Priority Questions

Deputy Kelleher is not in the Chamber so we will move onto Question No. 28.

Nursing Staff Recruitment

Louise O'Reilly


28. Deputy Louise O'Reilly asked the Minister for Health the steps that have been taken to implement the recommendations of an expert group report in August 2016 which called for additional nursing posts to be created and filled to look after all admitted patients in emergency departments and extra patients on wards; the steps that have been taken to secure and retain nursing positions that have been advertised; and if he will make a statement on the matter. [4858/17]

The question is about staffing in emergency departments, which is a frequent issue and one which I am sure the Minister is looking forward to debating.

The report of the emergency department expert group identified a need to take on additional nurses to care for boarded patients awaiting admission from emergency departments. This is particularly where the number of patients awaiting admission occupy over 50% of the emergency department cubicle capacity for the hospital concerned. Having regard to the formula set out in the report for calculating the required nursing complement, an additional 107 nursing and midwifery posts are to be created and filled to look after all admitted patients in emergency departments. The group also recommended that nursing numbers in emergency departments are brought to their full agreed staffing levels.

There are many initiatives currently under way to improve staffing levels throughout the country. The number in nursing and midwifery increased by 1,650 between December 2013 and December 2016.

The HSE is offering permanent posts to 2016 degree programme graduates, and full-time permanent contracts to those in temporary posts. The HSE is also focused on converting agency staffing to permanent posts. Its national recruitment service is actively operating rolling nursing recruitment campaigns. The campaigns encompass general, mental health, intellectual disability, registered children's nurses and also midwives. The acute hospital groups have advertised a number of emergency department nursing posts and are currently in the recruitment process. Of the 144 emergency department nursing posts that were identified as vacant, half have been filled to date.

The HSE ran a three-day open recruitment event over the Christmas holiday period in Dr. Steevens’ Hospital, which I was pleased to attend, for nurses and midwives from all disciplines who are interested in working in the Irish public health service. Some 220 people attended the event. Some 115 nursing and midwifery candidates were deemed successful following interview. This event will be followed by a series of career events for nurses throughout 2017 with the next one scheduled for 31 March 2017.

A relocation package of up to €1,500 continues to be available to nurses who return from overseas. These campaigns and others that are in the process of being developed will be used to fill the remaining vacant emergency department posts and the additional 107 posts that are to be filled. We remain absolutely committed to filling these posts. The Deputy will also be aware that we are currently in conversations about these very issues with the IMNO and SIPTU.

That was a comprehensive and eloquent answer to a question I did not ask. I specifically asked about the 107 posts that were identified. Regrettably, we have all become used to accident and emergency department overcrowding. The staff, God love them, have to put up with it on a daily basis. Whatever plans this Government or the previous one had to deal with trolley numbers, they are now escalating out of control. I heard An Taoiseach contradict the figures as to whether it is 400 or 600, but those 107 nurses are specifically needed.

Last week, we questioned the HSE and they advised us that the budget was not there when they consulted with the Department of Health for 107 nurses who are designated to nurse patients on trolleys. This is effectively a signal that the Department has given up and is accepting that trolleys are a reality. Whatever the Minister is doing is not working. Some 107 nurses are required in order to cope. Can the Minister respond to the HSE's claim that the Department did not fund those 107 nursing posts?

The intention is to recruit 1,000 additional nurses this year. That was announced on budget day. The details of that will be worked out among the operational plans for each of the hospital groups. The process is under way and will conclude shortly for the individual budgets for each hospital. We do need to grow nursing numbers and I am not disputing that with the Deputy whatsoever. We do need to have more nurses working in our emergency departments. We are having an intensive engagement with the INMO and SIPTU on recruitment and retention. Given the Deputy's own background, she will understand the sensitivity of discussing that process now. However, these issues are being actively discussed and considered at the moment through an intensive engagement with the INMO and SIPTU. I hope we can make progress on that.

In talking about beds and trolleys, it is important to note that the issue is not just in emergency departments, but throughout hospitals. The fact that we have closed 104 hospital beds due to staff shortages indicates that recruitment and lack of nurses is actively causing pressures within our emergency departments. If we want to clear what is a vicious cycle in the trolley situation, which now happens annually - there are similar pressures in Britain and Northern Ireland - bed capacity, recruitment and a real move to primary care, which includes a new GP contract, are the three fundamental aspects that need to be addressed. We are committed to recruiting and have already filled half the vacant posts in emergency departments. We are committed to filling the rest of them and want to see the 107 nursing posts filled also. We are actively engaging with the INMO and SIPTU on that.

The HSE personnel were clear with us when they said that funding was not available or forthcoming from the Department for the 107 additional posts that are required. Let us be clear, they are required to nurse the people who are on trolleys.

The fact that people are on trolleys is a failure of Government policy, and nobody could dispute that. The HSE said, however, that there is no budget for those 107 nurses. What does the Minister say to the man or woman standing beside their elderly relative this evening who is on a trolley or in a chair in an accident and emergency department? It was agreed that 107 nurses is the absolute minimum number needed to nurse those people on trolleys. Let us give up and accept that trolleys are going to be a reality for as long as they are needed, but let us try to provide a basic minimum level of staffing. Can the Minister confirm that the budget is there for those 107 nurses? Or can he confirm that it is not? The HSE personnel were very clear with us in stating that when they went to the Department of Health that budget was not there.

What I am clear about is that the budget is there to increase nursing numbers by 1,000 in 2017. That is what we funded for in the budget. How that is done is now a matter for the HSE in its operational plan. I am also clear that recruitment and retention of nurses is a key issue that needs to be resolved. I hear many doctors going on the radio saying that if one wants to end trolleys in emergency departments - which we have all wanted to do for decades, yet successive governments have failed to do it - we need more beds. I agree that we need more beds. It is not much good having the beds if they are closed because there are not enough nurses and other staff to open them.

There are 105 beds closed in the health service today due to staffing shortages. I fully accept that bed capacity and the ability to open extra beds is linked to the recruitment and retention of nurses, which in turn is linked to easing pressures on our emergency departments. That is why we have provided funding for 1,000 new nurses this year. It is a matter for the HSE to allocate how it wishes to do that. That is why we are actively involved today in discussions with the INMO and SIPTU. I will keep the House abreast of those discussions.

Health Services Funding

Billy Kelleher


27. Deputy Billy Kelleher asked the Minister for Health his views on whether the €9 million additional funding for the expansion of existing services or the provision of new services in acute hospitals is adequate to meet demand; and if any of this funding is now likely to be used for other purposes in view of the HSE decision not to appeal the 2015 ruling of the Employment Appeals Tribunal on consultant contracts. [4907/17]

I wish to ask the Minister for Health for his views on whether the €9 million additional funding for the expansion of existing services or the provision of new services in acute hospitals is adequate to meet demand. Is any of this funding now likely to be used for other purposes in view of the HSE's decision not to appeal the ruling of the Employment Appeals Tribunal on two consultant contracts?

I thank Deputy Kelleher for his question.

In order to respond to increasing demand for hospital services, budget 2017 provides an additional €118 million for hospital services in 2017. Of this funding, €109 million will be used to maintain our existing level of service to take into account the costs associated with our ageing demographics, meeting increased demand for medicines, medical technology, and new procedures in hospitals. We would be criticised if we did not take these matters into account.

This funding will also provide for the costs associated with the restoration of payments to staff under the Landsdowne Road agreement. Therefore it is €118 million extra for hospitals in 2017 with the bulk of that allocation going to dealing with demographics, medical technology, procedures and the Lansdowne Road restoration payments for staff doing important front-line jobs in our health service. As a part of that €118 million, €9 million has been allocated to expand existing or develop new acute hospital services this year. In order to increase capacity in our acute hospitals, €1.4 million of that has been allocated to open a new emergency department in University Hospital Limerick, and a further €1 million has been allocated to the opening of a new 75-bed ward block in University Hospital Galway.

The setting of budgets for individual hospitals and hospital groups, including the allocation of the remaining €6.6 million of new development funding, is currently being finalised by the HSE as part of the development of hospital group operational plans. New developments to be funded from the €6.6 million include additional ICU and HDU beds at Cork University Hospital, cardiology services at Waterford University Hospital, phase 2 of a new AMAU for Portlaoise Hospital, implementation of the new cancer strategy, which we should hopefully publish later this month, and implementation of the all-island paediatric cardiology service.

My Department is currently engaging with the HSE with respect to finalising the funding allocations associated with these new developments. The 2017 HSE national service plan outlines the HSE's need during 2017 to continue to pursue increased efficiency, value for money and budgetary control in delivering safe and effective healthcare services within its budget allocation. The HSE's decision not to appeal the 2015 Employment Appeals Tribunal ruling on consultant contracts will not impact on new development funding. The Employment Appeals Tribunal award will be met from existing resources and finance allocations. My colleague, the Minister for Public Expenditure and Reform, has set out the broader context for that.

It is extraordinary that in the overall budget the Minister talks about €459 million in headline figures and €180 million to address the ageing demographic profile in our acute hospital system. However, when one strips it all away we are talking about €9 million of additional funding to expand services. In other words, therefore, it is €9 million moving beyond where we currently are.

By any stretch of the imagination, that will have a profound impact on the capacity of hospitals to cater for what will happen in the year ahead. It is already transpiring. There are 601 people on trolleys today, 1 February 2017. It is the third highest figure in the history of the State. That is where we are. The idea that we can continue to say we have an expanded budget to cater for additional demand is wrong. The Minister must know in his heart and soul given the budget passed last year that the HSE service plan is already now a mythical creature. As we stand here on 1 February, we know we will have continued waiting lists, outpatient and inpatient, and people on trolleys because of inadequate funding for the acute hospitals system.

That is entirely incorrect. In the past, Opposition spokespersons on health would have been very critical of a HSE service plan that did not adequately set aside resources for demographics. We cannot talk about existing levels of services as though that does not impact on people. This is about trying to prepare the health service for the fact that more people will need health services next year and the year after as our population both grows and ages. Before we start adding additional services, I have a duty as Minister for Health to ensure that we fund adequately existing levels of service based on demographics. Words like "mythical" which the Deputy used would much more appropriately apply had I closed my eyes, blocked my ears and pretended there were no demographic pressures.

As the Deputy knows, there is much more than €9 million in the budget for developments for health services when one goes beyond the acute hospitals sector. I note the area of mental health, which is my colleague, Deputy McEntee's area. Deputy Kelleher referred specifically to waiting lists and we have the first ring-fenced budget for waiting list initiatives since the onset of the recession. I know Deputy Kelleher is very supportive of those initiatives and, indeed, proposed many of them. Funding for extra disability services has also been provided. As such, it is not just €9 million for new services. It is €9 million out of €118 million more for the health service in our acute hospitals sector and there are many more developments in primary and social care also.

I am trying to be helpful to the Minister by highlighting the deficiencies in the HSE service plan and the inadequate budget provided to him by the Government for health care in our acute hospitals system. This is primarily about the acute hospitals system itself. An additional €118 million is being made available to deal with the Lansdowne Road agreement and demographics. They are costs that should always be factored into the HSE service plan. For a number of years, the demographics were not being factored in. I accept that. However, in the context of new and additional treatments, procedures and service expansion beyond the demographic assessment, only €9 million is there. That will not deal with anything other than that which has already been assessed as going to come through the doors of hospitals due to demographic pressures. That is the reality. All that the Minister is providing for additional services above and beyond the demographics and the Lansdowne Road obligation is €9 million.

I appreciate Deputy Kelleher's helpfulness but that is simply not the case. For whatever reason, he is ignoring the reality that in addition to that €9 million, €20 million has been provided specifically for the NTPF to drive down waiting lists to more acceptable, albeit still high, levels by October 2017. It is intended to have no one waiting longer than 15 months for any procedure, whether inpatient, outpatient or day case. The Deputy is ignoring the fact that there is funding in the budget for 1,000 additional nurses. If we want to improve services in our acute hospital setting and across the health service, we need more nurses. The Deputy acknowledges the need for a bed-capacity review, on which we agree, and the work being undertaken to have it ready for the mid-term capital review. If we are serious about breaking the cycle of overcrowding that every Minister for Health has experienced in the last two decades, we will have to do something different on bed capacity. The Deputy's response ignores the fact that we are working actively and have started engagement on a new GP contract instead of operating off a 44 year-old contract which is out of date. A new GP contract will actually shift services decisively from the acute hospital setting into primary care. As such, there is a great deal more in the HSE service plan than just €9 million in addition.

Sale of State Assets

James Browne


29. Deputy James Browne asked the Minister for Health the plans in place for the sale of a hospital (details supplied); if the funds raised by the sale will be used for improving mental health services; and if he will make a statement on the matter. [4908/17]

My question is on the plans in place for the sale of St. Senan's Hospital and whether the funds raised will be used to improve mental health services.

The HSE has recently offered the property and farmland at St. Senan's Hospital in Enniscorthy for sale in two lots. Lot 1 comprises the vacant building which is about 130,000 sq. ft., or 12,077 sq. m., in size and circa 45 acres. Lot 1 will be sold by private treaty. Lot 2 comprises about 44 acres of land and will be auctioned unless previously sold. Given its unusual size, previous use and layout, It is difficult to identify what a recovering property market will pay for these lots. However, the guidelines published online and by the HSE set out that lot 1 has a guide price of €780,000 and lot 2 has a guide price of €63,000.

New replacement accommodation has already been delivered for all the mental health care services provided previously from St. Senan's and the delivery of health services has been discontinued at the St. Senan's site. The use of the sales proceeds from these disposals will be subject to sanction from the Department of Public Expenditure and Reform. It is intended that the proceeds of the sale of this property will be invested in much needed mental health and other facilities. Details will be devised and agreed in the context of overall capital plans.

Between 2011 and 2016, about €23 million has been raised by the HSE from the sale of surplus assets, which was €2 million to €6.8 million depending on the year. With significant additional funding from the Exchequer, sanction was obtained from the Department of Public Expenditure and Reform to invest these proceeds in mental health facilities, including new builds, refurbishments and upgrades. That sets a precedent. As Minister of State with responsibility for mental health, I will advocate that any funds raised from the sale of St. Senan's will be invested back in mental health accommodation rather than in service delivery.

I am somewhat comforted by some of what the Minister of State said. St. Senan's Hospital was built in 1868 and has been an iconic building in Enniscorthy, County Wexford, in and of itself as well as for staff, patients and their families over the last 150 years. It was closed down as part of A Vision for Change on the understanding that the facilities would be put into the community. There was also an understanding that an emergency unit would be placed in either Enniscorthy or Wexford town as part of the emergency department. It is critical but also it would be a fitting tribute to those who served as staff as well as to patients and their families that the money would be ring-fenced for mental health. That would also be in line with previous promises that the money would be kept in Wexford. It would provide additional accommodation for those who need access to emergency services for which they currently have to travel to Waterford or up to Wicklow. For a county of 150,000 people and a further summer population of 150,000, those services are needed.

As the Deputy outlined, recommendations were made under A Vision for Change to close St. Senan's. Following that, huge investment was made in the county of approximately €11.5 million which has resulted in a 50-bed mental health community nursing home on the grounds of Wexford General Hospital, a 13-place high support mental health hostel in Melview House, Enniscorthy and a ten-bed crisis housing facility in Enniscorthy to add to various other facilities. Recently, I visited Wexford with Deputy Browne and my colleagues, Deputies Paul Kehoe and Michael D'Arcy, and the local council. I also met staff in Tower House, a new mental health facility representing a further €3.5 million investment through the local authority and also the vocational education committee. Much work is going on and a lot of services have been provided. I agree that there needs to be continued investment in the area. As Minister of State with responsibility for mental health, I intend that any assets sold off results in the funding going back directly into mental health.

I welcome those words because there is a lot of anger and frustration even though many facilities have been put in Wexford by the previous Fianna Fáil Government and the previous Fine Gael-Labour Party Government. I appreciate the Minister of State's intentions. However, an emergency department is desperately needed down in Wexford. While the Minister of State cannot answer for the Department of Education and Skills, I ask that the Department of Health and the HSE are open to convincing the Department of Education and Skills to purchase the property for use as a second or third level education facility. It would be fitting for the town of Enniscorthy and the county of Wexford that the building would remain in public use for the further benefit of the local community.

We need to keep our options open here. Lot 1 will be sold by private treaty and the property will be auctioned off. We still do not know what the outcome of that will be.

We are talking about providing services across the board, not just in County Wexford, on a 24-7 basis.

The HSE is developing a plan as to what a 24-7 service would look like. We know that out of the 17 mental health areas, nine have full seven day a week services and seven have partial seven day a week services. The gaps need to be identified in order for a 24-7 service to be rolled out.

I again thank the Deputy for raising the issue. It is important that we continue to invest, not just in developing our services and staff but in our facilities, in order to make mental health a priority.

Health Services Funding

Gino Kenny


30. Deputy Gino Kenny asked the Minister for Health if, in view of the record number of acutely ill persons waiting on trolleys in emergency departments in January 2017 and the threat of strike action by nurses due to unsafe staffing levels, he will allocate emergency funding of €1.2 billion to urgently address the deficits in hospital beds, medical staffing and primary care services in the health service; and if he will make a statement on the matter. [4857/17]

I ask the Minister for Health whether, given the record number of acutely ill people who are waiting on trolleys in emergency departments in January this year and the threat of strike action by nurses due to unsafe staffing levels, he will allocate emergency funding of €1.2 million to address this problem urgently.

I thank the Deputy for the question. On budget day 2017, the Oireachtas approved gross expenditure of €14.606 billion for the health services, which is the highest level ever, demonstrating the Government’s commitment to investing the gains from a recovering economy in a better health service. The provision for this year represents a 3.5% increase on the final projected 2016 outturn. The Health Vote for 2017 has increased by 9.4% over the 2015 outturn, recognising the Government’s commitment to providing a health service that seeks to improve the health and well-being of the people.

The additional funding secured will continue to support the health service to provide the optimum level of safe services for patients within the budgetary limits. However, there are still real fiscal challenges facing the health service. Health care demands continue to rise due to our growing and ageing population, there is an increase in the incidence of chronic conditions and advances in medical technologies and treatments which are good for patients but come at a cost in terms of having a limited budget.

Accordingly, we must continue to focus on the effective use of limited resources and the management of funding made available by the Oireachtas. In the past, the health service did not manage its budget and the first call on any extra resources went into a black hole. We have managed to avoid that this year and all of the additional resources can be used for additional health services and demographic pressures.

On 20 October 2016, the HSE was notified of its maximum level of expenditure for 2017. The level of health services to be provided within this available funding is set out in the HSE’s 2017 national service plan. The allocation of additional funding to the health services is a matter for the Government and the Oireachtas, operating within the EU fiscal rules. It is fair to say that the Government used all of the fiscal space available to it, and health received a substantial increase in its budget as part of this.

This Government will continue to prioritise the needs of those requiring health services in determining the annual budget. This is evidenced by the provision of an additional €977 million in this year's allocation to the HSE compared to the original allocation for 2016. Perhaps in my response to the Deputy's follow-up question I will make the point that the level of funding is not the sole factor; we also have to consider how the money is spent within the health service.

This is not a perennial problem; it runs much deeper than the yearly crisis that is generated. I want to differentiate between the political and the personal, because that is important. I am sure the Minister and everybody else in the House does not want to see anybody on a trolley, but it happens. At one stage this year, 600 people were on trolleys. They are ordinary people who paid taxes and try to live a good life, but are sick and sought help from the Irish health service. It is an embarrassment, as a citizen of the country, to see people on trolleys waiting for basic health services.

I said I do not want to be personal, but rather political. The Fine Gael Party has been in government for the past six years and has had two previous Ministers for Health who failed abjectly. The Minister should be embarrassed to be a part of Fine Gael, a party that has let down many people in the country who paid tax and yet have to suffer.

I am very proud to be a member of Fine Gael. In my engagement in the House, I always try to not be partisan because I am conscious that many different people from all parties have stood in this position as Minister for Health over the past number of decades - not yet from Deputy Kenny's grouping but that may happen - and have faced similar challenges to those that I face this January and February. I can engage in political partisan talk, and I am well able to do so, but it will not serve the substantive issue.

Health services in Ireland, the UK and Northern Ireland, as well as many other countries, have faced significant pressures during the winter period. We need to have a discussion on what we will do to make sure that we do not see the same challenges next winter and in subsequent winters. I am convinced that if we keep doing the same things, namely, increasing the level of funding and the Minister of the day announcing more budgets, we will not break the cycle. Solving this problem will involve doing something different.

That is why I am a great believer in the work of the Oireachtas committee to come up with a ten-year strategy that removes party politics from the issue and provides a level of certainty. That is why we need a bed capacity review. How many beds do we need? We have not built a new hospital in this country since 1998. If I told the Deputy that we have not built any new schools since 1998 he would not be surprised that there were not sufficient places for schoolchildren. We need to determine what to do differently in terms of bed capacity, recruitment and so on.

I hope next year and the year after the Minister will be able to say there are no patients waiting on trolleys. The situation is very serious. Let us get down to the facts. This problem is also the fault of Fianna Fáil. Some 1,600 beds have been taken out of the Irish health service over the past nine years. Of course that would result in a crisis.

Worse than that is the morale of the accident and emergency staff, who are the best trained and motivated staff in the European Union. They are well qualified, but are demoralised by cuts in the health service and seeing people who could be their brothers and sisters on trolleys.

The Minister has the power to solve this issue. It is not rocket science. There is a solution to every problem. The solution to this problem is to provide more beds. The Minister should stake his claim and say there will be no trolleys on corridors in the next 18 months. If he can do that, he will go down in history.

I appreciate the Deputy's bona fides and we share a desire to fix this issue. I agree that the staff in our health service are incredible and are doing incredible work, and have done so over the past number of years with fewer colleagues standing beside them on the wards. That is now changing.

Since I became Minister for Health, we have increased the health budget not once but twice. We have put in place dedicated funding for waiting list initiatives. We are recruiting more staff. We are not cutting the health service budget.

I have to be honest with the Deputy. I have been in the job for nearly nine months. It is about how the money is spent. If we think that the answer is to believe that everybody needs to go to an acute hospital for every service, that we cannot do more in primary care and every time a new Minister for Health comes into office he or she should start changing the plan the health service will not work.

The health service needs a ten-year plan. That is why we have a cross-party committee, on which the Deputy's colleague, Deputy Barry, sits. It is due to report in April. That is why I am committed to working with the committee to implement the plan so we can collectively say to the citizens of this country that we have a roadmap for the health service, it will take ten years to get there, here are the milestones and here is how we will pay for it.

Home Care Packages Provision

Thomas Pringle


31. Deputy Thomas Pringle asked the Minister for Health his plans to introduce a home care scheme along the lines of the nursing home support scheme; when the consultation will start; when he expects to have a scheme in place; and if he will make a statement on the matter. [4859/17]

This question relates to the recent announcement that the Minister intends to start a public consultation on the development of a home care scheme along the lines of the nursing home support scheme. I would like to hear further views on it.

It is Government policy that long-term nursing home care should be a last resort and we want to develop home care services to provide a more viable alternative to nursing home care for a greater number of people. Traditionally, home care was viewed as providing a lower level of support than residential care and not as an alternative to it. Increasingly, however, it is considered possible to support many people to continue to live at home who would previously have gone into residential care. That is clear when we consider the length of stay of people in nursing homes, which has changed from around six or seven to two years. People are entering nursing homes much later in life, possibly with more complex needs. This requires an increase in the amount and intensity of home care, and more effective integration with other supports including nursing, therapies and other primary care services.

Arrangements for home care have developed over the years with a significant local focus and, unfortunately, there is considerable variation in access to services in different parts of the country. The services people in Meath receive may be different to those people living in Donegal receive. The HSE is incrementally developing a more consistent and coherent system of service provision. The service plan for this year sets a target of 10.57 million home help hours to support 49,000 people, including 16,750 home care packages and 190 intensive home care packages.

It is my view and that of the Government that we need a stand-alone funding scheme designed for home care that recognises its particular characteristics together with regulation of home care services.

A significant amount of detailed preparation needs to be done, and is currently under way, before final decisions are taken on the form of a home care scheme and the regulation of these services.

Last year, the Department commissioned the Health Research Board to carry out an evidence review of international approaches to the regulation and financing of home care services. The four countries examined were The Netherlands, Scotland, Germany and Sweden. The reason they were chosen was because of the type of framework they have and what it is that we are looking to apply here. The report is going through its final stages of being peer reviewed and will be published shortly. The Department is also undertaking a mapping exercise of current service provision nationally. This will take into account the scale and diversity of services funded by the HSE. This work will be used to identify major policy options for a new statutory home care scheme around the areas of regulation, financing, assessment and eligibility.

Once this is completed, a public consultation will be launched to allow stakeholders, including older people themselves, their families and healthcare workers, to express their views regarding a new home care scheme. It is my hope and intention that the consultation will be launched in May of this year.

I thank the Minister of State for her response. I wonder about her figures on the length of stay of those in nursing homes. ALONE's figures are that 35.4% of those in long-stay beds have low to medium care requirements, which is a huge proportion of those in nursing homes. This is a huge cost to the State. They could be cared for at home and, in many cases, would wish to be cared for at home. It seems that there has been a huge growth since 2004 in the number of low dependency residents in nursing homes. This is bad public policy and bad for the residents themselves.

It is vitally important that home care would be supported more fully. As the Minister of State stated, more than 4%, or nearly twice the national average, of people in my county of Donegal are cared for at home. Families need the additional support to ensure they can do this. It is also far more cost effective than the nursing home support scheme. It is therefore vitally important that we would have this scheme.

I welcome the fact that the consultation will start in May but I press on the Minister of State that it should not be a consultation to replace what is already in place in terms of home help hours and home care packages.

As we develop a new scheme, it is important to continue to invest and see our funding increase and the Government has committed to continue its investment. This year, we will see €30 million of the €40 million announced for the winter initiative go into our home care packages, with an additional €10 million on top of that. The nursing home support scheme, which took seven years to devise and has a budget of more than €930 million, is a scheme for residential care. We need to ensure that those who are entering the nursing home support scheme cannot be cared for or provided with that support at home. The difficulty we face is that the demand far outweighs our ability to provide the support at home. There is an urgency to it, but it is important that we do this right. Some 70% of home care is currently provided through an informal arrangement, with private providers and family members, which is why the public consultation is so important. The other 30% is provided through the HSE.

The reason the nursing home support scheme is oversubscribed is probably the lack of availability of home care packages. It is a little haphazard. Currently families struggle to get increased levels of support that would enable them to keep their elderly at home. Many would take that decision. I do not think that County Donegal, with 4% of its elderly people being cared for at home, is that unusual. If the supports were available, we would see far higher levels of home care throughout the country. I welcome the fact that the Minister of State is starting the consultation. I hope that it will not take seven years to develop the scheme and that the scheme that is developed will facilitate families and the elderly and not simply push them into the hands of private operators.

As Minister of State with responsibility for older people, I stress that my priority and the priority of the Government is to ensure that older people can remain with the people that they love and in their homes and communities for as long as possible. The difficulty we currently face is that there is no statutory scheme. There is no framework for the provision of home help. While it has been developed over the years, it is very much on a county-by-county basis. It is therefore important that we provide a framework and ensure that it is sustainable, equitable and regulated in an appropriate manner. This will take time but I am also conscious that it cannot go on for seven years. We certainly will not allow that to happen.