Nithe i dtosach suíonna - Commencement Matters

Home Care Packages Funding

I welcome the Minister of State at the Department of Health, Deputy Catherine Byrne, to the Chamber. Tá fáilte romhat. I ask Senator Robbie Gallagher to proceed with his Commencement matter and he has four minutes.

Go raibh maith agat, a Chathaoirligh. Ar dtús a Aire Stáit, ba mhaith liom fáilte mhór a chur romhat go dtí an Teach seo inniu.

I welcome the Minister of State to the House. I would like to discuss the crisis in home care and home help in the HSE sector. Elderly people are suffering without home care because the HSE has frozen the provision of home care packages. No new hours have been allocated in the community health organisation or CHO 1 area since February of this year. There has been a complete shutdown. The CHO area includes many rural counties, among them counties Monaghan and Cavan. Almost 300 people await home care packages in Monaghan and Cavan. Some people have been approved for a home care package but they are waiting for one to be provided. Almost 50 people are on what is called a priority list, which means they have a high dependency. They have waited more than a year for a service. In most cases these people are elderly and very vulnerable so are in need of care and support.

This is a national disgrace. There is a crisis in the sector. We are letting down the very people who have given so much to our country and who are now in need of our care and support in their later years. The system is broken, it is not fit for purpose and it needs a root and branch review. As I am sure the Minister of State will agree, most people would like, where possible, to remain in their own homes among their families and communities but the present system does not allow them to do so. Many people go to great lengths to ensure their loved ones remain in their own homes. Most have young families themselves and are working yet they do all they can to ensure their loved ones remain at home but we, as a State, are letting them down. Every cent we spend on home care and home help is money well spent. Many millions of euro are spent throughout the health service but every penny spent on home care and home support for our elderly is one of the best investments we can make as a State. It makes no financial sense whatsoever to fail to do this because the net result will be that our elderly people will end up in nursing homes, or worse still due to a lack of care, in an acute hospital lying on trolleys waiting to be seen by medical staff.

Clearly, I do not use the word "crisis" in an exaggerated fashion because there is a serious problem that needs attention. There are 300 people in Cavan and Monaghan awaiting home care and money is needed for the service to be provided. I call on the Minister of State and the Government to allocate funding to assist and help those people to remain in their own homes where they would like to be.

I thank the Senator for tabling this matter, which I am taking on behalf of my colleague, the Minister of State at the Department of Health, Deputy Daly.

The Government's core objective is to promote care in the community in order that people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible. A wide range of services are provided, including home supports, day care and residential care through direct service provision and voluntary and private providers.

Improving access to home care support is a priority for the Government. Over the past four years, there has been a considerable increase of nearly €140 million in the budget from €306 million in 2015 to almost €446 million in 2019. More than 53,000 people will receive in excess of 18 million home care support hours this year, including intensive home care packages for approximately 235 people. Despite this significant service provision, the demand for home care support continues to increase. The allocation of funding for home supports across the system though significant is finite and services must be delivered within the funding available.

Preliminary data indicate that during the first quarter of the year, 4.2 million hours were delivered nationally, 4,411 new clients commenced the service, and 6,238 people have been assessed and are waiting for either new or additional home care support services.

The Minister of State, Deputy Jim Daly, acknowledges that in some cases access to the service may take longer than we would like. However, the HSE has assured the Department that those on a waiting list are reviewed when funding becomes available. This is to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front-line staff. The local staff know and understand the clients’ needs and undertake regular reviews of those care needs to ensure that the services being provided remain appropriate.

The number of people waiting for funding for home care support services reflects a point in time. While the existing home support service is delivering crucial support to many people throughout the country, it is acknowledged that the service and access to it needs to be improved to better meet the changing needs of our citizens. That is why we intend to establish a statutory scheme for home support services which will improve access to the service on an affordable and sustainable basis while also introducing a system of regulation that will ensure public confidence. I will come back on some of the issues later.

I thank the Minister of State for her response and I appreciate that this is not her area. I am disappointed with the content of the response, however. There is clearly little comfort here for the more than 300 people waiting on home care packages in Monaghan and Cavan, and there is little comfort for their families as well. People are saying to me that we can spend billions building hospitals and we can spend billions on broadband, but when it comes to basic care, namely, looking after our elderly, we are selling them short. I appeal again for additional funding. We are talking about small amounts here and it could take as little as €100 per week to make sure that someone had a basic home care package to remain in their home. When that is compared with €1,000 or €1,200 to stay in a nursing home, or worse still to end up in an acute hospital setting, it does not make economic sense to go down the road we are travelling. I appeal again for Government to allocate more funding to the people who are waiting and suffering while they are waiting on this home care package to be provided.

I thank the Senator again for acknowledging the fact that the Government is in the process of developing a home care package in a different way. There was €140 million added to the overall budget this year, which raised it to €446 million. That is quite a substantial amount of funding but we all know that people are living longer and life expectancy is longer. As we all know, over the coming years there will be an increase in the population over 65 years of age, so we need to work actively together to provide a high-quality and flexible service that not only best meets the needs of individual clients but also reduces pressure on the health system elsewhere. The social care services, including home care, day care and respite, are an important component in enabling people to remain at home, as the Senator has said, and I can adhere to that myself. They also provide valuable support to carers.

We are aiming to improve the home care support service so that people can remain living with confidence, dignity and, above all, in their community with security. While existing services are delivering crucial supports throughout the country, it is recognised that home care supports need to be assured to better meet the changing needs of our citizens. I am conscious of the fact that I was replying to the Senator from a statement that has been given to me, but every day I receive calls about people's home care packages being delayed, or calls even just about home care hours. We will work together to develop the engagement and the details process to deliver a new stand-alone statutory system for the financing and regulation of home care services. This system is a key action under the Sláintecare implementation strategy, along with improving the development supports in the communities.

I will bring the Senator's concerns back to the Minister of State, Deputy Jim Daly. We all know that the best place to keep people is in their communities and homes, and we should be doing everything we can in that regard. There has been a substantial increase in funding, but I have mentioned that we are dealing with an older population and the numbers continue to build and increase for long-term care packages and home care packages.

Road Network

I thank the Minister of State. My issue is that, as the Minister of State is aware, there is a long-standing proposal to build the new Cork to Limerick motorway. It is back on the books and a new contract was signed recently to start the initial process of identifying the route and delivering a motorway between Cork and Limerick, or as people in Limerick would say, the Limerick to Cork route.

One of the problems I am facing on the north side of Cork city is that we have a major problem on both the western and eastern part of the north side of the city in that there is little road infrastructure available to take heavy traffic coming from the Mallow direction. On the eastern side, which is what my Commencement matter is about, there are heavy goods vehicles passing through residential areas in The Glen, Mayfield and down into Silversprings because that traffic is heading towards the Port of Cork. If we build a new Cork to Limerick motorway, it is important that we do not have a bottleneck when it comes to Blackpool. This traffic will still have to travel on to the Port of Cork.

I am seeking that in dealing with this Cork to Limerick road, we would also tie in at least part of the structure at this stage in the process, namely, the north-eastern relief road, which would connect the Cork to Limerick road to the Cork to Dublin road. There were proposals more than 15 years ago for what was called the north ring road, NRR. Unfortunately, on the north side of the city we do not have what is in Dublin, namely, the M50. We have old road infrastructure which is no longer adequate to deal with the traffic coming into the city, especially heavy goods vehicles which are travelling on to the Port of Cork, which is growing every year.

We are building a brand new port facility in Ringaskiddy, construction work is well under way and, therefore, it will be an attractive port for heavy goods to go to because we will be able to bring in bigger ships because the port will have deeper waters for ships to dock in. It is in that context that I am raising this issue and I wonder if the whole issue of the north ring relief road on the north-eastern side of the city can be tied in together with the Cork to Limerick road.

I thank the Senator and I am taking this issue on behalf of the Minister for Transport, Tourism and Sport, Deputy Ross. The Minister has responsibility for overall policy regarding and funding of the national roads programme. Under the Roads Acts 1993 to 2015, the planning, design and construction of individual national roads is a matter for Transport Infrastructure Ireland, TII, in conjunction with the local authorities concerned.

Within the overall context of Project Ireland 2040, the national development plan, NDP, has been developed by Government to underpin the successful implementation of the new national planning framework, NPF. This provides the strategic and financial framework for TII's national roads programme for the period from 2018 to 2027. In the ten years covered by the plan, in excess of €11 billion will be invested in the road network. There are two separate road proposals to alleviate traffic congestion for the north Cork city area. Under the NDP, there is a reference to an NRR, linking the N20 to Dunkettle. The Cork NRR is a scheme complementary to but independent from the M20 Cork to Limerick scheme and the NDP indicated that this scheme could be best assessed as part of the overall transport strategy for Cork. Another option is the provision of a Cork northern distributor road which is being considered under the Cork metropolitan area transport strategy, CMATS.

The NTA is in the process of finalising the CMATS, which will be published in the near future. This strategy will establish the context for the consideration of the Cork NRR and the northern distributor road as part of an overall transport strategy for the metropolitan Cork area, which would include the examination of public transport and demand management options. The Cork northern distributor road will be appraised first and afterwards consideration will be given to the need for the proposed Cork NRR.

The original preferred route for the N40 Cork NRR was established by Cork County Council and Cork City Council circa 2007-08. It is approximately 22 km in length. I refer to the east and west sections. As this will be subject to reappraisal, however, it is too early at this stage to establish whether it can be best delivered and justified as an eastern section or a western section, or both, and the impact the Cork northern distributor road will have on its appraisal.

The CMATS study that is currently under way will set the context under which both the Cork NRR and the northern distributor road are further examined and progressed, if appropriate, subject to the availability of funding. The Cork NRR, if progressed, will be determined in accordance with departmental guidance for scheme appraisal and the the TII project appraisal guidelines for national roads, including a route options assessment and business case. It is very technical.

I hope I am around to enjoy all these improvements in Cork.

I thank the Minister of State for her contribution. It concerns the one area where road infrastructure needs to be built. The reason I suggest the eastern section should be done first is the western section is complicated because of the landscape. If there is a decision to work on all parts of the north ring road together, one will keep hearing the project is expensive and that the funding does not exist. If, however, one approaches it the way I propose, at least there will not be a bottleneck in Blackpool owing to traffic heading for a port. This is the priority. It is in this context I am raising the matter. I acknowledge it is under the remit of the Minister for Transport, Tourism and Sport, not that of the Minister of State, Deputy Catherine Byrne.

As I stated, the response was complicated. Since I am not familiar with the locations in Cork that the Senator has spoken about, I have taken some notes. I will ask the Minister for Transport, Tourism and Sport to revert to the Senator. I will explain to him that the Senator has recommended that the eastern section be one of the first parts to be prioritised. That is all the information I have.

I am sure the Senator will be in the other House before too long and will be able to make progress on this.

I will pursue it with the Minister.