Seanad Éireann debate -
Thursday, 29 Nov 2012

Vol. 219 No. 3

Adjournment Matters

Home Help Service Provision

Senator Denis O'Donovan

I am sure the Minister of State seeks no great introduction to this motion but while I do not often use tough language, inside or outside this Chamber, what has happened in respect of home help is nothing short of being scurrilous and is attacking people at the very coalface. On the one hand, Government policy suggests and advocates that in so far as possible, one should keep people at home rather than putting them into hospitals, homes or institutions, while, on the other, the cutbacks that now have occurred are affecting in a very tough way the old, the vulnerable, the sick and the lonely. This is true in particular in HSE South, as according to the information I have, the impact appears to vary in different parts of Ireland. In many such instances, people's home help, sometimes available for two or three hours per week, has sustained them in their own homes. The home help calls in and might get such people up and out, get them washed, get them breakfast or whatever else.

More than 30 people contacted me to express their deep concern that the cuts to their home help provision would compel them to eventually end up in nursing homes. The Minister of State is aware that the cost of keeping people in a nursing home or public hospital is very significant in comparison with keeping them in their own homes in their own environment. In this context, the few euro spent every week on home helps is a very small amount in comparison with what would be the cost to the State otherwise. As for the cutbacks, I attended a meeting at which one home help, who obviously would not go public, stated she had five half-hours with five different people in the west Cork area. Incidentally, it is another disgrace that home helps are not allowed to open their mouths for fear that they could lose their jobs, such is the contract into which they have entered with the HSE. The aforementioned person observed that the logistics of this allocation mean that as soon has she given someone a ring and perhaps boiled the kettle to make a cup of tea for the unfortunate elderly person, the half hour is up and she then is rushing from A to B to C. It is a ridiculous situation and some of the people I have met, who provide the home help, have never complained in the past. Their hours have been cut and obviously they are trying to make a living out of it, as it is a career for some of them.

One must have a certain amount of compassion and training to become a home help and in this regard, the cutbacks are having an impact in the first instance on those for whom they are caring. These cuts make no sense when one considers the logistics and it is a case of being penny wise and pound foolish. In many instances, eventually, the elderly people who are dependent on the three, four or five hours per week - or whatever they are given - of home help, will be obliged, because of the lack of those few hours, to end up in homes. In some cases, this will cost the State a lot more than what currently is being paid to the home helps. I believe the situation is grave and these cutbacks should be rolled back. Given all the issues that can happen in the forthcoming budget, I note some Departments such as those responsible for social welfare and education and so on are being protected.

We are protecting some Departments, such as the Departments of Social Protection and Education and Skills. I am sure every decent person in government or elsewhere believes that protecting our old and vulnerable should be at the core but I do not believe that is happening. I am also very concerned that the cuts in some areas are far deeper and more severe. Last week in the other House, Deputy Denis Naughten said he got an answer under a freedom of information request stating that cuts in HSE south were the worst of all. In other words, the people in Cork county and city and in Kerry, who are complaining, have reason to do so because they have been targeted. The knife has entered more deeply into their system and the cuts have been far more severe than elsewhere. The Minister of State may have some good news for me. This is a very serious situation which needs to be addressed urgently.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

The Senator knows me long enough to know I would share his sentiments in regard to people who receive home help. They are not all elderly, although the majority are, but most definitely they are in need of assistance to support them in the community. I am afraid we will not know if there is good or bad news until after the budget which is still under negotiation.

The Government's policy firmly remains to support older people to live at home and in their communities for as long as possible. This is realised by the Health Service Executive through a range of community-based services such as mainstream home help, enhanced home care packages or by other supports such as meals-on-wheels, respite care or day care. These services, often delivered in partnership with non-statutory agencies, are designed to be as flexible as possible to best meet the needs of individual recipients and their families. Overall, approximately 100,000 people - 20% of those over 65 years of age - receive some form of HSE community-based supports each year, whether home care, day care, respite, etc.

On the immediate front, this has been a challenging year for the health services overall, including maintaining home care services in line with evolving resource pressures. The overall provision of these services is, therefore, regularly reviewed at national and local levels in the context of assessed client need against resource availability.

The HSE has a statutory responsibility to live within its budget voted by the Oireachtas. In this context, the HSE developed a range of proposals to reduce spending between now and the end of the year. In my opinion, that was way too short a framework and that is why the difficulty arose. It is a priority for the HSE to minimise the impact on clients of any spending reductions in the home help area. The HSE service plan target for this year was to deliver 10.7 million home help hours. The measures now being implemented envisage that almost 10.3 million home help hours will be provided this year to more than 50,000 people. Again, I think it was the timeline that caused the most difficulty.

The HSE is making every effort to ensure that services are provided in the first instance for direct patient care. Decisions in regard to the provision of home help hours will continue to be based on an assessment of individual needs and no current recipient of home help, who has an assessed need for this, will be without a service. That message has gone out very loud and clear from the Minister for Health in the past few weeks.

The focus now is on identifying those who are most dependent and require personal care services and maintain these clients by, if necessary, reducing the lesser dependent household duties such as shopping, cleaning, etc., even though I know it is these things which sometimes maintain people at home. The current review will also identify those whose health or circumstances have improved and whose hours can be reduced in order to facilitate new applicants or those requiring increased care. Home help hours are, therefore, recycled back into the system on a regular basis. The action originally planned by the HSE was to save approximately €8 million by reducing home help hours between now and the end of December - approximately 400,000 hours - and to save approximately €1.2 million by reducing home care packages.

The latest information available indicates that in trying to balance overall projected financial savings for the home help budget nationally, against maintaining adequate service in individual cases, the HSE will probably not meet the savings target envisaged. The position is being kept under review by the HSE and the Department of Health to ensure that the objective of reducing overall expenditure does not compromise maintaining assessed service to existing recipients. The HSE and the Department of Health are monitoring activity and financial trends in regard to home help on a weekly basis. Whatever action is deemed necessary between now and year end will be undertaken to balance the objectives I have outlined.

Senator Denis O'Donovan

The Minister of State's response does not tally with the reports I am getting, some of which are first hand. It is very mean of any Government - in the past, I criticised my own party in government on many issues - to try to save money from the home help service because it provides value for money. As the Minister of State knows, in many instances, the only contact some people have with the outside world is the home help who comes in for one or two hours. Citizens deserve that service and instead of cutting back in this area, money should be found somewhere else.

Today or yesterday a Government Senator made a very valid point that there have been cutbacks in front-line services, including an embargo on the recruitment of nurses, but apparently the number of administrative staff in the HSE has hardly been touched. The HSE is top heavy with administrative staff but there have been cuts to the number of nurses at the coalface, where we need them most, and home helps.

Will the Minister of State bring back the message to the Minister, Deputy James Reilly, that what is happening on the ground is appalling, that there should be no cut backs in home help hours and that in the context of the few million euro he is saving, he is being penny wise but pound foolish because many people will end up in respite care but will not return home as there will be nobody to care for them. It will cost the State 20 times what it is costing to keep people at home.

Deputy Kathleen Lynch

There is no disagreement between us. I could not disagree with anything the Senator said. Bringing the HSE budget back into line in such a narrow space of time was the difficulty. I fully agree it is the small things people receive that maintain them in the community. I have been making those arguments. I hope I will be successful but there is never a guarantee when it comes to budget time, especially when one considers the country is broke.

We have certain obligations under the programme we are in and the big difficulty is the lack of flexibility and the position in which we find ourselves. It is about trying to bring the country back on track after horrendous events. Unfortunately, the people who need our help most sometimes suffer. I will make all those arguments.

Obesity Levels

Senator Deirdre Clune

The issue of people who are overweight and obese is one we need to keep to the fore. Yesterday a report by Professor Ivan Perry of UCC was reported in the media. A study found the fact that people are obese or overweight is costing the country €1.1 billion every year. As that cost is based on scientific evidence, we should take it very seriously, and that is not to mention the effect on the health of these individuals and their demeanour. I am sure their mental health suffers in many cases also.

It is estimated in the report that two thirds of the cost is as a result of absenteeism and lost productivity due to back pain and the remainder is as a result cost of health care, be it GP, drug costs, physiotherapy and everything else that goes with being overweight and having certain conditions such as heart disease, colorectal and other types of cancer, type 2 diabetes and stroke. We must be clear about how we will tackle this issue. We must target children and young people to ensure these problems are not carried by them into adulthood. The Growing Up in Ireland report on Ireland's 13 year olds was published today and it found a quarter of those surveyed are overweight or obese. It also found almost 40% of girls were trying to lose weight.

As obesity has a huge impact on children, we must tackle it now in order that it does not become an even greater problem later in life. We must encourage good habits in terms of eating and exercise. Young people who are overweight are also at risk of developing asthma and diabetes.

We are doing a lot in schools about exercise and while it is unfair to target schools all the time, the children are in a learning environment there and it is where they form the habit of exercising with their peers. The environment in schools, however, with tuck shops and vending machines filled with crisps, sweets and sugary drinks, was mentioned in the report. We should consider banning the sale of junk food in schools. Children are in school to learn and making such foods available is not conducive to developing healthy eating or the habit of exercise.

We must also talk about labelling in supermarkets. Tesco and Lidl are considering this but in Britain, all supermarkets are introducing the traffic light system of labelling, whereby a red traffic light means a food should be avoided, amber means it should be eaten in moderation and green means it can be freely consumed. That would assist people to make healthy choices for their eating and shopping habits.

There are many other areas where action can be taken. The Restaurants Association of Ireland is putting calorific values on menus, although some restaurants are resistant to the idea, which I understand because anyone who has attended a cookery course with Darina Allen knows that she considers full fat butter and full fat cream as essential for flavour. We must be aware, however, of the effect of such ingredients on health and the development of habits that young people will continue in adulthood.

In the United States, the First Lady, Michelle Obama, is playing a strong role in tackling obesity. As a Government, we should be developing policies that keep this issue to the fore to ensure the message gets through and we develop a healthier population.

Deputy Kathleen Lynch

I was at a conference on older people recently where I heard that a study in Sweden has outlined that poor nutrition will kill more and cost more than obesity. Eating the wrong types of food will have a more detrimental effect. We sometimes forget that. Equally, the Growing Up in Ireland study told us about far more than just the issue of obesity. It also told us our 13 year olds were happy and we must look at this. There is always a contradiction between our children being healthy and active and being careful that they do not obsess about body image, which brings with it even more complications and difficulties. It is not as straightforward as we sometimes think. We must be balanced and careful.

The Minister for Health received the report The Cost of Overweight and Obesity on the Island of Ireland, funded by safefood Ireland and conducted by UCC. This study provides reliable figures for the annual economic cost of weight related ill health in Ireland. Initial findings estimate the annual cost to be €1.13 billion. The direct health care costs are €398 million, or 35% of total costs. In addition to this, two thirds of the economic costs were indirect costs in reduced or lost productivity and absenteeism, and these amounted to €728 million. These figures show a compelling case for obesity prevention based on changes in our food environment and physical activity levels. Obesity is the major health problem in Ireland, with studies showing that two out of every three adults, one in four primary school children and one in five teenagers are overweight or obese. Of particular concern is that in children as young as three years of age, one in four are overweight or obese.

Since entering office, the Minister for Health has made overweight and obesity a public health priority and has established a special action group on obesity. The group comprises key stakeholders and is chaired by the Department of Health. The Department recognises that no single initiative will reverse this growing trend but a combination of measures should make a difference. Currently, the special action group is concentrating on measures such as calorie posting in restaurants. The Minister has met food outlets and held a national consultation, and a tool to support food outlets in working out the calorie content of meals is being developed and a tax on sugar-sweetened drinks has been introduced. The group has carried out a health impact assessment and presented to the Minister a proposal based on the evidence for consideration. Action has been taken on the marketing of food and drinks to children and the group is working with the Broadcasting Authority of Ireland on new codes to restrict marketing of high fat, high salt and high sugar foods and drinks until 7 p.m. There has been action on the supply of healthy food products in vending machines. On the detection and treatment of obesity, three specialist obesity treatment centres have been established. The group is promoting the healthy eating and physical activity guidelines that were published this year and considering a physical activity plan.

The group is taking a cross-sectoral approach to help halt the rise in overweight and obesity. Of major importance is the new health and well-being framework for Ireland which will be launched as part of Ireland's Presidency of the European Union. This is an overarching strategic framework for sustained action to improve the health and well-being of the nation and will have as its key goals an increase in the number of Irish people who are healthy at all stages of life, the reduction of health inequalities, the protection of the public from threats to health and well-being, and the creation of an environment where every sector of society can play its part. This new framework will further prioritise the importance of preventing overweight and obesity in the Irish population, particularly in children. I thank the Senator for raising the matter.

Senator Deirdre Clune

I thank the Minister of State for that comprehensive reply. As she pointed out, the Minister is working on this issue. I accept the point that this is about striking a balance and certainly agree that we should avoid concentrating on body image and focus instead on the health and well-being of individuals, especially the long-term consequences of carrying weight. We must tackle this issue for people's benefit, as well as saving the State money.

Deputy Kathleen Lynch

It always strikes me as obscene the fact that one of the biggest killers in the developed world will be obesity and one of the biggest killers in the underdeveloped world will be lack of food and clean water.

We have been obsessed with food. Alan Shortt once said that when he watched television at night, after putting down the remote control, he felt like licking his fingers because there were so many food programmes on television. The media has a part to play in our obsession with food and the eating habits of the nation.