I thank the committee for the invitation to attend this meeting. I am joined today by my colleague, Mr. Robert Deegan, principal officer in the older people’s projects unit, and Dr. Jean Long from the Health Research Board.
Improving home care services so that people can live with confidence, dignity and security in their own homes for as long as possible is a key commitment of Government. Home supports are crucial to helping older people and, indeed, people of all ages with particular care needs to remain where they want to be, namely, at home in the surroundings with which they are most familiar and comfortable.
This is an opportune time to meet with the committee because the Department has commenced work on designing a new statutory scheme and system of regulation for home care. I look forward to hearing the views of the committee as well as the perspectives of the other speakers here today. Before I speak about plans for the future, it is important to first consider where we are at the moment.
I will mention rights and eligibility for home care services first. At present, home care services are provided through the HSE on the basis of assessed health care need and no personal contribution towards the cost is required. The HSE provides services both directly and through service level agreements with private and voluntary sector providers. The current system relies heavily on family carers, who play a crucial role in helping older people and others that need help to remain living in their own homes for longer. These carers not only make a profound difference to the health, well-being and quality of life of those that they care for, but also make an important and often unacknowledged contribution to the economy. This is reflected in the 2016 census results published earlier this month, which identified that about 195,000 carers are providing a minimum of 6.6 hours of care per week.
I will now consider resources. The HSE will spend approximately €370 million on home care in 2017, out of a total budget of €765 million for services for older people. This figure excludes funding for the nursing homes support scheme. The HSE’s national service plan provides for a target of just over 10.5 million home help hours; almost 17,000 home care packages; and 190 intensive home care packages, co-funded by Atlantic Philanthropies, for clients with complex needs, particularly those living with dementia.
In budget 2018 a further €37 million has been made available to further strengthen supports for older people, particularly to facilitate speedier discharge from acute hospitals over the winter period. A significant proportion of this additional funding will go towards home care services. The resources available for home care services, while significant, are limited, and with the increase in our elderly population, demand is growing year-on-year. Accordingly, services and the allocation of resources to individual clients require prudent management on an ongoing basis as demands for services increase. In this context, those clients who are assessed and approved for home care, and who are not being provided immediately with a service, are risk-assessed and placed on a waiting list for a resource as it becomes available. It is important to note that many people also purchase home care services directly from private providers.
I will now address regulation. Home care services are among the health and social care services for which there is currently no statutory regulation. However, the HSE is progressing a range of measures to improve home care provision overall, to standardise services nationally, and to promote quality and safety. This includes a national procurement framework for home care services, which came into effect in 2012 and was put out to tender again in 2016. This provides a mechanism for quality assurance. Providers are also monitored through service level agreements with the HSE.
I will now address the plans for the new statutory home care scheme. While the existing home care service is delivering crucial support to many people across the country, it is recognised that home care services need to be improved to better meet the changing needs of our citizens. The Department is of the view that a stand-alone funding scheme designed specifically for home care is needed, together with an effective system of regulation. In 2016 the Department’s intention to bring forward legislative proposals for the regulation of home care was indicated in a report entitled Better Health, Improving Healthcare. The programme for a partnership Government signalled the Government’s commitment to the introduction of a uniform home care service. As Minister of State with responsibility for Mental Health and Older People, Deputy Helen McEntee played a key role in advancing this undertaking, tasking the Department with the development of a new statutory scheme and system of regulation for home care.
The new scheme will improve access to home care in an affordable and sustainable way. It will provide transparency around service allocation and individuals’ eligibility for services, and ensure that the system operates in a consistent and fair manner across the country. The scheme will also result in more effective integration with other health supports including nursing, therapies, and other primary care services. A system of regulation will be designed to ensure public confidence in the standard of the services provided, and to bring Ireland in line with best international practice. It will be important to get the balance right in this regard and to ensure that the system of regulation is effective and not overly bureaucratic.
I will now speak about progress to date. As an initial step in developing the new system, the Department commissioned the Health Research Board, HRB, to undertake a review of the home care systems in place in four European countries. The review, which was published in April 2017, will help us to ensure that Ireland’s new home care scheme and system of regulation is informed by international experience. The committee will shortly be hearing from Jean Long of the Health Research Board, who will speak in more detail about the findings of this review.
The Department also launched a public consultation process on the financing and regulation of home care in July of this year. Over 2,600 responses to this phase of the consultation process were received. The purpose of this public consultation was to enable us to find out about the views of service-users, their families and healthcare workers on current and future home care provision. Preliminary analysis of the submissions has been undertaken, and we would be happy to share details of some of the initial findings this morning if that would be of assistance to the committee. A full report on the findings of the consultation will be published early next year. This will inform the Department’s development of the new funding scheme and regulatory arrangements.
The process for determining the type of home care scheme and approach to regulation that is best for Ireland is complex. A significant amount of analysis is needed to develop policy proposals on the form of the home care scheme and the system of regulation that will apply to these services. It is important that we get this right and take the time required to ensure that these measures will be successful, affordable and sustainable.
I thank the committee for inviting us to present here this morning, and I look forward to continuing engagement throughout the process of developing the new home care scheme.