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Dáil Éireann debate -
Tuesday, 18 Sep 2018

Vol. 972 No. 1

Saincheisteanna Tráthúla - Topical Issue Debate

Home Care Packages Provision

I assume the Minister of State, Deputy Finian McGrath, is taking this as, unfortunately, the Minister for Health is not here. I wish to raise the horrific situation in which so many patients and families in community healthcare organisation, CHO 7, an area that includes my county of Kildare and parts of west Wicklow, and CHO 8, which includes Laois, find themselves. Figures recently supplied to me show that some 6,458 older people are waiting for home care packages. According to the latest response I received to a parliamentary question, there are 724 people waiting on them in CHO 7 but when I rang the services, I was told that the same number of people were waiting for them last year so this is an ongoing issue. It is shocking. These figures are unacceptable.

There are many challenges in the health system, not all of which are about funding but come down to management and mismanagement. However, this is clearly an issue of funding. One family I have been helping applied for funding for the mother, who is 90 years of age, and was told funding would be provided after two weeks. The family was just about able to bear the financial brunt for two weeks but after those two weeks, it was told that no funding was available. Another family I know has been waiting for a home care package to bring their mother from Naas Hospital. In the meantime, she is taking up a bed that is needed for other people. I spoke to a nurse in the area today who told me about an 85 year old woman who broke her ankle three weeks ago and was allowed out of hospital last week. No care package could be provided. The woman was unable to shower, lives on her own and has been waiting two and a half weeks. It is a disgrace. We need to do far better. I will have more to say in my supplementary.

I wish to raise the issue of home care packages and home support services and the significant waiting lists in the Kildare-west Wicklow-south Dublin area. As the Minister of State is aware, it is called CHO 7. I have been dealing with a number of constituents who include stroke victims, cancer sufferers, people suffering from early onset dementia, older people who need additional support and a person recovering from the removal of their colon. I have been dealing with these cases all summer. Many of these people are in Naas Hospital, other hospitals or the community awaiting these additional supports. They are taking up hospital beds they do not need. There are people on trolleys in Naas Hospital who could be in those hospital beds. The people in those beds who have these issues have applied for home care packages. The waiting list is there because the budget seems to have been eroded earlier in the year. It makes no sense. Those people want to be at home, as would we if we were sick and could be cared for at home.

Some very basic questions need to be asked. First, we must reach a situation where the very significant waiting lists in the Kildare-west Wicklow-Laois area are reduced and dealt with as soon as possible. These are real human stories that are very harrowing to deal with. However, it is also not even smart. Even if it is an accounting exercise on the part of somebody in the HSE or the Department, it is not a good use of resources. We need to support people so that they can be minded at home to free up those hospital beds for people on trolleys who need them because those beds are very expensive for people who are in them, never mind the fact that they do not need or want to be there. If we compare the Kildare area of CHO 7 with CHO 4, which covers Kerry and Cork, we can see they have similar populations of over 650,000 if we include south Dublin in our area yet CHO 4's waiting list in June 2018 was less than a quarter of that of CHO 7. Did they have the same budget to start with, were they managed differently and how has this been allowed to happen? We cannot allow this to happen in the future.

I thank the Deputies for raising this very important issue. I know they have a particular interest in developing services in CHO 7. The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Home care is an important part of the supports for enabling older people to remain in their own homes and communities for as long as possible and for facilitating their discharge from acute hospitals.

Since being appointed as Minister of State with responsibility for older people, Deputy Jim Daly has made improved access to home support services a key priority. Progress in this area is reflected in the additional funding made available for the winter of 2017 and 2018, the increased funding and level of activity for 2018 and the work being progressed on the development of a statutory home care scheme.

Home support services were a particular focus in budget 2018 with an additional €18.25 million allocated. The HSE has operational responsibility for planning, managing and delivering home and other community-based services for older people. Services are provided on the basis of assessed healthcare need. The HSE 2018 national service plan provides for over 17 million home support hours to be delivered to 50,500 people at any time. Intensive home care packages for people with more complex needs are being provided to approximately 235 people at any time delivering approximately 360,000 hours in the full year. A further 156,000 hours relating to adverse weather funding earlier this year will also be provided.

This year's home support budget for CHO 7 is about €47 million with an additional adjustment in spring of €1.4 million in view of sustained pressures in the community and to address delayed discharges in hospitals. At the end of June 2018, there were 6,683 people in receipt of home support services in the CHO 7 area.

Working within its available resources, the HSE has sought to maintain and, where possible, to expand the range and volume of services available to support people to remain in their own homes, to prevent early admission to long-term residential care and to support people to return home following an acute hospital admission. Despite this significant level of service provision, the demand for home support continues to grow. It is important to note that the allocation of funding for home supports across the system, though significant, is finite and services must, therefore, be delivered within the funding available. In that context, it is acknowledged that in some cases, access to the service may take longer than we would like.

However, the Minister of State, Deputy Jim Daly, is satisfied that the HSE monitors the delivery of home care on an ongoing basis to ensure that activity is maximised relative to the individual clients’ assessed care needs within the overall available resources for home support and having regard to demand throughout the year.

As part of the Estimates process, the Department is actively engaging with the Department of Public Expenditure and Reform regarding funding for services for older people in 2019, including home support services. I have listened carefully to the issues raised by Deputy O'Loughlin in regard to the 90 year old mother who is waiting and the person who is in Naas hospital due to the discharge issue. Deputy Heydon mentioned stroke victims and also the issue of hospital beds and home care packages. Of course, these are priority issues. I will bring the points raised in the debate to the attention of the Minister.

To be honest, that answer is not worth the paper it is written on. There is nothing there that could in any way satisfy the 796 people who are on the waiting list. I outlined these specific cases. How many more cases are there across the country where people are taking up hospital beds when they just need to have a home care package in place? More funding has to be allocated for 2019 if the Government wants to see any reduction in the number of people waiting in hospitals for a home care package.

We are currently in a trolley crisis. August was the worst month on record and I heard this morning that 33 people are on trolleys in Naas hospital. Families cannot afford to put supports in place but they hate to see their relatives unable to come home due to the lack of supports. This is putting them in penury. Something has to be done to resolve the issue. Home care is a far better system for the patient and for the taxpayer when one considers the cost of keeping people in hospital. The Minister of State has to give solid answers and a solid vision for improving the current system. It is simply not good enough.

I thank the Minister of State for his response but questions have to be asked. Was the initial budget for the home care package for the greater Kildare area sufficient to start with? Why is there such a disparity between our area and other areas of similar population, given waiting lists are greater in our area? I accept additional funding was given in the spring of this year as a result of Storm Emma, which affected many parts of the country, although Kildare appears to have been disproportionately affected. However, that additional money did not provide any extra home care packages for the Naas hospital area because it all went to Tallaght and St. James's hospitals. I suspect that not much money went into the community either.

That is a challenge for us and we have to learn from it. I acknowledge the role management play in Naas General Hospital, although I suspect managers were nearly punished in the spring for not having many delayed discharges and for managing as well as they possibly could. I deal with some great people who are managers in the HSE and the Department of Health. While that is great on an individual basis, the system has to be looked at and we have to learn from this situation. First, we have to ensure money goes in and that we clear the backlog of the significant number of Kildare people who do not have access to home care packages but who need them. Then, we need to understand why this happened and ensure it does not happen again. I will keep asking these questions until I get answers because this is too serious and there are too many people affected by it.

Arrangements for home care have developed over the years with a significant local focus and there is considerable variation in accessing services in different parts of the country. It is accepted there is considerable demand for home support services over and above the existing service levels, so the Deputies have hit the nail on the head with their main points.

A Programme for a Partnership Government includes a commitment to increase funding for home support services and, as I mentioned, the Department is actively engaging with the Department of Public Expenditure and Reform in regard to funding of older people's services in 2019, including home support services. The Department is actively engaging on this issue and we are listening to the concerns. My Department is currently engaged in a detailed process to determine what type of home care support scheme is best. I am happy to say we reached an important milestone in the development of a new support scheme in June, when we published the report of the findings of the public consultation on home care. The consultation process took place last year and approximately 2,600 submissions were received. The report includes a number of interesting points made by respondents in regard to innovative new models and it is available on the Department's website. The findings will now be used to help to inform the design of the new home care scheme.

In the meantime, the Department and the HSE are continuing to improve the existing services, including in 2018 through the introduction of a single funding stream for home support services. This new approach is providing significant benefits, including making services easy to understand, streamlining the application and decision making processes and facilitating service users to move to changed levels of service as their needs change, without the need for an additional application process.

However, there is also another reality, which is that there has been a 12% growth in the overall population, a 59% growth in the population aged over 65 and a 95% growth in the population aged over 85. A classic example of what we are trying to do is that the HSE has undertaken a new tender for home care, which is expected to run from 1 September 2018 until December 2020. A list of 48 approved providers is available for the provision of home care support services across the nine CHO areas.

Social and Affordable Housing

I do not know if the Minister of State is aware of the financial situation of MDY Construction. Some reports suggest it is in receivership or, if not, it is definitely in financial trouble, given that all of the subcontractors have taken all of their equipment and left all of its sites. This has left social housing units either just started, half-complete or literally days from completion.

What I want from the Minister of State is reassurance, in particular for those waiting for housing in Orchard Meadows in Cherry Orchard, where this week 35 homes were meant to be allocated to families who have been waiting for them, some of whom have managed to delay their notice to quit from landlords but who now have insecure tenancies because they were meant to move into these new homes this week. At Dolphin Park, which is a senior citizens complex where the Minister turned the sod in April, the project was flying ahead but is now totally stalled. There are other sites where work has stalled, for example, at Kilbride in County Wicklow, where more than 40 social housing units were due to be ready next year. The reassurance I am looking for is that everything that can be done will be done to deliver these homes to the families who are waiting for them, in particular the homes in Cherry Orchard, which are in a state of readiness. I visited the site twice in the last month and I see no reason these homes cannot be allocated to the families who have already been told which house they will have. Let us think about that. They have already put their children into schools locally in anticipation of the move, given the project has already been delayed by a number of months thus far.

That is one job of work. The other job that needs to be tackled by this Government is the continuous abuse of subcontractors. Here again we have workers and subcontractors with no wages and no income, which will cause other financial difficulties, if not collapses of small companies. This needs to be borne in mind.

To add to that, I doubt if there are many in this House who can imagine what anticipation, hope and joy a family have when they are told, after years of waiting, with many of them in homeless accommodation, that this is their home. Deputy Ó Snodaigh spoke about the homes in Cherry Orchard, which are gorgeous. They are passive housing and have lovely fitted kitchens and so on. They are waiting to be occupied but we then hear that MDY Construction has gone under. We are not sure how it has gone under but I am told by local council officials that there is the involvement of a vulture fund. Will the Minister of State tell us if it is the case that a vulture fund has called in a historical debt from this building company, which is involved in building State-funded affordable and social housing? If that is the case, are we not in a mad situation in this country where vulture funds are literally handed, for little or no money, profitable land and housing? They have gobbled up nearly everything that remained from the crisis through NAMA and they are being given more and more each day. Now, it appears their actions are halting the much-needed building of social and affordable homes.

This is like another Carillion, except that this time it affects people who have been on housing waiting lists for long periods in places like Cherry Orchard, Rialto and Wicklow. How do we justify this?

We need answers and, more importantly, action. While the local authorities are doing their best, as stated by the Department, what does that amount to when 36 families are anxiously waiting to move in and a whole set of residents have been discommoded because there is no capacity to move the mounds of earth surrounding their estates or reopen their park? All of this is happening. Days go by, rumours spread and the community is losing hope. They do not deserve that. With all of his plans for a housing development agency, the Minister, Deputy Eoghan Murphy, must take action. We also need answers as to what has happened here.

I thank Deputies Ó Snodaigh and Bríd Smith for raising this matter which I am taking on behalf of Minister, Deputy Eoghan Murphy. It is unfortunate and regrettable for all concerned that MDY Construction Limited is experiencing financial difficulties and has ceased work on a number of construction sites. It is the main contractor for a number of social housing projects with Wicklow County Council, Kildare County Council, the FOLD housing association and Co-operative Housing Ireland. In all, there are around 190 new social housing units across these projects and they are at different levels of advancement. The contracting body in each case is either the local authority or the approved housing body responsible for the project delivery, and they are therefore dealing directly with the issues arising from the main contractor discontinuing construction work on these sites.

Without question, these projects will be completed in full and as soon as possible. Despite the risk of delays arising, we have seen in situations where this has happened with social housing projects before that local authorities and housing associations have done all the due diligence needed and completed the projects. That is what will happen with these projects. At this early stage, it is a matter which local authorities and approved housing bodies are handling and the Department will continue to keep in close contact and work continuously with them to facilitate the earliest possible recommencement and completion of all the projects. The necessary steps have been taken by the local authorities and approved housing bodies to secure their sites and, as I speak, the legal and financial issues are being addressed. It would be inappropriate for me to pre-empt the appropriate decisions and actions to be taken by the contracting bodies. It is important they secure the sites, as they have done, and take the correct next steps as early as possible to support the earliest possible completion of the projects.

Regarding media reports which have suggested that these developments will become ghost estates, I note that this is simply not the case. As I have said, we intend that these projects will be completed as soon as possible and that the social housing homes will be made available to the people who need them, fully complete and built to the usual high quality we have seen with the social housing developments completed each month. The provision by the Minister of the funding and support necessary to complete these projects will not be an issue. Local authorities and housing associations know that and they are taking the necessary steps to handle the challenge as a matter of urgency and to move the projects forward.

MDY did not cease building, rather the subcontractors ceased to build because they had not been paid. They have removed scaffolding and all of their equipment from the sites because, once again, subcontractors have been screwed by a bigger company which would not pay them what was due. The other people who have been screwed in this instance are the tenants, in particular those in Cherry Orchard. The reason I focus on them is that the houses in Cherry Orchard were ready to be occupied. I have visited quite a number of them in the past month and I note that they are in walk-in condition. They are of a high standard. The families have visited them and been told what number they will have. A woman I spoke to yesterday was in floods of tears because she is due to leave her rented accommodation on 3 October. She had managed to get an extension from May on the basis that she would be in by July. That is what people were told originally. A significant number of the other tenants who will be moving in have children with autism and other disabilities and have been looking forward to homes with gardens. They have enrolled their children in local schools and, while they remain away from the vicinity, they have had to make travel arrangements for the past two months to Ballyfermot and Cherry Orchard.

Dolphin Park is next to an existing facility for senior citizens, which it is to replace. That is 43 houses. There is also a primary care centre. Communities are asking what assurance they can be given that there will be no undue delay. I want the Minister of State to provide a commitment, in particular in the case of Cherry Orchard, that people can move in this week. The houses which have not been handed over are within a day of being finished.

We have to take seriously the urgent need to complete the projects and move people into their homes in Cherry Orchard. One of the subcontractors says it is disgraceful how things have gone with Ireland's housing crisis. He says it is not MDY's fault, but is rather something in the background we do not know about, which is having a knock-on effect with every supplier and subcontractor. He says that while MDY wants to fulfil the contracts, it cannot for whatever reason.

I ask again. Is a vulture fund involved in pulling MDY's money and pursuing a historical debt? If so, will we eventually do something about the use of vulture funds in the property market in this country? It is causing untold misery for all of these families in Cherry Orchard and beyond. I say to those in Cherry Orchard, Rialto and everywhere else who have been affected that the best thing they can do is be outside the Dáil on 3 October for the national housing demonstration to call on the Government to end once and for all the use of the private market to deal with the public housing crisis. The Government must build social and affordable houses on public land and stop using private markets where companies are themselves being caused hardship when vulture funds pull out. Will the Minister of State answer the question on vulture funds and provide a commitment that the houses will be occupied?

I have provided the commitment that the houses will be occupied as soon as possible. I am not familiar with the financial situation of MDY but I will try to find out and ascertain if I can the reasons for its financial difficulties. They have not been brought to my-----

Will the Minister of State email us?

I will get the officials to respond, if they are in a position to do so, on the financial difficulties of MDY. The issue raised by both Deputies on subcontractors is a valid one and the subject of at least one Private Members' Bill. There may be others. There have been other examples nationally in recent times where subcontractors have been left high and dry following the collapse of larger construction businesses.

On the points Deputy Ó Snodaigh makes about Cherry Orchard, I note that of the 72 units to be constructed, 36 are completed and 36 are under construction and due, originally, to be completed by November 2018. I cannot give a commitment that they will be occupied this week, but I can try to establish from the local authority and the approved housing body when it is expected they will be occupied. As someone who has been involved in politics for 20 years, I understand the sense of hope for a family who have been on a housing list for a long time. They know the house they are supposed to get, but this suddenly happens and they do not know when they can move in. It is certainly not a position the Government supports in any way. Those 36 houses should be occupied as soon as possible. We will revert to the Deputies with specific answers to the questions.

Is the Minister of State, Deputy Finian McGrath, taking Deputy Donnelly's matter?

Tá sé as láthair. We could have used this time.

It is an important health issue, namely, an update of the health budget.

As the Member who tabled the next matter is not present, we will proceed with the Thirty-seventh Amendment of the Constitution (Repeal of offence of publication or utterance of blasphemous matter) Bill 2018. Do we have a Minister to deal with the matter?

We do not have one, a Cheann Comhairle.

I suggest someone needs to wake up and realise there is a responsibility to have people here.

The House stands suspended for five minutes, pending the arrival of whomsoever may deign to join us.

Sitting suspended at 6 p.m. and resumed at 6.05 p.m.

As we still do not have a Minister, does Deputy O'Callaghan, as the only Member present, wish to propose that we suspend for a further five minutes?

That is probably suitable. I think the Government and, indeed, all Members of the House are anxious that this legislation be dealt with expeditiously. It is unfortunate that others are not here yet.

Sitting suspended at 6.05 p.m. and resumed at 6.07 p.m.
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