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Seanad Éireann debate -
Tuesday, 15 Dec 2009

Vol. 199 No. 7

Health Services.

Cuirim fáilte roimh an Aire Stait. An cheist atá os comhair an Tí agam ná cúram baile dóibh siúd atá tacaíocht de dhíth orthu sa bhaile agus na ciorruithe a cuireadh i bhfeidhm sa scéim sin. I ndiaidh dom an cheist seo a ardú don chéad uair thart ar mhí Iúil agus ceisteanna Dála a chur, fuaramar eolas go raibh ciorruithe á gcur i bhfeidhm agus go raibh thart ar 1,746 uaire á ngearradh ón tseirbhís seo i gContae Dhún na nGall gach mí. Idir an dá linn, bhíomar in ann socrú a fháil le Feidhmeannacht na Seirbhíse Sláinte, FSS, nach ndéanfadh sé níos mó ciorruithe ar feadh 2009. An cheist atá agam ná an bhfuil sé ar intinn ag an bhfeidhmeannacht na ciorruithe a chur i bhfeidhm i 2010 nó an bhfuil an méid uaireanta atá ceadaithe i mbliana do Dhún na nGall le bheith ar an leibhéal céanna.

The matter before the Seanad relates to the home help supports being provided to those in need of that service in County Donegal. On 9 July I raised the issue for the first time in the Seanad and at the time we were told more hours were being provided for Donegal than was budgeted for. The Minister failed to inform me at the time that cuts were being implemented, although I knew from speaking to constituents on the ground that the cuts were taking place across the board.

After further investigation, through raising the matter in the Oireachtas and through parliamentary questions, we found that serious cuts were being imposed on the service in Donegal. In total it was estimated that 2,246 hours were to be withdrawn every month from the service in the county. With others, I launched a campaign to try to halt those cuts to a very vulnerable sector of Donegal people. We had support from the IMPACT and SIPTU unions, and that led to a large rally of up to 1,000 people demonstrating outside the HSE office in Ballybofey.

After a number of deputations and delegations with the area manager in Donegal we came to a compromise. On 14 August 2009 there was an agreement that there would be no further cuts in 2009 and the hours being delivered in the county would remain at 52,500 hours per month for the remainder of that year. However, there has been no guarantee that further cuts will not be announced in 2010. As we face into that year many elderly people who have lost hours in the past are fearful of additional hours being cut from their home help supports. There are approximately 800 home help workers in Donegal who have seen their hours and income cut seriously.

There is a real need for additional support to be given. The cutbacks were a disgrace and the hours should be reinstated for those who are most vulnerable and in need. The Government has set a clear path of attacking the most vulnerable, the weakest and the poorest in society. That stance was reinforced last Wednesday in what was the most despicable budget ever introduced by a Government since the foundation of the State.

Will the Minister of State confirm that the hours currently being provided under the home help scheme in Donegal will not be reduced in 2010? I would like to see those hours which have been cut from people reinstated but we need certainty that there will be no further round of the cuts we saw in the first couple of months of 2009.

I thank the Senator for raising this issue as it provides me with an opportunity to reaffirm the Government's continued commitment to services for older people generally and, in particular, to the important area of home support services. Government policy on older people is to support people to live in dignity and independence in their own homes and communities for as long as possible. Where appropriate, the health service also supports access to quality long-term residential care. This policy approach is renewed and developed in the partnership agreement Towards 2016.

The development of these services reflects the prioritisation and significant investment by the Government in recent years with, for example, over €200 million in additional funding provided to develop community-based services nationally. This additional funding related, for example, to home care packages, home help, meals on wheels, and day or respite care. The aim is to meet client needs through a variety of supports which focus on a multidisciplinary approach to deliver services centred on a person's home. It is important to stress that notwithstanding current financial pressures generally, the Government has made every effort to protect home care services for older people. The Government recently made available an extra €10 million in the 2010 budget to increase the provision of home care packages. This will be focused on identified pressures in the acute hospitals and long-term residential care systems.

Home care packages are a relatively new initiative introduced in 2006 and developed in the mean time through phased investment of €120 million in new funding. A package comprises a variety of enhanced community-based services and supports, including cash grants or a significant home help element in many cases to best meet the needs of an older person. Clients may have significant medical, nursing and therapy requirements and may be recently discharged from hospital, or at-risk of admission to hospital, if such needs are not met in a planned way.

The HSE service plan 2009 envisages around 8,700 people benefiting from packages at any one time, or over 11,500 in the course of this year. The Department of Health and Children earlier this year commissioned an independent evaluation into the operation of home care packages. The report was published on 3 December and will help inform future policy and service direction for older people generally.

Home care services are delivered either directly by the HSE or on behalf of the executive in partnership as appropriate with the voluntary sector or through private providers. The position nationally on home help shows that, for example, expected expenditure this year is around €210 million, an increase from 10.8 million home help hours in 2006 to nearly 12 million hours this year and numbers benefiting increasing from just under 49,600 at the end of 2006, to around 54,000 this year.

I understand the HSE management in Donegal met representatives of relevant unions and home support workers earlier this year to discuss various aspects of home support provision in the county. These relate, for example, to standardised assessments, compensatory pay under the national home help agreement and the question of third-party service delivery.

The HSE has indicated that home help hours per recipient in Donegal compares favourably to the rest of the country. The HSE has recently been advised of its budgetary allocation for 2010 and is in the process of preparing its national service plan for next year. As the Senator will be aware, the executive is legally obliged to provide services within its allocation and will shortly be submitting a service plan to the Minister. The question of the future provision of home help services in Donegal can be considered only in the context of the overall HSE service plan.

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

As on 9 July, the Minister of State has given no really relevant information on the question I asked. At that time the Department refused to tell me that it was to cut home help support hours and it has since cut them by 10,476 hours in County Donegal. The Minister of State has failed to say whether there will be cuts.

I can pick up two elements from this. When the service plan is given to the Department, will the Minister forward to me the details on the number of home help support hours for Donegal? I believe the Department will follow the greatest fear I have, which relates to third-party service delivery. This is the privatisation of home help supports and there is no doubt that is on the agenda because it has been confirmed to us by senior members of the HSE in Donegal. I will resist that and fight the Department tooth and nail on it.

There are 800 people in Donegal providing an absolutely fantastic service for many patients in the communities which demand this work. They cannot be treated in the way they have been. The Department has already breached contracts by its actions last year and it is despicable how they have been treated. I ask the Minister of State to review the position and enter into proper dialogue with the unions to ensure we will not see home help workers and the HSE facing off in the coming months.

I will take on board the Senator's comments.

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