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Dáil Éireann debate -
Thursday, 16 Sep 2021

Vol. 1011 No. 2

Saincheisteanna Tráthúla - Topical Issue Debate

Housing Provision

We move now to Topical Issue matters. Deputies Christopher O'Sullivan, Stanton, Martin Kenny and Verona Murphy are all involved. I call Deputy O'Sullivan to discuss the need for significant increase in accessible housing in the local authority housing stock.

I thank the Acting Chairman and the Minister of State. The issue I wish to raise is the lack of existing housing, particularly social housing, for people with disabilities and particularly the cases that have been presented to me regarding those who are wheelchair bound.

It became very apparent over the summer recess, in particular, that more and more people are in positions where they are seeking social housing that requires accessibility. The simple fact of the matter is that those houses are not there. There is a chronic shortage of social houses for people with accessibility issues or who are wheelchair bound and it is something that we need to address.

I will give an example of the types of situations from people who are presenting to my office in Cork South-West. One individual, a young gentleman, is wheelchair bound and is currently renting, and is also on the social housing list. That is a key link. So many people with disabilities are on low incomes and because that is intrinsically linked, unfortunately, in today's society, we have issues where many people with disabilities are on the social housing list. The housing stock is simply not there, however, and it is not adapted to care for their needs.

A perfect example is in Clonakilty, where we currently have 100 social houses being built along with Kinsale, where there are a further 50 houses. There are about another 50 houses in Skibbereen and more in Dunmanway. In one of the social housing developments in Clonakilty, which has more than 50 units, only six of those units have downstairs toilets and only one of those 50 units has a disabled or accessible toilet. Considering more than 640,000 people in Ireland have a disability, which is one in seven people, the ratio of houses within our social housing stock that are accessible to wheelchair users is nowhere near high enough. People like the gentleman about whom I spoke earlier are, therefore, in serious trouble and in dire need of housing.

I appreciate the Housing for All document, which is a plan that I believe in and will back fully. I know it will be implemented and it has good, strong sections on housing for people with disabilities. However, I firmly believe that in the interim, to look after the situations like those I described, we need to provide our local authorities with capital funding in order that they can either adapt their existing housing stock as houses become vacant, or acquire houses on the market and adapt them on a case-by-case basis for people with disabilities, particularly those who are wheelchair users. I urge the Minister of State to work with the Minister, Deputy Darragh O'Brien, to ensure that local authorities are provided with that funding to allow adaptation of existing stock.

I thank Deputy O'Sullivan for raising this very important issue. The recent launch of Housing for All demonstrates the absolute commitment of this Government to ensure that affordable, quality housing is available to everyone in Irish society, including those with disabilities and our older people.

The commitment was also reflected in the Programme for Government: Our Shared Future, in which we set out to ensure that there is an appropriate mix of housing design types provided within social housing, including universally designed units and accommodation for older people and people with disabilities. Local authorities are responsible for the planning and provision of social housing in their areas and, therefore, decide the number of specific types of dwellings to provide in their developments based on identified need. At national level, we are determined to ensure that they will have the funding and resources to deliver the housing that is needed and that houses provided will meet the standards of those who need them most.

We are ensuring that the ambition of Housing for All is translated into clear, target-driven local authority delivery action plans. The housing delivery action plans will set out how dedicated social housing provision for older people and people with disabilities will be delivered and including social housing delivery partners, matching the scale and extent of housing need identified and having regard to the forecast in the Department of Housing, Local Government and Heritage's July 2021 disability capacity review.

It should be emphasised that social housing in Ireland is built to an exceptionally high standard and that is evident right around the country. The design standards are set out in Quality Housing for Sustainable Communities: Design Guidelines. In preparing these guidelines, particular account was taken of the objectives of Government policy on sustainability, including access for people with disabilities and meeting the varied needs of occupants through their lifetime. The design approach on social housing seeks to eliminate barriers of accessibility for all users, particularly older people and those with mobility impairment or other disabilities. Where units are being designed for those with disabilities, the guidelines refer to the National Disability Authority publication, Building for Everyone: Inclusion, Access and Use.

More recently, the Housing Agency published a roadmap entitled Designing Housing to Meet the Needs of All, which has specific regard to the principles of universal design. Of course, all new buildings and extensions or material alterations to existing buildings must comply with the legal minimum performance standards set out in the building regulations, of which part M aims to ensure visibility for all.

To further explore the potential design of accessibility in new housing units and housing more generally, the National Disability Authority is currently preparing policy advice and completing a cost-benefit analysis of achieving universal design solutions in housing action under action 97 of the National Disability Strategy 2017-2021.

My Department is participating in a technical group convened to undertake the development of a comprehensive economic and social evaluation of universal design models. Recently I attended the Oireachtas committee dealing with housing for people with disabilities and-or older persons and the challenges they face. We have significantly increased funding in our local authorities through our mobility grant mechanisms and through those for our older persons to try to support independent living and accessibility in people's homes where they most need it and where the most vulnerable need to be protected. I assure the Deputy we are fully committed to this.

As I go around the country to see the new housing builds, it is incredible to see the future-proof mechanisms attached in each to try to prepare for the future, as families and our needs change. I hope more people have that opportunity to be independently housed in their own homes for longer.

I appreciate the Minister of State's response and I can hear his dedication to ensuring people have the option of independent living in accessible houses. However, we are still in the situation in which we are. The development I referred to in Clonakilty will provide secure housing for so many vulnerable people on low incomes. Out of the 50 houses, to have only one adapted toilet is not good enough. Perhaps local authorities need to be explicitly instructed to ensure that when they are building social housing developments, a much higher percentage of those houses are accessible to reflect the number of people in Ireland living with disabilities or who are wheelchair users. That needs to happen. I gave the example of that young gentleman who is renting and who cannot avail of those mobility aid grants. There is also a woman who is, again, a wheelchair user. She is living in an isolated rural part of my constituency and her children are moving on to college. She has a feeling of isolation and desperation. The option for her to move into a town such as Clonakilty, Kinsale, Bandon or Dunmanway is not there because the houses are not there.

I completely back the long-term plan and strategies for housing provision, but in the short-term period, there are instances in which people are desperate for accessible housing. I urge the Minister of State to make funding available in this budget for local authorities, before those bigger-scale developments happen, for the acquisition and adaptation of existing houses. That would take pressure off.

There is a commitment of €4 billion in multi-annual budgets in our national development plan, which was not there before and is backed up by the Housing Finance Agency and the Land Development Agency. That will be key to unlocking many of these developments to which the Deputy referred. I assure him the grant mechanisms will be supported to ensure local authorities have the resources to discharge their duties. I am also progressing with our new disability strategy, which had almost 1,600 submissions, of which 28% were from people with disabilities and lived experiences, which are so important. As the Deputy quite rightly referenced, we have a huge amount to do in terms of right sizing and giving people opportunities to live in homes that are suitable to meet their needs, especially the most vulnerable in our society. We now have the housing needs and demands assessment tool in the Department, which will assist local authorities in identifying the need they must supply into their functional area.

Obviously, it is disappointing to see that there is no future-proofing in a 50-unit housing estate. If the Deputy wants to bring the details of that estate to my attention, I will have that investigated, because it is important the signal goes out from the Department that you need to future-proof developments and the vulnerable must be protected. When housing allocations are appointed to tenancies, policies are in place for the quota that should be allocated for those with disabilities and the most vulnerable. We would be keen to follow up on that, if the Deputy wants to forward the details to me.

I assure people we will shortly have the strategy from 2022-2026. We have done a huge amount of engagement on it. The money is there and we want to ensure people can live in their homes longer and that the most vulnerable are protected.

Mental Health Services

I thank the Ceann Comhairle's office for picking this matter this evening and allowing me to be here. We have a central Midleton mental health centre. It was built in the 1970s. It is called the Owenacurra mental health centre. It provides mental health services, continuing care, mental health care and respite for people in a vast area. Last June, a decision was taken to close the centre. Some 19 residents are currently in the centre. We were told there would be moves to find alternative accommodation for these people. There is also a day centre, which facilitates between 40 and 60 people per week. It is also used as a respite centre for two people every two weeks. That is a very important service to the people of east Cork.

I have two big issues. First, I want the HSE and the Minister of State to tell me what the long-term plans are to replace this service. I do not think there are any at present. That is crucial. People do not want to lose this hugely important service. The second issue concerns the 19 residents. I accept this centre is not fit for purpose and is of its time, but it is the home for these people. Would the Minister of State like to be told tomorrow that he will be transported to Enniskillen or Cavan, away from his friends and what he knows and is familiar to him? People in this centre can walk down town. They are known around the town. They can walk into the shops and churches and are comfortable in their surroundings. If any of us were moved to a strange place, it would be difficult, but if you have mental health challenges, it is even more difficult.

I am calling on the Minister of State to pause the closure of this centre. It will be done on a phased basis. I know there are problems in the centre and that the building is not fit for purpose, but there is no immediate danger to anybody. It is just next door to the Garda station. The fire station is only a couple of hundred yards away. There is no danger to anybody. I want a pause.

There has been some communication with families and residents this week, even though this was announced last June. Residents and families are anxious. They need clarity. The social interaction is hugely important. It has been said to me that you could not get a better service. It is a community. These people are part of the community.

I would also like the Mental Health Commission to have a look at this and ask what the impact on people is if they are moved from their homes to a strange place far away. We have no clarity as to where people will go. I accept the bona fides of the people in the HSE. They are doing their best and I want to be supportive of the work they are doing. They are faced with a huge challenge. I ask that they pause this for a number of months until we have a clear plan with respect to what the long-term service will be in that area. It is not acceptable this service be closed down with no place to reopen a similar service. We need to look after the residents.

We passed the Assisted Decision-Making (Capacity) Act 2015, which means that people have a right to make their own decisions and that must be respected, regardless of their capacity. We need to bear that in mind. I ask the Minister of State to go back to the Minister of State, Deputy Butler, and ask her to ask the HSE to pause the closing of this. It is not ready and there is huge distress and upset in the area over this. The anxiety levels are high. These people have enduring mental health difficulties and it is wrong that this is happening at this time. There can be a better solution, which is what I want. I want time and space for that to be found.

I thank the Deputy for raising this important issue. The Minister of State with responsibility for mental health and older people, Deputy Butler, has been regularly liaising with the HSE on this very important matter, since it was announced. The HSE has affirmed that in the context of the closure of the centre, the needs and preferences of each resident are of paramount importance.

On 28 June, the HSE notified the Department of Health that the HSE's Cork-Kerry community healthcare organisation had taken the difficult decision to close the Owenacurra centre in Midleton as the building is not fit for purpose. Owenacurra is a long-term residential centre with 19 residents but it also accommodates a mental health day service. The Mental Health Commission, as regulator, had raised serious concerns about the centre and the HSE shares those concerns. HSE estates confirmed that the building is in very poor condition with major defects and is not fit for purpose. It was originally planned to refurbish the building but as work progressed on those plans it became clear that no matter what refurbishment took place, the building could not meet either building or commission standards.

The HSE's priority is the welfare of the 19 residents of the centre. It has confirmed that all of the residents have had their needs assessed so that they can be appropriately placed in accordance with their assessed needs. I understand meetings with the multidisciplinary team to discuss options and the wishes of each individual resident, with family where consent is provided, are ongoing and I understand that it is planned to complete the programme of meetings this week. The multidisciplinary team continues to have ongoing discussions with all residents and a key contact lead is available as a facilitator for residents, families and the team. Social work input has been increased, including support from a housing co-ordinator, and increased consultant input is also available. A member of the independent Irish Advocacy Network is part of the project steering group, in addition to a mental health service user family member and carer engagement representative, to ensure the residents and families continue to have independent supports available throughout the process. The process of engagement with the staff is also being progressed, informed by the terms of the public service stability agreement 2021-22, Building Momentum, and underpinned by the nationally agreed redeployment protocol. The HSE is reviewing what healthcare services are required in the Cork-Kerry area and if this site is suitable for the delivery of any of these services. The future of the entire site will be considered at a later stage. A suspended mental health day service is also located within the building and work is under way to identify an alternative location for this service, as close as possible to the current location. The Deputy highlighted that people with mental health challenges may be moved to a strange place and he wants me to bring these views back to the Minister of State. He has also asked that this decision be paused. I will bring his concerns to the Minister of State tomorrow and see if she and her team can address them directly with him.

I thank the Minister of State for his response and for his commitment to bring my views and the views of the people in the area, which are quite strong and quite worried, back to the Minister of State, Deputy Butler. This is in no way an attack on the HSE, the Minister of State, the Department or anyone else. We want to come up with a proper solution. That is why I am asking that this be paused. I am told that some of the residents have been advised that they may have to go into Cork city, Kanturk or Sarsfield Court, which is miles away. At the moment they are in a comfortable area. They are familiar with their surroundings, they can go down town and into the shops and pubs or the local church, which is very close by. People know them, greet them and make them feel welcome. They are integrated into the community. That is going to be ripped out now and that is not good enough at this stage.

The engagement about which the Minister of State spoke only started this week. That is a very short amount of time and people have been concerned all through the summer. I understand there is no immediate danger in the building whatsoever so that is why I am saying we should pause this and engage. There are some older people who I understand may be happy to go to nursing homes at this stage. That may be so but each of these people has to be engaged with, and have their families present if they so wish, and we have to respect their wishes in that regard to see what can be done here.

The other issue is that the overall service for the residents, the respite care, which was not mentioned in the Minister of State's briefing, and the day service will all be lost to a vast area. East Cork is the size of some small counties, going from Youghal right up to Cork city and beyond, and north of that as well. That will all be completely lost and there are no plans that I can see to replace those services at a time when we are all concerned about the impact of mental health, the growth of the challenges people face because of Covid and other concerns and the constant negative news we are getting through the media all the time that the world is doomed and we are all going to hell in a handcart. This is having a big impact on people. We need to do better. I again implore the Minister of State, and the HSE and others if they are listening, to pause this for a while. Let us get together and talk about it and let us do better.

I thank the Deputy again for raising these very important issues. Improving all aspects of mental health service delivery is a priority for the Minister of State, Deputy Butler, the Government as a whole and the HSE, in line with the national service plan for 2021. This includes continued collaboration between the relevant agencies to ensure that quality and standards in our mental health facilities are further improved in line with the best practices and recommendations. With regard to Owenacurra, the most important thing is the safety and welfare of the current residents. The HSE has a plan in place to close the centre on a phased basis and to keep clear and open channels of communication with the individuals residing in the centre and their support networks. The aim is to secure an appropriate alternative placement based on assessed needs and in line with the will and preference of each individual. I hope the HSE will achieve these aims in respect of Owenacurra. I have taken on board what the Deputy has said about trying to stand back and, between all the stakeholders, to pause this decision. He also said that consultation only happened in the last week. That is a very fair and reasonable point. I will bring the Deputy's views to the Minister of State and hopefully she can liaise and work with him and all the stakeholders to get a satisfactory outcome.

Hospital Overcrowding

I am glad the Minister of State is here this evening to take this question regarding Sligo University Hospital and the overcrowding in the emergency department there. We share the same constituents so I am sure he is as aware of these issues as I am. Over the summer I have had various contacts from both patients and staff who have expressed their concerns in regard to the overcrowding situation, which they see as dangerous. I have an email here that I received on 28 July:

I am a nurse in the Emergency Department in Sligo University Hospital ... I don’t think you or your colleagues will ever begin to understand the fear and stress [that working in an ED] has caused me. I continued to work there as wave after wave of COVID hit. I worked in there when my colleagues were hit with COVID and I luckily never succumbed to it. We were so short staffed on days and nights that we were lucky if we got a 30 minute break in our 13 hour shift and yet we kept giving.

We are now in dire straits we start days at 8am and some mornings the patients we left in the waiting room the previous night are still sitting waiting to be seen! Admitted Patients are spending more than 48 hours on trolleys! The lowest point I saw was when admitted patients were taken off trolleys and put sitting on hard chairs down an X-ray corridor for the day waiting for a bed on the ward to become available and given back a trolley for the night if they remained in ED.

I know the Minister of State is aware of this situation, as many people in Sligo are. It has gotten some publicity in the media over the summer because this is an absolutely ridiculous situation with so many people in the emergency department and it is so overcrowded. Last Thursday my own young fella broke his finger playing hurling and I spent four hours there with him. He was seen and looked after very well by the staff there and there was no issue with that. However, I saw first-hand the stress of people waiting there, who were worried about loved ones who had been admitted, wondering where they were and what was happening with them. One man said he was waiting 27 hours sitting on a chair to find out what was going on. The stress that this puts on people is unacceptable in this day and age. Much of this comes back to the central point that the staffing is not in place.

I also spoke to a nurse about this issue this morning. She sent me an email yesterday and I rang her and talked to her about it. She told me that today at 3.30 p.m., 71 people had been through the emergency department in Sligo and in that time, from 8 o'clock this morning, there were five staff nurses and three care assistants. That is all there was for the huge volume of patients they were trying to deal with. There is clearly a huge problem with staffing in this hospital.

The level of staffing that is required and meant to be in place is between 12 and 14 staff nurses, in addition to care assistants and other backup staff. That is not in place nor has it been. Management told unions on various occasions that it is recruiting more staff to be put in place. Quite frankly, they are now in a situation where they do not believe that it will happen having been let down so many times by promises of this nature. It is not appropriate in this day and age that this kind of situation should continue.

This is not just an issue in the emergency department. It is an issue for the entire hospital. In most wards, there are beds along corridors and additional spaces are used to cater for people in an attempt to take the pressure off the emergency department. There are clear problems relating to space - there is a new wing being built at present - and the staffing, which is the primary issue and needs to be dealt with as quickly as possible. Many people have told me that when nurses qualify, they apply for positions in hospitals and they are actually not being recruited. That is a matter that needs to be addressed in some way. Staff are being taken on by the hospital in other ways besides being directly recruited by the HSE and that needs to end. We need to get as many staff in place as quickly as possible to resolve this issue. I look forward to the Minister of State's reply.

I thank Deputy Kenny for raising this important issue and for the way in which he has articulated it. At the outset, I acknowledge the stress that overcrowded emergency departments cause patients, their families, and the front-line staff working in very challenging conditions in hospitals throughout the country. I acknowledge the work and commitment of staff in ensuring the uninterrupted provision of emergency care throughout the pandemic. I am aware of these issues, in particular, those in Sligo University Hospital.

I have had numerous meetings with management at Sligo hospital, the most recent of which was yesterday, along with the Minister, Deputy Donnelly, where we heard first-hand about the challenges facing the hospital and the commitment of all staff to deliver high-quality care to patients. Both the Minister and I expressed our full support for the extensive development plans for Sligo hospital. The HSE reports that emergency department attendance figures have now reached 2019 levels, and exceed them in some sites. The number of patients waiting on trolleys has been increasing steadily since June 2021, although trolley counts for September to date remain 25% lower than the 2019 level.

The emergency department at Sligo University Hospital, SUH, as outlined by Deputy Kenny, has been extremely busy with an increased number of people attending in recent months. In addition, a surge in Covid admissions and a Covid outbreak have impacted on the hospital's capacity to deal with both Covid and non-Covid admissions. These factors have resulted in an increase in the use of trolleys to provide care. Trolley numbers for July-August 2019 versus 2021 have increased from 491 to 811, which represents a 65% increase. This is contributing to pressures in the emergency department and in the wider hospital. While attendance and admission numbers have now returned to pre-pandemic levels, the continued requirement to provide separate Covid-19 and non-Covid-19 pathways presents an additional challenge to patient flow in all hospitals and emergency departments, including SUH. The winter plan 2020-2021 has provided several hospital avoidance measures to support SUH. These include the appointment of a dementia adviser and frailty intervention team to avoid admissions and reduce length of stay. In addition, seven-day cover has been in place in SUH since January 2021.

Staffing and recruitment plans are under way to address deficits across the hospital. A significant overseas nursing recruitment campaign is being actively progressed nationally, with a strong intention to bring additional resources into the service. Localised recruitment has also been under way. Therefore, we expect 14 additional nursing staff to start in the emergency department in the next two months. The modular emergency department will become operational in the coming weeks and will provide additional waiting, triage and minor injury spaces for patients. It will also provide a decanting space for patients arriving by ambulance. Also included in this unit are additional facilities for staff such as restrooms, seminar rooms and office spaces. This area will provide much improved staff facilities going forward. In addition, the internal reconfiguration works within the existing emergency department will also take place over the next 12 weeks to provide improved patient space within the department.

I acknowledge the email - it is very stressful - written to Deputy Kenny about the situation. We hope the nurses will be recruited as quickly as possible.

I appreciate that the Minister of State understands the plight of the staff and patients in SUH. The management have made promises and are working with unions and the nursing staff to try to resolve this issue, but so far it has delivered very little. The email referred to was written at the end of July. I received another one yesterday. It stated:

Last weekend was a weekend that none of us wants to see again. There were too many horrific traumas with negative outcomes. There were 6 staff nurses on night duty for some of these and there were nights where they didn't even get a break all night. Not even a cup of tea to try to mentally process or prepare themselves for the next patient.

No profession should have to do this sort of thing or put up with this kind of situation.

It further stated, "We are in a desperate situation...". They need help as quickly as possible.

I was told today that management has said that it expects to recruit eight additional staff by the end of September. The Minister of State referred to 14 staff in his reply. That would be excellent if it were to happen, but the problem is that these promises do not seem to be delivered, either on time or at any stage. That is the real difficulty in all of this. I spoke to a nurse recently who is newly qualified, is waiting to be recruited and has applied for numerous positions but simply cannot get one. She has been told through the grapevine that she first needs to work with an agency for a while and then she will eventually be recruited by the HSE. The agency staff working for the HSE are being paid but the agency is taking its cut. This is costing the State twice as much to employ agency staff as it is to employ them directly. This is a folly and it needs to end. We all know that, yet no one does anything about it. That is one of the issues that need to be tackled immediately. We need to sort out this situation so that nurses can be recruited as quickly as possible. The nurses who are working there do not want to stay. They are looking around at the chaos and are thinking that they could have a better job and life if they were to go across the channel to England or to another country, such as Australia, where there are proper terms and conditions, and working conditions for nursing staff. This will continue unless we sort out this problem. The only way we can do that is to get the management right and the adequate number of staff to provide the service that people demand and need.

We expect 14 additional nursing staff to start in the emergency department in the next two months. We will work together to ensure that it is progressed as quickly as possible. The health service capacity review 2018 was clear on the need for a major investment in additional capacity in both acute hospitals and the community, combined with a wide-scale reform of the manner and the location of where health services are provided. Approximately 800 beds have been provided on a permanent basis over the number available at the end of 2019.

As I outlined, ongoing and planned developments at Sligo University Hospital will provide additional facilities for staff and patients, including additional beds, and space for waiting, triage and minor injury patients when the modular emergency department extension becomes operational in the coming weeks. Additionally, the internal reconfiguration works within the existing emergency department will also take place in the coming weeks to provide improved patient space within the department. These additional facilities cannot come quick enough. They will improve the experience for patients visiting the emergency department and, hopefully, the staff who work there.

Action plans are in place to deal with the current overcrowding, involving senior management, to ensure the focus remains on optimising the efficient and effective delivery of necessary treatment to all patients in a timely manner. Already, these actions are seeing an improving situation in the hospital. Staffing and recruitment plans are under way and we must work together to address these deficits. Local recruitment is also under way with additional nursing staff due to start in the emergency department in the coming months.

I remain active on this issue, because I am aware of it within the Department, and will work with colleagues in the Department and the HSE, and with management and staff in the hospital, to support the provision of high-quality, innovative and safe care to patients served by Sligo University Hospital and the wider Saolta University Health Care Group.

I will inform the Minister of the Deputy's views on agency staffing. This has been a very serious situation and I thank him for how he has articulated it today. I hope, working together will all the stakeholders, that we can to get through this. It is very difficult for the management, staff and patients in the hospital. I will do everything I can, as Minister of State and as a person for whom Sligo is my local hospital, to work with the stakeholders to address this issue.

Home Care Packages

I am again raising an issue that I put to the Minister of State, Deputy Rabbitte, on the floor of the House some 12 months ago. It relates to the provisions that are being made by the HSE, together with the education sector, to recruit staff, and whether there is consultation and communication in that regard. I refer to the home care support packages that are not being delivered. The hours are there but the staff are not. I am incredulous that when people contact the HSE, the service provider will say it can give them 21 hours but it does not have anyone to deliver the care.

On 10 August, I had to resort to writing to the Minister, as follows:

Dear Minister, I am contacting you today with what I am sure you will agree are two very urgent and upsetting situations. For me, it is incredibly regrettable that I have to seek intervention directly from the Minister and your Department in both these instances as, for me, such cases as I am representing today should be afforded the immediate delivery of approved hours without excuse or delay. [I will not use the individuals' full names, only initials.]

BW has muscular dystrophy, is incapacitated and a full-time wheelchair user. BW's full-time carer is presently in hospital recovering from major surgery, which has resulted in an emergency situation where BW is now in urgent need of assistance in her home place. BW cannot toilet herself [and] she cannot attend to her own personal hygiene or prepare any meals. She is presently assisted by her sisters, who are both unwell and unable to provide BW with the care she needs. Both BW herself and her sisters have attempted to engage with the PHN [the public health nurse] as well as making direct contact with older persons' services, just to be fed with lame excuses and no resolutions. This lady is an urgent and emergency case, which is being passed from one person to the next, with zero interventions or solutions to providing approved care hours.

I wrote that letter on 10 August. Today is 16 September and it took three weeks for action to be taken.

The other case I wrote to the Minister about concerns a person with the initials PS. I wrote as follows:

PS has a terminal diagnosis which is no longer receptive to treatment. All treatment has now stopped and PS is now seeking to return to her home for comfort measures. Also, a referral has been made to the palliative care team in Wexford to allow PS home. Home care hours are required to assist the family with PS's care. I am sure you will understand that time is not on the side of PS or her family and they are now extremely anxious to get her home. This is an incredibly upsetting and traumatic situation for PS and her husband and family, who now simply want her home to spend what short time is left in the comfort and love of her own home and family. However, she is being denied returning to her own home as approved care hours cannot be delivered due to staff shortages.

These are just two cases. I could go on providing more; the reality is I have instances almost in treble digits of where home care packages are not being delivered. The hours are there but the staff are not there to deliver them. Can somebody, please, tell me what is going on? Do we have the money? I attended a meeting of the Committee of Public Accounts today at which HSE representatives were in attendance to account for having spent €81 million - "spent" is a very conservative word - on ventilators we did not receive. How many carers would €81 million train and provide for the people of Ireland who have paid tax all their lives and are trying to get home to die in peace? I want my question answered and I do not want to have to stand up in the Chamber again to ask it.

I thank the Deputy for raising this matter. I recognise that it is a very complex issue. I know from personal experience that trying to get carers is a difficulty. It is a key priority of the Government to enable more people to engage in services that allow them to remain independent and to live in their own homes with dignity and independence for as long as possible. In order to advance this, the Government is committed to establishing a new statutory scheme for the financing and regulation of home support.

In July, the Minister of State with responsibility for mental health and older people, Deputy Butler, announced the selection of a number of sites for a new home support pilot project. This pilot will deliver an additional 230,000 hours of home support over a six-month period and will test a reformed model of service delivery for home support. The Community Healthcare Network, CHN, sites selected for the pilot are Tuam, Athenry, Loughrea, Bandon. Kinsale, Carrigaline, Ballyfermot, Palmerstown and east Westmeath. The pilot will underpin the development of the statutory scheme for home support services. A national home support office will be established to support the testing of the reformed model of service delivery. In addition, approximately 130 posts have been funded for the national roll-out of the interRAl Ireland assessment system, which the home support pilot will test as the standard assessment tool for care needs. In parallel, work is ongoing by the Department to make progress with other aspects of the scheme, including the development of a regulatory framework and the examination of options for the financing model.

While this new home support scheme is under development, the Government is prioritising improving access to home support services. An additional €150 million was made available for home support for older people in budget 2021. The national service plan set a target to provide 24 million hours of home support. This is an ambitious target that will increase provision by 5 million hours, or more than 25% above the 2020 target.

The Covid-19 pandemic has led to unprecedented challenges across our health services, nowhere more than in older persons' services. While there have been challenges in the delivery of home support hours, particularly during the third wave of the pandemic, significant progress has also been made. Preliminary data indicate that at the end of July 2021, more than 11.4 million home support hours had been provided to 53,732 people. This means that 1.5 million more hours were provided compared with the same period in 2020 and the number of people waiting for approval of funding for a new or additional service has greatly reduced.

The Department, the HSE and the Minister of State, Deputy Butler, are committed to ensuring that we continue to allocate additional home support hours where they will be most effective coming into the winter period. There has been a sustained focus in recent years on reducing delayed transfers of care and enabling patients to be discharged from hospital sooner. As of 14 September, there were 468 cases of delayed transfer of care. There were 93 people categorised as waiting for a home support service, of whom 57 were approved for funding and waiting for carer availability. The HSE will continue to work towards increasing home support provision. However, challenges remain in regard to capacity and efforts are ongoing to recruit staff across both direct and indirect provision.

The Department of Health is committed to working across Government and with relevant stakeholders to ameliorate these issues. The programme for Government committed to establishing a workforce planning expert unit to work with the education sectors, regulators and professional bodies to improve the availability of health professionals and reform their training to support integrated care across the health services. I take on board the cases the Deputy outlined, involving individuals she referred to as BW and PS, and the letter she wrote in that regard. Their cases are harrowing and I hope we will be able to address those issues in the coming weeks and months. However, there is an issue with both retaining and recruiting staff.

I thank the Minister of State for his reply but I have to say it is more spin. This Government is going to spin itself out of existence. There is not a word about delivery in his reply. He talked about challenges. The challenge here seems to be to rein in the HSE in some shape or form such that money can be spent where it is required. We cannot accept that €81 million just got thrown into the atmosphere without any cognisance of what that means for people's health.

It means we do not recruit healthcare workers and pay them appropriately in order that they are enticed into the sector. I cannot have Departments deciding whether a 73-year-old man who ends up paraplegic as a result of an accident is an older person or a disability case, because that is what happened when I wrote to the Department. One came back and said it was not it, it was the other Department. That took another week, just for issues like that to be ascertained. It is outrageous. I am sorry to be going off on one here, but this is deeply frustrating for families in very vulnerable positions. Let us imagine the trauma of having one's 73-year-old husband and a father turned into a paraplegic as a result of an accident and not being able to come home from hospital for the want of two carers coming in for 45 minutes in the morning and for 45 minutes in the evening. Does that sound like too much to ask for a 73-year-old farmer who paid his tax all his life, whose wife wants to be the primary carer, to take him home and deliver the care he deserves? The co-ordinator says there can be one carer for 45 minutes once a day, five days a week, not seven, and they will be left to their own devices for the other two days even though his wife is also 73 years of age. This cannot go on. This is why I am so against what is going on here for the past eight weeks, that we voted on last night. The real work that needs to be done is just going unnoticed.

I take on board what the Deputy says and I will bring back her exact views to the Minister. The Government did improve access to home support services as a priority. Last year we did provide €150 million for these services. The Covid-19 pandemic has highlighted the importance of supporting the most vulnerable in society to be cared for in their own homes for as long as possible. It is of the utmost importance that all individuals accessing home support are provided with a high quality level of care which is safe and person-centred.

The statutory home support scheme is a key enabler to providing more alternatives to nursing home care and a wider opportunity for people to live fuller more independent lives. The scheme will provide for the financing and regulation of home support services in order to provide equitable access to high quality services based on a person’s assessed care needs. The system of regulation will ensure public confidence in the service provided, as well as safeguarding service users.

The sector probably needs a lot more pay. Such increases will be part of the Minister's deliberations on the budget. It is very difficult to attract people into the sector and I agree that they probably need more reimbursement. The funding is there, and I hope that all the stakeholders will be able to work to try to attract people because it is a very difficult job, but it is also necessary to keep people in their own homes away from the front-line services.

The Department of Health is examining the potential demand and costs of introducing this scheme. Following that, work will be undertaken to examine the associated workforce requirements for the introduction of such a scheme. I understand officials from the Department will engage with all the relevant stakeholders and the other sectors as required. It is an issue we hear about as politicians across the country, and we need to address it.