Dáil Éireann Debate, Thursday - 7 March 2024
365. Deputy Colm Burke asked the Minister for Health to confirm what steps are being taken to ensure that home and community care services are responsive to the evolving healthcare needs of the aging population and the high waiting lists in Ireland; and if he will make a statement on the matter. [11302/24]
View answer374. Deputy Colm Burke asked the Minister for Health what action his Department is taking to address recruitment and retention challenges within the home and community care workforce to ensure a consistent and qualified staff; and if due consideration would be given to increasing the wages of homecare supporters in order to increase the number of individuals in this position; and if he will make a statement on the matter. [11312/24]
View answerOn 3 October 2023 the Government approved the proposal put forward by the Minister for Health and I for the establishment of a 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. In addition, 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. The Commission will be comprised of independent experts and will be supported by a secretariat from the Department of Health. The Commission will be comprised of independent experts and will be supported by a secretariat from the Department of Health.
The Commission will be an independent commission, the members of which were appointed by Minister Donnelly and I. On 14 December 2023 we announced the appointment of Professor Alan Barrett, Chief Executive of the Economic and Social Research Institute, as Chairperson of the Commission. On 29 February 2024 we announced the appointment of the remaining members. The Commission is due to be formally established in the coming weeks.
The Enhanced Community Care Programme aims to increase levels of healthcare provision in the community setting, thereby reorienting the focus of care delivery away from the acute hospital system, towards general practice, primary care, and community based services. The focus is on implementing an end to end care pathway that cares for people at home and over time prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so and enable a “home first” approach.
The work that has been undertaken by the Integrated Care Programme for Older People (ICPOP) over recent years, has shown that improved outcomes can and are being achieved particularly for older people who are frail, through a model of care that allows the specialist multidisciplinary team engage and interact with services at a local level, in their diagnosis and ongoing care.
This model is now being implemented at scale, with the rollout of Community Specialist Teams (CST) for Older People (ICPOP) to support local services and GPs to respond to the specialist needs of older people, bridging and linking the care pathways between acute and community services to improve access to and egress from acute hospital services.
These CSTs service a population on average of 150,000 and are being co-located together in ‘hubs’ located in or adjacent to Primary Care Centres reflecting a shift in focus away from the acute hospital towards general practice and a primary care and community based service model. The services are fully aligned with the acute system with clinical governance being provided though the relevant model 4 or 3 hospitals, but with the services being delivered in the community setting.
For the first 8 months of 2023 (latest data available), of the total patient contacts of the ICPOP Community Specialist Teams (CSTs), the following outcomes were achieved:
• 71% were discharged home,
• 6% were admitted to acute hospital,
• 4% were admitted to long term care,
• 13% of people (target is 10%) were reviewed on same day / next day of referral, reflecting timely review by the team of more urgent cases, and
• 64% of people (target 55%) assessed by the CSTs have a Clinical Frailty Score (CFS) of 5-9, representing more severe frailty, demonstrating that progress is being made in prioritising complex and more frail patients and therefore supporting community based intervention and avoiding admission to the acute setting.
This demonstrates that the ICPOP teams are seeing complex and more frail patients urgently, and that most of such cases are discharged home as opposed to having to go to an acute hospital.
Improving access to home support is a priority for the Government. Since Budget 2021 my Department has provided approximately €230 million in additional funding. Preliminary data indicates that over 22 million hours of home support were provided in 2023, exceeding the HSE’s target, and over 55,000 people were in receipt of home support at the end of 2023. The HSE is expected to meet its targets again in 2024. In addition, the minimum proportion of new home support hours ringfenced for people with dementia will increase from 5% in 2021 to 18% in 2024.
An estimated 5,863 people were assessed and waiting on care at the end of 2023. Of these, an estimated 3,067 people on the waiting list were waiting to commence a new service and an estimated 2,796 people were waiting on additional service. The waiting list is predominantly due to the shortage of care workers to deliver services. Addressing this shortage is a priority for Government.
In March 2022, I established the cross departmental Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants. It set out to examine the challenges in front line carer roles in the home support and long term residential care sectors. The report was published on 15 October 2022 with 16 recommendations. Implementation of the recommendations is being overseen by a cross departmental Implementation Group, chaired by the Department of Health. Progress delivered includes securing an improved rate for home support which delivers on commitments for sectoral reform such as payment for travel time, paying carers the National Living Wage at a minimum, and bringing legacy rates in line with the new revised rates of funding.
The implementation group met for the third time on 1 February 2024 and a progress update will be published shortly. The most recent progress report was published in October 2023 which can be viewed below: www.gov.ie/en/publication/66dd1-strategic-workforce-advisory-group-on-home-carers-and-nursing-home-healthcare-assistants/.
