must be implemented to ensure the best quality of life for older people in Ireland in the future. In that context, a key objective of the new strategy is to help people develop and maintain a positive quality of life as they grow older by encouraging people of all ages to think positively about their own ageing, to plan sensibly for their later years and to facilitate them in adopting the type of lifestyle practices that will have the effect of adding years to their life and life to their years. This means we must maintain, develop and enhance home care front-line services, ensuring older people are facilitated to remain at home. The majority of older people continue to live in the community well into later life. The housing grant for older people administered by local councils has been very effective in improving the standards of living for older people in Ireland. It must continue and be supported.
This Government has given a commitment that anybody who has been assessed as having a service need will have that service provided. The Minister, Deputy James Reilly, recently urged us to use the "get smart" approach. Given that most people wish to remain at home, let us nurture and encourage all of those community services that currently exist. The continuation of home care packages enables a tailored approach to the needs of older people. These home care packages differ from the normal care in the community in that they allow for the provision of enhanced services beyond the normal levels available in a community and can prevent or delay admission to acute hospitals or long-term care.
There are, of course, additional supports available in communities, such as meals on wheels, which I run in two towns in my constituency. Many day and respite care places are offered by wonderful voluntary organisations. Last week I had the pleasure of meeting the Support 4 Older People organisation in Drogheda. It offers a wide range of services and is not financed by the State. We do not give people in the voluntary sector enough credit.
An increase in life expectancy is a product of successful health, economic and social policies. Increasing numbers of old people are an indicator of the successes achieved in that society. Rather than portraying ageing of the population in a negative light, Ireland should develop a strategic framework for the co-ordination of policy reforms to meet the challenges we face. We must ensure that we do not use the fiscal crisis to bring us down, but use it as an overarching strategy to point to the destination at which we wish to arrive. What can be done now, given that we are all agreed that this is where we are heading? Let us be ambitious and work towards making Ireland the best place in which to grow old.
In speaking on this motion, it is most important to highlight the fact that our goal is for people, where possible, to grow old in their own homes, surrounded by their families, neighbours and friends in an area in which they have generally lived for most of their lives. The benefits of this are obvious. There is the quality of life benefits for the older person and also the quality of life benefits for their family and those around them.
Within my extended circle of friends, families and constituents I see situations where the son and his wife or the daughter and her husband are working during the day but trying to be around to help their parents as much as possible. They give up a huge amount of their free time to help and support them. They just need a little extra support to help their parents in that situation to remain living at home. The State has a crucial role to play in ensuring that nobody goes into long-term care unless they really need to or want it. In the past, that has not always been the case. The issue is how we ensure that model is rolled out into the future.
The fair deal was mentioned earlier. There should be a revised fair deal model to provide for the possibility of a funding mechanism for people to have a home care package. I have encountered cases in the past where people, if they had access to long-term care, were able to use the fair deal. Such a mechanism was more difficult for home care. I must stress that any mechanism in that situation would have to be cognisant of how much cheaper it is to provide the services in the home. If somebody is in their home rather than a nursing home, they will need physiotherapy, home help, the services of the district nurse and whatever else is required. However, there is no cost of heating, electricity and so forth in a nursing home, while the cost of bed and board is borne by the person who remains in their home. It is a completely different funding model, with a much smaller contribution. Nonetheless, a model that assists that outcome is very important and should be rolled out. I would support it in the right circumstances and with the right conditions.
During my time as a councillor in Kildare County Council and as a Member of this House I have seen the massive benefit of housing adaptation grants for older people and people with disabilities. They play an integral part in an overall strategy of enabling older people to remain in their homes. Those grants are currently suspended by Kildare County Council, as is the case with other local authorities. I have lobbied the Minister for the Environment, Community and Local Government, Deputy Phil Hogan, and the Minister of State, Deputy Jan O'Sullivan, heavily on this issue and I urge the Minister of State who is present, Deputy Alex White, to look at the current model, given the financial difficulties of our local authorities. They are struggling to meet the 20% contribution. I implore the Minister to convey to his colleagues the necessity to reduce that contribution from 20% to 10%. In the case of my local authority, if that cut was made to the local authority contribution, it would get those grants moving again.
Over and beyond the positive impact that has in enabling people to remain in their homes, it also has a positive impact on the local economy, with local tradesmen getting that work. The money feeds right in. With reform of local government and a property tax being collected locally to pay for local services, local authorities will be able to prioritise expenditure. The current model, however, must be examined to enable local authorities to do what they can.
I welcome the national carers strategy that seeks to prioritise funding for accessible living environments, and this is in line with that. The positive ageing strategy was run on a trial basis in Louth and then was rolled out in Kildare. The positive experience we have had with that in Kildare will be relayed to the Minister. He is to bring a draft plan to Cabinet before the end of the year on the rolling out of that scheme nationally.
We need a strategic and co-ordinated approach on the well-being of older people. I recognise that people who are now retired and in need of care are the same people who were working and raising families in the early 1980s when Charlie Haughey told them to tighten their belts. Having made all the sacrifices back then, they are now in the autumn of their years and it is vital we give them the care and respect they are due. I am delighted this Government is doing that with €320 million being invested in home care packages.
I have huge sympathy and regard for carers and the vulnerable people who depend on their support. Like many Members, we are not happy with the cuts to home help and care packages for the most vulnerable. The health service, however, is difficult to manage properly. There is no shortage of critical issues in health. These critical issues are constantly competing to become the most urgent issue for the Government of the day. If we look through the health service,s we are starting to see huge structural defects across the administration and set-up of the health services. We are trying to address those issues against a background of massive budgetary adjustments at the same time. Tonight we are talking about carers and home care packages, but there are other significant issues in health at this time that are just as urgent and considered just as critical by the people involved.
There has been a major shift in the mental health services from inpatient care to community care, and the Minister of State, Deputy Kathleen Lynch, is dealing with it carefully and sympathetically because it requires a new mindset on how to manage patients with serious mental illness. That should be acknowledged, as should the Minister of State's work.
We must also reduce waiting times for patients. For the first time in my career, and I have been involved in health for 25 years, I know how long my patients must wait for an outpatient appointment. This was information we did not have before and we must reduce those times as quickly as possible, but it requires a massive change in how the hospitals are managed and how doctors, nurses and physiotherapists do their jobs. There is no idea what we must overcome to get that right in order that we can see patients quickly.
We are now working on reducing the costs of drugs because they were out of kilter with what we should have been paying, and the Minister of State, Deputy Alex White, has been given the responsibility of getting primary care to work better. This is an area with which I was involved before I joined politics, and I am still involved with it now. I have seen significant changes in general practice, even since I came in. Some of the drugs we were using to treat patients when I first qualified as a GP are considered obsolete. The treatments for patients are completely different from those I was trained to administer as a junior doctor. There has been an explosion in the use of IT within primary care. The ways we manage out of hours, the paramedics and ambulances have all changed. We are constantly working with the HSE and the medical colleges to make those changes happen.
I am enthusiastic about how change will work in primary care and how doctors, physiotherapists, social workers and home care teams will all work together for patients. We are so good at being cynical and hypocritical in this Chamber about this topic that we need to be more positive and say what is working well. There are problems, but many of them are from the background of wasting money in the health service and many of these reforms were highlighted when we were in opposition. We highlighted the changes that must come about and they are now coming about because we have a Government that is focused on making change. If I was to make any criticism, it would be that we should do it even faster. These reforms will work and will deliver better health services.
I have listened to so many Members on the Opposition benches opposing change and I have watched over the years when people opposed the cancer strategy and major operations in small expert centres. In spite of what is happening in Roscommon, Deputy Flanagan might one day acknowledge that the changes might be good for the people of Roscommon. Perhaps, however, he dug himself into a corner and cannot acknowledge it. I have seen the changes happen in recent years and I have seen things getting better for patients.
Am I in the wrong debate? We are supposed to be talking about home care packages.
The Deputy can hold on to his cynicism and hypocrisy for as long as he likes but I will be enthusiastic.
What about the cuts to home care packages?
I am going to be positive about the changes that can happen for patients and I hope we are real drivers for change on this side of the House.
Sinn Féin proposed this motion but Sinn Féin and its DUP colleagues run the health service in Northern Ireland and are bringing forward many of the changes about which we are talking and encountering many of the problems we are encountering. Sinn Féin enjoys the benefit of getting £4 billion from Her Majesty's Government to lessen the impacts the cutbacks are having on the health service in Northern Ireland. North of the Border, Sinn Féin is doing it while south of the Border, we are doing it. We are trying to work to the best of our ability to deliver the best possible health services.
We are all agreed it is vital that citizens who require home help hours and home care packages get the hours and service they are entitled to expect in any decent society. Home help services and packages are a lifeline to some of the most vulnerable members of our community. This year, 10.7 million hours of home help support will be provided in communities from Louth to Limerick and Donegal to Dingle. This compares favourably with the number of hours allocated in 2006 at the height of the boom.
My admiration and respect for the critical work done by those who care for older people and those with various needs in the community is beyond measure. We often forget about those who deliver the services on the ground day in and day out. The home help services are the Cinderella of the Irish health system. The work of the home helps has never been formally recognised by the HSE. It is effectively undervalued and ignored. The heroes and heroines of the service, the home helps themselves, have been disrespected and devalued by the HSE since 2007. They have no basic contract or agreed hours. In essence, those who are engaged by the HSE do not enjoy the protections and supports provided to those HSE staff governed by the Croke Park agreement. It is high time this wrong was put right by the HSE and that there was meaningful engagement to deal with those issues.
Turning to the content of the motion, it is said a person can only be called a hypocrite if he judges others first. There is no shortage of inhabitants of the high moral ground among the Members opposite. They are always ready to judge the actions of others, but the Members opposite do not come to this debate with clean hands. Sinn Féin's record of government in the North is pockmarked with hypocrisy and failure when it comes to health and social services.
Does the Deputy know the difference between the North and the South?
Compare Sinn Féin's pronouncements tonight with its decision last week that will see at least half and perhaps all state-run residential care homes in Northern Ireland close in five years.
Not true. That is untrue.
That is hypocrisy and deception of the most shameful kind, particularly viewed in the context of this motion. Is the party tabling the motion tonight the same party that is closing 70 schools in Northern Ireland, only a matter of miles from my constituency where we are building a considerable number of schools and extending even more? By slashing spending in the North to the tune of €5 billion, as it is preparing to do on the one hand, while keeping a straight face when opposing any adjustments at all in the South, Sinn Féin is taking the Irish people, North and South, for something of a ride. There is a credibility problem Sinn Féin must address, but it will not because it cannot.
The motion states the party wants to reduce pressure on acute hospital services when members of Deputy Adams's organisation in my constituency have apparently spent thousands of euros in recent weeks publicly thanking me for doing just that by securing a 30 bed step-down unit in the cottage hospital in Drogheda to take pressure from a hospital Deputy Adams could not identify on a map less than a year ago.
Where issues arise around the prioritisation of funding for home care support, I can say with confidence that we can and will address them. Unfortunately the Members opposite who tabled the motion will continue to find it impossible in the next few years to reconcile their words in the Chamber with their actions in the North.
I call Deputy Peadar Tóibín who, I understand, is sharing time with Deputies Brian Stanley, Michael Colreavy, Gerry Adams and Mary Lou McDonald.
Tá an leabhar Comparative Politics for Idiots ar fáil in Easons. B'fhéidir gur cheart do chuid de na daoine anseo é a cheannach chun an difríocht idir an taobh seo den Teorainn agus an taobh eile a fháil amach. D'fhreastal mé ar chruinniú de chuid Third Age i gCnoc an Línsigh i gContae na Mí an Luan seo caite. D'éist mé le scéalta ó dhaoine aosta mar gheall ar na ciorruithe uafásacha ar an seirbhís chúnamh baile. Chuala mé scéal amháin ó bhean a úsáideann cathaoir rothaí. Bhí seacht n-uaire á fháil aici gach seachtain, ach tá ciorrú d'uair amháin sa tseachtain á dhéanamh ar an seirbhís sin. Tá ciorrú eile á dhéanamh ar bhean eile a fhaigheann 30 nóiméad de chúnamh baile - déantar a dinnéar di - gach tráthnóna. Dúirt cúntóir baile liom go bhfuil an méid ama a chaithfidh siad a thabhairt dá gcliaint níos mó ná an méid ama as a n-íoctar iad. Ní leor leathuair a thabhairt d'fhear nó do bhean má tá éileamh i bhfad níos mó ag an duine sin. Is gá dóibh níos mó ama a thabhairt dár n-othair, ach ní fhaigheann siad níos mó pá le haghaidh an ama sin.
Tá cuid den seirbhís seo á soláthar saor in aisce ag a lán cúntóirí baile faoi láthair. De bharr a gcuid daonnachta, ní féidir leo imeacht gan chúnamh ceart a thabhairt dá gcliaint. Is cleachtadh coitianta é seo. Tá an córas ag déanamh mí-úsáide as daonnacht na n-oibrithe. Tá an Rialtas ag goid seirbhísí i gceann de na hearnálacha is leochailí sa tír. Is polasaí leithleasach é seo. Ní cheart dúinn déileáil le daoine atá tar éis saol fada oibre a chur isteach - a íoc cáin, a thóg glúin nua agus a mhair dhá nó trí cúluithe eacnamaíochta eile - sa chaoi seo. Tá Páirtí an Lucht Oibre, atá bródúil as a thaifead ar chearta na n-oibrithe, mar dhea, ag mí-úsáid na ndaoine a thugann cúnamh don dream sin. De ghnáth i gcúrsaí polaitiúla, ní bhíonn an mhoráltacht agus an t-airgeadas ar an taobh céanna - bíonn saghas coimhlint eatarthu. Ar an ábhar seo, tá siad ceangailte le chéile. Nuair a laghdaíonn an Rialtas an córás chúnamh baile, is ionann sin agus daoine aosta a bhrú isteach sa chóras sláinte, lena mbaineann costais i bhfad níos mó. Is polasaí craiceáilte é seo. Laghdaíonn sé sláinte an duine agus mianach an tsaoil agus cosnaíonn sé níos mó.
Nuair a bhí mé ag smaoineamh inné mar gheall ar chumas an dream a fhaigheann an tseirbhís chúnamh baile, thuig mé nach mbeadh an cuid is mó dóibh in ann teacht go dtí geataí Teach Laighin amárach chun a gcuid tuairimí a chur in iúl mar pháirt den bhfeachtas ar an ábhar seo. Níl sé ar a gcumas ag na daoine is laige sa tír é sin a dhéanamh. Ta sé dochreidte go bhfuil an Rialtas ag piocadh orthu. Tá rogha ollmhór ag an Rialtas - bí cinnte faoi sin. Tá deacrachtaí acu, ach is féidir leo an t-airgead seo a fháil in áiteanna eile. Tá siad ag laghdú an méid uair chúnamh baile a fhaigheann na daoine is laige sa tír, ach fós ag tabhairt airgid do na sealbhóirí bannaí. Níl seans ar bith go n-ardóidh an Rialtas seo an ráta cánach a íocann iad siúd a thuileann níos mó ná €100,000. Cad faoi cháin rachmais? God, no. Ní dóigh liom go dtabharfaidh an Lucht Oibre cáin rachmais isteach fad is atá an dream is laige fós sa tír. Impím go díreach ar Pháirtí an Lucht Oibre a meon ar an ábhar seo a athrú agus tacaíocht a thabhairt don rún. Iarraim orthu siúd a fhaigheann cúnamh baile breathnú go géar ar na Teachtaí a vótálann in aghaidh an rúin seo agus na Teachtaí a vótálann ina choinne. Ní cheart dóibh dearmad a dhéanamh ar an méid a tharlóidh nuair a dhéanann an Dáil vótáil.
The programme for Government states that the Government is the first in the history of the State that is committed to developing a universal single-tier health service which guarantees access to medical care based on need and not income. It goes on to state that investment in the supply of more and better care for older people in the community and in residential settings will be a priority. There is nothing in that vision for health care with which we would disagree.
Health care and care for the elderly has become a nightmare for the people we represent. This should not be seen as a factional issue, it is one that affects people across the board. Nowhere is this more real than in the treatment of home helps and the people they serve. Home helps, home care providers and carers provide an essential service to those who want to live independently at home and in their community. The HSE home helps are the success story of home care for the elderly and community care. They are an efficient and reliable front line service, costing between €12 and €15 per hour while the private agencies cost between €20 and €23 per hour. The Minister has taken an axe in the name of cost cutting and balancing budgets and cut the number of HSE home helps to 9,380 and has continued, like his predecessors, to cut front line services. In the past five years 2 million hours have been cut. Some home helps have had their hours cut to single digits while some are expected to go from one house to another and spend just 15 or 30 minutes there. Those who had two hours home help get one hour, those who had one hour home help get half an hour while those who had half an hour home help get 15 minutes. The service has been cut to the bone.
I have spoken to many home help workers who have come to see me about it. Home helps are being forced to cut corners or work free, which they should not be expected to do and they work over and above the call of duty. In my constituency of Laois-Offaly, the reduction in the numbers employed as home helps and carers is startling. In the past 12 months, the HSE has lost 60 home help staff and reduced the number of hours for remaining staff while at the same time there has been a direct increase in private agency staff which, I understand, is more expensive. Having discussed the issue with elderly people I am informed that the service is not as good.
The Labour Party needs to address the issue. I am not trying to score political points but I am making the point that the Minister is privatising and outsourcing the service. This means home helps have fewer rights and worse conditions and the elderly are not getting as good a service while the taxpayers are not getting a bang for their buck. This completely contradicts the commitment in the programme for Government to finance community and long-term care which supports older people to stay in their homes. The Government is tripping itself up over broken promises. Some 95% of people over 65 years of age live independently in their own homes and the State must provide the small amount of services they need to continue living into old age with dignity.
The Minister of State with responsibility for older people, Deputy Kathleen Lynch, has cut back on the home help service. The reduced funding is making it impossible for people to stay in their own homes. Meanwhile the Government is threatening to close nursing homes, particularly those in Shean and Abbeyleix. On the one hand there is a threat to close nursing homes and some have already been closed.
On the other hand, this service is being cut back.
Some people who should be living at home with a small amount of assistance have not been getting it. They are then forced into nursing home care - in some cases the HSE is putting them into private nursing homes which needs subvention. The health plan as it operates in Laois and Offaly is in tatters and I am sure it is the same in the other 24 counties. I urge Deputies, particularly Labour Party and Independent Deputies to vote in favour of the motion. We should be judged on how we look after the most vulnerable in our society. The most vulnerable people in our society are older people who depend on us and depend on their home helps to do that bit of work for them in the morning, to get them out of bed, get them ready for the day and look after them. As this is how we will be judged, I am asking Deputies to vote in favour of our motion and to support home helps and support our elderly.
The purpose of the motion is to request Deputies of all parties to do the right thing by reversing the most recent and previous cutbacks in the home care services, which affect the most dependent people in our communities, those who cannot live independent lives in their own homes without societal support. It is difficult to say everything I want to say about this in five minutes. I want to talk about the things that people are saying to me. I want to talk about things like humanity, respect, decency and social obligations. I want to talk about the legal framework and particularly the distinction between discretionary and mandatory services. I want to talk about stated Government policy as opposed to ideology and practice. I want to talk about consequences for people, for their families, for health professionals and not least for politicians.
When I talk to people about cutbacks in home help services I am talking about elderly people living alone in isolated rural areas who cannot rest, wash, set the fire or cook for themselves. They are being told that their home help is being cut from one hour five days a week to 30 minutes three days a week, following a so-called assessment. I have spoken to parents of severely autistic children after they have been informed by the State that their child is not sufficiently disabled to merit the carer's allowance or a respite care. I have spoken to family members who have seen home help reduced or withdrawn from their elderly dependent relatives. I have also seen reductions in day-centre services, transport services, voluntary organisation funding and carer's allowance - if the family is lucky enough to qualify for half rate carer's allowance.
Owing to the decisions made by this and the previous Government, it is now the case that not even the postman calls to elderly people living in isolated rural areas. What about aspects such as humanity, respect, decency and social obligation? Irish people are very good at looking after their dependent family members. Most Irish people will only place dependent relatives, whether they are children, parents or grandparents, into residential care when they can no longer maintain them at home. If civilised people in Irish society could speak with one voice, that voice would say, "Reverse these cutbacks". We, as a Parliament working on behalf of society, should do everything in our collective power to help people to do the right thing. Instead of that we are withdrawing the meagre supports available to help people to do the right thing.
Do we do this because home help and home care services are not legally mandatory services? Is this why they are always first to be cut? Is it because those who receive and also provide home care are not an effective political lobby? Is it because the real unstated agenda is to privatise all home care support services? The Government claims it wants to keep people living in their own homes for as long as possible. It claims to be developing primary and community services in order to reduce demand on acute hospitals and on residential care. It also claims the best place for people to be is in their homes as long as they can stay there. This makes humanitarian, social and economic sense. Deputy Nash spoke about hypocrisy. The real hypocrisy will be when he presses the button to vote tonight. It is hypocrisy to have these stated intentions and then make home help and home care services a privilege rather than right.
These cutbacks will mean more people in residential care and will mean people spending longer than is medically necessary in our overcrowded acute hospitals. The cutbacks will regrettably but inevitably result in elderly vulnerable people prematurely dying alone. They will result in carers and home helps reaching and passing breaking point. They will result in local public health nurses, who provide an invaluable caring role within the community, being regarded as agents for HSE cuts and they will result in more money going into the pockets of for-profit health care providers. Deputies from the Government parties must know this.
I begin by commending the thousands of home helps throughout the State, mostly women, who are the essential support for many of our older citizens. Many home helps spend much longer with their clients than the minimum amount dictated by the HSE - and they certainly do not do it for money. Home helps are paid €14 per hour. They have very poor terms and no legal protections. The cost of providing this service through the private sector is €23 per hour and the taxpayer picks up that tab.
I welcome the home helps and their representatives who came here this evening. I believe they represent the true spirit of community and volunteerism because without their very unselfish efforts many of our most vulnerable citizens would fall through the cracks of a system that is deeply flawed. Home helps allow citizens to live with dignity and independence in their own homes and in their own communities. They form a crucial part of a community-based health care system that helps to prevent many citizens unnecessarily spending days, weeks or months in hospital beds.
They are mostly women. Women are compassionate and have the sense that perhaps the male gender does not have. They see the need and they meet it. Often it is an older citizen living alone, in isolation, frail, helpless and lonely. Sometimes it is a couple who have been together for decades. They do not want to be separated and need a home help to avoid having to go into a nursing home. In many cases the home help is the only social contact these folk have. They walk into homes where older citizens are unable to dress, feed themselves, light fires for heating, wash or clean up. They are being told they have to do this in 15 minutes or half an hour. They include citizens such as an 80-year-old partly sighted woman from outside Drogheda who was released from hospital recently after a hip replacement. She has limited mobility and cannot light her fire. Yet she was allocated half an hour of home-help service a week. Shame on the Minister - it is a disgrace.
The Government and the Members opposite appear immune to all of this. Since I came here I have tried to figure this out. Government Members live in these communities and these are their family members and friends. I have still not figured it out. They praise the work of home helps and claim to understand the needs of older citizens, yet they take decisions and support policies, including the Government's amendment to this motion, that devalue the role of home helps, cut back those services, and expose vulnerable citizens to harm. They extol the virtues of care in the community and the work of home helps, yet they strip away the resources needed to make them work. They express concern at the number of older citizens in hospital beds, who should be discharged while they implement policies that stop home care packages and keep older citizens in hospital at greater financial cost. They bemoan the absence of compassion while pursuing a policy of privatisation and profit.
That is the nub of it. The Minister cannot with credibility manage the public nursing home sector while benefiting from the privatisation of nursing home provision and refusing to publicise the criteria by which the Government determines where primary health care centres should be sited.
There are cultures and societies in the world which genuinely care and venerate their older citizens and ancestors. I am firmly of the view that the majority of Irish people share this opinion. This cannot, however, be said of the Government parties. The decision to close 14 long-stay residential care beds and 15 respite beds in the cottage hospital in my constituency is one example of this. The facts are clear: almost one million home help hours will be lost. For the benefit of Deputy Nash, this means that some of the 1,184 citizens in County Louth currently in receipt of home support will lose that support. That is totally unacceptable. It is a sign of the Labour Party's embarrassment on this issue that only one member of that party is in the House for this debate.
I ask all Deputies to support this motion. Anything else is an abdication of our responsibility as Deputies.
I have listened to what people on all sides of the debate have had to say. It is useful to recap at this juncture on what we are agreed on. We are all agreed that it is better for older people to live and be cared for at home. There is a unanimous view across the House on this matter. We know that aside from the social desirability and the dignity concerns of people living and being cared for at home, this adds up economically. We are, I believe, also agreed on that.
The Carers' Association, the voluntary organisation for carers throughout the country, was in Leinster House today on a lobbying exercise because it, like others, is fearful of what might come in December's budget. The association usefully set out in tabular format, in euro and cent, why it makes cost savings sense to care for people in their own homes. They have that argument won, game, set and match. I believe we all subscribe to that view, which is what makes the Minister's position on this matter all the more astonishing. Unlike others, a year and a half into the term of office of this Government, I am not very surprised that the Minister would try again to hit at those he deems to be vulnerable. I am not surprised that Deputies from across the Labour and Fine Gael parties are now so craven that they will come into this Chamber and defend what they know to be indefensible and try to point to a distraction and run for cover. None of that surprises me. That is the Government's form. What does astonish me, when something is not just self-evidently right and equitable but also cost effective, is that this Government, which obsesses on the need for adjustments, fiscal responsibility and good housekeeping, would turn its face from the evidence which tells it the smart and economic thing to do is to ensure people are cared for at home. This is not what the Government wants to do.
There has been a 20% cut in home help hours since 2008. Precisely half of those cuts have been and will be made under the watch of the current Minister. Between February 2011 to the end of this year, there will have been a drop of one million hours from the system. The Government should not rewind the tape and say this is all the fault of Fianna Fáil. This is the choice of the Fine Gael and Labour parties. They are choosing to impose these cuts. The drop in the number of hours has and will continue to have further real consequences for people. Deputy Adams gave one example, namely, an elderly woman returning home after a hip replacement with mobility issues to be insulted with the offer of half an hour's home help. I do not know whether the Minister has experience of getting a child ready for school, bathing a child or caring for an older person. One will not get a whole lot done within half an hour for an elderly person who is in any way compromised. One will do even less for that person if his or her allocation is as low as 15 minutes. One of my constituents, who has complex health needs and a complex medical history, was allocated 15 minutes home help. That is the time allowed to the carer for this person to be taken from bed and bathed. Those tasks will not be done in 15 minutes. The real cynicism of this approach is that the Minister knows that carers and home help staff epitomise the decency of community and voluntary effort and public service. He is counting on the probability that while only 15 minutes is officially allocated and paid for, the decent carer will remain on and see the person right. The Minister is gambling on that decency, which makes his cynicism all the more disgusting to me.
The Government amendment to the motion is curious and revealing in terms of its being full of self-congratulation, welcoming all and sundry and giving itself a great pat on the back. Perhaps the Minister will answer this question. What has he to be proud of in terms of the removal of €8 million worth of home help hours from the system, leaving older, vulnerable and, in many cases, sick people in such jeopardy? Why would anyone with a grain of decency or sanity welcome that? During the course of this debate, one of the Minister's colleagues, a member of the Fine Gael Party, chided members of Sinn Féin for their emotion. He ran the predictable line around identifying sources of funding. The Deputy knows full well that we accept that services must be funded. He also knows full well that this year, like every other year, Sinn Féin will put forward its proposals on that score. The Deputy concerned stated in the course of his contribution that everyone is against cuts. Is that really the case? Is everyone in this House against cuts to home help hours? Was the Deputy speaking for Fine Gael? Is that party against cuts to home help hours? If that was a statement of fact, the Government would not have tabled an amendment to this motion and every Deputy would do right by carers, home help staff and the elderly by supporting the Sinn Féin motion.
Often when criticisms are made of policy decisions, adjustments and cutbacks, the Government's cover is that the quantum of savings is so great it has no option but to face into what it deems to be a tough choice for it. This mean-minded, indecent cut to home help will save just €8 million. In the grander scheme of the health budget, that is loose change. I do not know how, taking account of value for money and the real needs of citizens in their homes, the Minister can, with any credibility, argue for or proceed with these cuts.
He was forced by people with disabilities to back down from his proposal to take personal assistants from them. He should, if he has any semblance of decency, voluntarily retreat from these cuts in respect of home helps. He will sow the seeds of his own disaster if he proceeds with this cut. The acute hospitals are over-budget and under strain on his watch, and he knows this. He is averse to public nursing home beds and he certainly has closed enough of them. The next line of attack is in respect of home helps. A cut like this will mean greater illness and vulnerability among older people. It will mean more of them will need more expensive medical intervention, more of them will be in hospital and, sadly, given the current state of the service, it will mean more of our elderly citizens will be on hospital trolleys.
I thank all Members of the House who contributed to the debate yesterday and today. No one disputes the fact that high quality home care makes a big difference to older people and their families. There is no doubt the work to date of all those involved in the development and implementation of policy and the provision of services has contributed positively to the lives of those who receive these services. It is also a vital element in meeting the preferred wishes of older people and people with disabilities and their families to stay in their homes where at all possible. It also helps in tackling wider health and social system pressures and addressing poverty in many cases.
With the growing demand for such services, there will be challenges ahead as services evolve to meet the needs of older people and, as far as possible, care for them in their own homes and communities. Services will have to adapt and be more flexible in their use of funding while maintaining at their core the person-centred approach. Let me be clear. The Government is committed to a single tier publicly funded health system. This is why the Government is committed to universal health insurance.
It has long been the case that the HSE has worked in partnership with the not-for-profit and private sectors to augment its valuable services to people who need home care at local level where, for whatever reason, the HSE is not in a position to do so itself. This may include where there are resource limitations locally or to ensure care in the evenings and at weekends. Among recent HSE initiatives to improve service nationally has been the introduction of a new procurement framework for approved agencies providing services on its behalf. Each local health office, and the clients it serves, now has a choice of four approved providers for new home care packages to supplement its own provision. While these developments have been designed to standardise and maximise the use of limited resources in the face of increasing demand, they are also intended to enhance quality, safety and other relevant aspects of service for providers and care recipients alike.
I must signal clearly that I make no apologies for seeking to maximise the amount of home care we can afford with what is, after all, a substantial budget. I am seeking new models of working in the public sector to achieve efficiencies and seeking to provide a choice of provider where this is possible. This must include partnership arrangements for the voluntary and private sector. Key services realise this objective while also relieving pressures on acute hospitals and long-term care residential systems. The range of community-based services include home care, meals on wheels, and day and respite care. In 2012 we will spend approximately €320 million on home help and home care packages. Approximately 50,000 people receive mainstream home help and, at any one time, approximately 11,000 people receive home care packages.
I must ask Deputy Adams whether it is true that Sinn Féin in government in Northern Ireland is closing long-stay beds.
I ask Deputy Mary Lou McDonald whether Sinn Féin is closing schools with fewer than 105 pupils.
The Minister should know this.
The Deputy says "No" but the facts might prove somewhat different, in the same way as the Deputy says he was never a member of the IRA and all the rest of it.
We need to ensure the highest standard of care will continue to be provided to all care recipients in a safe and secure environment, whether in long-term residential care or home-based settings.
Is it in order for me to answer the Minister?
Normally during these debates it is up to the person speaking to give way.
I will not give way.
All developments can only be addressed in the light of the current economic and budgetary pressures. Any decisions taken by the HSE can only reflect the most realistic options which have been designed to minimise front-line impact. The HSE will continue to review how existing funding might best be allocated to ensure maximum service provision.
I remind the House that my guiding principle is to treat the patient at the lowest level of complexity which is safe, timely, efficient and as near to home as possible, and nowhere is closer to home than the home itself. I acknowledge and salute the invaluable work done by home helps in helping us achieve this goal, that people, older people in particular, remain in their homes for as long as possible with all that means for their well-being. I commend the Government amendment to the House.
Will the Minister reverse the cuts then?
I do not know who the Minister is trying to kid with his last statement. It is a bit rich for him as Minister for Health to come to this House and state this is his guiding policy while at the same time overseeing the removal of 1 million hours of home care support from these very vulnerable people. It is an appalling decision by the Government and the parties which will support the decision. People throughout the country are angry at the decisions the Minister is implementing in the Department of Health. I hope that in my county on Friday we will see thousands of people taking to the streets to protest against the cuts to home help hours. The march will leave St. Conal's Hospital in Letterkenny and go to Market Square. I am sure there will be people from all walks of life, including those who support other political parties and no political parties. What will unite everyone is the fact we are opposed to the appalling decision by the Government to cut home help hours.
My colleagues have outlined the facts, but they cannot be overstated. A total of €8 million is to be cut from the home help budget between now and the end of the year. An additional €1.7 million will be cut from home care packages. In total 450,000 hours of vital care and support for many of our community's most vulnerable people will be taken away. In my county of Donegal, we have seen brutal and savage cuts to home help packages for our sick and elderly in recent years. We have seen home help supports taken from vulnerable people in the county. These cuts were implemented not only by the Fine Gael and Labour Party Government, they were in the main implemented by Fianna Fáil and the Green Party Government. Many people I know listening at home in Donegal will be surprised at the crocodile tears shed by the Fianna Fáil Deputies during the debate, when they remember that in 2010, in one year in just the one county of Donegal, the Fianna Fáil Government cut 99,595 hours of home help support. It is a bit rich for Deputy Micheál Martin to come into this House crying about something we all know he would do if he had the chance to sit on the Government side of the House.
From speaking to those on the front line providing support, I know that, as Deputy McDonald said, many of them do not go to a home for 15 minutes or half an hour. They stay on to help the individual through the day to ensure their needs are met.
This is because they are people who are passionate about giving the support and care needed by people in their communities. They are people who live up to the rhetoric, not the type of spiel we have heard from the Minister about his aim and ambitions to do this, that and the other. These people are doing it, many times without pay from the Department because the Government has cut their hours.
The plan to cut home help hours by 450,000 hours is cruel and heartless. This will mean a further loss of 20,000 home help hours between now and the end of the year for people in my county. That is almost 2,000 hours per week. It is on top of the 25,000 hours that have been taken away from that county so far this year. It is not feasible to expect a basic level of service will be provided at this level.
I am very conscious that we are talking about figures - 450,000 here, a 4% cut there and savings of €8 million. However, behind every one of those figures is an individual with a particular need for care. Many of these individuals have been in receipt of home help support for many years. As the HSE on the Government's instruction has decided to cut more hours, they have been assessed time and again and it has been clear that there is a need for them to have the hours they have been allocated. I have sat with them by the fireside and looked them in the face and they have told me they cannot cope with the reduction in hours. Yet the Minister is coming again to strip away the last few hours they have left.
What the Minister is doing is cruel and heartless. The Minister and Government Deputies say they have no option but I will give the Minister an option. He says he wants to save €8 million by cutting 450,000 hours of home help supports for very vulnerable people. I would tell him to dig into his pockets. There are 226 Members in this House and the Seanad. We could reduce Ministers' pay to €100,000, Deputies' pay to €75,000 and Senators' pay to €60,000. That leaves every single one of us with a very generous income and would save €4.3 million - over 250,000 home help hours. Politics is all about choices. I would rather stand up here and ask for my pay and that of Senators to be cut instead of taking away that basic need of vulnerable people to stay in their homes so they can live their lives to the fullest. That is the choice the Labour Party and Fine Gael Deputies will be asked to make tonight. I believe they will take the wrong position because it is nothing more than cowardly behaviour to attack the most vulnerable people in our society. I listened to Deputy O'Brien last night recount his own experiences and he is not alone. There are thousands more who have different stories and the Government decides to target them. There are other people whose pockets we can dig into. They are sitting beside the Minister and we can alleviate the burden of the cuts he is planning to introduce.
Deputy McLellan has six minutes, while Deputy Ó Caoláin has two minutes.
I welcome the opportunity to speak on this important and disturbing issue. Let me say at the outset that Sinn Féin is absolutely opposed to any cuts in home care packages or home help hours. Essentially, there are two key aspects of this debate. One is the care of vulnerable people and the other is the underemployment of working class women. With regard to the issue of care, Sinn Féin is of the view that the State should recognise the right of people to live with dignity and independence in their homes and communities for as long as possible. With regard to the issue of underemployment, home helps employed by the HSE are public service employees. Thus the State has an obligation under the terms of the Croke Park agreement not to impose compulsory redundancies or reduce their rates of pay.
Unfortunately, care in the community and the provision of sufficient and decent working hours are outside of and beyond the political imagination of the current Fine Gael-Labour Government. In the neoliberal worldview, which both parties have fully internalised, there is no room for a politics grounded in a sense of fairness, compassion, humanity or social solidarity. Rather, what we have instead is a Government that is prepared to engage in slash and burn-type politics irrespective of the consequences. The fact that Fine Gael and Labour are actively engaged in the dismantling of the welfare state is not a cause of concern for either party but then why should it be? Fine Gael has, after all, since the foundation of the State prioritised the interests of private business and the more affluent sections of the Irish middle class. It follows that in this political pecking order, the poor, the working class and the vulnerable are at the bottom. The Labour Party, on the other hand, claims a more noble history. It is the party of the great socialist and humanitarian James Connolly, a man who was born into terrible poverty, struggled for most of his short life to etch out an existence for his family and had to live with the added burden of disability and ill health.
Given such different beginnings, one wonders how we arrived at the current political juncture whereby a party that has a long history on the right of Irish politics finds itself in power with the party Connolly founded, namely, the Labour Party. Perhaps this is an overly simplistic answer to what is a complex question. Nonetheless, it is my belief that both groupings have been well and truly seduced by the trappings of power and have been rendered all but redundant by their wholehearted embrace of the cruel and ruthless neoliberal economic policies they so vigorously defend week in and week out in the Chamber. Having captured the State, they are now on a home run and have developed the capacity to defend the most heinous of cuts. Hidden in a discourse that prioritises the primacy of the market, their cruelty knows no bounds. Their mission, or so the logic goes, is to save Ireland from itself and in order to do this, the most vulnerable in our society, be they children, the elderly, people with disabilities, the poor or the sick, must be made pay the price for our supposed national rejuvenation which will, or so we are told, come about when the troika decides we have paid our dues to international financiers and capitalist marketeers.
How else are we to make sense of the Minister's turnabout on the issue of home help hours? While in opposition, he criticised the plan of then Minister for Health and Children, Mary Harney, to cut home care hours and restrict time spent on certain tasks, stating, "This draft plan is retrograde and flies in the face of what is clearly value for money". A year later, just months after taking office, the Minister told reporters, "I will be doing everything we can to ensure that, not alone there are no cuts, but we get an increase in home care help hours for people".
Deputy McLellan has two minutes remaining.
The Minister went on to say that home help maintains people at home, giving them dignity and independence and also saving the taxpayer a lot of money. Since taking office in 2011, the Minister has significantly cut home help hours. Figures revealed by Age Action Ireland show that since 2008, HSE management has slashed home help hours by almost 20%. Almost one half of these reductions have occurred since Deputy Reilly was appointed Minister last year. However, what is most notable is that since Fine Gael and Labour came to power in 2011, the number of home help hours has slumped at an astonishing rate, from 11.2 million in 2011 to a planned 10.25 million by the end of this year. This fall includes a 500,000 hour cut earlier this year and a further 450,000 hour cut announced just two weeks ago. What is even more startling is that all of these cuts happened despite the number of people officially needing the support falling by just 9% during the same period.
Yet again, the market-driven policies so beloved of right-wing parties like Fine Gael take precedence over the real and pressing needs of the most vulnerable in society. In this context, the comment by the Minister of State, Deputy Kathleen Lynch, last night that no one would be left without a service cannot be taken seriously. When the Labour Party stands up in this House and defends these cuts, it is consciously and deliberately taking jobs and livelihoods away from the very people they claim to represent, namely the working-class women of Ireland. James Connolly would not agree with these cuts and the party he founded is no more.
At the outset, I thank all Deputies who participated in this debate last night and tonight. In particular, I thank those who will then proceed to support the motion in the Sinn Féin Deputies' names. I thank those people from the home help sector who attended the debate last night and again tonight, especially those home help providers who gave personal testimony as front line service providers to Deputies yesterday in the AV Room.
I urge all Deputies to reject the amendment in the name of the Minister for Health. It is an insulting amendment. There is no other way to describe it.
There is not even within it an acknowledgement of the cuts that have taken place under the Minister's watch or the cuts to home help hours and home care packages over which he is now presiding. What we have instead is weasel words. Nothing else comes to mind when we examine what the Minister says. His amendment states, "anyone who has been assessed as needing a service will have that service provided". These are weasel words because they allow the Minister and HSE to weasel out of providing a service, even at the basic level of need, and to impose cuts. While an assessed person may retain the service, one must ask at what level. There is evidence to support my argument in many cases and we know it will unfold over time that home help hours will be greatly reduced, to the point where a person will merely have a 15 minute visit by a home help, as instanced during the course of this debate. This is absolutely outrageous. The Minister's words in this regard are also weasel words because they will continue to deny people with a genuine need from gaining access to supports.
We have pointed out that by cutting back the home help hours and home care packages, the State will incur a greater cost because people will be forced out of the home environment into residential care. No head-waving by the Minister will change the unmistakable fact that we are facing even more serious scenarios as a consequence of these cuts because people will find themselves alone. Older people will die alone because the service will not be available to them. One should not forget the backdrop to this, namely, the work of Willie Birmingham in the 1970s and 1980s. We are returning to the grave conditions of those years because many older members of the population, whose average age is increasing, will not be able to gain access to the essential home help service that would give them comfort and dignity and the certainty of ending their days where they want to be. I ask every Member of the House to support the motion in the name of the Sinn Féin Deputies and to reject the outrageous amendment tabled by the Minister for Health.
Amendment put:
The Dáil divided: Tá, 78; Níl, 49.
Tá
- Barry, Tom.
- Burton, Joan.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Carey, Joe.
- Coffey, Paudie.
- Collins, Áine.
- Conaghan, Michael.
- Connaughton, Paul J.
- Conway, Ciara.
- Coonan, Noel.
- Corcoran Kennedy, Marcella.
- Coveney, Simon.
- Creed, Michael.
- Daly, Jim.
- Deasy, John.
- Deering, Pat.
- Doherty, Regina.
- Donohoe, Paschal.
- Dowds, Robert.
- Doyle, Andrew.
- English, Damien.
- Farrell, Alan.
- Feighan, Frank.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Griffin, Brendan.
- Hannigan, Dominic.
- Harrington, Noel.
- Harris, Simon.
- Hayes, Brian.
- Hayes, Tom.
- Heydon, Martin.
- Howlin, Brendan.
- Humphreys, Heather.
- Humphreys, Kevin.
- Keating, Derek.
- Kehoe, Paul.
- Kenny, Seán.
- Kyne, Seán.
- Lawlor, Anthony.
- Lyons, John.
- McCarthy, Michael.
- McEntee, Shane.
- McFadden, Nicky.
- McGinley, Dinny.
- McHugh, Joe.
- McLoughlin, Tony.
- McNamara, Michael.
- Maloney, Eamonn.
- Mitchell O'Connor, Mary.
- Mulherin, Michelle.
- Murphy, Eoghan.
- Nash, Gerald.
- Neville, Dan.
- Nolan, Derek.
- Noonan, Michael.
- Ó Ríordáin, Aodhán.
- O'Donovan, Patrick.
- O'Mahony, John.
- O'Reilly, Joe.
- O'Sullivan, Jan.
- Phelan, Ann.
- Phelan, John Paul.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Spring, Arthur.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Twomey, Liam.
- Varadkar, Leo.
- Wall, Jack.
- Walsh, Brian.
- White, Alex.
Níl
- Adams, Gerry.
- Boyd Barrett, Richard.
- Broughan, Thomas P.
- Browne, John.
- Calleary, Dara.
- Collins, Joan.
- Collins, Niall.
- Colreavy, Michael.
- Cowen, Barry.
- Crowe, Seán.
- Daly, Clare.
- Doherty, Pearse.
- Donnelly, Stephen S.
- Dooley, Timmy.
- Ellis, Dessie.
- Ferris, Martin.
- Flanagan, Luke 'Ming'.
- Fleming, Tom.
- Grealish, Noel.
- Halligan, John.
- Healy, Seamus.
- Healy-Rae, Michael.
- Higgins, Joe.
- Kelleher, Billy.
- Kirk, Seamus.
- Lowry, Michael.
- Mac Lochlainn, Pádraig.
- McConalogue, Charlie.
- McDonald, Mary Lou.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- McLellan, Sandra.
- Moynihan, Michael.
- Murphy, Catherine.
- Nulty, Patrick.
- Ó Caoláin, Caoimhghín.
- Ó Cuív, Éamon.
- Ó Snodaigh, Aengus.
- O'Brien, Jonathan.
- Pringle, Thomas.
- Ross, Shane.
- Shortall, Róisín.
- Smith, Brendan.
- Stanley, Brian.
- Tóibín, Peadar.
- Troy, Robert.
- Wallace, Mick.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Caoimhghín Ó Caoláin.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 77; Níl, 49.
Tá
- Barry, Tom.
- Burton, Joan.
- Butler, Ray.
- Buttimer, Jerry.
- Byrne, Catherine.
- Carey, Joe.
- Coffey, Paudie.
- Collins, Áine.
- Connaughton, Paul J.
- Conway, Ciara.
- Coonan, Noel.
- Corcoran Kennedy, Marcella.
- Coveney, Simon.
- Creed, Michael.
- Daly, Jim.
- Deasy, John.
- Deering, Pat.
- Doherty, Regina.
- Donohoe, Paschal.
- Dowds, Robert.
- Doyle, Andrew.
- English, Damien.
- Farrell, Alan.
- Feighan, Frank.
- Fitzpatrick, Peter.
- Flanagan, Charles.
- Griffin, Brendan.
- Hannigan, Dominic.
- Harrington, Noel.
- Harris, Simon.
- Hayes, Brian.
- Hayes, Tom.
- Heydon, Martin.
- Howlin, Brendan.
- Humphreys, Heather.
- Humphreys, Kevin.
- Keating, Derek.
- Kehoe, Paul.
- Kenny, Seán.
- Kyne, Seán.
- Lawlor, Anthony.
- Lyons, John.
- McCarthy, Michael.
- McEntee, Shane.
- McFadden, Nicky.
- McGinley, Dinny.
- McHugh, Joe.
- McLoughlin, Tony.
- McNamara, Michael.
- Maloney, Eamonn.
- Mitchell O'Connor, Mary.
- Mulherin, Michelle.
- Murphy, Eoghan.
- Nash, Gerald.
- Neville, Dan.
- Nolan, Derek.
- Noonan, Michael.
- Ó Ríordáin, Aodhán.
- O'Donovan, Patrick.
- O'Mahony, John.
- O'Reilly, Joe.
- O'Sullivan, Jan.
- Phelan, Ann.
- Phelan, John Paul.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Spring, Arthur.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Twomey, Liam.
- Varadkar, Leo.
- Wall, Jack.
- Walsh, Brian.
- White, Alex.
Níl
- Adams, Gerry.
- Boyd Barrett, Richard.
- Broughan, Thomas P.
- Browne, John.
- Calleary, Dara.
- Collins, Joan.
- Collins, Niall.
- Colreavy, Michael.
- Cowen, Barry.
- Crowe, Seán.
- Daly, Clare.
- Doherty, Pearse.
- Donnelly, Stephen S..
- Dooley, Timmy.
- Ellis, Dessie.
- Ferris, Martin.
- Flanagan, Luke 'Ming'.
- Fleming, Tom.
- Grealish, Noel.
- Halligan, John.
- Healy, Seamus.
- Healy-Rae, Michael.
- Higgins, Joe.
- Kelleher, Billy.
- Kirk, Seamus.
- Lowry, Michael.
- Mac Lochlainn, Pádraig.
- McConalogue, Charlie.
- McDonald, Mary Lou.
- McGrath, Finian.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- McLellan, Sandra.
- Moynihan, Michael.
- Murphy, Catherine.
- Nulty, Patrick.
- Ó Caoláin, Caoimhghín.
- Ó Cuív, Éamon.
- Ó Snodaigh, Aengus.
- O'Brien, Jonathan.
- Pringle, Thomas.
- Ross, Shane.
- Shortall, Róisín.
- Smith, Brendan.
- Stanley, Brian.
- Tóibín, Peadar.
- Troy, Robert.
- Wallace, Mick.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Caoimhghín Ó Caoláin.
Question declared carried.
The Dáil adjourned at 9.24 p.m. until 10.30 a.m. on Thursday, 18 October 2012.
