I welcome the Minister for Health, Deputy Varadkar, to the House. The Minister is dealing with the second and third motions. May I ask Senator Quinn if he will agree to allow Senator Moran to go first?
Adjournment Matters
Disability Support Services Provision
I appreciate that Senator Quinn has given way and I thank him for doing so. I welcome the Minister for Health, Deputy Varadkar, to the House.
I wish to raise on the Adjournment a matter that I first raised more than a year ago. Unfortunately, in that time, nothing has changed. I wish to raise the case of a young girl with an intellectual disability who is in urgent need of residential care. I have spoken to those in the HSE and St. John of God in Drumcar, where the girl attends day services. Unfortunately St. John of God has a no-admissions policy now and the HSE has insufficient funding to provide a residential placement. I have tried everything to move this case forward and have met the officials on the many occasions.
This young girl has an intellectual disability, but she also has extremely challenging behaviour and her parents cannot cope with the situation. I have been to their house and I know the young lady in question. The situation is at crisis point. I am raising this case today but I am also relating it to the more general issue, because I know that in my area of Louth there are up to 30 people on the waiting list for residential placement with the HSE, and I am led to believe the list for places in St. John of God is even greater. This is a major problem and it will become a crisis as the years go by and as elderly parents are trying to cope with their loved ones and find places for them. I am asking for this case to be progressed. I know that since my last meeting with St. John of God it has been agreed that this girl will receive respite hours. Everybody recognises the urgency of this case, which is at crisis point.
Let me restate that we are at a major crisis point. I am asking the Minister not to give me a stock answer again. I acknowledge that additional respite care has been offered, but to me it is like putting a plaster on a very deep wound. It will solve the situation only in the medium term. In the long term we need an admissions policy or extra funding or whatever it takes. I am raising the case of one individual, but there are three crises in County Louth and 30 people on the waiting list. How many more are there throughout the country? These are vulnerable people and their families are the most vulnerable families. They have so much to deal with.
I thank Senator Moran for raising this issue. I am taking this debate on behalf of the Minister of State, Deputy Kathleen Lynch, who is unavoidably absent as she is attending a conference today.
The named individual is a service user of St. John of God Services, Drumcar, County Louth, and it is from this organisation that she has received all her services to date. I am informed that she lives with her parents and attends day services five days a week. Drumcar Services is a section-38-funded organisation that provides services for clients with severe and profound intellectual disabilities. Louth disability services are aware of the current issues pertaining to this family due to the advancing age of the parents, who are finding caring for their daughter very challenging. Her name remains on Louth disability services' waiting list for funding, which is monitored vigilantly.
The vision for the HSE's disability services programme is to contribute to the realisation of a society in which people with disabilities are supported as far as possible in participating to their full potential in economic and social life and have access to a range of high-quality personal social supports and services to enhance their quality of life. The HSE national service plan for 2014 and the 2014 operational plan for the social care division outline the quantum of specialist disability services, the key reform initiatives and the additional investment in 2014. The HSE will spend €1.4 billion and employ a staff level of approximately 15,000 whole-time equivalents in 2014 to provide specified levels of service. An additional investment of €14 million in 2014 also has been made to address deficits in disability services, implement a reform programme to transform services to a community-based model of person-centred supports, and focus on the implementation of the Health Information and Quality Authority standards for residential services for people with a disability. These developments and reform proposals will be carried out in an environment of effective communications and engagement with all those involved in services, including people with a disability, through the HSE's National Consultative Forum. The emerging residential need in the absence of residential development funding over the past number of years is a major challenge for all services providing support to clients with a disability. The issue of funding for residential services will be considered in the context of the Estimates and service planning process for 2015, which will occur in October and November.
In the meantime, I am told that a plan is in place to support this person in attending her day placement at St. Mary's, Drumcar, and ongoing regular respite has been arranged for her.
Unfortunately, as I said, I am aware that respite has been arranged, from meeting with the officers of St. John of God and asking them for additional respite care.
We have raised the issue of putting services in place. I know that €1.4 billion is being put into the HSE for services, but that is no good to a family who are struggling to cope with the person at home. I know that this lady has been sent home from Drumcar because the staff could not cope. That is not helping anybody. I ask the Minister to intervene because residential placement has to be provided urgently for this person.
I appreciate that this very severe case is genuine, and I acknowledge that the Senator has raised the matter and taken up this cause. This is a disability matter. I will mention this debate to the Minister of State, Deputy Lynch, and inform her of the exchange.
I wish to be straight up about this. I do not think it should be the role of the Minister for Health or the Minister of State at the Department of Health to intervene in individual cases. Inevitably, when services are constrained and there are waiting lists, for a Minister to intervene on behalf of an individual means displacing somebody else. It means skipping a waiting list or it means using political influence to benefit one individual at the expense of another.
I am not asking for that at all. I am not asking for anybody to do that. I am asking that funding be provided for residential placements for those people who are in urgent need of them.
The Senator has made the case.
I raised it a year ago and nothing has changed.
I appreciate that clarification, because there are Deputies and Senators who ask me to intervene in such cases.
I am not asking for that, and I agree totally with the Minister.
The Senator has made the case.
I need to clarify that as well.
That is fine. I fully accept the clarification. What it means is that this is a matter for the Estimates process and the service plan. As the Senator is aware, the HSE is running over budget under almost all headings. The Minister of State, Deputy Kathleen Lynch, and I are working very hard to secure a realistic budget for next year so that in the 21 days after the budget we can develop a service plan which will result in improved services across the board.
Particularly in crisis places.
There are many crisis places.
Nursing Homes Support Scheme Applications
I welcome the Minister. I look forward to his reply, as he is under orders to be positive, to provide solutions, and not to talk about problems. I am sure my query will be dealt with.
I wish to speak about the Fair Deal scheme - not how it operates, but its current funding. The Minister could probably give some of the same answer that he gave to the previous speaker. The scheme is a positive and effective one, which I discussed on many occasions with a previous Minister and Tánaiste, Mary Harney. I am concerned that we see the Fair Deal scheme as the only way of dealing with the accommodation needs of the elderly community. I hope, as the Minister plans ahead, that home care packages, home help services and carer's allowance - although that is within the remit of another Department - will receive significant focus. I noted in passing an interesting piece of legislation, perhaps not yet debated in the other House, tabled by Deputy Willie O'Dea of Fianna Fáil. He suggested that where a person is deemed eligible for the Fair Deal scheme, the cost of the scheme be made available for private care or home care arrangements. We need to be much more flexible in regard to care of the elderly.
It has come to my attention from a few individual constituency cases, about which I have made inquiries of HSE staff, that since mid-summer or thereabouts a number of applicants have been approved as eligible for the Fair Deal scheme from a medical and income point of view, but the sanctioning of these applicants has slowed down by as much as 60%. People who were advised in mid-summer that they would probably have to wait six or seven weeks for the final sanction have found that the waiting period has more than doubled, but I appreciate that this is a funding issue. In one case, I put much pressure on a family, at the behest of a hospital, to have the person taken home from the hospital on the advice that the Fair Deal scheme would apply after five or six weeks, but now it could take ten, 12 or 15 weeks. I know it is a funding problem, but the Minister may be in a position to comment. It appears the situation has deteriorated since mid-summer. There was a blip in February and March and the situation improved, but since late June or early July delays have increased significantly.
Perhaps the Minister would give an overview of his future approach to care of the elderly. While I want to see the Fair Deal scheme supported, encouraged and properly funded, there must be solutions other than nursing homes. I have said here often that if our only aspiration for the elderly is a clean nursing home bed, that is inadequate. Care in the community, care in the home, family support, carer's allowance, home help and so on should play a much more significant role. The taxpayer would benefit because it is less expensive. The older person would benefit as he or she would be with family, friends or neighbours. Perhaps the Minister will work on this issue and comment on the current funding difficulty for the Fair Deal scheme.
I thank the Senator for raising the issue. I am taking this Adjournment matter on behalf of the Minister of State, Deputy Kathleen Lynch, who has responsibility for older people and who is speaking at a health-related conference.
The nursing homes support scheme is a system of financial support for individuals who require long-term nursing home care. Anyone who is ordinarily resident in the State and who may need nursing home care, regardless of age, can apply for the scheme. The total budget for long-term residential care in 2014 is €939 million. It should be pointed out that a number of people covered by the funding arrangements which preceded the scheme are also covered by this.
The HSE operates a national placement list to enable it to operate within the budget allocated for the nursing homes support scheme. All applicants who are approved for funding are put on the placement list in chronological order by the date of determination of their application. Funding issues to applicants in this chronological order to ensure equity nationally. The current waiting time on the placement list is 15 weeks, with 2,007 people on the list awaiting release of funding. The HSE makes every effort to match available funding to demand by releasing funding on a weekly basis. In the first seven months of 2014, 3,553 new clients were funded under the scheme. The length of time an applicant remains on the placement list depends on the number of new applicants awaiting approval for the scheme at any given time and the number of applicants currently receiving payment under the scheme. Therefore, the duration of time on the placement list can fluctuate.
The provision of services must be managed within available resources. The scheme is continuing to take on new clients within the limits of the resources available, in accordance with the legislation. The resources that are available will be applied to provide the best possible mix of supports and services in a way that most effectively matches the needs and preferences of older people themselves. There is a particular focus on enabling people to live as independently as possible. For this reason, €23 million was transferred from the nursing homes support scheme to provide additional community services, with a view to allowing more older people to be supported in their own homes and communities for longer, which is in line with the expressed wishes of older people.
The Senator will be aware that the nursing homes support scheme is currently the subject of a review. The review will consider the long-term sustainability of the scheme as well as looking at the current operation and management of the scheme. Work on the review is advanced and is expected to be completed in the coming months. The report will then be made publicly available.
I thank the Minister for his comprehensive reply. He mentioned that the HSE makes every effort to match available funding to demand by releasing funding on a weekly basis. That is fair enough, but I am advised that up to seven weeks ago, on a Monday or a Tuesday, the funding released each week from the central office would cover a five-day period and, obviously, a set number of applicants, whereas now that funding covers applicants only for two and a half days. That is the reason the delays have more than doubled. I am advised that sanctions for funding have decreased by 60%. It is fair to say that money is being released weekly, but a significantly reduced number of applicants are sanctioned each week. I ask the Minister to bring this to attention of the Minister of State, Deputy Kathleen Lynch. I look forward to the review and I appreciate the funding crisis. I appeal to the Minister to try to make progress but also to ensure that the broader spectrum of care for the elderly, services and future methods of dealing with the elderly are considered also.
I cannot confirm the detail of what the Senator has said, but the basic point he makes is correct. The scheme's funding is constrained, as it was cut this year. As a result, the waiting time has slipped from about four weeks, which most people found to be reasonably acceptable, to 15 or 16 weeks, which people find unacceptable. They are right to find it unacceptable. As things stand, that will get worse as the year goes on. The effect is that older people cannot be transferred from hospital to nursing homes, where they would be much safer and less likely to acquire infections. Thus, there is a problem of delayed discharges in hospitals. There are almost 700 delayed discharges today. If those beds were freed up, we would be able to deal much better with accident and emergency overcrowding and elective waiting lists. That is the present situation and there is no point in denying it.
The Senator's second point is a valid one. I have some experience of the health service in England, where home care and community care are much more advanced. It is easier, therefore, to keep people in their homes for longer and to get people out of hospital because they know that the public health nurse and the home care services will click in on a Saturday or Sunday, or a Friday evening if the need arises.
Ireland has underdeveloped social care services. As a consequence, we have people going into nursing homes sooner in their lives than they might want to. That is the major structural thing that needs to be changed over the next couple of years in Ireland. The more immediate problem is one of funding.
Seanad Elections
The Minister of State is welcome to the House, particularly in respect of this problem. My attention was drawn to this matter by Mr. Robbie Sinnott, who is in the Visitors Gallery. He is visually impaired.
The Taoiseach has declared his intention to respond to the referendum on the abolition of the Seanad by introducing minimal reform of the university seats prior to the next election. Graduates of third level institutions will be entitled to vote for six Senators if the planned Seanad electoral (university members) (amendment) Bill is enacted prior to the next election. However, graduates who suffer from impaired vision are only able to vote by asking someone else to vote for them, as the Constitution decrees that elections for these Seanad seats must be by postal vote. Therefore, a blind person must disclose his or her intention to a third party and rely on the third party to vote as requested. This is contrary to Article 18.5° of the Constitution, which guarantees a secret ballot. How can the dilemma be solved? The answer can be found in modern technology. The Constitution declares that the Seanad election must be a postal ballot, but that could include e-mail. I understand that most graduates, even those who are visually impaired, are capable of using e-mail, and I urge the Minister of State to explore this solution.
Some 53,000 people have extreme visual impairment in Ireland. I do not know how many third-level graduates are included in that figure, but the proposed Seanad electoral (university members) (amendment) Bill could be an early first step towards a solution to a challenge that will face the State in later years if we are to be a society that treats all the citizens equally. I urge the Government to consider the problems that this entails.
I thank the Senator for raising this issue. I am replying on behalf of my colleague, the Minister for the Environment, Community and Local Government, Deputy Kelly. A fundamental principle of our electoral system is voting by secret ballot. This is enshrined in the Constitution for Dáil, Seanad and presidential elections. For local and European elections and for referendums, the provisions on secrecy are set out in primary legislation.
Arrangements for the holding of elections and for registered voters to cast their ballots are all built on this principle. The electoral Acts make special provision for certain voters and, over the years, improvements have been introduced aimed at making the voting process as accessible and inclusive as possible. These include provision for voting at an alternative polling station if a person's local polling station is inaccessible. Voters who cannot go to their polling station due to a physical disability or physical illness may avail of postal voting or the special voting arrangements provided in hospitals and nursing homes. The placing of photographs and political party emblems on ballot papers and the display of a large-print copy of the ballot paper in polling stations are aimed at assisting visually impaired voters in particular.
Special provision is made for voters whose sight is so impaired that they are unable to vote without assistance at a polling station. Such voters may vote with the assistance of a companion or the presiding officer, as they choose. While this arrangement meets the needs of many voters, it may not meet the needs of all, and the Department of the Environment, Community and Local Government is committed to improving these arrangements. Our commitment to enhance access to voting by persons who are blind is stated in the national disability strategy.
In June of this year, officials of the Department of the Environment, Community and Local Government participated in a National Disability Authority trial of a range of options for voting by visually impaired persons. These included the use of tactile voting templates. The report on the trial is awaited from the authority.
That is an outline of the position generally. Seanad elections are somewhat different in that voting does not take place in polling stations. Article 18.5° of the Constitution provides that the election of Members of Seanad Éireann shall be by secret postal ballot. Senator Quinn, having been elected by the graduates of the National University of Ireland on many occasions, is no doubt well versed in the electoral procedures that operate for the constituency. I am a member of that constituency. At an election, each registered graduate is sent, by registered post, an envelope containing voting documentation, including a ballot paper and a declaration of identity form. These arrangements apply to all voters in the NUI constituency.
Members of the House will be aware that in February 2014 the general scheme of the Seanad electoral (university members) (amendment) Bill was published for consultation. There was a very useful debate in this House on its proposed provisions in March. The general scheme is part of the legislative process to implement the 1979 constitutional amendment to extend the Seanad franchise to graduates of institutions of higher education in the State that heretofore did not form part of the Seanad university constituencies.
As part of the consultation process on the general scheme, a number of submissions were received - 22 in total. One was about voting arrangements for visually impaired persons. It recommended that consideration be given to allowing all those on the register for the university constituencies the option of voting by e-mail. It is an interesting idea. However, fundamental issues arise concerning whether e-mail would meet the constitutional requirement of conducting Seanad elections by secret postal ballot. Notwithstanding this point, the technical feasibility of introducing such a system would have to be a consideration. Our experience with electronic voting in Ireland was a not particularly good one.
Another idea proposed in the submission was to allow voters with a visual impairment the option of using a cardboard or plastic template which would be placed over the ballot paper. This template would be in a format readable by a person with a visual impairment. The National Disability Authority trials of these templates were already mentioned. The Department of the Environment, Community and Local Government looks forward to receiving the findings of this research and will give them due consideration. The Minister is open to ideas that can improve upon the arrangements currently in place for voters with a visual impairment. The Department must be mindful that any proposed reforms have to be consistent with existing constitutional provisions and must be capable of being deployed usefully in practice.
I appreciate the reply. This is a challenge, and the question is whether the Government can meet the challenge. I am delighted to hear that there is research going on and I am delighted to hear some steps are being taken. The first thing that must be done is to recognise the real difficulty there is for people who are blind and who cannot have a secret ballot without having somebody else vote for them. We are capable of solving that problem. The Minister of State has touched on one of two ways in which we can move in that direction. We do not have much time, on the assumption that the Seanad electoral (university members) (amendment) Bill will come before the House some time soon. I hope the Government will see that it is possible to do something to ensure that the large number of people - although a small number of graduates - who are visually impaired have this problem solved. These people have to take part in a postal vote at home and must ask someone else to open the envelope, tell them they want to vote for A, B and C and then not know whether it has happened. These people need to have a solution and I am delighted to hear the Government is working on it. I urge the Minister of State to move as fast and as securely as he can in order to make sure this improvement takes place.
I will ensure the sentiments expressed will be conveyed. I will convey them personally to the Minister for the Environment, Community and Local Government on behalf of Senator Quinn.
The Seanad adjourned at 2.40 p.m. until 2.30 p.m on Tuesday, 30 September 2014.