Health Services

I welcome the Minister of State, Deputy Áine Brady. After much hard work and effort by the local senior citizen committee and my colleagues the Minister, Deputy Brendan Smith, Deputy Rory O'Hanlon, and local councillor, Mr. Michael McCarey, the health centre in Cootehill was opened in 2002 by the then Minister of State at the Department of Health, Mr. Tom Moffatt. In November 2006 the Darley day care centre opened its doors. This centre provides excellent care for 125 elderly people from within an eight mile radius of Cootehill town and for areas such as Latton in County Monaghan, Bunoe, Kill, Drung, Tullyvin, Knockbride, Maudabawn and Shercock in County Cavan.

Last Monday night, with Oireachtas colleagues and local councillors, I attended a public meeting at which more than 250 users of the service and their families were also present. Concern was voiced regarding a proposal by the HSE to change the way the services were delivered in the Cootehill centre and throughout Counties Cavan and Monaghan.

The company which provides the management of the Darley centre has been given notice by the HSE that its contract will end on 1 September. This has caused unnecessary concern and anxiety to the elderly people who have benefited so much from the very positive experience they have gained from their weekly attendance at the Darley centre.

I understand the HSE is considering the possibility of renting premises with a view to extending the provision of primary care in Cootehill. I very much welcome this proposal which would see the people of Cootehill and surrounding areas availing of occupational therapists, speech therapists and physiotherapists. I also welcome the fact that administrative staff would also be based in these premises in Cootehill. However, it is not necessary to move the Darley day-care centre from its purpose built facilities. It is not necessary to fragment the service its users are provided with on a weekly basis. One cannot fragment a service without affecting it.

I pay tribute to the hard working voluntary committee in Cootehill which provides much needed services to the people in the area. I also pay tribute to the local councillors, namely Councillors Michael McCarey, Sean Igoe and Don Smith, who work with the people and deal with their concerns. I assure the people of Cootehill and surrounding areas that I, with my colleague, the Minister, Deputy Brendan Smith, and other Oireachtas colleagues, will do everything in our power to ensure services are maintained in the premises in Cootehill from which they are run. We will also pursue the expansion of primary care services in Cootehill.

The overriding policy of the Government is to support older people to live with dignity and independence in their own homes and communities for as long as possible. Where this is not an option for whatever reason, the HSE supports access to quality long-term residential care, as appropriate. In accordance with this approach, a priority of the Government in recent years has been to develop a range of community-based supports such as home help and home care packages, as well as day or respite care. Between 2006 and 2010 additional investment of over €200 million was provided for the HSE to develop such community supports for older people. Without these initiatives, many older people would experience inappropriate admission to acute hospitals or be admitted to residential care earlier than might be required. The HSE service plan for 2010, approved by the Minister for Health and Children in February, commits the HSE to providing agreed levels of service nationally in these key community support areas. The plan includes day or respite care which is often available through various day care facilities or as part of a home care package. Such services can be delivered either directly by the HSE or in partnership with local voluntary or private providers.

Broadly, the level of community supports for older people in 2010 is in line with the 2009 provision. This includes an increase in the number of home care packages available owing to additional funding of €10 million given in the last budget for this purpose. The key activity targets contained in this year's HSE service plan are: almost 12 million home help hours in respect of around 54,500 people; increased home care package provision from 8,700 recipients at any one time in 2009 to 9,600 in 2010; and a total of 21,300 day care places which it is estimated will cater for up to 80,000 people. While this target is slightly down from a comparable figure of 21,600 places in the service plan last year, the respite or day care levels agreed will be generally compensated for in 2010 within the overall home care supports component of the plan. It should be noted that any changes to these national target commitments, as part of the agreed HSE service plan for this year, would have to be notified to the Department.

Other important initiatives are also being taken at a strategic level to improve community based services for older people. Arising from an evaluation of home care packages published by the Department in December 2009, the HSE is progressing various improvements in home care provision. The Department accepts the need for a more standardised approach to home care generally, whether by way of public or private provision. This year the HSE intends to finalise standardised access and operational guidelines for the delivery of home care packages; adopt a voluntary code of quality guidelines for home care support services for older people; progress a procurement framework for home care services; and introduce procedural guidelines for the home help service to standardise access to and allocation of home help hours.

As the Senator is aware, the HSE has operational responsibility for the delivery of health and social services nationally. He will appreciate that all developments relating to older people, including day care services at individual centres such as the centre in Cootehill, have to be addressed in the light of the current economic and budgetary pressures. The HSE 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 HSE recognises the challenges ahead in meeting the increased volume and complexity of need within our ageing population, while also attempting to address the demand for integrated, co-ordinated and appropriate services based on the principle of maintaining older people at home for as long as possible. From this perspective, in the Cavan and Monaghan area it is considering options to provide additional services in Cootehill for the benefit of people in the town and surrounding areas.

The local health manager established a strategic planning group for services for older people in Cavan and Monaghan in March to examine, amongst other matters, the manner in which day care services for older people are being delivered across all of Cavan and Monaghan. As a result, there may be changes in the method of service provision. There are possibilities with regard to the future provision of these services, each of which is being explored and negotiated. In the case of day care services for older people, it is the aim of the HSE that older people requiring this service will access it as close to their own home as possible and within their own community.

Day care services are provided at the Darley Health Centre for older people from Cootehill town and the surrounding community. The majority of older people attend weekly or biweekly on a rotational basis. I understand many users of the day care service in Cootehill also access other local day care services and that there is capacity to increase this option. An information session was held on 25 May led by the general manager and key HSE personnel to inform the current service provider and the voluntary organisations representing the local views of older people of the proposed review of day care services. A decision has been taken that existing users will continue to be provided with the same frequency of day care services, whether at the Darley Health Centre or a different facility. It was emphasised that this should not mean a reduction of services for any person attending day care services in the Darley Health Centre.

Every effort will be made by the HSE locally to best meet the needs of each individual. The timeline for bringing the new and changed day care service into operation is the end of the first quarter of 2011. The HSE will continue to work with local services and people from Cootehill in developing new services. It is a matter for the HSE to manage this service, bearing in mind all relevant factors such as overall resources, local circumstances and evolving service priorities.

Part of the problem is that Ministers of State read replies they have been given by the HSE. In reply to a query from my colleague, Deputy Conlon, the HSE stated there would be no change to the services being provided at the Darley Health Centre. The Minister of State said, "A decision has been taken that existing users will continue to be provided with the same frequency of day care services, whether at the Darley Health Centre or a different facility." One cannot provide the same quality of service if the older people who attend the Darley Health Centre have to travel to outlying areas. That is the reality. If one fragments a service, it will be affected.

Part of the problem with the HSE in Cavan, Monaghan and throughout the Twenty-six Counties is that different views are taken. It should state exactly what the proposal is and address the concerns of the 125 vulnerable elderly people who attend the Darley Health Centre in Cootehill on a weekly basis and are suffering unnecessary anxiety. They are being provided with an excellent service. The service providers have been told that from 1 September their services will no longer be required. That leaves them in limbo. Frankly, that is not good enough. The communication between the HSE and the Darley Health Centre is not good enough. The HSE needs to communicate with the centre. The reality is that if the HSE starts to meddle with it, it will affect the services provided for older people. In answer to Deputy Conlon, it stated there would be no change to the services provided, but the reality is that there will be a change, based on the reply the Minister of State has given. I, therefore, ask the HSE to reconsider its decision. As I said, while I welcome the expansion of services in Cootehill, the service provided at the day care centre should be left as is.

I will be delighted to meet the Senator later when I have received further information.