Dáil Éireann Debate, Thursday - 18 January 2024
61. Deputy Marian Harkin asked the Minister for Health his views on the poor performance by the Government on the delivery of commitments and progress for family carers as outlined in the family carer scorecard 2023 published by an organisation (details supplied); and if he will make a statement on the matter. [1701/24]
View answerThe Government recognises the essential role that family carers play in the provision of care in Ireland. Every day, family carers through their selfless hard work, knowledge and compassion enhance the quality of life of the most vulnerable in our society. As highlighted by the Family Carers Ireland Scorecard 2023, responsibility for improving the situation for family carers is overseen by a number of different Government Departments. The Government acknowledges that there is still more work to be done and that it should be noted that many commitments are to be delivered over the lifetime of the Government. Nevertheless, much work related to the Programme for Government commitments has already been accomplished or commenced, as set out below.
Department of Health
Carers’ Guarantee
In the area of health, for which I am directly responsible, annually recurring funding of €2 million was provided in Budget 2021 under the National Carers’ Strategy to improve equity of access to supports for carers across the country. This funding is an important step towards delivering on the Programme for Government commitment to develop a Carers’ Guarantee, providing a more standard package of supports to family carers in every region, in tandem with the community and voluntary sector. €1.9 million of this funding is being channelled through Family Carers Ireland for the delivery of a broad range of supports to carers, while the remaining €100,000 is supporting the development and delivery of online supports through Care Alliance Ireland.
National Carers’ Strategy
Government policy on family carers is set out in the 2012 National Carers' Strategy which provides the strategic direction for future policies, services and supports provided by Government departments and agencies for carers. The Strategy is designed around a core vision which recognises and respects carers as key care partners who are supported to maintain their own health and well-being, care with confidence and participate as fully as possible in economic and social life. Oversight of the Strategy is led by my Department, with individual Government Departments leading on action areas that fall within their remit.
Extension of GP Visit Cards to carers in receipt of the Carer’s Support Grant
Since September 2018, individuals in receipt of either a full or half-rate Carer's Allowance or Carer's Benefit are automatically eligible for a GP visit card. On foot of this measure, as of December 2023, 7,098 people in receipt of either full or half-rate Carer's Allowance or Carer's Benefit have gained GP Visit Card eligibility. It is also noted that many carers may have already held a medical card or GP visit card prior to this policy change.
A range of other measures have also been introduced in recent years to expand access to GP Care including the automatic awarding of a GP visit card to all people over 70 in 2015 and as provided for in Budget 2023, eligibility for GP visit cards was extended to people who earn up to the median household income (€46,000 or less). Over 400,000 additional people, who otherwise would have attended their GP on a private basis, are expected to become eligible for free GP care under this expansion. It is envisaged that these measures will be supported by a significant package of additional capacity supports to GP practices.
It is likely that many of those currently in receipt of the Carer Support Grant will be among those positively affected by this expansion, although an estimate of the exact number is not currently available.
Commission on Care for Older Persons
On 3rd October 2023 the Government approved my proposal, in collaboration with the Minister of State for Older People, to establish an independent Commission on Care for Older Persons. The Commission will examine the provision of health and social care services and supports for older persons and make recommendations to the Government for their strategic development. Subsequently, a cross-departmental group will be established under the auspices of the Commission to consider whether the supports for positive ageing across the life course are fit-for-purpose and to develop a costed implementation plan for options to optimise these supports. €1.243 million was secured in Budget 2024 to support the work of the Commission, which is due to formally commence early this year.
Statutory Home Support Scheme
My Department is currently developing a regulatory framework for home-support providers with the aim of ensuring that all service-users are provided with high-quality care. This will comprise of primary legislation for the licensing of home support providers, regulations for home support which will set out the minimum requirements that a provider must meet to obtain a licence, and Health Information and Quality Authority national standards. The Heads of Bill are currently being drafted by my Department with a view to bringing the Heads of Bill to Government for approval early this year.
Mental Health Services
The National Treatment Purchase Fund (NTPF) works with public hospitals, to offer and provide funding for treatment to clinically suitable long waiting patients who are on an acute hospital inpatient/day case waiting list for surgery, having been referred on to such a list following clinical assessment by a consultant/specialist at an outpatient clinic. As psychological services are not inpatient/day case or outpatient waiting lists within an Acute hospital setting, they do not meet current NTPF criteria.
The total allocation for mental health services in 2024 is approximately €1.3 billion, which is the fourth year in a row in which the mental health budget has been increased. This significant investment will enable continued policy implementation and service improvement in line with our national mental health policy, Sharing the Vision. This year’s budget allocation builds on the investment this Government has made over the last number of years to deliver the policy priorities of Sharing the Vision through the provision of mental health supports across a broad continuum from mental health promotion, prevention and early intervention, to acute and specialist mental health service delivery. This will enhance the delivery of vital services to as many people as possible over 2024.
As part of the funding allocated to mental health services, new development funding has been secured to advance initiatives on youth mental health, and around priority groups identified within the national suicide prevention strategy Connecting for Life. This new development funding will be focused on increased CAMHS staffing, a new Youth Mental Health app, a referral pilot for children's community services including CAMHS (piloting an approach to service referrals known as ‘No Wrong Door’), the expansion of Suicide Bereavement Liaison Services, and expanding the Traveller Counselling Service. A priority for the HSE under its annual Service Plans is to improve access to the HSE Child Care Psychology service, and to the specialist CAMHS service, and to reduce waiting lists for both.
Department of Children, Equality, Disability, Integration and Youth
Disability Services
Budget 2024 saw further increases to funding for specialist disability services with a total of €2.8bn committed for next year across a range of service areas including residential, respite, children’s services, adult day services, personal assistance and home support. The precise level of delivery of services for people with disabilities, based on the funding provided in the Budget, will be set out in the HSE’s National Service Plan for 2024.
The Disability Action Plan 2024–2026, was published in December 2023. This plan supports the implementation of the Disability Capacity Review, in accordance with the Programme for Government commitment. The Action Plan sets targets for addressing demographic pressures, making significant progress on unmet needs, working to replace remaining congregated and institutional residential care with community-based models, and continuing the reform towards individualised, person-centred models of service while growing service capacity appropriately.
Residential Services
Demand for full-time residential placements within designated centres is extremely high. The HSE profiles those actively seeking specialist disability services, including residential services, using a profiling tool, the Disability Services Management Application Tool (DSMAT) which it has developed.
DSMAT is a support to the CHO areas in their decision-making processes, representing an indicator of need. This means that services are allocated on the basis of greatest presenting need and associated risk factors, noting that needs can change.
Residential services make up the largest part of the Specialist Disability Services funding disbursed by the HSE – approximately 58% of the total budget. Approximately 90 service providers provide residential services to over 8,000 individuals throughout the country. The HSE advise that, as of September 2023 there were 8,355 residential places for people with a disability, delivered predominantly by section 38 and section 39 organisations funded under the Health Act 2004.
In accordance with the National Service Plan 2023, the HSE received funding to provide a range of residential supports including:
• 43 additional residential places in response to current need (at end of September 2023, 103 new emergency residential places were developed).
• Support 18 delayed transfers of care in line with the Winter Plan (at end of September 2023, 27 people received new residential places with 3 further receiving home care packages).
• Provide 23 residential care packages to young people ageing out of Tusla services in line with the Joint Protocol (at end of September 2023, 25 packages were developed).
This reflects the Government commitment to augmenting disability services, with an overall increase in recent years from €1.7bn at the close of 2017 to close to €2.8bn in 2024. In residential services for adults and children, €20.5m in extra funding has been provided.
Respite Services
Successive Budgets have provided additional funding for respite services. €5m funding was provided in Budget 2021 for the development of nine additional centre-based respite services, along with a range of alternative respite projects including Saturday clubs, breakaway schemes, and summer schemes. In 2022, €9m was provided to further build the capacity of respite services for children and adults, as well as providing alternative models of respite.
In accordance with the National Service Plan 2023, the HSE:
• Established five additional respite services and increased one service from part time to full time opening to provide 7,872 additional nights to 278 people in a full year.
• Provided 27 additional in-home respite packages to children and young adults in a full year.
• Provided 265 day-only respite packages to 180 people in a full year.
Budget 2024 provided for an additional €15m in New Development funding for Respite. The HSE National Service Plan for 2024 will set out how this money will be spent in order to provide additional respite both as day sessions and overnight stays.
Day Services
HSE-funded day programmes for people with disabilities support over 20,000 people and include a range of centre-based and community-based activities. Substantial progress has been made over the past decade in supporting people to participate in mainstream activities and in the life of their community under the New Directions policy. Since 2015, a process to attend to the needs of young people leaving school and rehabilitative training programmes has been implemented, now known as ‘the school leaver process’. The Government has provided €18.2m in new development funding for school leavers in 2024.
Assessment of Need
The Government recognises the challenges around the Assessment of Need (AON) and acknowledges that there is more work to be done to address these challenges, particularly on waiting lists and the impact that high AON demand has on service provision. To address these issues, an allocation of funding in Budget 2023 and Budget 2024 was provided to facilitate CHOs to procure diagnostic ASD assessments through the private sector. The total amount involved was approximately €16m. Private providers are currently contracted by the HSE and Lead Agencies to provide assessments. The Roadmap for Services launched in October will be examining the matter of AON from a wider perspective than what has happened to date, with the future development of solutions to the challenges of AON taking account of all stakeholder input, including that of families.
Department of Social Protection
Enhanced State Pension Provision for Family Carers
The Government agreed to enhanced State Pension provision for people who have been caring for incapacitated dependents for over 20 years. It will do this by attributing the equivalent of paid contributions to long-term carers to cover gaps in their contribution record. This is the first time in the history of the State that such a scheme will be in place.
These contributions will be treated the same as paid contributions for State Pension (Contributory) entitlement only and can be used to satisfy the minimum 520 contributions condition. The Long-Term Carer's Contributions (LTCC) will be available to those who provided full time care for 20 years (1040 weeks) or more to an incapacitated dependent. The periods of caregiving do not need to be consecutive.
In September 2023, the Department of Social Protection introduced a system to allow carers to register their caring periods. This will facilitate the expeditious processing of LTCC upon enactment of the legislation. Individuals can apply for the long terms carers contributions at MyWelfare.ie
The legislation required to introduce the LTCC is contained in the Social Welfare (Miscellaneous) Bill 2023 and is currently in the Oireachtas, with the scheme being fully implemented from January 2024.
Income Supports
The Carer’s Allowance is the main scheme by which the Department of Social Protection provides income support to carers in the community. Carer’s Allowance is a support for carers on low incomes who live with and look after people who need full-time care and attention. In 2023 the expenditure on the Carer’s Allowance scheme is estimated to be over €1 billion. At the end of November 2023 there were 95,598 recipients of Carer’s Allowance.
The conditions attached to payment of Carer’s Allowance are consistent with the overall conditions that apply to social assistance payments generally. This system of social assistance supports provides payments based on an income need with the means test playing the critical role in determining whether or not an income need arises as a consequence of a particular contingency, be that illness, disability, unemployment or caring. The application of a means-test not only ensures that the recipient has an income need but also that scarce resources are targeted to those with the greatest need.
Over the last number of Budgets, the Government has introduced many increases and once-off payments to support carers. Significant improvements to capital and income disregards for carers were also made over the last few years. Since June 2022, cumulative increases to the Carer’s Allowance income disregards of €117.50 for a single carer and €235.00 for a carer who is part of couple. These are the highest income disregards in the social welfare system.
It is important to note that there are a range of other supports for carers provided by the Department of Social Protection which are not based on a means assessment, such as the Carer’s Support Grant, Carer’s Benefit and Domiciliary Care Allowance.
Department of Rural and Community Development
Seniors Alert Scheme
The Department of Rural and community Development is responsible for the Seniors Alert Scheme (SAS) which encourages community support for vulnerable older people in our communities through the provision of personal monitored alarms to enable them to live securely in their homes with confidence, independence and peace of mind. Funding is available under the scheme towards the purchase by a registered community-based organisation of a personal alarm or pendant.
The current version of the scheme came into effect in September 2021 and along with the provision of free monitoring for the first year and a revision of the living alone requirements, introduced a new key feature in the additional option of a digital alarm, for use with web-based connections.
The SAS is a demand–led scheme, and at the moment, everybody that has applied to the scheme, and who meets the eligibility criteria, has been approved. Since 2016, and as of November 30 last year, almost 122,000 participants have been approved for the Scheme nationally.
Initial discussions have taken place between officials from my Department and the Department of Rural and Community Development to consider the potential role of the SAS as part of the increased use of assistive technologies aimed at supporting people to continue to live independently within their communities.
In addition, a national publicity campaign will be launched shortly, to further raise awareness around the scheme and encourage families and individuals to avail of this potentially lifesaving equipment. While the campaign will have a national reach, it will have a particular focus on the regions with current low take up and will be availing of the most recent census data in this regard.
Department of Education
Appropriate School Places
Over the last number of years, the Department of Education and the National Council for Special Education (NCSE) have introduced a number of strategic initiatives to plan for and provide sufficient special class and special school places. These initiatives are bearing fruit with almost 1,300 new special classes sanctioned and seven new special schools established over the last four years.
The Department of Education engages intensely with the NCSE in relation to the forward planning of new special classes and additional special school places. This forward planning work is well underway ahead of the 2024/25 school year. As a result of this forward planning, in 2023, the Department of Education announced the establishment of two special schools for the 2023/24 school year, with further capacity being expanded in 11 other special schools. In December 2023 a further four special school were announced for the 2024/25 school year. Along with the two new special schools, 386 new special classes – 252 at primary and 134 at post-primary level – have been sanctioned by the NCSE to open in the 2023/24 school year.
Department of Finance
Home Carer Tax Credit
Significant progress has been made to increase the Home Carer Tax Credit (HCTC) over the last two Budgets to support stay-at-home parents and those with caring responsibilities. In Budget 2023 the HCTC was increased by €100 from €1,600 to €1,700 per annum, which equated to a 6.3 per cent increase and benefitted approximately 67,000 households, primarily married one-earner couples with children. Likewise, in Budget 2024 the HCTC was increased by a further €100 from €1,700 to €1,800, per annum, which represented a 5.9 per cent increase and is estimated to benefit around 80,500 households.
Department of Housing, Local Government and Heritage
Housing Adaptation Grant Scheme
Funding for the Housing Adaptation Grants for older people and people with a disability has been increasing year on year since 2014. The 2024 Exchequer provision is €74.5 million or €93.125 million when accounting for the 20% local authority contribution. This is an Exchequer increase of €8 million in 2024 and will facilitate the payment of over 13,000 grants.
Since the launch of the scheme in November 2007, significantly increased levels of activity continue to be experienced by local authorities with over 150,000 grants being paid to older people and disabled people. This has facilitated those applicants to remain in their own homes and communities, and in many cases preventing premature entry to residential care.
Ensure appropriate mix of housing, including universally designed units and accommodation for older people/disabled people
The Department of Housing, Local Government and Heritage jointly published the National Housing Strategy for Disabled People 2022-2027 with my Department and the Department of Children, Equality, Disability, Integration and Youth in January 2022 and jointly published the National Housing Strategy for Disabled People 2022 – 2027 Implementation Plan on 22 June 2023.
The Strategy and Implementation Plan will operate under the framework of Housing for All-A New Plan for Ireland, published in September 2021, which provides a new housing plan for Ireland to 2030 with the overall objective that every citizen in the State should have access to good quality homes through a steady supply of housing in the right locations, with economic, social and environmental sustainability built into the system. The strategy sets out, over four pathways, a broad suite of measures to achieve its policy objectives together with a financial commitment of in excess of €4 billion per annum. The Plan is committed to ensuring that affordable, quality housing with an appropriate mix of housing design types provided within social housing, including universally designed units, is available to everyone in Irish society, including disabled people.
The Building Regulations - Part M (Access and Use) already underpins the principle of Universal Design. In addition, the Design Manual for Quality Housing provides practical information on delivering quality housing for sustainable communities which includes how the principles of universal design may be economically incorporated into dwellings. The design approach to social housing seeks to eliminate barriers to accessibility for all users – particularly disabled and older people.
The Design Manual is intended to guide local authorities and Approved Housing Bodies, and their consultants, on the design of social housing including the internal layouts of individual social homes. The manual includes guidance on the approach to ‘Housing for People with Disability’ and specific design approaches developed with the input of the Centre for Excellence in Universal Design in the National Disability Authority.
