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Seanad Éireann debate -
Thursday, 9 Jul 2009

Vol. 196 No. 13

Home Help Service.

Cuirim fáilte roimh an Aire Stáit. The first time I raised the subject of this Adjournment debate — the decision of the Government and the HSE to withdraw home help services — in the Seanad was approximately six weeks ago, when it first reared its ugly head in County Donegal. This evening, I am calling on the Minister for Health and Children to reverse her decision to reduce by 2,246 the number of home help hours being given to the elderly people of County Donegal. Since I became aware of this issue and started to ask questions about it and raise it in the Seanad, I have received numerous replies from the Minister, Deputy Harney, and from HSE officials. I have been given many figures and statistics setting out the various numbers of hours that are apparently being provided. I appeal to the Minister of State, Deputy Haughey, to put such information to one side this evening. I am not as interested in computer data and statistics printed on paper as I am in the elderly people of County Donegal — Mary, Johnny and Paddy. I am concerned about people like the 97 year old woman whose home help services have been completely withdrawn, or the wheelchair-bound father whose services have been reduced to just 15 minutes a day. The people to whom I refer dug deep when this country needed people to dig deep. They went to hiring fairs before they were teenagers and were hired off to other families. When they went to Scotland to work as tattie hokers, they sent money back to their families and communities at home. Many of them lived through very difficult times, including the First and Second World Wars. When their country needed them, they stretched out their hands. They want their country to respond to the serious needs they have today.

As I said earlier, Fianna Fáil is shaping a new type of Ireland. When I say it is an Ireland of which I can no longer be proud, I accept that I am making a strong statement. This issue involves more than statistics, numbers of hours and other forms of data — it goes to the core of what we are all about. It is shameful for any Government to treat the elderly as they are being treated at present. At a national level, the Government is withdrawing almost 27,000 hours of critical home help support on the basis of computer data, rather than on the basis of need. It is completely wrong and utterly unjust. In my view, it is one of the worst crimes the Government has committed in recent years. I appeal to the Minister of State to encourage his colleagues to do the right thing at this late stage. A great deal of damage has been done to elderly people and a great deal of hurt has been caused to their family members.

The terms of employment of home care workers have been changed. Some of them are now working just three hours a week, which makes absolutely no sense. I noticed today that the Government has sent 1.3 million postcards, at what must have been a phenomenal cost, to homes across the country to tell people about guarantees that mean nothing. The House debated the matter earlier. In some cases, the postcards have been sent to people in County Donegal whose loved ones are having to cope with reductions in front-line services like home help hours. The Government does not have the cop-on to understand it is more important to give people an additional 15 minutes of home help support — to help them get out of bed, onto a commode and back into bed, for example — than it is to send postcards around the country. It needs to get its act together.

The issue I have raised is at the root of the problem of where this country is going. What type of country is this Government shaping? While I accept that we have to make decisions if we are to get the country back on track, we should not attack people who need the State to provide help so they can get out of bed, get onto a commode, get washed and get back into bed. The Minister of State knows it is wrong to cut services of this nature. I am sure the Taoiseach knows it as well, so why is it continuing to happen?

IMPACT and SIPTU have organised a protest for 2 p.m. this Saturday. I hope thousands of people will take to the streets to speak with one voice of their anger and disgust at what the Government is doing. I appeal to the Minister of State to give the people of Donegal the answer they are looking for. The Government should promise to review this matter and ensure that any cuts deemed necessary are made on the basis of the needs of patients and elderly people, rather than on the basis of the impression that County Donegal has a higher need than the HSE has budgeted for. I remind the House that it is proposed to reduce by 2,246 the number of home help hours being provided in the county. I do not know how much that will save, but it is not worth taking the dignity of our elderly people, which can never be paid back. I appeal to the Minister of State to give us the right answer tonight.

I will respond to Senator Doherty on behalf of my colleague, the Minister for Health and Children. I thank the Senator for raising this issue and thereby giving me an opportunity to reaffirm the Government's continued commitment to services for older people and, in particular, the important area of home help services.

The Government's policy on older people involves supporting them to live in dignity and independence in their own homes and communities for as long as possible. If this is not feasible, the health service supports access to quality long-term residential care, where appropriate. This policy approach was renewed and developed in the partnership agreement, Towards 2016. The development of services for older people throughout the country reflects the prioritisation of, and significant investment in, this area by the Government in recent years. For example, additional funding of just over €200 million was provided to develop or expand community-based services between 2006 and 2008. This additional funding related to home care packages, home help, meals on wheels and day or respite care, for example. Home care services are delivered either directly by, or on behalf of, the Health Service Executive, in partnership with the voluntary sector or through private providers, as appropriate.

I will set out the position in relation to home help. It is expected that the HSE will spend €211 million on the home help service this year. Over €55 million in development funding has been provided since 2006. The number of home help hours being provided has increased from 10.8 million in 2006 to almost 12 million this year. The number of people benefiting from the home help service has increased from 41,400 in 2006 to approximately 54,500 this year. Home care packages, which are a relatively new initiative, were introduced in 2006. They were developed across the country through the Government's phased investment of €120 million in new funding. Home help packages consist of a variety of community-based services and supports, including a significant home help element in many cases, to best meet the needs of older people. Home help clients may have significant medical, nursing or therapy requirements. They may have recently been discharged from hospital. They may be at risk of admission to hospital if their needs are not met in a planned way. The HSE service plan envisages that approximately 8,700 people will benefit from home help packages at any one time. Over 11,000 people will benefit over the course of this year.

It is important to stress that, notwithstanding its current financial pressures, the Government has made every effort to protect home care services for older people. This year, the HSE aims to deliver the same quantity and quality of home help and home care packages nationally as it delivered in 2008. I understand that the HSE in County Donegal provided 54,246 home support hours per month in the first quarter of 2009. This was in excess of the number of budgeted hours, which is 52,000 hours per month for 2009. Since 2003, there has been a 60% increase in the number of home help hours delivered to older people in Donegal. In addition, 191 people in Donegal benefit directly from home care packages.

Of this country's 32 local health offices, the local health office in Donegal provides the third highest number of home help hours per capita to those over 65 years of age. The HSE has indicated that it intends to achieve efficiencies in service delivery by reviewing the scale of provision, particularly on Sundays and bank holidays when premium pay rates apply. It aims to meet patient needs through a variety of supports, including public health nursing, day hospitals, day centres and home care packages. Any person in County Donegal who is not satisfied with the level of home support being provided can appeal the decision to the HSE appeals officer in the north west.

It is clear that the Government has made considerable improvements in recent years to enhance home care provision across the country, including County Donegal. There is no doubt that demand can, at times, exceed service resources. I am satisfied, however, that the HSE will continue to deliver the home help service in the best possible manner, taking account of evolving circumstances at national and local levels.

Will the Minister of State take a clear message to decision makers at Cabinet level to the effect that this issue is not going to go away? The response the Minister of State has been asked to deliver tonight on behalf of the Minister for Health and Children, Deputy Harney, is complete and utter nonsense. I have that response already and it is devoid of any real facts as regards what is happening on the ground, the real people in the real stories. I ask him to take a clear message to the effect that the people of Donegal are not going to tolerate this. This is not the last that the Government has heard of this.

Missing Persons.

I welcome the Minister of State and I thank the Cathaoirleach for the opportunity to raise this very important matter on the Adjournment.

A couple of weeks ago I tabled a matter on the Adjournment regarding the number of children who have gone missing from the care of the HSE. I received a response on behalf of the Minister for Health and Children that was really quite alarming. While full figures for the years 2006-08 were not available, the figures that were available for 2000-06 and the incomplete figures for 2006-08 indicated that approximately 397 children remain missing from the care of the HSE. All of these, with the exception of one child, I understand, are unaccompanied non-national minors. I am very concerned that these children are extraordinarily vulnerable. They do not have any families to speak up for them. They do not have any links with or ties to the country and therefore have not established relationships that would allow people to advocate on their behalf and continuously urge the authorities to locate them and be assured they are safe.

What is particularly alarming is that while it is accepted a number may claim to be unaccompanied, when they come into the care of they HSE, they tend to abscond in order to join up with family members. That appears to account for a certain number, but we are not sure how many. I presume some of those numbers may be for children who are located or whose whereabouts are accounted for.

It now appears that a number of these children are being trafficked into Ireland, either for the purposes of child labour or the sex trade. I am aware that a number of investigations are underway at present by the Garda Síochána into some such incidences. It is really important that we as Members of the Oireachtas speak up for these children and that we ensure their safety and whereabouts are kept to the forefront in everybody's mind. I welcome the new joint national protocol which the Minister indicated was signed in April to ensure that the Garda works in conjunction with the HSE to locate every child who has gone missing.

I would appreciate any update the Minister of State might give regarding the effectiveness of this as well as any update on the measures that have been undertaken by the Garda to find these children. Most importantly, there is a danger that where so many children can go missing without there being much public awareness of the phenomenon, that a false message could be sent out to the effect that Ireland is a soft target for trafficking, and this obviously cannot be let happen. I would welcome any update the Minister of State can provide.

I am replying on behalf of the Minister for Justice, Equality and Law Reform, who is unable to be present due to other business.

The joint Garda-HSE protocol referred to by the Senator sets out the roles and responsibilities of both agencies in relation to children missing from care. The joint aim of both organisations is to reduce the number of such cases, prevent them from suffering harm and return them to safety as soon as possible. We are all very conscious of the devastation and stress caused to families and their relatives when a child goes missing. Thankfully, the vast majority of these children are located safe and well.

The protocol underlines the prominence given to this issue by both organisations, and the HSE and the Garda have worked closely in its development. It provides clearly defined arrangements for addressing issues relating to children in care who go missing and sets out the most important actions to be taken by both organisations when a missing child in care report is made to the Garda Síochána. In addition to children who come into HSE care in the more traditional ways, the protocol also covers separated children seeking asylum.

An important feature of the protocol is the establishment at local level of a Garda liaison role with the HSE care placements. This local liaison role includes a mechanism to identify children in care who are reported missing frequently and raises the responsibility for such cases to an appropriate level of authority in both organisations.

At a national level both the HSE and An Garda Síochána agreed to review the protocol after six months of operation and at appropriate intervals thereafter. It was felt that six months was the minimum period of operation before a meaningful review could be carried out. The HSE has commenced a process to change its model of care for separated minors such that they can avail of foster care and residential arrangements across a broader spectrum than previously available. The HSE has also appointed a senior manager with responsibility for managing these changes and developments on a full time basis. This senior manager is actively engaging with all stakeholders.

The Garda Commissioner is committed to ensuring An Garda Síochána meets the challenges posed in locating missing children and has assigned additional personnel resources to the missing persons bureau at Garda headquarters.

An area to which the Minister attaches priority is that of child trafficking. A dedicated anti-human trafficking unit was established in his Department in 2008 to ensure the State's response to human trafficking is co-ordinated, comprehensive and holistic. The Criminal Law (Human Trafficking) Act 2008 provides for severe penalties for trafficking of children and adults for the purposes of exploitation, which demonstrates the Government's determination to ensure that perpetrators of child trafficking are dealt with appropriately.

In adopting a proactive approach to human trafficking, the Garda Síochána has given priority to the issue of child trafficking. For example, Operation Snow, an initiative undertaken by the Garda national immigration bureau, is designed to prevent the trafficking and smuggling of minors into, out of and within the State; to ensure the welfare of suspected victims of such criminal activity is adequately provided for; and to achieve prosecutions where criminal activity of the nature concerned has been detected. From the commencement of the operation in 2007 to the end of 2008, almost 200 incidents had been the subject of investigation, with assistance provided for a total of 164 children. The majority of these investigations revealed family reunification and other immigration motives as the explanation for suspicious activity by non-Irish nationals.

The Minister is informed that, excluding separated children seeking asylum, 53 children have gone missing from HSE care from January 2009 to date. Of these, 51 are accounted for. Two remain missing, although contact has been made with them, and all appropriate efforts are being made to ensure their safety. Regarding separated children seeking asylum, the HSE has indicated that 27 children went missing between January and May 2009, of whom two are accounted for. Figures for 2007 and 2008 in respect of Irish children gone missing remain incomplete due to variations across the HSE in the definition of what constitutes a missing child.

I can assure the Senator that the Minister, the Garda Commissioner and the HSE are fully aware of the importance of this issue and are committed to taking all necessary actions to ensure that these missing children are located and come to no harm.

I thank the Minister of State for his response. I am not being awkward, but with all due respect his response had no details about what measures have been taken to locate the 397 children who remain missing from the care of the HSE. I welcome the initiatives in place which the Minister of State has outlined tonight. They are very important and will go a long way to protecting children in the future. The last couple of months have been very traumatic for Ireland as we struggle to come to terms with the contents of the Ryan report and await the outcome of the Dublin archdiocese report but I am really concerned about what has happened to those 397 children and what measures have been taken to find them. I intend to keep raising it and would appreciate if any details are available and if some indication can be given that we are still looking for those children and trying to ascertain what has happened to them.

I will endeavour to get the additional information for the Senator. I note her comments and will ensure they are considered by the relevant Ministers.

The Seanad adjourned at 9.40 p.m. until 10 a.m. on Friday, 10 July 2009.
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