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Seanad Éireann debate -
Tuesday, 25 May 2010

Vol. 203 No. 1

Home Help Services

Cuirim fáilte roimh an Aire agus gabhaim buíochas leis an gCathaoirleach as cead a thabhairt dom an rún seo a chur os comhair an Tí.

The issue of carers and the future development and evolution of the national carers strategy is important. As the Minister knows, there was a 4.1% cut in social welfare which had a profound impact on carers. Carers suffered a cut of €8.80 per week which amounted to approximately €470 per annum. Carers do a lot of work on behalf of the State which is not recognised. We all buy into the idea that more people should be cared for in the family home in their family surroundings. That applies to the elderly, sick and disabled.

The national carers strategy was published to much fanfare and with many promises. Given the economic realities we face, some of it had to be put on hold. One of the final acts of the National Economic and Social Forum was the publication of its home care study which made the very interesting point that there was no uniformity in the packages available. They were dependent upon the county or area in which one was living. If we are serious about the protection of our elderly, Senator Bradford's call on the Order of Business for a constitutional referendum to protect our elders is not a bad idea. I support him in that regard and made that comment before. I am sure the Minister who is a visionary would have a similar view.

I am concerned about a number of issues. The Minister flew a kite regarding pensions a couple of weeks ago. People had concerns before last night's "Prime Time Investigates" programme which were augmented by it and "The Frontline" programme about putting time limits on carers regarding the person for whom they are caring. I do not know how one can put a time limit on showering, drying and dressing an 80 year old person or a person who is disabled.

The issue of the half-rate carer's allowance is one which needs to be addressed. Many carers in receipt of it are concerned. Young carers are also an issue. In Cork, Maria Maher was the national young carer of the year. The HSE, through the National University of Ireland, Galway, published a report some weeks ago which showed that children as young as seven or eight years of age were caring for people. That cannot be sustained.

I hope the home care packages for home helps and carers will be augmented and supported. However, cuts are taking place, despite the fact that the Government and the HSE have stated the number of home help hours is up on the figure for last year. Whether we like it, the provision is inadequate. I hope we will look on this issue as being needs driven, rather than as one that is purely about resources. I understand resources are finite, but if we are really serious about caring for and cherishing all of the people, our elders must be protected and the level of support provided for them enhanced, as illustrated by last night's television programmes.

There is a difficulty with the provision of respite care and emergency cover for those who need it. In the past week I have spoken to families which cannot access respite care or emergency beds. The HSE has a different view on the question of need. I hope, therefore, the Government will give a commitment to carers and home helps. I hope also that the Minister will row back from flying the flag in cutting the old age pension and that resources will be enhanced in the forthcoming budget, with the level of support available for those who need it most being further enhanced.

Carers and home helps save the State a lot of money. If we are serious about protecting all of the people, including our elders, I am sure the Minister's reply will be positive.

I thank the Senator for raising this matter. Ba mhaith liom buíochas a ghabháil leis an Seanadóir as ucht na ceiste seo a ardú inniu. Mar a deir sé, baineann an cheist seo go príomha leis an HSE, ach baineann sí le mo Roinn freisin.

In the last budget we protected the half-rate carer's allowance which I believe was only introduced in 2007. Before last year's budget the carers' groups had very much prioritised this issue. We also made no change to the rate of payment to carers over 66 years, but like all working age payments, carer's allowance for those under 66 years was cut. I got the very strong impression from the carers' groups I met before the last budget that their main concern was to protect the half-rate carer's allowance.

The Senator said I flew the flag when it came to pensioners. I did not. I was asked a question which pre-empted decisions to be made by the Cabinet in the budget. Anybody who tries to wriggle out of me before the budget what the Cabinet might do on any subject will not receive an answer because it is not a matter for me to give one. As the Senator is aware, the Cabinet makes decisions collectively. Somebody tried to wriggle out of me an answer on what the Cabinet might do next November and then spun the story that I would cut the old age pension. That was being pre-emptive and against all proper processes in government. I was very disappointed when people interpreted my reluctance to answer the question as being tantamount to a decision. Equally, it could have been said I had not ruled out a massive rise in the old age pension. I said I could not in a piecemeal way pre-empt what Cabinet would do next November in the budget. Unfortunately, that will have to remain my policy on all these issues. Irrespective of what questions I am asked about the budget, I will not give answers until decisions are made. Therefore, nobody should read anything more into any non-committal answers I give on the budget. If the Senator were to ask if I could confirm whether there would be would a €100 rise, I would say I could not rule anything in or out; therefore, one could say I had not ruled out a €100 rise. It might be a little unrealistic, but the principle is that one cannot pre-empt Cabinet decisions on budgetary issues.

I am concerned that some older people have been given the impression that the Government has made a decision to cut pensions. It has made no decisions and I regret any upset caused to older people. That is the last thing I would want to do and I am sure the Senator would not want to do so either.

The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not possible, the Health Service Executive supports access to quality long-term residential care where this is appropriate. Notwithstanding the significant overall economic pressures facing the country, the Government has continued to prioritise services for older people, as reflected in the additional funding of €10 million provided in the last budget to expand home care packages nationally. These packages often contain a significant home help component at individual recipient level.

The HSE national service plan 2010, approved by the Minister for Health and Children earlier this year, commits the executive to providing the same level of service for home help as in 2009 — almost 12 million home help hours for approximately 54,500 people, an increase of more than 5,000 home care packages for 9,600 people and a total of 21,300 day care places which we estimate cater for up to 80,000 people. Between 2006 and 2010 there was an additional investment of more than €200 million to enable the HSE to develop community based services for older people.

Other important initiatives are also being undertaken at a strategic level. Arising from an evaluation of home care packages, published by the Department of Health and Children in December last, the HSE established a task group to progress this year various improvements in home care provision. The Department accepts the need for a more standardised approach to the regulation of home care generally, whether by public or private provision. This year the HSE intends to finalise and circulate standardised access and operational guidelines for the delivery of home care packages; adopt and disseminate a voluntary code of quality guidelines for home care support services for older people; and develop and publish a procurement framework for home care services. The Department is also considering the overall regulation of the community sector in the light of the recommendations made in the report of the Commission on Patient Safety and the report of the Law Reform Commission on the legal aspects of carers.

The Senator will appreciate that all developments in the area of home care must be addressed in the light of the current economic and budgetary pressures. The Health Service Executive has been asked to make a rigorous examination of how existing funding might be reconfigured or reallocated to ensure maximum service provision is achieved. This requires a stringent ongoing review of the application of the resources available. The Health Service Executive has operational responsibility for the delivery of health and social services. It is, therefore, incumbent on it to review, as appropriate, the home help service at local, regional and national level in the context of changing circumstances and overall service priorities.

The reconfiguration and reallocation of funding for services are causing most distress to our elders, in particular, as well as to those in receipt of home care packages. A great deal of stress is being caused by bureaucracy in the making of cuts. I welcome the Minister's remarks about the old age pension. However, it was his choice of words that caused the furore. He said he could not give a commitment in regard to a €100 increase. Can I take it that he is ruling out a cut in the old age pension?

I said one could not rule anything in or out because it was not possible for a Minister to give an indication one way or the other about any element of the budget. Therefore, nothing should be read into my remark that I would not disclose in May things that had not happened. How could I do so? No matter what question I am asked, the same answer will be given. Decisions on budgetary issues will be taken by the Cabinet.

Does the Minister believe his remarks are inflammatory and frightening people?

That is not relevant to the matter in hand.

People are choosing to interpret the reluctance of a Minister to break an absolute constitutional obligation not to pre-empt the collective decisions of his Cabinet colleagues in such a way that they are saying it indicates something that it does not indicate. I regret that the matter is being spun in that way. Anybody who has ever asked me a question about matters that have not yet been decided by the Cabinet has received the same answer, namely, that I will not comment on them. Every member of every Government since the foundation of the State has adhered to the practice of not pre-empting Cabinet decisions. One cannot comment on issues because in addressing them it leads to conclusions on the part of others. That is not how matters work.

Would the Minister support cuts?

We make collective decisions. As I have often had to explain to people who do not understand the Cabinet system, although I would have expected a Senator to understand it——

I understand it all right.

——we are constitutionally bound to act as a collective. Collective decisions can only be made when we sit down together to form a collective view. In that sense, there is no view on any of these issues. That is the constitutional obligation on a Minister and it has nothing to do with what I think. I acknowledge that the Senator respects the constitutional position in that regard.

The Seanad adjourned at 5.10 p.m. until 10.30 a.m. on Wednesday, 26 May 2010.
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