Home Care Packages: Motion [Private Members]

I move:

That Dáil Éireann:

recognises that:

— Home Care Packages (HCP) aim to help people who need medium to high caring support to continue to live at home independently;

— the HCP scheme is not established in law, as it is an administrative scheme, therefore there is not an automatic right to the scheme, or to avail of services under the scheme;

— the HCP scheme is not means tested, and there is no charge or contribution to be paid for the services provided;

— the HCP scheme is resource limited and the extent of the support available is subject to the limit of the resources allocated each year to the Health Service Executive (HSE);

— the level of service or support one receives may vary in different parts of the country depending on the local population, their individual needs, who is available to deliver services and the demand for the scheme, and there are major regional disparities

within these figures with 554 people waiting in Community Health Organisation (CHO) Area 9 at the end of December 2016, compared to nobody in CHO Area 7;

— vulnerable people are being denied essential services as individual applicants who have been approved for a HCP may be placed on a waiting list for the HCP scheme following a risk assessment of their needs and the numbers waiting for home help are

increasing as at the end of December 2016, there were 2,039 people assessed as needing home help but waiting for a service and by the end of April 2017, the number waiting had increased by more than 20 per cent to 2,456;

— if a caregiver becomes ill, it is difficult to source cover due to the limitations of the resources;

— Ireland has an ageing population and thirty per cent of the population will be aged 65 plus by 2030, which raises very significant challenges and opportunities for Irish society and in particular for the Irish health services;

— home help hours available are minimal and range from less than an hour to a maximum of five hours per week, usually Monday to Friday, between 9 a.m. and 5 p.m.; and

— increased privatisation of community care is a clear indication that the public system is not working for people; and

calls on the Government to:

— promote positive ageing and secure the right to comprehensive and high quality services;

— support older people to live independent fulfilled lives by enabling them to age with confidence, security and dignity in their own homes and communities for as long as possible;

— maximise the use of community and home based care and support the important role of family and informal carers’, in order to maintain older people at home for as long as possible;

— effectively reduce pressures on hospitals by reducing inappropriate admission of older people to acute care or residential care and facilitating timely discharge of older people from Accident and Emergency departments and acute hospitals;

— establish the HCP scheme into law, therefore allowing people to have an automatic right to the scheme and to avail of services under the scheme;

— introduce a HCP modelled on the principles of the Fair Deal Scheme with a statutory objective of relieving the burden of care families experience, and those that qualify for the scheme could use the money for home care instead of a nursing home;

— support caregivers so that they might be able to continue to provide care for older people; and

— increase home help hours so that an efficient service can be provided to additional older people.”

It is my pleasure to introduce this Private Members' motion on behalf of the Rural Independent Group on the issue of home care being placed on a statutory footing. This motion applies to people of all ages, be they children, persons with disabilities, or those who become dependent as they age. It concerns the provision of home care to everyone who needs it. The purpose of home care is to keep people living at home in their community and to maximise their potential to remain as independent as possible. It also seeks to avoid unnecessary institutional care and to defer the entry to institutional care for as long as possible; for a person's entire life, if possible. We want to put home care on a statutory footing to ensure that it is governed by legislation.

The Minister entered into a period of public consultation which has now concluded. There were over 2,000 submissions to that consultation. Those submissions are being published at the moment, and the delay in introducing a report is due to the number of submissions received. I believe the date was extended for a month or so, and I understand why the delay happened. However, we would expect that when a report is produced that legislation would be provided as speedily as possible.

Home care needs to be put on a statutory footing because its provision can be a postcode lottery. It is very patchy throughout the country, and some areas receive care while others do not. It is very uneven. We know there are limited resources, but when it is placed on a statutory footing we would expect that resources would meet demand. It should be primarily based on need, and also the depth of need. I believe that home care on a statutory basis should be provided through the public system. There are private providers, which provides competition for the provision of home care, but it does not necessarily drive down costs. The Minister should consider home care as a public-based system.

The debate on whether this should happen is now over. We need to have home care on a statutory basis. How is it going to be delivered, when will it happen, what form will it take and how will it be funded? I hope that the process of consultation and the drawing up of a report and legislation will be done in a speedy fashion. We had a hearing at the Committee on Health a number of weeks ago which suggested that there would be a two to three year process before legislation for statutory home care was finalised. I hope that can be speeded up and that statutory home care can be delivered in a shorter timeframe than that.

The scheme needs regulation, and we understand that. It must be transparent and there must be integration with other services. We do need to have a home care system, but it must be integrated with other systems. It must be complementary to family carers rather than replacing family carers. It must be flexible and adaptable to individual circumstances, and it must be person-centred. Funding mechanisms must be developed, and this is very important when one considers whether the scheme will be free or whether the recipient will make a contribution. That is a very important element of the statutory basis of home care.

We need to look at this from a different perspective. There may be room for a social insurance model rather than a model based entirely on taxation, and there may be a need for ring-fenced funding so that funding cannot be cut on the whim of a government or in circumstances which put pressure on State funds. It is a false economy to limit funding to home care because it only transfers services on to much more expensive nursing home care and hospital care.

We should look at home care in an anticipatory way. We should be providing home care to people who are becoming frail but have not had an emergency and have not had to enter hospital because of an illness or a fall. It should be provided so that we can predict and supply services to people before things escalate. One example I have come across recently is that of a man who, as they say in rural Ireland, "Took to the bed", and unfortunately, because he was not receiving home care services or physiotherapy services he became so incapacitated that he needed to access acute services. We should be providing home care to try and prevent those situations from happening.

Home care is very important in terms of the social determinants of health. It encompasses not just health but housing, social protection and transport as well. All of these things feed in to supporting our elderly people to stay within their communities. Many areas have developed supported housing for our elderly. When they become isolated, incapacitated and live alone with a lack of family support they can come into a community based housing setting where they get low support but are supported by the community. They can continue to live independently in the community with that level of community and low-level support. There are many examples of housing situations around the country like that, and it is another aspect of home care that we could look at.

There is much un-met need, and the changing demographics are against us. Our population is ageing, which will be a huge problem in the future. We need to anticipate its development. It makes economic and social sense to do this, and it makes no sense to ration home care services. That is a false economy. Home care keeps pressure from our accident and emergency departments, from our lengthening trolley queues, and it reduces hospital admissions and hospital referrals if we can support our elderly people or those with disabilities within the community and prevent them from having to go through our secondary services. The answer to our home care problem is in the Sláintecare report, which was produced last May. That includes many hospital avoidance measures which could keep people living within our community. The Taoiseach mentioned this morning that if each GP referred two fewer patients each week and kept them at home instead the multiples of patients going on our waiting lists would be reduced by thousands. This can only happen if there are GP services, public health nursing services, properly staffed primary care teams and community intervention teams. These would all be very important in providing support for our community of dependent people. That aspect of home care should also be included in the Minister's deliberations.

It is important to provide respite care for carers. Many carers are working 24-7, 365 days of the year.

There is a huge deficiency in respect of providing respite care so that they too can get a break and do not burn out. We have problems in the transition from childhood to adolescence. Respite falls away and must be fought for again. Carers are very concerned about what will happen to their dependant children and the dependant adults they look after when they pass away or become incapacitated. That must also be looked at in respect of home care packages.

We have to look at the recruitment and retention of those who supply care. There is an issue here. Many people who would supply home care services in their communities are disincentivised from doing so because the social welfare system is against them. If they worked for a few hours each day for five days of the week they would lose their entire social welfare entitlements. If it was based on hours per week rather than hours per day, there would be many people within communities who could provide caring services to their neighbours, friends and families. They cannot do so currently because they are disincentivised by the social welfare system. That is something which should be looked at. If an exception is necessary to allow people work for one or two hours a day without losing their social welfare payments, one should be arranged between the Department of Employment Affairs and Social Protection and the Department of Health. I mentioned this to the previous Minister for Social Protection. He had issues with it, but it needs to be looked at again because in many instances patients who need care have been given home care packages and have been allocated hours but cannot get a service because there are no carers to provide it.

We also need to look at the UN Convention on the Rights of Persons with Disabilities. We need to ratify it as quickly as possible and get over the road blocks in respect of the deprivation of liberty and assisted decision making. It makes no sense not to provide home care. The Minister of State knows that as well as I do. It is a false economy.

I thank my colleague for bringing this motion before the House. It is a wonderful thing that, with the advances in medicine and in our general health, people are living longer, more fulfilling lives. The number of people in Ireland aged over 65 is soaring. It has jumped by almost a fifth in the space of just five years according to the 2016 census. The population of those aged over 80 has doubled over the past quarter of a century alone. Thankfully the majority of them are still living at home. More than 40% are living alone. Current projections indicate that by the middle of this century the number of people aged 80 and over will be pushing the 500,000 mark. We need to do more to ensure that these older people can stay out of long-stay residential care for as long as possible. This motion seeks to put home care on a more solid footing. It also makes solid economic sense to the country as a whole. The cost of helping people to live largely independent and happy lives within their own communities is a fraction of what it costs to keep them in a nursing home or hospital.

Of course, any discussion of the future of home care services for older people must include a serious look at the situation regarding day care centres. These centres play a vital role in the efforts to enable an older person to remain in his or her own home for as long as possible. They offer not only services for the physical welfare of the older person, but also a most important social outlet for people whose only other contact from day to day is probably the postman. We need to look at funding for these centres and ensure that it is adequate to allow them to continue the good work they do in supporting older people in local communities.

The cost to the HSE of a person attending one of these day care centres is an average of €66 per week according to a reply I recently received from the HSE in response to a parliamentary question I tabled on the issue. The equivalent cost to look after the same person in a nursing home is more than €800 a week on average, and a lot more in many cases, particularly in Dublin. It is therefore clear that any investment in day centres is a most cost-effective way to help our older people continue to live independent healthy lives in their own homes and their own communities.

Many of these centres are facing an uphill struggle to maintain their services at the level they wish to. In County Galway there is a wonderful day care centre in the village of Claregalway. It is open five days a week from 9.30 a.m. to 5 p.m. It was opened more than five years ago after a group of local people came together with the aim of providing the facility for the village and the wider community. It is a place where older people can visit, enjoy social interaction and take part in various activities and educational programmes to enable them to continue living independently. The centre also provides a day respite service for carers of people suffering from long-term illness. Various activities and educational programmes are provided which are specifically designed for the elderly community to keep them up to date on what is going on around them.

On that issue, I have visited the day care centre and what I have found and what I have been told more and more over the last number of months and years is that the HSE is actually telling people to attend it. It is cheaper to tell the family to put their elderly family members into the day care centre than to put them into nursing homes. The HSE is actually using the day care centres as nursing homes and it is not giving any money to the day care centres to provide that service. That is an absolute scandal. It is going on around the country. Health care workers are doing that.

It is the same thing with Cuan Mhuire. Cuan Mhuire is an excellent facility run by Sr. Consilio Fitzgerald which provides services for people who have drink problems. If a person goes into a hospital with a drink problem, the hospital will pay for a taxi to drop him or her out to Cuan Mhuire. The hospital will tell Sr. Consilio that the person is now her problem and no longer that of the hospital. That is what is going on out there. That has to be addressed urgently.

The centre in Claregalway is supported by fully qualified staff and care assistants. A wheelchair accessible bus service is available to bring people to and from the centre. While the Claregalway and District Day Care Centre gets funding from the HSE, it is barely enough to pay to provide even one month's service in the year.

I will finish on this point. Planning permission has been received for a new day care centre and an early retirement village in Claregalway. A local farmer gave the land free of charge to build this new day care centre and nine or ten independent living units. Fair play to the Department of Communications, Climate Action and Environment. It is providing the funding to build the independent units. Nobody wants to give funding towards the building of the day care centre however. Will the Minister of State look into that and see if any funding to open that facility can be provided by the State?

I am glad to be part of the group which brought this motion before the Chamber tonight. It is imperative that all of us, as elected Members, ensure that our elderly people are looked after properly and to try, as far as possible, to keep them in their own homes as long as we can. We all know that nursing homes give people great attention and great care. However, if one asks the residents in a nursing home who have their senses, they will inevitably say that they would love to go back to their homes if they were well enough. That is where they want to be.

We have to acknowledge the great efforts of the home help people and the great work which they do. These carers are the finest people in the world. The attention and care they give to the elderly is wonderful. The elderly people really appreciate them, but the problem is that they do not get enough time to spend with the patients. That is sad. I will give the Minister of State an example. There was a man named Tim. The Minister of State talks about minutes. Tim needed an extra quarter of an hour in the morning and the same in the evening for a second home help provider to come in and help the family member or the other home help person. He was refused that, but there was no problem in the world with getting him into a nursing home and getting the fair deal scheme to cover it even though the cost was much greater. It was the same person in either case, but that man was happier in his own home. Once he was helped out of bed, put sitting near the fire and had everything laid on for him, he would manage for the rest of the day. It is sad to think that we could not get the extra few minutes for him for whatever reason.

There is something wrong in Kerry. We do not seem to have enough funding. I will give the Minister of State an example of another woman. She was in Cork University Hospital. I have spoken about boundaries today. One of our parishes is divided between Cork and Kerry. Half of it is in Cork, half is in Kerry. The people in the hospital said that she would get 20 hours a week home help but when they found out that she lived in Kerry, they said she would only get ten. How could that be?

The Cork crowd do it better.

She would get 20 hours of home help in Cork, but only ten in Kerry. That is the truth.

They come from west Cork.

It is scandalous.

It badly hurt many people that the Minister a couple of weeks ago said that elderly people were going to be means-tested for home help. That is shameful and disgraceful when a proper service is not currently being provided. Many people only get a half an hour of home help in the morning and the same in the evening, amounting to five hours per week. Such people do not receive any assistance at weekends or bank holidays and definitely will not get any on Christmas Day. They have to pay for private home help, which means that they are using up their pensions and have to get help from family members. That is the truth of what is happening in Kerry. It is not fair. Members know that some HSE officials receive huge salaries. It is not fair that the Government is thinking of means-testing sick and elderly people whose home help provision has been cut to minutes. We are asking that in certain cases where people need more home help and the fair deal scheme is an option, some of the money allocated to the fair deal should instead be used to provide proper care for them at home.

I want to particularly thank day care services. There is a wonderful such service in Rockmount in Kilgarvan, another in Rathmore and more in other places, towns and villages in Kerry. Such organisations provide a great service. They pick up elderly people on a bus and bring them out for a few hours on three or four days each week. It means a huge amount to people and the family members caring for them that they can have a break.

As regards respite, there is a lovely new hospital in Kenmare which has only one respite bed for the entire area. Half of the beds in the hospital are not being used. Such situations need to be examined. I could talk for far longer but I am butting into someone else's time. Families are doing great work but we need to help and support them and that is why we have been elected to this House. Will the Minister of State listen to what is being said and to ensure that those people get recognition?

I welcome the opportunity to address the House this evening and I am happy to say that the Government is not opposing the motion.

Recent research undertaken has shown that it is the preference of most older people to continue to live independently in their own homes and communities. That is confirmed by my experience of speaking to older people around the country and meeting with organisations which represent them. For that reason, I am strongly committed to ensuring that older people can continue to live in their own homes, surrounded by their family and friends, for as long as possible.

Home care services are central to achieving that objective. Such services help to reduce the level of inappropriate admission of older people to hospital and nursing homes as well as facilitating their timely discharge from hospitals. Although home care has traditionally been more associated with lower-level support than residential care, many older people with complex care needs are now being maintained at home. That shift increases demand for service provision that, because of our ageing population, will intensify in the decades to come.

The increasing life expectancy of our citizens not only bears testimony to our social and economic progress but also represents an opportunity. Older people make a huge contribution to their families and to our society and economy. As emphasised by the national positive ageing strategy, if we are to reap the benefits of that enormous demographic bounty, it is incumbent on us to enable people to age with confidence, security and dignity in their own homes and communities for as long as possible. That is my responsibility as Minister of State at the Department of Health with responsibility for older people and it has the support of Members on all sides of the House.

The Health Service Executive has responsibility for planning, managing and delivering home care and other community-based services for older people. The HSE’s home care services are provided on the basis of assessed health care need and no personal contribution towards the cost is required. Contrary to what Deputy Danny Healy-Rae said, there is no proposal to means-test home help provision in its current form.

There was. A report in a newspaper stated that was being considered.

That newspaper might have an ambition for it to be considered but I can assure the Deputy that I do not.

The door has been left open for that to be done.

There is no proposal by the Department or the HSE to means-test care.

Significant resources are currently being invested in home care services. In 2017, the HSE will spend approximately €370 million on home care, with targets for the delivery of just over 10.5 million home help hours, almost 17,000 home care packages and 190 intensive home care packages co-funded by Atlantic Philanthropies for clients with complex needs. The 2017 funding represents an increase of €27 million over that made available in 2016.

However, the Government is aware that those resources, while significant, are insufficient to meet the growing demand for home care and that that must urgently be addressed. Accordingly, an additional €41 million was made available for older people’s services in budget 2018. That allocation comprises €9 million once-off funding in 2017 and €32 million next year, a significant proportion of which will be allocated to home care services. Working within available resources, the HSE has sought to maintain and, where possible, expand the range and volume of services available to support people to remain in their own homes. Private and voluntary sector providers play an important role in that service delivery, complementing the work of staff employed directly by the HSE to provide a flexible and responsive service.

In addition, although home care is among the health and social care services for which there is currently no statutory regulation, the HSE is progressing a range of measures to improve home care provision overall, to standardise services nationally and to promote quality and safety. Those measures include a national procurement framework for home care services which provides a mechanism for quality assurance. It came into effect in 2012 and was again put out to tender in 2016. Within the framework, private and voluntary sector providers are also monitored through two-year service level agreements with the HSE. More broadly, home care service provision is monitored by the HSE on an ongoing basis relative both to the overall availability of resources and to individual clients' care needs.

Home care service provision has developed over the years with a significant local focus and there is more variation than the Government wish there to be in the delivery of services across the country and at different times of the year. To help address that regional disparity, the HSE is in the process of implementing a standardised, comprehensive care needs assessment procedure across the country which will ensure consistency in the eligibility criteria applied for home care and long-term residential care. Following the completion of a pilot of that single assessment tool in May, national level implementation is now in progress.

While the existing home care service is delivering crucial support to many people across the country, the Government recognises that it needs to be improved to better meet the changing needs of our citizens. In particular, I am very conscious that the current system relies heavily on family carers. That was movingly highlighted by the "Prime Time" programme last week. Carers play a crucial role in helping older people to continue to live in their own homes and they make a profound difference to the health, well-being and quality of life of those for whom they care. Carers also make an important and often unacknowledged contribution to the economy. That is reflected in the 2016 census results published last month, which indicated that approximately 195,000 carers are providing a minimum of 6.6 million hours of care per week.

It is Government policy to recognise, respect and value the role of carers as key care partners. The national carers strategy was launched in 2012 to set the strategic direction for future policies, services and supports provided to carers by Departments and agencies. This is a whole-of-Government approach underpinning the reality that the needs of carers are many and must be met by many Departments. Carers require supports to help them to maintain their own health and well-being and to empower them to participate, where possible, in economic and social life.

The Government's commitment to supporting carers was demonstrated earlier today when I, along with the Minister for Health, Deputy Harris, and the Minister of State, Deputy Finian McGrath, announced Government approval for additional funding to enable all carers in receipt of carer's allowance to qualify for a GP visit card.

There has been no press coverage of that measure.

That measure will ensure that all carers in receipt of carer’s allowance who up to now have not qualified on means or age grounds will now be able to attend a GP free of charge. The measure will be implemented in 2018 subject to the drafting and enactment of the necessary legislation by the House.

How many people will benefit from that measure?

As I have said before in the House, we need a bespoke, stand-alone scheme specifically designed for home care. A Programme for a Partnership Government signalled the Government's intention to introduce a uniform home care service and we are fully committed to the development of a statutory home care scheme and system of regulation.

This is a priority for me and the Department of Health, and we have undertaken to ensure that legislation will be enacted within two to three years to support this. The new statutory scheme for the funding-----

-----and regulation of home care services which we will introduce will improve access to home care in an affordable and sustainable way. It will provide transparency about individuals' eligibility for services and about service allocation and ensure that the system operates consistently and fairly across the country. A system of regulation will be designed to ensure public confidence in the standard of the services provided and to bring Ireland in line with best international practice. It will be important to get the balance right in this regard and to ensure that the system of regulation is effective and not overly bureaucratic. The new scheme will also result in more effective integration with other health supports, including nursing, therapies and other primary care services and will have consequent benefits for the family carers. The development of the scheme will be supportive of the complementary goals and objectives set out in the national carers' strategy, the national dementia strategy and the national positive ageing strategy. It will also align with the Sláintecare report. It is important to note that it is not only older people who may require home care services. This issue will be considered as we prepare proposals for the new scheme.

As an initial step in developing the new system, the Department commissioned the Health Research Board to undertake a review of the home care systems in place in four European countries. The review, published in April of this year, will help us to ensure that Ireland's new home care scheme and system of regulation is informed by international experience. In addition, in July the Minister, Deputy Harris, and I launched a public consultation on the financing and regulation of home care, which closed in October. The purpose of this public consultation was to enable us to find out more about the views of service users, their families and health care workers on current and future home care provision. We received more than 2,600 responses, and a report of the findings will be published early next year. These findings will help to inform the Department's development of the new funding scheme and regulatory arrangements. The process for determining the type of home care scheme and approach to regulation that is best for Ireland is complex. A significant amount of analysis is needed to develop policy proposals on the form of the home care scheme and the system of regulation that will apply to these services. It is important we take the time required to ensure that these measures will be successful, affordable and sustainable.

Within the context of this ongoing work, this evening's debate is very welcome. I think everyone in the House will agree that, in addition to more resources for home care, we need to establish a funding and regulatory scheme that will ensure that, for generations to come, all our older people are supported to live independently at home for as long as possible in accordance with their wishes. I look forward to working with Members on all sides of the House, as well as with other key stakeholders to advance this important initiative. I assure the House that I will be fully engaged in this process in the period to come and will work to ensure that the new scheme delivers the best possible outcomes for older people in Ireland.

The next slot is Fianna Fáil's. There are 20 minutes in it and seven speakers are listed. I do not know if we will get to them all, but Deputy Butler is first.

We are all now, thankfully, living longer, and most of us will live independently for the rest of our lives. Less than 5% of all the elderly require care late in life, and all parties agree that every effort should be made to facilitate this in so far as possible in the comfort and security of their own homes. Fianna Fáil believes that the funding allocated to enable older people to remain at home provides not only the best value for money, but also the most humane result for older people. Many thousands of families help their loved ones to stay at home when they are ill or very frail, and they receive very little assistance from the State. This needs to change, especially to deal with the growing challenges of dementia care. Fianna Fáil will support the Rural Independent Group's motion.

I have had many discussions about this with the Minister of State. By 2040 there will be 1.4 million people in Ireland aged over 65, of whom 450,000 will be over 80. We all know that home helps, the people who work in this sector, are absolutely fantastic, and they are not paid a large amount. What many of the Deputies here will note is that the problem is not too bad from Monday to Friday because we are dependent on HSE staff. It is not always easy to get the correct package for one's patient or one's constituent, but once the package is allocated, nine times out of ten Monday to Friday seems to work pretty well. However, Saturday and Sunday can be a huge problem because we depend a lot on agency staff who do not get paid as much as the HSE staff, which we all realise. On top of that, not all agencies pay home care providers' travel expenses. This is particularly relevant for people living in rural areas. I dealt with such a case over the weekend in which someone is living 12 miles from Waterford city and the home care providers are only allocated a half an hour morning, midday and evening. However, it takes a half an hour to drive out to the house, a half an hour to give the service and a half an hour to drive back, and they do not get fuel allowance for this so they do not want to come out. I have found this to be a huge issue.

I also draw the Minister of State's attention to the fact that over 63% of 55,000 people with dementia live at home. Every day, 11 people in this country are diagnosed with dementia, and this will not change. Unfortunately, another 11 people probably go undiagnosed. These people who live at home with dementia need supports and intensive packages. I welcome what the Minister of State said earlier, that a lot is being done but that more needs to happen, because on 30 September of this year only 139 intensive home care packages were in place. That is a dismal number when one considers that we have, as I said, 55,000 people with dementia, 63% of whom live at home and are looking for support from carers.

I have been doing quite a lot of work with the Alzheimer Society of Ireland. It is astonishing to learn that 58% of people who have dementia forget to eat, 54% forget that they have eaten and eat again, and 51% do not finish their meals. This is where the home care provider is so important. He or she comes in morning, lunchtime and evening, reminds the person living at home to eat his or her dinner, take his or her medication and, in some instances, go to the bathroom. These are small, simple things but they make all the difference for someone who can stay at home, have the wraparound supports he or she needs and be there with loved ones. These home care packages are a central part of community health care. They allow older people who may need assistance and support to stay in their homes rather than having to be treated in hospital, and as the motion quite rightly states, this is cost-effective.

Before I finish, I wish to refer to the Bill that my colleague, Deputy O'Dea, introduced earlier in the year, the Nursing Home Support Scheme (Amendment) Bill. The Bill provides for people, instead of being allocated nursing homes under fair deal, to avail of the same hours in their home at a fraction of the cost. The Bill is waiting on a money message, and I appeal to the Minister of State to raise this with the Taoiseach.

I commend Deputy Harty and his colleagues in the Rural Independent Group on putting forward this motion, which is extremely important. I know that our party spokesperson on older people, Deputy Mary Butler, has been doing lot of work in this area with different advocacy groups and highlighting to the Minister of State and to the Government the need to put additional resources into it.

All of us who are public representatives are very conscious of the importance of home support, home help and home care packages. In my own constituency work the one major concern I have had for a considerable time is the delays in the actual provision of the home care package or the home support following its initial approval. Far too often the HSE at local level must make decisions in a budgetary context, whereby the patient has been approved for home help or home support but the funding is not in place to provide it as soon as the patient needs it. Over the next few weeks, right until February or March, I am sure we will hear of overcrowding in emergency departments and be given figures concerning people who have been medically discharged but are still in acute hospital beds. In many instances, and we receive calls from the families of these people, the home care packages will not have been put in place, and we all know that caring for a person at home costs a fraction of keeping that person in an acute hospital bed.

The lack of provision has an additional adverse impact in that it causes delays for other people seeking to access acute hospital services.

The only way we will ever have a reasonable level of provision is if home support funding is provided on a demand-led basis. When a patient is medically approved as needing that support, it must be put in place. Health Service Executive officials at local level, public health nurses and administrators should not have to juggle plates to ensure the budget is not exceeded. If a person is deemed to require home help, he or she should not have to wait weeks to receive it, with the resultant cost elsewhere in the health service. We get very good value for money from the people who provide home care packages. As Deputy Butler said, they go way beyond the call of duty. People want to remain in their own homes and that is where the best care can be provided.

I commend my colleagues in the Rural Independent Group on using their Private Members' time to debate this issue. Last week at the Committee of Public Accounts, we had the pleasure of hearing from Mr. John McKeon, Secretary General of the Department of Employment Affairs and Social Protection. Having asked the same question on several occasions in this House and before that in the Seanad, I again queried whether any research had been done on the potential benefit of loosening or relaxing the means test for the carer's allowance, which, together with the provision of a medical card, some home help hours and perhaps a housing adaptation grant, might help to afford people the dignity of staying at home and avoid the necessity of paying out an average of €1,000 per week in fair deal costs or €1,000 per day for an acute bed. Remarkably, as is so often the case, the impermeable walls between Departments, much like the pigeon holes in Leinster House reception, are such that nobody speaks to anybody else. The answer from Mr. McKeon was no, the matter had never been investigated. An official from the Department of Public Expenditure and Reform who was in attendance at the same meeting confirmed that the matter had not been looked into by that Department.

Instead of talking to each other in this House and making all the right sounds superficially about what could, should and might be done, will the Minister of State bring together the Secretaries General of the Department of Employment Affairs and Social Protection, the Department of Public Expenditure and Reform and the Department of Health to examine whether a relaxation of the means test for the carer's allowance, together with the provision of some additional supports, would result in an overall saving for the State? My expectation is that we could save a great deal by taking that approach, which would additionally have the great advantage of allowing people the dignity of remaining in their own home in later life. Will the Minister of State speak to the Secretary General in his Department to see whether such a consultation may be commenced? I understand there is some type of management administration system whereby the Secretaries General of the various Departments get together from time to time. Perhaps they just have coffee, but as I learned last week, they certainly do not discuss a cross-departmental approach to schemes like this. Will the Minister of State be the pioneering person who takes the initiative and knocks a few heads together to see whether the approach I have outlined can be made to work and what savings it might produce?

A June 2016 report on home care provision by the Irish Association of Social Workers, Age Action Ireland, the Alzheimer Society of Ireland and University College Dublin's school of social policy, social work and social justice was a timely study and a welcome contribution to the debate on how best to care for older people. We have heard numerous reports of people finding it difficult to access adequate home care. It is important that we understand why this is the case and what can be done to resolve it. Fianna Fáil is of the view that the funding allocated to enable older people to remain at home not only serves to provide the most comforting and dignified type of care but also offers the best value for money.

In 2015, the HSE estimated that some 2.2 million extra hours of home help and a further 3,500 home care packages for older people are required. Unfortunately, those additional resources were not provided for in the 2016 service plan. The programme for Government includes a commitment to increase home care packages and hours, but we are concerned at the lack of detail as to how that commitment will be delivered. The June 2016 report to which I referred clearly highlights the inconsistencies between the various local health areas when it comes to the availability of home care. That inequality of provision must be addressed as a matter of urgency. It is unacceptable that there are so many inconsistencies in the system, with older people missing out on home care simply because of the area in which they live.

Real progress in meeting the challenge associated with this area of health care provision must be made during the lifetime of this Dáil. Home care is the preferred option for older people and it is well recognised that such provision helps to keep people active in their communities, which in turn brings enormous health benefits. Every Deputy has had people coming into constituency clinics whose situations were transformed after being allocated home help hours and home care packages. It is wonderful to see. We are all agreed that caring for older people in their homes is the best form of care we can provide and the most cost-effective for the State. As Deputy Butler pointed out, it is of particular benefit for patients who suffer with dementia to be cared for in their familiar surroundings and by their own family. I understood that in Cavan-Monaghan, somebody has to die before the staff are made available to care for people at home. Home care hours are allocated but the staff are not there to deliver the package. I appeal to the Minister of State to ensure sufficient staff are in place to enable home care packages to be activated and facilitate people to access the service immediately.

I commend the Deputies in the Rural Independent Group on bringing forward this motion in Private Members' time. I thank my colleague, Deputy Butler, for the work she has done on this issue. The way in which we look after older people and the degree to which we facilitate them to live longer in their own homes will determine the quality of our society. These are issues that matter greatly and have a direct impact on people's lives. Fortunately, we are now living longer and most of us will live independently for the rest of our lives. Fewer than 5% of the population will require care late in life and every effort should be made to accommodate them in the comfort and security of their own homes. Home care provision is the most cost-effective way for the State to honour its responsibility to older people. Of far greater importance, it also results in the best outcome for the people concerned.

Currently, older people and their families have two options. They can avail of a fair deal package, which is available on a statutory basis, or they can seek to access a home care package, which, unfortunately, is discretionary and, in many cases, grossly inadequate. It makes sense for all concerned that home care provision be placed on the same statutory footing as the fair deal scheme. As things stand, the home care package regime is not patient-driven and there are significant geographical disparities in the availability of services. Often it depends on where a person happens to live as to whether he or she may avail of home-based care. In my own county of Tipperary, due to a lack of qualified home carers in the area, there is little or no service available. Families have no choice but to look to the fair deal scheme far sooner than is necessary. Moreover, there is no transparency regarding eligibility criteria and the decision-making process, with such matters entirely at the discretion of the health service. As a result, many infirm older people have little choice but to opt for nursing home care, at a far greater cost to the Exchequer. Day care centres and respite care are likewise extremely important for elderly people. Respite care gives families who are looking after a person on a home care package a break of one or two weeks, which is vital for the long-term well-being of the persons carrying out the care. Day care centres, too, provide an invaluable service and must be properly funded.

In 2015, the Health Service Executive estimated that an additional 2.2 million hours of home help and a further 3,500 home care packages for older people are required. There was no provision for that in the service plan for 2016. Those additional resources must be provided for older people.

I join colleagues in thanking the Rural Independent Group Deputies for bringing forward this important motion, which I expect to attract cross-party support. It is an issue all Deputies encounter in their clinics and often in their own lives. My grandmother went through a prolonged period of availing of home care before spending time in hospital prior to her death. She would have liked to go back home at the end but that, unfortunately, was not possible.

It is a very real issue that affects people in our constituencies and lives.

As policy makers, we know that we have to deal with the challenges posed by an ageing population. We see it in every aspect, from pensions, health insurance through to planning. We also know that the ESRI's report in projecting forward to 2030 shows that the population is expected to increase by between 600,000 and 1.1 million and that within this population increase the share of people aged over 65 years is expected to go from one in eight to one in six. The number aged 85 years and over is expected to double, while the number living longer and healthier lives is growing rapidly. This is hugely positive for all of us, but, as policy makers, we have to be able to address this issue in terms of service provision.

I will comment on some of the points made within the motion. There is a note about the increasing privatisation of home help and community care services. We increasingly hear advertisements on radio placed by various providers offering different packages. I will not make any comment on the efficacy or usefulness of any of the providers, as they could be very good or bad. I do not know, but I do know that the proliferation of such adverts and services demonstrates that the public service is not working. I also know - it does not take a genius to figure it out - that one must be able to afford to avail of private services, as many cannot do. That is an immediate indication of inequality in the system.

We often tend to take for granted that people in a family are helping out in caring. I have seen this in cases in my constituency. Often the State takes it for granted and it may not place the same store on this work, in a monetary and every other sense, but people can be caught in that bind where they are often sacrificing careers and other relationships to care for an elderly family member and not being recognised by the State for doing so. It strikes me that it is imperative the scheme is recognised in law on a statutory basis, like the fair deal scheme, in order that people could avail of what should be an automatic right. Currently, the scheme is discretionary.

Statistics tell us that 10% of people have an unmet need and cannot avail of services. I stress that the figure is probably much higher. Because so many know that they will not be able to avail of the service, they just do not apply. As a consequence, the 10% figure could actually be a lot higher.

I will conclude on a local note. An exemplar in the care of older people is McAuley Place in Naas where Margharita Solon and her team run a fantastic operation. When the Minister of State's predecessor, Deputy Helen McEntee, was in office, she came to visit the centre. I was there on the day she came to inspect the facility. To the Minister of State and everyone else in the House who has an interest in this area, McAuley Place in Naas is an exemplar on a national scale when it comes to how to do this; older people are living fulfilled lives with dignity and independence, with the services they need on their doorstep to support them at that stage of their lives.

I propose to share my time with Deputies Pat Buckley and Martin Kenny.

I commend the members of the Rural Independent Group for bringing forward the motion which I believe is extremely important. It is good that we are talking about the issue. I have had occasion to see on a number of levels the operation of the home help service in action. I have represented home helps for many years. It is not true to say HSE home helps will not work at weekends, as has been suggested. They will work at weekends; they want to work at weekends and are only too happy to work outside normal hours because they do not offer just a nine-to-five service. We would like to see the Government funding this service and not running to the private sector to provide it. The fact that there are advertisements on radio placed by private services does not indicate that the public services are failing, rather it indicates that the Government favours private providers, from which we do not see value for money or a good return on the investment made.

I also had occasion to see the home help service work in the case of my uncle Bernard. I call him my uncle, but he was just one of the people to whom I was very close and he passed away on Sunday. He had Parkinson's disease and his home help, literally, was a lifeline. Like everybody else, he had to fight for every single hour and minute of home help he received. Our medical and health professionals and scientists are enabling people to live longer, which is really good and positive. Unfortunately, the efforts of the scientists and doctors have not been matched on the political side in coming up with solutions to help people to stay in their own homes. We need to plan for a society that is ageing. To do this we need help and an input from experts and stakeholders in the field. We also need to listen to home helps. Very often I hear people say they cannot get a home help to work at certain hours or in certain circumstances. That is not the case. I have never worked with a more flexible group of workers. They provide a huge amount of care and we are going to need to rely on these services more. We can see that the number over the age of 65 years has increased by 19.1% to 637,567 since 2j011. There was also a 15.6% increase in the number over the age of 85 years. It is fantastic and I hope we will all get to live to a good age, but, unfortunately, the default position of successive Governments has been to allow carers, families and loved ones to carry the can. Today one in 20 people is a family carer. Collectively, they provide unpaid care worth a staggering €10 billion each year. When people have come to meet me, I have told them that if there was a carers' strike, Ireland would grind to a halt. Of course, they do not strike as they are busy just getting on with it. We need to ensure we will plan to have services available and that we will look at the demographic evidence to see what services will be needed in the future. We also need to talk to older people, the people who need a hand and supports, to ask them what they want. That is why it is important that home help and home care packages are provided on a statutory basis. It would mean that people could count on availing of the service as a right.

My uncle Bernard worked hard all of his life. He was my father's best friend and they first met 57 years ago when they worked at Cahill May Roberts. He was a driver and my father a van boy. They worked every single day of their lives and paid tax. At the end, when Bernard was sick, he had to fight again for a home help service in order that he could be at home and live with a little dignity. The statistics are all moving in the one direction. Ireland has an ageing population, which is a positive development, but we need to put and secure in place the right to a home care package and to remain in one's own home and the dignity it gives.

It is hard to believe there are more than 195,000 carers in the State, but it is more worrying that more than 29,000 of these carers are over the age of 65 years and that more than 3,500 are under the age of 15. My mother worked as a carer for over 30 years and, with other carers, knows the importance of providing care for older people in their own home. It offers them respect and gives them security. It also gives them back their sense of independence. That is the reason Sinn Féin is committed to ensuring older people can live with the dignity and respect they deserve, but it is not only older people who need our help. While many with a disability are able to live their lives the way they choose, many of them require some level of care at times and cannot be excluded. Despite the need for an increased number of care hours, it is worrying that budget 2018 included no commitment to increasing the number of personal assistance hours or respite care services. Last week I submitted a parliamentary question to the Minister for Health which was subsequently referred to the HSE. I asked the Department what its plans were to ensure Fermoy Community Hospital would remain open and be resourced adequately to meet needs in the area. The hospital was facing the loss of 14 respite beds because of staffing issues. The problem has been averted but only temporarily. We must invest in services for our ageing population.

A home care package gives an individual dignity. It also promotes positive mental well-being and instils self-worth and self-pride. We must, however, also give care givers as much support as we can. I commend the Rural Independent Group on bringing forward the motion as we must support the 118,000 female care givers and the 77,000 male care givers.

We need a social care service with equal access for all based on their needs and to the greatest extent that resources allow.

I commend the Rural Independents Group for putting down this motion this evening. All of us are conscious in all our constituencies of people who are waiting and trying to get home care packages, people waiting for home help hours and the fight and struggle that goes on. I am sure that it is the same everywhere, including for the Minister of State, that when one contacts whoever is sorting out those hours in the constituency, one is told that they have a few more hours available than was the case last year but demand has grown. This is a problem that we have. Demand keeps growing because our elderly population are, naturally, in need of some more care as more people fall into the category. It is not that we did not know it was going to happen. We have the statistics. There is a statistics office that knows the age of everybody and has a fair idea of the trends. Unfortunately, we do not seem to have planned for this or worked out how to resolve the problem.

I am always struck by the cost-benefit analysis of this matter. Money spent on home care packages or on providing home help to people is the best money that the Government could spend on the health service. First, it employs people at the coal-face to do work and put money back into the community, usually the same community as the person who is getting the care. Second, it ensures that person will stay out of hospital and longer term care which is much more expensive for the public.

There were references to the privatisation of provision of elder care and home care packages. It is something I find happening all the time. I came across a person recently who was looking to have home help hours increased. They were told that they could be given so many hours a week but the levels had been cut the previous month and if they wanted to get their hours back to the same level, they would have to get a company to provide the service and they would have to pay for it themselves. That is well and good for some people but many people do not have the resources to do that. The Government should not allow a situation to develop where a package of care is set in place, and then to put pressure on people to pay for it, the hours are withdrawn forcing people to pay for it themselves. That is happening in too many cases across the country.

The Government must realise that money spent on elder care is the best spent money possible. Somewhere in the highest echelons of the HSE, someone needs to turn on the light and realise that if the money is spent on home care, it will save triple or four times that somewhere else. Unfortunately, that message is not getting through.

There was an announcement today on respite, which is not a dissimilar topic. RTÉ recently broadcast a "Prime Time" programme which exposed the position regarding respite care. It is a terrible indictment of this Government if this is the only way to get money to people in need is to have exposés on the matter on television with "Prime Time". We need to step up and ensure that the money is spent in the right place, and then it will be saved elsewhere.

I congratulate Deputy Harty and his colleagues on bringing this motion before the House, and for his opening statement where he placed his emphasis on the delivery of this service through the public system. I welcome that. I welcome the Government's confirmation that it is accepting the motion. It is positive, but it prompts the question of why this proposal was not brought forward by the previous Government, with its overwhelming majority, given the cost effective nature of the proposal. It gives the lie to the constant mantra that this Dáil is paralysed. This is a good example of the new politics working and making a difference.

Our population, while relatively young compared with other European countries, is still ageing. Figures have been quoted tonight of 637,567 aged over 65 years. Over a quarter of those live alone and independently. That is 100,000 more people than were aged 65 years in 2011. The significant increase in the numbers aged over 65 years, and over 85 years, which is some 68,000, requires careful planning and investment. The lack of an integrated service, poor transport, disconnectivity and inappropriate housing is actively leading to unnecessary admissions to long-term care and into hospitals. These admissions are completely preventable. What is needed is quality support to enable people to remain in their own home which is the key and in line with what people want. Most importantly, it is the most cost-effective policy which any sensible Government would have pursued long ago.

Unfortunately that has not happened. Approximately 60% of the current budget for the provision of services for older people, around €1.7 billion, is spent on long-term residential care. That is 80% to 20% going into private, for profit institutions. Only around 4% of people over 65 years live in long-term residential care. The reality therefore, which has never been discussed, is that 96% of people over 65 years do not live in long-term residential settings and, most importantly, do not wish to. They want to be involved in the decision-making process as to how they will spend their lives, and to be part of the democratic process. From replies to parliamentary questions by myself and other Deputies, we know that in practice home care packages and home help hours have been reduced significantly and are fewer than they were in 2008. Home care packages have increased but the net increase is not an increase because the demand is higher than what has been provided.

The lack of a proper service to help people to remain in their own homes adds to the acute crisis in our hospitals. It leads to delayed discharges and admissions. Responses to my parliamentary questions echo what many Deputies have said this evening, that families are fighting tooth and nail to the most basic home care package. There are people who have suffered a stroke or other serious illness who want to go home, their families want to take them home and they face a battle of only getting ten hours, for instance. If they fight or they go to a Deputy they might get more, but then again they might not. That is the level of what is happening on the ground.

It has been said already that what is needed is a statutory entitlement to home care. It will require increased spending but only in the short term. In the long term, it will save the State money and lead to a healthier population in that age group. More respite care is also needed. We need extra investment in community nursing home facilities. I have been told a figure of 80% to 20% for private care which does not represent a balanced market. We need long-term planning and investment given the significant demographic changes.

Deputy MacSharry has said that he raised the following matter, and I raised it subsequently last week at the Committee of Public Accounts. The Secretary General of the Department of Employment Affairs and Social Protection had not considered that it might be more cost effective to look at the domiciliary care allowance, the carer's allowance and providing home care packages and to do a cost-benefit analysis of it compared to the cost of long-term residential care which is approaching €1 billion. It was just under €1 billion in 2017, and that was catering for only approximately 23,000. If one looks at all the other packages, for much less money they provide care for an extraordinary proportion of the population. It came as a surprise to Deputy MacSharry and I that this had not even been considered and that across Departments, they might look at more cost-effective ways.

Finally, I will be parochial. All this makes perfect sense and the Minister has nodded many times to speakers tonight. However, there seems to be a disconnect, or a cognitive dissonance, between what people want and what public representatives say in the Dáil on their behalf, and what the HSE is actually doing on the ground. I lár na Gaeltachta, sa Spidéal i nGaillimh, tá dream agus níl siad in ann aon áit a fháil chun cruinniú a bheith acu i lár na Gaeltachta. A group, the average age of whose members is 80, is not allowed to meet in a premises owned by the HSE which, for over a year and a half, has remained empty. On the one hand the HSE gives the group a grant but on the other it refuses to facilitate them in a building it owns. This leaves us having to write lots of letters.

I support this motion in a general way but I have one reservation over the fact that it is to be done on the basis of the fair deal scheme. I believe fair deal is really "unfair deal" and I would be most unhappy if we went down that road. However, I certainly agree with the sentiment of the motion.

Gabhfaimid ar aghaidh go dtí an chéad Teachta eile, an Teachta Gino Kenny. Tá brón orm. Ba chóir dom glaoch air roimh ré. Tá cúig nóiméad go leith aige anois.

I commend the independent rural alliance on the motion.

We are the Rural Independent Group, not the rural alliance. The Deputy should correct the record.

The Deputies are very sensitive tonight.

They are pedantic. I will get it right the next time. I commend them on the bulk of their motion but there are certain things with which I do not agree, though they are for another day. Having worked as a care assistant for the past 16 years of my life, and for five years as a home care worker before I came in here, I understand the vital importance of home care work, not only for the worker but for the patients and their families. Whether they are convalescing at a hospital from long-term illness or coming to the end of their life, it is vital to them.

Millions upon millions of hours - some 10 million - were cut from home care packages over the past ten years, by the Fianna Fáil-Green Party Government and the Fine Gael-Labour Party Government. Fewer people got a home care package in 2015 than in 2008. A total of 2.24 million fewer hours were delivered and this has had a hugely detrimental effect on people's well-being.

I am surprised that nobody has pointed out that, at this moment, 75,000 people are trying to avail of home care packages but only 21,000 are actually availing them. That means a huge gap of 50,000 people. I personally know families in extremely difficult circumstances who would beg public health nurses and doctors for their loved ones to come back home but they cannot provide the service, which has a knock-on effect as these people do not want to be in hospital but want to be at home with their loved ones.

There are 50 for-profit home care providers and it is an extremely lucrative business. Most workers are paid between €9 and €11 per hour but the private company charges the HSE double that amount. It is profitable but not efficient from the point of view of the taxpayer. There are many people who are now reaching an older age and who want to be cared for in their home environment rather than in a hospital and it is more cost-effective to do so. One does not want to depict a doomsday scenario of the health services because some amazing people work in the service, such as doctors, care assistants, auxiliary and office staff but there is a two-tier health care system and, like under apartheid, if one has money one can get the best but in the public health system one has to wait and sometimes to beg.

According to the Irish Nurses and Midwives Association, 526 patients are on trolleys today. People do not want to be outpatients or in hospitals but want to come home so we support this motion. Hopefully, it can be addressed in a fundamental way, unlike previously.

Deputy Michael Healy-Rae is sharing with Deputy Michael Collins and they have ten minutes.

I thank Deputy Harty and the other members of our group and I thank David, Mairead, Mairin, Tríona and all in Deputy Mattie McGrath's office for their diligent work in bringing forward this motion. The Government parties, the Opposition parties, namely, Fianna Fáil and Sinn Féin, and the Independents all agree with what we are saying and the only reason they are doing that is that we are right. There has to be recognition of the great work being done in caring for our people at home. We are all aware of the fair deal package and I wish to acknowledge the great work done by our community hospitals and local nursing homes, which take great care of elderly people, people with dementia of different forms and people who cannot exist at home.

In the past, Ministers thought it was a good idea to close down our community hospitals such as those in County Kerry like Killarney Community Hospital, Kenmare Community Hospital and Caherciveen Community Hospital, and a couple of hospitals in west Cork. Everybody knows now that we could not do without our community hospitals and I am proud of the fact that our father, Jackie Healy-Rae, as chairman of the Southern Health Board, took on the Minister of the time and highlighted the fact that it was outrageous and nonsensical. He was proved right over time and it was right to keep our community hospitals open because they provide an invaluable service. Our nursing homes also provide great care.

We are suggesting how funding should be allocated to support people who want to remain in their own homes. Every person's dear wish would be to stay at home, whatever else happens, because there is no place like one's own humble home as people like us, who spend a lot of time away from home, know very well. We are all the same and we would all like to be in our own old corner.

It might be nothing fancy-----

The Deputy is going to sing us a song now.

I could sing a song about it too. There is nothing fancy about it, but our own old home is our own home and we all respect this. When people are getting elderly, and getting tired and worn out, this is what we should be trying to do. When I say "we" I mean we as public representatives collectively, which is why I am so proud of and gladdened by the Government and the Opposition this evening, that we are all united on what we are suggesting. I again thank Deputy Harty in particular because we have great politicians in our group, but Deputy Harty is our doctor. Not many groups have their own personal doctor, but we do.

The Government does.

He is our guidance on this, and he is our way forward in suggesting and proposing to us what we should be saying. This is why I believe we have-----

I hope you disclose to SIPO if he sees you.

That is why we have full and unanimous support here this evening and this is so important.

Elderly people cherish and dearly appreciate every day they can have at home, and every way financially this can be supported is the most economical way in the world of seeing to a person's needs.

I am disappointed my colleague from south-west Cork, the Minister of State, Deputy Jim Daly, left just before I was to speak on health issues, because he could relate to a lot of the difficult issues for many people in the constituency. I am delighted to be able to bring forward this motion this evening, along with my colleagues in the Rural Independent Group, and I thank Mairéad in Deputy Mattie McGrath's office, and any other person who has given assistance in this regard.

This morning on Leaders' Questions, I again raised with the Taoiseach the issue of waiting lists with opthamologists in the HSE, and the HSE's failure to provide urgent operations for people throughout the country, especially cataract operations. The Minister of State and I know this is not the only failing of the HSE. As my colleagues said earlier this evening, there is a huge crisis in home care.

The entire health care system is quite questionable. As recently as ten minutes ago, I received a call from a lady in Kinsale who has serious cancer and requires urgent treatment. She attended a clinic this morning expecting to be seen, but was turned away and told to come back on 27 December. This is appalling treatment of a human being who is suffering severely. It is a question that goes right to the core of our political system.

As recently as yesterday, I met a man in my constituency whose elderly mother was unable to avail of any home care, despite her age and frail demeanour. This person requires constant care and her family is able to provide only so much. They have been refused any sort of home help hours to date. In this motion, we call for the home care packages scheme to be established into law in order to allow everyone an automatic right to the services within the scheme.

The increased privatisation of community care in this country is a clear indication that the public system is not working for people. Last week, the country watched in horror at the RTÉ "Prime Time" carers in crisis programme. We saw that thousands of people all over the country spend virtually their entire lives looking after loved ones who are unable to care for themselves. In many cases the carers suffer ill health themselves. Census 2016 recorded a 35% increase in the number of carers who are aged 85 and over. Carers provide more than 6.5 million hours of care per week. On average, carers care for their loved ones for almost the equivalent of a full 40-hour working week. Almost 9% provide full-time 24-hour unpaid care, with no real break at all. This is an outrageous attack on our elderly, and nothing short of abuse of the people who are caring for them.

What needs to happen here is on the first day that it is proven through medical evidence that a loved one requires care, a social welfare payment should be made to the carer. This would totally cut out the shambolic carry-on of leaving a carer five, six or seven months without a payment, which is nothing short of outrageous. Would the people whose job it is to apply the carer's allowance wait six months for their wages to come through? I highly doubt it, and we would not want them to do so, but we stand idly by as politicians and allow this to happen to people who are dedicated to their job and who, in many cases, work 24-7.

In recent months, works have been completed in Bandon Community Hospital for the elderly. These cost millions of euro, and much was funded by the local community. As of yet, the new facility remains closed, and many people are unable to get respite care in Bandon hospital at this time. In spite of my efforts, I have been pushed from one Minister to another in seeking an answer, which no one can give me. The greater Bandon community is left dismayed. Who is in charge of the health service?

Our carers do wonderful work, but they are hugely stretched and unable to receive any respite care for themselves. Our motion also calls for the Government and the Minister of State with responsibility for the elderly to increase home help hours to ensure that an efficient service can be provided to more older people. In addition to this, the fair deal scheme is, ironically, the most unfair scheme that has existed in this health service. People who have worked tirelessly all of their lives, simply put, are being robbed of all they have through this system. People all over west Cork with loved ones in community hospitals and nursing homes are contemplating selling their homes, or else taking their loved ones home to die, due to the exorbitant costs they face in this scheme.

Bus loads will leave west Cork over the coming weeks to avail of cataract operations in the North. This is a simple failure towards the elderly people of this island, those people who, as I stated, worked hard and paid their taxes. This country would rather let them go blind than resolve a crisis that affects 8,000 elderly people. The very simple solution would be to open up surgical theatres throughout the country, such as that in Bantry General Hospital, and get the procedures carried out in a timely manner.

Ireland has an ageing population, and 30% of the population will be aged over 65 by 2030. This raises significant challenges and opportunities for Irish society and, in particular, for the health service, as it is in crisis now and it looks to be worsening. I cannot imagine how it might be in ten years if we do not begin to change this.

I thank all of the Deputies for a very worthwhile debate on this very important matter. It is clear from the comments tonight that there is agreement on the need for reform of home care services and the development of a new statutory home care scheme. I see examples of this in my constituency of Wexford.

It is one of the great success stories of our age that so many more people are living for so much longer. The success achieved in recent decades in improving health and extending life expectancy should be acknowledged and celebrated. However, without doubt, our ageing population poses significant challenges that need to be recognised and addressed across a wide range of areas. Each contributor this evening has definitely highlighted this. This includes ensuring the best possible health and social services are in place to meet the changing needs of people as they age.

It is important that society supports us all as we age, and that when it is needed, access is provided to high-quality health and care services and supports, from primary care through to acute care, community, residential and end-of-life care. Most of the Deputies who contributed from all sides of the House have highlighted some of the greatest examples of the care available to each and every one of our ageing population, including our relatives.

Our health care system must acknowledge that older people, by and large, prefer to stay in their own homes, as Deputy Michael Healy-Rae highlighted, for as long as they can. As the House heard from the Minister of State, Deputy Jim Daly, earlier, we are already looking at how this can be facilitated and supported. Everyone understands and agrees there is no quick fix for this situation. It is critical that the appropriate supports are in place to match each person's needs at whatever point he or she is at in his or her interaction with the health care system. This means providing a range of flexible supports, including better home supports, increased use of technology, supported living models and quality residential care, both short and long-term stay.

The future of home care services affects us all.

As the national positive ageing strategy emphasises, ageing is a lifelong process that does not start at 65 years of age. We all have a responsibility, as individuals and collectively, to ensure that Irish society is age friendly and that Ireland is a good country in which to grow older.

I assure Members that the development of the new home care scheme is being advanced by the Department of Health as a priority. However, Members will appreciate that the development of policy proposals and the legislation to underpin them is a complex undertaking. It is ambitious in its scope and we owe it to future generations to get it right. When one does something one must do it right so one need not revisit it to correct it. The Minister of State, Deputy Jim Daly, has targeted enactment of the required legislation within two to three years. While this timeframe is ambitious, the concern for many is that it will be far too long. Our older people need assistance now, as a matter of urgency. Therefore, I wish to reassure Members that the Government is committed to increasing funding for home care in the coming years, as recommended in the Sláintecare report. The Department of Health will work closely with the HSE to maximise the value of this investment. We are also particularly mindful of the need to support family and unpaid carers. I reaffirm the Government's commitment to the national carers strategy.

I welcome this opportunity to assure the House of the Government's commitment to bring about real and substantial improvement in the provision of home care services. Everybody recognises the great assistance and care that family members give to elderly relatives and friends. It would be remiss of me not to recognise all of the carers as we enter the Christmas season. These people are on 24-hour duty and they deserve recognition. Most of the Deputies have mentioned that elderly people wish to stay in their own homes. They can do so only because of the family members and the care assistants who call to them often three or four times a day or if they are lucky enough to be in receipt of home care packages. Those people deserve recognition as we approach the holy season of Christmas. They are the real heroes who will continue to care for their relatives and friends. I see that in my constituency of Wexford, as other Members do in their communities.

I thank the Deputies for tabling this important motion. I assure them that this is receiving attention from the Minister of State, Deputy Jim Daly, and his officials.

I thank Deputy Harty and all the other people who helped with this, as well as my colleagues, Deputies Michael and Danny Healy-Rae, Grealish and Michael Collins, for their input and their contributions. I also thank all the other Deputies who spoke on the motion. I must lament that the Labour Party Members are as láthair arís, as are some of our friends in the Social Democrats and the Green Party. The Labour Party has abandoned the people of rural Ireland. Last week I said cad a dhéanfaimid feasta gan adhmaid, but cad a dhéanfaimid feasta gan Pháirtí an Lucht Oibre? One Deputy in my constituency is blowing every day about what he is doing for the people. It is all blunderbuss and he is firing blanks. I refer to Deputy Alan Kelly. He is not here.

The Minister of State gives us thanks, but we do not want thanks. The carers do not want thanks either. They want solace, support and to be heard. Deputy Butler was talking to the Minister of State, Deputy Jim Daly, today. A simple solution is to ask for a seven-day weekly rotation in the HSE home help service. That would solve the issue of the weekends. It should not be rocket science. At the weekends and at times such as Christmas there is nobody, and that is not good enough. This motion was tabled in an effort to coerce the Government to act on this.

We tabled a motion over a year ago, in November 2016, regarding the fair deal and the unfair deal that farmers and the self-employed are getting. Tá an tAire from west Cork imithe anois but he is due to meet Maura Canning and her group from the wonderful committee in the IFA tomorrow. I hope he has good news for them because he has met them several times. He tells them that he is waiting to hear from the Attorney General. When we seek to cut something we do not have to consult the Attorney General. However, when we have cut something and we wish to reintroduce it we must consult the team in the Office of the Attorney General. That is the case with the motorised transport grant that was cut five years ago. When Deputy Finian the hero McGrath was on this side of the House he was a great man, but he is doing sweet bugger all to reintroduce that. We are also waiting for the HSE. It is a total mockery and shenanigans of the highest order. The people can see through that.

There are 55,000 people with dementia in this country. There are 129 home care packages for that number of people. It is an absolute insult. We know what we are waiting for in respect of the fair deal. The Carers Association and many other groups are doing Trojan work, yet we make them pay VAT on any equipment they buy. A commitment in the budget to return the VAT was strongly sought by our group in the talks on forming a Government. This is money from people's pockets on which they have already paid their tax. They give it voluntarily so we should not even dream of having VAT on those items.

There are 70,000 people seeking a home care package and 50,000 have been left without one. Any modern, self-respecting democracy would not allow this to continue. The budget for the HSE has grown to €16 billion this year and I am sure it will be well over that in next year's budget, but we get fewer outcomes and less ordinary service. The people we are discussing are the people who worked hard and tirelessly to educate their families and to do everything else over the decades. Now they are in ill health. That might be only around the corner for some of us. It could happen any day. We do not know. We are all approaching that era. There are also young people who are sick for different reasons. However, we cannot assist the enablers who do this work. Instead, we persecute them.

On the other hand, private agencies have been established. Somebody said that there are up to 50 private agencies. I did not think there were so many, but it is a large number. Many of them have been set up by former and retired HSE officials, which is a scandal. There should be a moratorium whereby when people leave the HSE or the public service, they cannot set up private businesses on the following day or have the business established before they leave. That is morally and financially bereft of decency and it must be stopped. It is happening in the planning area as well, whereby people are consultants before they leave and retire. We must break that cycle and the grip they have on the handlebars of power in this country. It is not allowing ordinary people to give solace and support to their families with a modicum of dignity.

They can see the money they can charge in this area from within the HSE. They can see there is manna from heaven if they set up such a company when they retire with their package. Home helps are paid €11 per hour at best. It could be €9 or €10 per hour for a few miserly hours. They might only be given 40 minutes and some have been cut down to 30 minutes. They would only have arrived in the house. These are not clinical people who just wish to get in and out. These people are interested and passionate. They have made a career of caring for people. They wish to come into the house, meet and greet, light the fire, cook the breakfast and do whatever necessary, delicate work is required, which many of us would not like to think about, with the patient or the people for whom they are caring. It is valuable work. We are continually cutting their hours and giving them so few hours that they are going around in a spin. We pay them €9 or €10 per hour, yet we pay up to €25 per hour to the private companies which, in turn, only pay up to a maximum of €11 per hour to their employees. Who is getting the rest? I am not a mathematician but I do not need to be to calculate that. It is going into the pockets of the many people who set up companies and who worked in the HSE. They failed the country when they were in the HSE and did not deliver. They were not public servants. Some of them have become self-serving.

There are many good officials and workers.

In particular, I salute the people on the ground, who include the community welfare officers and district nurses, but they are so busy with paperwork and regulations, of which we got more today from the Minister for Children and Youth Affairs, that they barely have time to see patients because they are writing report after report. I salute all those people and the managers of the home help service who do their best to distribute the little they have.

I will provide some figures relating to carers. Family carersprovide more than six million hours of unpaid care every week, saving the State approximately €4 billion annually according to the charity Family Carers Ireland. In an article in IrishHealth.com, Deborah Condon stated:

According to the charity, almost 200,000 family carers in Ireland provide 6,287,510 hours of unpaid care every week, ‘yet despite the enormity of this contribution, family carers are struggling'. It noted that since 2009, there has been a €2.7 billion cut in health and social care spending and this has led to a reduction in vital services, such as respite, home care and residential services.

The article went to state:

"Their work saves the State €4 billion each year. Despite this contribution, many carers find it more and more difficult to get respite and access services. Isolation, financial hardship, depression, stress, poor health and exclusion from paid work remain hallmarks of many carers' lives," explained Catherine Cox of Family Carers. She insisted that because of Ireland's ageing population, care in the home 'is one of the biggest health service issues facing the incoming government'. "We are asking politicians to commit to investing in and implementing real supports for family carers that fit with the realities of caring in Ireland today," she said.

This is the reality. We paid much homage to the carers' strategy for years. Another report is gathering dust, which is totally unacceptable. The Tipperary branch of Family Carers Ireland found that carers provide a staggering 256,120 hours of care per week. This breaks down to an average of 42.1 hours per carer per week. These statistics, which have been provided by the CSO, not the carers, serve only to confirm the heroic efforts that are being made each and every day of the week by the carers of County Tipperary. The findings also record that 7,041 people stated that they provided regular unpaid personal help for a friend or family member with a long-term illness, health problem or disability and that this comprised 4.4% of the county's population in April 2016. Of the carers in the county, 4,225, or 60%, were female while 2,816, or 40%, were male. What is deeply concerning, however, is the finding that there were 138 carers aged under 15 years. This demands immediate examination.

The Minister of State has accepted the motion. This is not good enough for us in the Rural Independent Group. We want this implemented. We are not going to wait like we waited since last November for the fair deal package. We want it done now. We will hold a press conference tomorrow on the plinth of Leinster House to announce this to fight for this vital support and some modicum of decency for these people in their homes. They are Trojan people.

I want to mention day care centres, of which there are many across my county from Carrick-on-Suir to Clonmel to Fethard to Cahir, Cashel and Tipperary town, Nenagh, Templemore and Thurles. The Government tried to screw them in the budget regarding VRT and the VAT they get back on their buses, buses which they need. The Government wants everyone to be out on a limb. The Government is made up of a callous and cold crowd. It should get the HSE by the scruff - the CEO, Tony O'Brien, and others - and bring them in to hold them to account. They are not serving the people. They are not looking after the ordinary people who need services. The Taoiseach had the cheek this morning to say that GPs should keep two patients a week out of accident and emergency departments. What is he going to do? They have no care at home. If we looked after them at home and enabled them to be kept at home, the accident and emergency departments would not be half as busy. There are more than 560 people on trolleys. Is that a modern Ireland for which the people of 1916 fought. I am almost finished and I appreciate the Ceann Comhairle's forbearance. Some of the other Deputies did not even bother to turn up to debate this. It is a very serious issue and those of us in the Rural Independent Group will not sit idly by and allow this to continue because it is outrageous and despicable. It is the worst treatment that sick people, young and old, get. Deputies Michael Collins and Michael Healy-Rae have to organise buses to Belfast to get operations to stop people going blind. Where is the Government's moral compass? It is lost in the sheets of paper files and the baggage in government. I hope the Government finds its compass, or someone needs to use a compass, to look after the people whom the Government was elected to look after.

In the passion of his contribution, the Deputy made reference to the chief executive of the HSE, Mr. Tony O'Brien. I am sure it was not the Deputy's intention to cast any personal aspersions on Mr. O'Brien.

No, he is the boss. He is the boss rather than the Minister so the Minister is only a puppet.

Lest we have any difficulty in the future-----

There will be no difficulty but he should sort out what is before him.

Question put and agreed to.
The Dáil adjourned at 10.45 p.m. until 10.30 a.m. on Wednesday, 13 December 2017.