Dáil Éireann Debate, Tuesday - 3 October 2023
593. Deputy Mattie McGrath asked the Minister for Health if he plans to extend the fair deal scheme to include the cost of home care and home supports being provided privately due to the lack of home supports being provided to those who require full-time care and attention in the home; and if he will make a statement on the matter. [42269/23]
View answerThe Programme for Government commits to ‘Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high quality, regulated home care’. The Government is committed to establishing a new statutory scheme for the financing and regulation of home support services, which the Department of Health is currently developing. This is not the equivalent of a ‘Fair Deal’ scheme at home but rather a new way of delivering home support that will facilitate effective, efficient, fair and transparent care needs assessment and planning and appropriate service delivery.
Work is ongoing within the Department across four broad areas to progress this commitment: (i) Regulation of home support providers; (ii) the examination of future funding options for home support services; (iii) working with the HSE to develop a reformed model of service delivery for home support; and (iv) Implementation of the recommendations of the Strategic Workforce Advisory Group.:
(i) Regulation of home support providers
The Department of Health is currently developing a regulatory framework for providers of home support services with the aim of ensuring that all service users are provided with high quality care. This will comprise of (i) primary legislation for the licensing of home support providers, (ii) regulations which will set out the minimum requirements that a home support provider must meet to obtain a licence, and (iii) HIQA national standards.
Legislation: The Heads of Bill are currently being drafted by the Department in order to bring the Heads of Bill to Government for approval before the end of the year. The Department is engaging with key stakeholders in relation to the legislation.
Regulations: The draft regulations are at an advanced stage informed by a public consultation, which concluded on 4 August 2022. The analysis of submissions has been carried out by the Institute of Public Health (IPH) which demonstrated strong agreement in relation to regulation of home support service provision. A report on the findings of the public consultation was published in January 2023. Legal advice and engagement with key stakeholders (HIQA, HSE, Private and Voluntary Providers, and service user representative groups) will assist with final revisions to regulations for providers of home support services in 2023.
In addition to this, HIQA have initiated the process of developing standards for home care and home support services.
(ii) The examination of future funding options for home support services
Currently home support services are fully exchequer funded. The Department is examining potential options for a new funding model for home support. The ESRI undertook a programme of work on behalf of the Department on the potential demand for, and cost of, home support which culminated in two reports. The Department is exploring further research and engaging with international experts. As part of this work, the Department commissioned a rapid response from the EU Observatory on Health Systems and Policies which explores the impact of user charges on home care sustainability in Ireland. This report was published in March 2023. This research will form an important part of the evidence base for the development of a sustainable funding model for home support services in the context of our ageing population. No final decision on future funding have been made and further research is currently underway to enhance the evidence base.
(iii) The development of a reformed model of service delivery for home support
In 2022 a Pilot for testing of a reformed model of service for the delivery for homecare became fully operational in 4 Community Healthcare Organisations (CHOs). A draft evaluation of the pilot, produced by the Centre for Effective Services, has been completed.
The rollout of interRAI as the single assessment tool for care needs in the community will assist with equitable resource allocation. InterRAI standardised outputs will be used to determine prioritisation and levels of care required. The HSE have begun recruitment process for 128 interRAI Care Needs Facilitators. The process for the development of a home support IT system is underway in the HSE. This is a significant project which is vital to deliver reform in the sector. The business case has been submitted to the Digital Government Oversight Unit and is currently going through Peer review.
The HSE is undertaking a recruitment process for a number of key posts to support and enable the establishment of a National Home Support Office. Funding is provided for 15 full time jobs including 9 Community Healthcare Organisation home support manager/coordinator posts. Four WTEs have been appointed to date including the head of service, with the remaining posts to be filled as soon as possible. A proposed location in Tullamore for the National Home Support office is being sourced by the HSE.
(iv) Strategic Workforce Advisory Group
Addressing the shortage of care workers in Ireland is an urgent priority for the Government. To this end, the cross departmental Strategic Workforce Advisory Group was established in March 2022 to examine, and formulate recommendations to address, the challenges in frontline carer roles in the home support and long term residential care sectors.
The Group was chaired by the Department of Health and comprised representatives from seven government departments (Children, Equality, Disability, Integration and Youth; Enterprise, Trade and Employment; Health; Higher and Further Education, Research, Innovation and Science; Justice; Public Expenditure and Reform; and Social Protection), the HSE, HIQA and SOLAS.
The Report was published on 15th October 2022. Providing an overview of the work of the Group and its key findings, the report presents a suite of 16 recommendations spanning the areas of areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development and sectoral reform.
Implementation of the 16 recommendations is being overseen by a cross departmental Implementation Group, chaired by the Department of Health. The Department is engaging with recommendation owners to define an implementation plan. A meeting of the group took place on June 29th. The implementation group will meet quarterly and publish progress reports thereafter.
Recommendation 9 has been implemented. The Statutory instrument authorising the issuance of 1,000 employment permits for homecare workers was signed on 16th December 2022. Work is underway on all recommendations, with a further four at an advanced stage.
