Wednesday, 15 May 2019

Questions (9, 15)

Bernard Durkan


9. Deputy Bernard J. Durkan asked the Minister for Health the extent to which home care packages are being made available to patients who might otherwise need hospitalisation; the number to date approved in each of the regions; the extent of the funding given, required or pending; and if he will make a statement on the matter. [20879/19]

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Peadar Tóibín


15. Deputy Peadar Tóibín asked the Minister for Health the overall number of persons waiting for home help services by county; and the average and longest wait. [20920/19]

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Oral answers (6 contributions) (Question to Health)

My question seeks to ascertain the availability of home care packages which are a useful development to provide home care services, thus alleviating the burden on hospitals and accident and emergency departments.

I propose to take Questions Nos. 9 and 15 together.

I am taking these questions on behalf of my colleague, the Minister of State, Deputy Jim Daly, who is at a dementia conference today. Improving access to home support is a priority for the Government. Over the past four years, we have seen a considerable increase of nearly €140 million in the budget, which has grown from €306 million in 2015 to almost €446 million this year. This year the HSE intends to provide 17.9 million home support hours to 53,000 people and intensive home care packages to 235 people.

The Deputy is right to highlight this issue because despite this significant level of increased investment in service provision, demand for home support continues to grow and will only go in one direction as, thankfully, people continue to live longer. The allocation of funding for home supports across the system, though significant, is finite and services must be delivered within the funding available. This is the challenge we need to grapple with. Preliminary data indicate that at the end of March, there were 52,360 people in receipt of home support. 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 were assessed. I will arrange to have the specific information requested by both Deputies forwarded in tabular form.

I acknowledge that in some cases access to the service may take longer than we would like. However, the HSE has assured my Department that those people who are on a waiting list are reviewed, as funding becomes available, to ensure that individual cases continue to be dealt with on a priority basis. If Deputy Durkan comes across cases which he believes have not been assessed in that manner, he should let me know.

We need a new statutory home support scheme. We all talk about wanting to provide care for people in their homes and communities. The only law we have passed is the fair deal, the nursing home support scheme. We need to do a fair deal 2.0, a version of the scheme for home care. My colleague, Deputy Daly, who is leading on that, has just concluded a very substantial public consultation where many thousands of submissions were made. He intends to develop that scheme and the system of regulation to try to improve access on an affordable and sustainable basis because, as our population ages, that is the way we need to deal with this.

Would it be possible to intervene in the usual way in the health services to move this forward? It seems to have stalled or somebody has hit the pause button on the availability of home care packages in all constituencies but particularly in north Kildare where there seems to be a considerable backlog. Will it be possible to energise the system such that we might see an improvement in the numbers on waiting lists for that service?

Absolutely. The Minister of State, Deputy Jim Daly, and I are keeping in very regular contact with the HSE on this issue because apart from the societal impact of not providing home support and the impact on a family, it can have a significant knock-on effect on hospital admissions, the use of hospital beds and delayed discharges, to use a phrase I do not like. The Minister of State continues to monitor this and work with the HSE to ask that it come up with new and innovative ways to do this.

I need to provide some context. In 2015, we were providing a budget of €34.1 million for home care in community health organisation area 1, CHO 1. That is now €44.3 million. In CHO 2, where it was €30.6 million, it is now €47.6 million. In CHO 7, which I think is the Deputy's area, it was €28.7 million and is now €54.5 million, which is nearly a doubling of the budget. We are substantially increasing funding to every CHO every year. Thankfully, our population is ageing and we need to consider a new scheme to supplement this. The work the Minister of State is doing, which is a part of Sláintecare, on a statutory home care scheme will be key to reforming the delivery of this service.

Does the Minister remain satisfied that adequate staffing can be made available throughout the service to ensure its workability, having particular regard to what he correctly identified as hospital and accident and emergency department overcrowding, and thereby alleviate the serious burden on the hospitals and on patients who are concerned about having to wait on seemingly never-ending waiting lists? As one who has repeatedly raised this question on waiting lists, I wonder if we could come to a stage in the not too distant future where we address the waiting lists in advance in order that they become much shorter than they are now.

I have no doubt we could do that. In advance of the introduction of the fair deal scheme, the question of significant delays in accessing nursing home care was a very persistent one in this House, probably tabled by Deputy Durkan, who is known for his parliamentary questions, and by many other Deputies. The fair deal scheme, which was landmark legislation, brought through by the former Minister, Mary Harney, put in place for the first time a statutorily based scheme, a legal entitlement, guidelines, rules and the like. We do not have that for home care. We have an ad hoc system that works well in some parts of the country and not so well in others. Providing more certainty about how something works will help to attract more people to work within that sector too. I am confident that increased investment coupled, crucially, with reform and the introduction of a statutory home care scheme, we can significantly reduce waiting lists for home care and provide people with certainty about the supports they receive.