Home Help: Motion (Resumed) [Private Members]

The following motion was moved by Deputy Louise O'Reilly on Tuesday, 25 June 2019:

That Dáil Éireann:

recognises:

— the invaluable work carried out by home help workers;

— the contribution made by homecare in assisting with tackling delayed discharges from hospitals;

— that care delivered in the home is the preferred form of care for most people and their families;

— the cost-effective nature of home support by comparison to hospital care and nursing home care:

— average weekly cost for home support services is approximately €165;

— weekly cost of a hospital bed is approximately €5,992; and

— weekly cost of a nursing home bed is approximately €1,048;

— that the best value for money is provided by directly employed and not-for-profit homecare workers;

— that travelling between clients is work and should be remunerated as such; and

— that any form of co-payment for basic homecare is an additional burden which families should not have to bear in any form;

notes that:

— there are over 6,000 people on waiting lists for home help;

— the number of people over the age of 65 is increasing by over 20,000 persons a year;

— the proportion of people over the age of 85 is projected to double in the next 20 years;

— by 2030 the over 65 cohort will increase by 59 per cent, and the over 85 group by over 95 per cent;

— the Economic and Social Research Institute’s report on Projections of Demand for Healthcare in Ireland, 2015-2030: First Report from the Hippocrates Model noted that demand for homecare packages is projected to increase by between 44-66 per cent by 2030, while the demand for home help hours is projected to increase by between 38-54 per cent in the same period;

— in spite of increases in home support, resources have not kept pace with demand for services;

— the numbers receiving home supports in the community does not provide an accurate reflection of current and future need, with some older people opting not to apply as they know that services are insufficient to meet their need, as noted by Age Action;

— unmet need is associated with a variety of negative consequences that can affect the health and well-being of older people;

— without access to homecare supports many older people have to pay for private care, rely on loved ones to provide unpaid care, or are forced to move to a residential care setting which is often not their first choice thus undermining their human right to live with dignity and independence; and

— research conducted by the Oireachtas Library and Research Service published in 2018, showed that while the level of funding allocated to home supports was approximately €450 million, the allocation to the Nursing Home Support Scheme, the ‘Fair Deal’ scheme, was significantly higher at €962 million; and calls for:

— immediate steps to ensure the viability and sustainability of homecare provision;

— no reduction in the provision of home help hours and an end to the effective freeze on the allocation/recycling of hours;

— immediate investment in a recruitment campaign for directly employed home helps;

— an increase in the number of home help hours provided by directly employed homecare workers;

— an investigation into the value for money provided by private homecare providers;

— a Government commitment that any statutory entitlement to homecare will not place an additional burden in the form of co-payment for those who need the service;

— the immediate elimination of any call-out which is below 30 minutes;

— the development of a system of time management and tracking to ensure that payments for travel time are calculated fairly and transparently and related to actual time travelled; and

— the establishment of a working group or task force to examine the job of home help workers to look at:

— how the job can be made more attractive to ensure the supply of a well trained workforce;

— how the job can keep pace with the changing demographics;

— making the job sustainable as a full-time option;

— guaranteeing fair terms of employment and rates of pay across the sector;

— a sectoral employment order; and

— ensuring services are deployed to meet the need of older persons.

Debate resumed on amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“recognises:

- the invaluable work carried out by homecare support assistants;

- that the Home Support Service is a core service for older people and is highly valued by service users, their families and by the Health Service Executive (HSE), providing supports which assist older people to live independently in their own homes for longer and enabling large numbers of people to return home following acute hospital admission, who otherwise would remain in hospital or would be admitted to long stay residential care;

- that the core stated objective of this Government is to promote care in the community so that older people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible;

- that the Oireachtas Committee on the Future of Healthcare Sláintecare Report supports a significant shift in our model of care to one that is focussed on prevention and early intervention, which will provide the majority of care in the community, and the Government’s Sláintecare Implementation Strategy sets out an ambitious programme of reform to deliver this vision;

- that over the past number of years, improving access to home support has been a priority for the Government, as reflected in the increases in the home support budget which has grown from a base of €306 million in 2015 to about €446 million in 2019, representing about a 45 per cent increase in the annual budget for this service;

- that the 2019 HSE National Service Plan provides for 17.9 million home support hours to be delivered to over 53,000 people at any time, and the Intensive Home Care Packages to be delivered to approximately 235 people at any time, delivering a further approximately 360,000 hours; and

- that despite this significant level of provision, demand for home support continues to grow;

notes:

- that the HSE reviews people on the waiting list, as funding becomes available, to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front line staff who know and understand the clients’ needs, and who undertake regular reviews of those care needs to ensure that the services being provided remain appropriate;

- that the allocation of funding for home supports, though significant, is finite and services must be delivered within the funding available and in line with the HSE’s budget, delivery plan and the National Service Plan;

- that the HSE has confirmed that there are no cuts to the Home Support Service and that the HSE will meet its service plans target to deliver 18.2 million hours this year;

- that all Community Health Organisations are working to ensure the best use of available funding to support the greatest number of people requiring homecare services;

- that following a Labour Court recommendation in 2014, the HSE implemented new contracts for its directly employed homecare staff, providing each worker with a guaranteed minimum number of hours per week and a guaranteed income each week with actual work assignments, managed in a reasonable way to meet the needs of clients over the course of 12 months, and that this new contract was regarded by staff, unions and management as a positive development for HSE employed staff;

- the future demographic projections and their implications for future service provision;

- that while the existing homecare service is delivering crucial support to many people across the country, it needs to be improved to better meet the changing needs of our citizens;

- that the Programme for a Partnership Government signals the Government’s intention to improve homecare services and to introduce a uniform homecare service; and

- that the Minister for Health has committed to establishing a new stand-alone statutory scheme and system of regulation for homecare services; and

confirms that:

- there are no cuts to the Home Support Service, the HSE will meet the service levels set out in its 2019 National Service Plan this year, the allocation of new hours will continue to be based on clients’ needs and the resources available, and hours that become available will continue to be reallocated within the increased budget provided in 2019;

- a review of existing home support services will be commissioned that will, amongst other things, examine:

- the policies and procedures currently in operation at national, regional and local levels pertaining to the administration of services;

- the quantum of services provided by the HSE (through direct service provision), voluntary providers and private providers, and the coordination of these services within this ‘mixed economy of welfare’ at national, regional and local levels;

- the ratio of care workers to service users at national, regional and local levels, and whether the supply of appropriate skilled staff is adequate to meet current and projected demand for home support; and

- the current funding of the Home Support Service, including analysis of the distribution of the budget for home support services at regional and local levels, the calculation of the unit cost of home support services, the proportion of the funding allocated to direct service provision by the HSE, the methodology for the allocation of funding to service providers through the HSE’s tendering processes, and how this relates to the funding of direct service provision by the HSE; and

- a new statutory scheme and new system of regulation for home support, informed by international and national evidence and stakeholders’ engagement, will be developed that will:

- improve access to home support services that people need in an equitable, affordable and sustainable way, ensuring that the system operates in a consistent and fair manner across the country; and

- ensure that the public can be confident that the services provided are of a high standard and will bring Ireland in line with best international practice

-(Minister of State at the Department of Health, Deputy Finian McGrath).

An Leas-Cheann Comhairle

I must now deal with a postponed division relating to the motion re home help. On Tuesday, 25 June, on the question, "That the amendment to the motion be agreed to," a division was claimed. In accordance with Standing Order 70(2), that division must take place now.

Amendment again put:

The Dáil divided: Tá, 47; Níl, 66; Staon, 0.

Tá

Barrett, Seán.
Brophy, Colm.
Bruton, Richard.
Burke, Peter.
Byrne, Catherine.
Canney, Seán.
Cannon, Ciarán.
Carey, Joe.
Coveney, Simon.
Creed, Michael.
D'Arcy, Michael.
Daly, Jim.
Deasy, John.
Deering, Pat.
Doherty, Regina.
Donohoe, Paschal.
Doyle, Andrew.
Durkan, Bernard J.
English, Damien.
Farrell, Alan.
Fitzgerald, Frances.
Griffin, Brendan.
Halligan, John.
Heydon, Martin.
Humphreys, Heather.
Kehoe, Paul.
Kyne, Seán.
Lowry, Michael.
Madigan, Josepha.
McEntee, Helen.
McGrath, Finian.
McLoughlin, Tony.
Mitchell O'Connor, Mary.
Moran, Kevin Boxer.
Murphy, Dara.
Murphy, Eoghan.
Naughton, Hildegarde.
Neville, Tom.
O'Connell, Kate.
O'Donovan, Patrick.
O'Dowd, Fergus.
Phelan, John Paul.
Ring, Michael.
Rock, Noel.
Ross, Shane.
Stanton, David.
Zappone, Katherine.

Níl

Aylward, Bobby.
Barry, Mick.
Boyd Barrett, Richard.
Brady, John.
Brassil, John.
Breathnach, Declan.
Broughan, Thomas P.
Browne, James.
Buckley, Pat.
Burton, Joan.
Butler, Mary.
Byrne, Thomas.
Calleary, Dara.
Casey, Pat.
Cassells, Shane.
Chambers, Jack.
Collins, Joan.
Collins, Michael.
Collins, Niall.
Connolly, Catherine.
Coppinger, Ruth.
Cowen, Barry.
Crowe, Seán.
Cullinane, David.
Curran, John.
Donnelly, Stephen.
Ellis, Dessie.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Fleming, Sean.
Harty, Michael.
Haughey, Seán.
Healy, Seamus.
Howlin, Brendan.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Lawless, James.
MacSharry, Marc.
McGrath, Mattie.
McGrath, Michael.
Mitchell, Denise.
Moynihan, Aindrias.
Munster, Imelda.
Murphy, Catherine.
Murphy, Paul.
O'Callaghan, Jim.
O'Dea, Willie.
O'Keeffe, Kevin.
O'Reilly, Louise.
O'Rourke, Frank.
O'Sullivan, Jan.
O'Sullivan, Maureen.
Ó Broin, Eoin.
Ó Cuív, Éamon.
Ó Snodaigh, Aengus.
Penrose, Willie.
Quinlivan, Maurice.
Rabbitte, Anne.
Ryan, Brendan.
Ryan, Eamon.
Sherlock, Sean.
Shortall, Róisín.
Smith, Brendan.
Stanley, Brian.
Tóibín, Peadar.

Staon

Tellers: Tá, Deputies Seán Kyne and Tony McLoughlin; Níl, Deputies Aengus Ó Snodaigh and Denise Mitchell.

Amendment declared lost.

Deputy Mary Butler

I move amendment No. 2:

(a) To insert the following after “should be remunerated as such;”:

“— the recent and welcome agreement on travel expenses for homecare support workers;

— that the introduction of new five-over-seven-day rosters is not supported by adequate information technology (IT) systems;”;

(b) To insert the following after “sustainability of homecare provision;”:

“— home support to be adaptable and responsive especially for conditions such as dementia;

— individual need to be the decisive determinant of care, not geography or funding;

— the accelerated implementation nationwide of the Single Assessment Tool;

— investment in IT systems to support the implementation of five-over-seven-day rosters;

— a guarantee that the recent agreement on travel payments for homecare support workers will not impact on the delivery of the additional 800,000 home support hours pledged in the 2019 HSE National Service Plan;”; and

(c) To insert the word “basic” after “statutory entitlement to”.

Amendment put and declared lost.

Question put: "That the motion be agreed to."

The Dáil divided: Tá, 68; Níl, 46; Staon, 0.

Tá

Aylward, Bobby.
Barry, Mick.
Boyd Barrett, Richard.
Brady, John.
Brassil, John.
Breathnach, Declan.
Broughan, Thomas P.
Browne, James.
Buckley, Pat.
Burton, Joan.
Butler, Mary.
Byrne, Thomas.
Calleary, Dara.
Casey, Pat.
Cassells, Shane.
Chambers, Jack.
Collins, Joan.
Collins, Michael.
Collins, Niall.
Connolly, Catherine.
Coppinger, Ruth.
Cowen, Barry.
Crowe, Seán.
Cullinane, David.
Curran, John.
Donnelly, Stephen.
Ellis, Dessie.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Fleming, Sean.
Harty, Michael.
Haughey, Seán.
Healy, Seamus.
Howlin, Brendan.
Kelleher, Billy.
Kelly, Alan.
Kenny, Gino.
Lahart, John.
Lawless, James.
MacSharry, Marc.
McGrath, Mattie.
McGrath, Michael.
Mitchell, Denise.
Moynihan, Aindrias.
Munster, Imelda.
Murphy, Catherine.
Murphy, Paul.
O'Brien, Jonathan.
O'Callaghan, Jim.
O'Dea, Willie.
O'Keeffe, Kevin.
O'Reilly, Louise.
O'Rourke, Frank.
O'Sullivan, Jan.
O'Sullivan, Maureen.
Ó Broin, Eoin.
Ó Cuív, Éamon.
Ó Snodaigh, Aengus.
Penrose, Willie.
Quinlivan, Maurice.
Rabbitte, Anne.
Ryan, Brendan.
Ryan, Eamon.
Sherlock, Sean.
Shortall, Róisín.
Smith, Brendan.
Stanley, Brian.
Tóibín, Peadar.

Níl

Barrett, Seán.
Brophy, Colm.
Bruton, Richard.
Burke, Peter.
Byrne, Catherine.
Canney, Seán.
Cannon, Ciarán.
Carey, Joe.
Coveney, Simon.
Creed, Michael.
D'Arcy, Michael.
Daly, Jim.
Deasy, John.
Deering, Pat.
Doherty, Regina.
Donohoe, Paschal.
Doyle, Andrew.
Durkan, Bernard J.
English, Damien.
Farrell, Alan.
Fitzgerald, Frances.
Griffin, Brendan.
Halligan, John.
Heydon, Martin.
Humphreys, Heather.
Kehoe, Paul.
Kyne, Seán.
Lowry, Michael.
Madigan, Josepha.
McEntee, Helen.
McGrath, Finian.
McLoughlin, Tony.
Mitchell O'Connor, Mary.
Moran, Kevin Boxer.
Murphy, Dara.
Murphy, Eoghan.
Naughton, Hildegarde.
Neville, Tom.
O'Connell, Kate.
O'Donovan, Patrick.
O'Dowd, Fergus.
Phelan, John Paul.
Ring, Michael.
Rock, Noel.
Ross, Shane.
Stanton, David.

Staon

Tellers: Tá, Deputies Aengus Ó Snodaigh and Denise Mitchell; Níl, Deputies Seán Kyne and Tony McLoughlin.

Question declared carried.

Dáil Éireann debate - Thursday, 27 Jun 2019