The first Topical Issue is in the name of Deputy Martin Ferris.
Topical Issue Debate
I was contacted by the Minister of State at the Department of Agriculture, Food and the Marine, Deputy Tom Hayes, this afternoon. He is unable to be present and asked me to defer the matter to next Tuesday when he can be present.
Thank you. We will proceed to the second Topical Issue.
Respite Care Services Availability
I thank the Minister, Deputy Varadkar, for attending. The lack of respite care is an important issue. I am raising the matter on behalf of carers throughout Dublin and in other parts of the country who are currently having difficulty gaining access to respite care beds for their loved ones.
The HSE has advised that the north Dublin city area has not had a respite bed available for persons under the age of 65 since the start of January 2015. As a result of this bed shortage, carers are not getting the one or two week break they need. As the Minister knows, they provide an invaluable service not only for their loved ones, but also for the State, as they are doing work that saves the State billions of euro each year. Many family carers provide full-time care, 24 hours a day and seven days a week. Their loved one is dependent on them but, unfortunately, the carers have no legal entitlement to days off or any type of break from this very demanding job. Respite care is essential for these carers and for the thousands of people throughout the country who provide temporary care and relief for those who provide caring duties.
Respite care also helps to reduce pressure on other areas of the health service such as acute hospitals, and this problem is having an effect on Beaumont Hospital in my constituency, as the Minister is aware. In addition, primary care centres must be rolled out to deal with the overcrowding in hospitals. What is the Minister doing about the unacceptable waiting lists that currently exist for carers waiting to have a loved one get respite care? Can he comment on the shortage of respite care beds? What action is he taking to increase the supply? Will he also comment on the average waiting time for those waiting for care?
I thank the Minister for attending for this Topical Issue. Like Deputy Flanagan, I have encountered a significant amount of distress among carers not only in my constituency, but throughout the greater south Dublin area. Everybody knows the value we attach to respite care. It is very important for carers that they have an opportunity to break from routine. It is also very important for their dependants, particularly in the case of children with intellectual disabilities and so forth, to have the opportunity to express their independence and to go to a different environment.
I have met with a group of parents who live in the south Dublin area, all of whom care for adult children with intellectual disabilities. In 2012 and 2013 they were in receipt of 20 days respite per year. That figure has now reduced to 12 nights respite per year. In some instances carers do not receive any respite at all. It appears to be quite random and ad hoc, and is causing a large amount of distress. There are also instances where respite care has been arranged and agreed. Due to the changes in staffing the notice period is now much longer than it was previously, so the respite care might be arranged weeks if not months in advance. However, due to emergency residential care requests, the respite care might be cancelled at short notice or at the last minute, even on the afternoon or evening it was due to begin. That makes it difficult for families to plan and for carers to provide the type of care that is required by their dependants.
I thank Deputies Flanagan and Creighton for raising this issue. I am replying on behalf of the Minister of State, Deputy Kathleen Lynch.
A key objective of the Government's health policy is to support people to live in dignity and independence in their own homes and communities for as long as possible. Carers are vital to the achievement of this objective and are considered the backbone of care provision in Ireland. A break from caring can lessen the psychological and emotional stress they experience and can help carers to continue to provide the support that they give.
Respite services for adults and children with disabilities are provided in a variety of settings, depending on the needs of the family and available resources. In 2015, some 5,274 people with a disability are expected to avail of residential centre based respite services, utilising 190,003 bed nights. In addition, between 2,000 and 2,500 persons avail of non-centre based respite services such as holiday residential placement, occasional respite with a host family, overnight respite in the home, and summer camps. The provision of residential respite services for people with a disability has come under increased pressure in the past couple of years. Any available development funding has focused mostly on the provision of day places for pupils graduating from school, rehabilitative training programmes or emergency residential placements. The need for increased respite facilities is acknowledged and the HSE continues to work with agencies to explore various ways of responding to their needs.
For older people's services, respite may be provided via an enhanced home care package for the period of respite or in public or private nursing home beds.
Respite beds may also be contracted by the HSE in private nursing homes. There are about 1,860 short-stay public beds, including "step up-step down" care, rehab and respite care, which are used in a flexible manner to meet local needs at any given time. They are interchangeable for use depending on demand. It is acknowledged that a higher level of respite care is required across the greater Dublin area. Some €8 million of the additional €25 million allocated in 2015 will provide 115 additional transitional care beds for discharges from acute hospitals, including the opening of Mount Carmel later in the year. Some €5 million has been allocated for the provision of additional home care packages targeted on a needs basis to individuals who are discharged from Dublin hospitals. This will assist in allowing individuals to return and to remain at home and support the carers in the provision of in-home services. This is in addition to the €315 million that has been provided nationally for home support services. This stronger emphasis on home care and other community services provides a greater range of options to avoid admission to acute hospitals, support early discharges and, where appropriate, rehabilitate and re-able patients after periods of particular difficulty.
The funding that is available for services must be balanced across all of the various service areas in a way that achieves the best possible outcomes for the greatest number of service users and prioritises areas of greatest need as far as possible. The demand for services has increased in recent years and we need to ensure that home care supports are as easily accessible as possible in order that as many older people as possible can be supported at home. The shortage of respite care was one of the issues raised by the carers' representatives at the annual carers' forum, which was hosted by the Department of Social Protection on Tuesday. I assure the Deputies that my Department and the HSE will follow up on this issue.
I thank the Minister for his response. I know he has a huge volume of work on his desk, but will he prioritise this issue? Carers are being taken for granted. When one considers what is involved, they really do need their breaks. They are necessary for them to be able to continue to look after loved ones. This issue has been raised by many constituents, but particularly by service users of Prosper Fingal and St. Michael's House. One constituent was informed by St. Michael's House that although it recognised that more respite care is needed, it does not have the funding to provide that service. At the end of December last year, the HSE advised that a restrictive budget has meant that it has had to reduce respite care services. More beds are needed and they need to be freed up on a more regular basis in order that the service is spread among more families.
Will the Minister outline some of the issues raised at the annual carers' forum, what progress has been made and what plans he will put in place around them? Is there any update on the national carers' strategy? Further, will the Minister speak to his colleague, the Tánaiste and Minister for Social Protection, and ask her to look at the respite care grant? It has been reduced, sadly, in recent years, from €1,700 to €1,375. This is scandalous. These people need to be looked after properly. It is to be hoped that the Minister will do this.
I thank the Minister for his reply. I do not wish to repeat what Deputy Flanagan has said. I would be interested to hear some feedback on the carers' forum which was hosted on Tuesday. I would also like to have more of an insight into what the Minister believes is required, in terms of bed numbers and capital expenditure, to deal with the backlog for respite care which exists not just in Dublin but throughout the country. What would be the ideal?
The carers' forum is operated by the Department of Social Protection and the HSE takes part in it, for obvious reasons, but the Department of Health does not operate it. The same applies to the carers' strategy, which is led by the Tánaiste and Minister for Social Protection. It would be wrong of me, therefore, to give an update or a report on it, given that I was not present and it falls within the responsibility of the Department of Social Protection.
Will the Minister inquire about it?
I am sure all sorts of issues relating to domiciliary care and respite care grants and so on were raised. I would expect that to be the case.
I am aware of one or two cases of people in my constituency who have not been able to get respite care. It often happens because emergency residential care is required for someone else. That, I suppose, is the nature of these things. There are always competing financial demands. Also, where there is a social or personal care help need, it is often given to people who at that particular point in time need it a little bit more. I will seek a report from the HSE on it and I will ask what additional measures could be put in place to ensure we have adequate respite facilities for carers. We want to be able to support them in what they do. The fact that they do what they do reduces the need or the potential need for long-term residential care.
General Practitioner Services Provision
I wish to raise the issue of the need for the HSE to appoint a new GP to fill the vacant position in Borris-in-Ossory in County Laois. I appreciate that the Minister is here in person. The background to this situation is very straightforward. It is happening in many areas in rural Ireland, in particular. The doctor who has been there for many years, Dr. Fitzgerald, is retiring. I thank him and his patients will thank him. He is entitled to retire and we wish him well. A question has now arisen regarding replacing him. The HSE advertised the position and conducted interviews. Two people applied for the position, but the financial package that was available was not sufficient to allow a doctor to move into the area.
Historically, when a GP who held a GMS medical card contract lived and practised in a centre of population with fewer than 1,500 people and there was no town with a population of more than 1,500 people within three miles of it, the GP was entitled to a rural practice allowance. The figure for the rural practice allowance is about €16,216. I understand the position in Borris-in-Ossory was advertised without this allowance. The town of Borris-in-Ossory meets the population requirement. Further, there is no town within a three-mile radius of it with a population of more than 1,500 people. We are talking about serving an area which includes Borris-in-Ossory and surrounding areas such as Ballybrophy, Killasmeestia, Pike of Rush Hall, Ballaghmore and Camross. Essentially, from the Minister's perspective, this is a town on the road between Mountrath and Roscrea on the old N7 road. The town was bypassed recently by the motorway.
A very strict interpretation of the rules is being applied by the HSE. One issue is that it is saying that the GP must live in the area. Historically, sometimes a house came with a practice. This is not the case here and no one thinks a GP should be offered a house in this day and age. If a GP is getting a practice, like everyone else he or she will have to provide his or her own house. However, the HSE seems to be saying that because the person will not be living and practising in the area, he or she will not be eligible for the rural practice allowance. I am asking the HSE, through the Minister's office, to go back to the people who applied in the first place and to offer them the rural practice allowance. This will make the position financially viable. The rural practice allowance allows a GP to have funding to support a practice nurse, secretary and, if necessary, manager. This cannot be done without an extra allowance. The GP cannot pay for this out of his own salary.
This leads to a bigger issue. GPs in many practices throughout the country have been telling me that they would love to be employed as a doctor, that is, to do the business they are trained to do. However, they have to run the local health centre and look after various other matters such as the costs of administering the centre, IT facilities, human relations issues and the practice nurse and other staff that come and go through a health centre. It is a management position in its own right. All of this is taking up GP's time which should be spent on patient care. The rural practice allowance should be allowed in this case.
Last Sunday, the local parish priest raised this issue at mass. He asked local politicians to speak up for the area because he felt some of the small areas no longer had a voice. I am asking the Minister, therefore, to ensure that the position of the GP will be filled in Borris-in-Ossory and if this means giving the rural practice allowance, I ask the Minister to do that.
The HSE is committed to the provision of high quality GP services through the GMS GP contract. GMS GP posts are filled in line with the HSE's human resources recruitment guidelines. Periodically, challenges can be experienced in regard to the permanent filling of GP posts. In areas where this challenge is experienced, every effort is made by local HSE management to ensure the provision of GP services to all GMS patients.
The retiring doctor in Borris-in-Ossory advised the HSE of his intention to resign from the GMS scheme in November 2014. The GP's practice is a single-handed, rural practice with a GMS panel size of approximately 830 patients. The GMS panel was advertised by open competition and interviews took place in late 2014. Two applicants applied and both were placed on a panel following successful interview. Both candidates subsequently declined the offer of the position. The position was subsequently re-advertised by open competition, in early February 2015, and interviews are scheduled for 4 March 2015. The retiring doctor has agreed to continue in post at least until after the March interview and the conclusion of the selection process, allowing time for the post to be filled. We are very grateful to him for that.
While GP numbers are keeping pace with overall demographic trends, this does not always prevent shortages at local level. GPs, once qualified, tend to work for existing GP practices or as self-employed contractors, and are free to decide where to establish their practices. Isolated rural areas and deprived urban areas, very often with limited private practice opportunities, may sometimes find it difficult to attract GPs to fill vacant posts. The HSE is seeking to address this issue at present with the medical organisations with a view to developing practical measures. This includes reorganising lists with existing doctors in local areas and adopting more flexible contractual arrangements which would encourage young GPs to work in such areas.
The Department and the HSE are currently in discussions with the Irish Medical Organisation, IMO, about the introduction of flexible or shared GMS contracts. The possibility of extending the GP retirement age from 70 to 72 years is also being considered. The introduction of flexible or shared GMS contracts would provide more family-friendly working arrangements better suited to younger GPs who have young families, thus making it more attractive to pursue working in the GMS scheme.
Under the programme for Government, it is intended to develop a new contractual framework for GPs which will be more suited to current needs and will facilitate the planned development of primary care services. Substantive discussions on a new GMS contract for GPs will commence shortly with the IMO.
Mechanisms for encouraging GPs to set up practices in rural and urban disadvantaged areas will be considered, as appropriate, in the context of these discussions. In the meantime, where GMS GP vacancies arise in an area, the HSE will take the necessary steps to ensure that continuity of service to GMS patients is maintained.
I thank the Minister for bringing us up to date on the recruitment process. The Minister said there had been an earlier competition and that both candidates had declined the offer of the post. They declined it because of the financial package on offer, which excluded the rural practice allowance. If the HSE is re-advertising, which has happened, and interviews are to be conducted in the coming weeks, the Minister should ensure that the rural practice allowance is brought back to the table. I understand that management in the HSE at local level appreciates the need for this and has requested HSE approval at national level. This has been declined. This is essentially why we have to go through the advertising process again.
The Minister actually copperfastened the fears of the local community in his reply when he said he was examining various options including the reorganisation of lists with existing doctors in local areas. Essentially, if he goes down that route, which is what everyone is concerned about, some patients in the Borris-on-Ossory catchment area will be told to go to Roscrea and the rest will be told to go to Rathdowney or Mouthrath. That is the fear of the local community. The Minister wants to disperse the facilities that are already in place. There has been a big investment in the health centre over recent years and it would be a shame not to continue to have a doctor there. We know a single-doctor practice can only provide a limited amount of hours, but what will happen is that once the new recruit, be it a lady or a male doctor, is part of the MIDDOC system, there will be out-of-hours coverage for people in the relevant areas. To talk about reorganising the lists and sending some people miles further from where they traditionally got their service is not the answer.
My final plea to the Minister, on behalf of the people of Borris-on-Ossory, is to commit to reinstating the rural practice allowance. He has just said it can be financially difficult to attract people to the area. Doctors are entitled to earn a reasonable living, and this allowance is essential in that regard. It is essential that it be part of the package.
There is a panel of 830 patients. Unfortunately, this is relatively small from the point of view of a GP. Unless it is heavily supplemented by private patients and private incomes, it can be hard to operate a practice on that basis. The panel may be small from the point of view of an applicant GP. The service is, of course, very important to the community itself.
The rural practice allowance has rules applying to it. There are also contracts agreed with the IMO. It is not open to me to change the rules or bend them on an ad hoc basis for the benefit of any individual GP or community. When trying to fill a rural list, which is a difficulty in some parts of the country, we are up against the fact that an increasing number of GPs do not want to work in single-handed practices. They want to work in groups, as part of multidisciplinary teams and in primary care centres, because that is what they were trained to do. That is why this will be an ongoing problem. Even if allowances were higher and there were additional financial incentives, young GPs coming through the training system would want to work in group practices with sub-specialties and so on. This presents a difficulty.
With regard to the options, they always include the possibility of bringing in a locum and re-advertising the position, if needs be. Dividing the list would only be done as a last resort. I agree that it would not be desirable. I certainly hope the interviews on 4 March will be successful.
Social and Affordable Housing Eligibility
I thank the Office of the Ceann Comhairle for facilitating me in raising this issue. I thank the Minister of State, Deputy Paudie Coffey, for being present and congratulate him on the work he is doing in reforming the delivery of social housing. The social housing strategy for the period to 2020 provides the roadmap in terms of tacking our social housing crisis. Some 35,000 additional social housing units will become available over the next six years. This is important and is really tackling the issue. It is a substantial effort, and I thank the Minister of State in that regard.
One of the knock-on consequences of the recession is that additional demands have been placed on social housing. We have significant waiting lists, and this has been compounded in recent years by the recession, falling incomes and mortgage difficulties. In addition, the rise in rents for residential properties is driving more low-income households to seek support. In my county, County Clare, there are more than 3,000 approved applicants on the council's housing waiting list. They are approved applicants on the basis of the current maximum net income limits that apply. However, I have come across a number of cases in which low-income households are falling outside these limits. Their circumstances need to be addressed.
Let me give a practical example of what I am speaking about. I met a couple recently in my constituency office in Ennis who are living in a one-bedroom apartment with their three children. One partner is in receipt of jobseeker's allowance and the other is working but her take-home pay is very low. Their total household income is €608 per week and out of that they have to pay €500 per month for rent. In order to qualify for social housing under the current limits, their net income would have to be €528. In accessing their net income, the means test can take account only of PRSI, PAYE and USC payments. Although this family's income is extremely low and there is much demand on that limited income, the local authority cannot take into account its outgoings, such as rent or other reasonable expenses.
These tight income restrictions are forcing low-incomes families into even more serious hardship because, in cases like this, the option is for the working partner to reduce her working hours so as to be able to pass the social housing assessment. Effectively, people are being driven out of work and into the social welfare system when the objective should be ensuring that work pays more than the social welfare system.
No household should be forced into greater poverty. The solution is to increase the income thresholds in Clare and bring them into line with the thresholds which apply in a number of our neighbouring counties such as Limerick, Galway, Kerry and Cork. Currently, Clare is included in Band 3, with the maximum net threshold for a single person assessed at €25,000, an allowance of 5% for each additional adult and 2.5% for each child. The maximum limit was increased by €5,000 in 2011. However, the disparity between the various local authorities is a real problem and it should be bridged in order to give low income families in Clare the same opportunity to access social housing as low income families in other areas.
An increasing number of low income families are becoming at greater risk of homelessness. I appeal to the Minister to consider the situation which applies in my constituency of County Clare and increase the income limits in the context of the Social Housing Strategy 2020.
I thank the Deputy for raising this important issue.
On 1 April 2011, the Social Housing Assessment Regulations introduced a new standard procedure for assessing applicants for social housing in every housing authority. The aim of the new system is to move closer to a transparent, consistent and fairer approach to eligibility for social housing. The regulations include maximum net income limits for each housing authority, in different bands according to the area, with income being defined and assessed according to a standard household means policy.
Before the new system was put in place, there was considerable inconsistency in the various local authorities across the country. Some authorities had income limits for social housing, but some had none. The way income was assessed for limits also varied widely, with different disregards and policies in the various housing authorities. This meant that applicants for support who were on similar incomes could be treated very differently depending on where they happened to live. This approach was neither efficient nor fair.
The income bands and the authority area assigned to each band was based on an assessment of income needed to provide for a household's basic need plus a comparative analysis of the local rental cost of housing accommodation across the country. The limits also reflect a blanket increase of €5,000 introduced by this Administration prior to the new system coming into operation. That was done to broaden the base from which social housing tenants are drawn and thereby promote sustainable communities. As a result, the net income threshold for a one adult, two children household in County Clare, for example, is €26,250 net income after tax, PRSI and the universal social charge, USC, with higher limits applying to larger households.
Under the household means policy, which applies in all housing authorities, net income for social housing assessment is defined as gross household income less income tax, PRSI and the universal social charge. Most payments received from the Department of Social Protection are assessable. The policy provides for a range of income disregards, and housing authorities also have discretion to decide to disregard income that is temporary, short-term or once-off.
Given the cost to the State of providing social housing, it is considered prudent and fair to direct resources to those most in need of social housing support. I am satisfied that the current income eligibility requirements generally achieve that. However, I recognise that the current limits may discriminate unfairly against certain classes of households and these limits will be considered in the context of the review of social housing assessment procedures currently being undertaken by my Department, as part of the broader social housing reform agenda outlined in the Social Housing Strategy 2020.
I thank the Minister. The last paragraph of his statement is helpful in that he recognises that the current limits may discriminate unfairly against certain classes of households and said that the limits will be considered in the context of the review of social housing assessment procedures being carried out by his Department.
I would like the Minister to consider the example of the couple I mentioned. Many low income families are now at greater risk because they are trapped in the system. They cannot afford to get on the property ladder. They cannot get a mortgage from the banks, and they are not qualifying for social housing. I gave the Minister a typical example of a couple with a net income of €600 a week but their rent of €500 a month cannot be taken into account, which is unfortunate, although I understand where the Minister is coming from also.
The Minister might outline the different bands. Clare is in Band 3. I do not understand the reason for the discrepancy in terms of the counties I mentioned, namely, Kerry, Limerick, Cork and other counties because housing is scarce in County Clare. There are 3,000 approved applicants for social housing. There is never enough housing to meet demand. There is always a significant demand for social housing, but I will consider what the Minister said about the review his Department is carrying out. I ask him to personally look at County Clare in the context of that review, bearing in mind the example I gave him. That couple genuinely want social housing, and they are not in a position to get a mortgage to buy a house of their own.
I note the points the Deputy has made. I am satisfied that the current income limits generally provide for a fair and equitable system of identifying those households unable to provide accommodation from their own resources. These limits generally provide that a household in receipt of social welfare will not breach the thresholds. That is illustrated by the fact that the Summary of Social Housing Assessments 2013 reported that of the 89,872 households on waiting lists nationally, 65,151, or 72%, were entirely dependent on social welfare. The comparable figure for County Clare is 78%. However, as I have indicated, the income thresholds will be examined as part of the review of social housing assessment procedures currently under way. This examination will look at the policy applied to determine the types of income that should be counted in the assessment and which should be disregarded.
In terms of particular anomalies in the current system that discriminate unfairly against certain classes of households, I would be happy to consider any general issues such as those of which the Deputy has made the House aware. I am precluded from becoming involved in any specific applications to a housing authority but I can assure the Deputy that we will examine anomalies in the overall review to see if we can address those and ensure, as I said at the outset, that the process is fair and efficient, and in the best interests of all the tenants who badly need this assistance.
The Dáil adjourned at 5.20 p.m. until 2 p.m. on Tuesday, 3 March 2015.