I thank the Chairman and members of the committee for the opportunity to make an opening statement. I would like to comment briefly on the home help service and update members on a number of aspects of the service. Members have been provided with a more detailed paper setting out the aspects of the service which we can discuss later.
The first issue is the context in which the service is operating and moving towards the integrated care model. The delivery of health services to older people must change for a number of significant reasons. They are, predominantly, the following: the fact that people are living longer; the population is increasing and ageing; expectations and demands are increasing; and costs are also increasing.
Government policy with regard to health services for older persons has the following two core elements: community and home-based care should be developed to maintain older people in their communities for as long as possible and to support the important role of the family and the informal carer; and, where that is not possible, high-quality residential care should be available.
The integrated care model of service delivery being developed within the HSE provides for appropriate care in appropriate settings, along a continuum from home and community-based services through acute intervention to long-term residential care, with older persons needs and preferences being central to decision-making.
In that context this report outlines the significant progress made in developing home help services and home care packages since 2006, identifying the impact in terms of people benefiting as well as the significant support to the acute hospital sector. These developments are part of an overall movement towards an integrated model of care across hospital and community, which will require continued sustained investment if the model is to be successfully implemented.
The home help service is a core community service supporting older people to remain in their own homes, preventing admission to acute services, delaying or preventing admission to continuing residential care and facilitating early discharge from the acute sector to the community.
Significant progress has been made in developing home help services since 2006, with significant impact in terms of the numbers of people benefiting as well as providing support to the acute hospital sector. In terms of numbers, this has increased from 10.8 million hours in 2006 to 11.97 million hours in 2009. The total number of people in receipt of services increased from 41,400 in January 2006 to 53,791 in December 2009.
The 2010 budget for the home help service is €211 million, which provides 11.9 million home help hours with approximately 54,500 persons in receipt of the service at any time. It is important to outline that this includes all care groups. It is not just for older people. It also applies to our mental health services, our disability service and services for children and families. The 2010 targets are the same targets as applied in 2009. This level of service, if applied equally to all clients, would equate to four hours home help per client per week.
While the resources available are substantial, they are finite. The capacity of the HSE to provide approved levels of home help service continues to be reviewed in the context of overall resources available to the HSE. Local health managers must ensure that home help services are delivered within the allocated budgets. This requires a stringent ongoing review of the application of the resources.
Levels of services provided by the home help service to individual clients are reviewed regularly to ensure they continue to support the clients' assessed care needs.
In some parts of the country, particularly in Dublin and the greater Dublin area, the home help service is provided by voluntary organisations. It is recognised that these voluntary organisations provide a valuable service. They face challenges in the future in terms of standards, and increased professionalisation of the service. Given the particular relationships that have developed, the HSE will need to provide some support to those providers in facing these challenges.
Home care packages are enhanced levels of home help services which may be provided through the home care package scheme where the assessed needs of the client indicate that such enhanced service is required. In 2010, the home care package scheme budget is €130 million, which is expected to benefit over 13,000 people. By the end of 2010, a total of just over 9,600 people will be in receipt of a home care package at any time.
Regarding home help service and duties, the development of the home help service has seen the professionalisation of the service in recent years with the implementation of the national home help agreement. Home helps are now paid at care attendant rate. This has resulted in greater flexibility in service delivery and improved consistency in service quality, through training, to the benefit of service users. That has placed a greater onus on the HSE and its role as an employer and with regard to management of risk, which requires increased supervision given the numbers of high-dependent older people now supported in the community.
Home helps provide a range of services to assist people with activities of daily living based on the assessment of need undertaken by health professionals. These duties include both personal and domestic care relevant to the individual's assessed needs. The range of duties is set out in a more detailed paper which has been circulated.
Home help service training is provided on an incremental basis to facilitate changes in service provision. For example, where an older or disabled person becomes more dependent, the existing home help may need training to develop his or her skills to provide the necessary personal care. Initial training for new home helps includes induction, moving and handling, health and safety, and domestic and personal care.
Moving and handling training is a critical aspect of training, particularly where personal care tasks are involved. Moving and handling training is arranged locally in each region to address the particular requirements of each local health area. One example of the extent of training in Cork-Kerry is set out in the detailed paper already circulated.
FETAC level 5 training is available currently through arrangements with a consortium of all 33 VECs, led by the city of Dublin Vocational Education Committee. Supervisory staff may avail of the supervisor programme at FETAC level 6. In addition, FETAC programmes levels 3 and 4 are also available where appropriate, for example, if the home help requires literacy support or if English is the second language. More details on these programmes are set out in the paper circulated to the members.
The home help service has emerged over the years from what was essentially a friendly neighbour service to one that is becoming more professional and demanding as increased numbers of clients with significant and complex needs are maintained at home. Although generally the home help service is well regarded by clients there remains room for improvement and in 2010 work is under way to roll out a number of improvements that will ensure all applicants for home help services are treated in a similar way and have their application assessed in a similar way regardless of where in the country they live. Procedural guidelines for the home help service are in the process of being developed. Given the large numbers benefitting from the service it is critical that national procedural guidelines for the standardised access to and allocation of home help hours to clients are available to assist staff in managing the scheme in an equitable way across the country.
Given that the service evolved over a number of years from the old health board structure and because it is a discretionary service — there is no statutory requirement on the HSE to provide the service and no statutory entitlement for clients to receive it — different approaches to accessing the service emerged in different areas. It is a priority of the HSE to standardise access to this service so that all our clients can expect to be able to access the service using the same criteria regardless of where they live.
Procedural guidelines will assist staff in applying equitable access criteria to all applicants and in allocating home help services in a consistent way while incorporating flexibility to allow the professional staff allocating the service to take full account of the particular care needs, abilities and dependencies of the client. In this way for example a client in County Mayo and one in County Wexford can expect to be able to apply for and be assessed for the home help service in a similar way, and, subject to the limit of the resources, have appropriate services allocated to support their differing needs and dependencies. Guidelines will also help to ensure that important service is provided in an economical way while taking account of individual needs.
Another aspect of service improvement relates to draft national quality guidelines for home care support services which reflects that the needs of older persons and their carers are based on good practice, will ensure national cohesion and will support the service delivery system to minimise risk in the home care setting. The guidelines will address key issues across public, voluntary and private providers. The resource and general capacity implications will need to be considered before a strategic and operational proposal, recommending how the guidelines might be implemented across agencies in the public, private and voluntary sectors, on a phased basis within available resources, can be submitted to the HSE management team.
The HSE is committed to supporting older people to live in their own homes for as long as possible if that is their wish. Significant levels of service are available and are being provided across the country. However, as the population of older people continues to grow, the resources available to support them to remain at home must continue to expand if service provision to individual clients is to be maintained or improved.