Home Help Service Provision: Statements

I thank the House for raising this business. There has been much speculation and media attention in recent weeks asserting that there might be a cut in the funding available for home care. This is not the case and I am glad to have the opportunity to clarify the position.

Home supports enable older people to remain in their own homes and communities. They also facilitate the timely discharge from hospital. The Government has made improved access to home support services a priority. This is reflected in the ongoing additional investment made in these services in recent years, with the budget growing from €306 million in 2015 to almost €446 million in 2019. That is an increase of approximately 45% in the annual budget for home support. In 2018, the total budget for the service was €416.8 million, providing over 17.5 million hours. This year, the HSE intends to provide approximately 18.2 million home support hours, including intensive home care packages, to more than 53,000 people. In 2019, almost €30 million has been added to the home support budget. When one considers the year-on-year targets, this means that this year's national service plan targets the delivery of 800,000 more hours than the 2018 target.

Throughout the winter period, additional home support was provided, supporting early hospital discharges and preventing hospital admissions. Almost 1,100 clients were approved for new home supports nationally and 857 packages had commenced by the end of March 2019. Preliminary information for the end of April indicates that 52,571 people were in receipt of home support hours, including those in receipt of intensive home care packages. Between January and April, approximately 5.8 million hours were delivered, with 5,761 new clients commencing the service. This is 144,000 more hours than were delivered during the same period last year.

The allocation of funding for home supports, though significant, is finite and services must be delivered within the funding available. The home support service is not demand-led and is therefore operated in line with agreed budgetary limits and targets as set out in the HSE's national service plan. Services allocated to new clients and additional hours provided to existing clients are dependent on a number of factors, including the number of additional hours approved and funded each year, the hours that become available through recycling, the value of the service that becomes available for recycling and the value of the service required by the new or existing client.

To achieve compliance with its funding allocation, the HSE must ensure that the value of the total number of hours provided does not exceed the budget. This means that the HSE has to manage its service delivery over the course of the year to align with the total funding available. It also has a responsibility to ensure that activity is planned so as to anticipate critical demand pressures, most particularly in respect of emergency pressures in the initial and latter parts of the year. The significant roll-out of packages in the first quarter of the year reflected these requirements, with the HSE now managing the recycling of hours in line with normal prudent management of its budget, as it does every year.

It is not correct to say that no new clients will be allocated home supports for the next five months. The allocation of new hours will be based on clients' needs and the resources available, and the recycling of hours is ongoing in line with budgetary management. I acknowledge that, in some cases, accessing the service may take longer than we would like. Despite the significant level of provision, demand for home support continues to grow and 6,310 people have been assessed and are waiting for either new or additional services. However, the HSE has assured the Department that people on the waiting list are reviewed as funding becomes available so as to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front-line staff, who know and understand the clients' needs and who undertake regular reviews of those care needs to ensure that the services being provided remain appropriate.

While the home support service is delivering crucial support to many people across the country, the Government fully accepts that it needs to be further improved to meet the changing needs of our citizens better. It is for this reason that my Department is progressing the development of a new statutory scheme and system of regulation for home support services. The Sláintecare implementation strategy commits to the introduction of the new scheme in 2021.

The home help crisis is hitting the most vulnerable the hardest. After listening to the Minister of State, I do not believe that we are on the same page. However, I acknowledge his statement that the Government fully accepts that the service needs to be improved further to meet the changing needs of our citizens better.

It is cruel that so many people are waiting for home help hours to be allocated. The latest figures from the HSE reveal that 6,310 people were on waiting lists for home help services at the end of April. Currently, 53,000 people receive home care supports, but the figures show that one in ten people who need such supports are still waiting for them. Some of these people have very serious issues. In recent years, the number of people waiting for home help hours has increased significantly. Despite this, resources have failed to meet demand, leaving some services losing hours.

The recently announced restriction on new applications for home help services is appalling. This regressive decision will have many knock-on negative consequences for families, carers and the wider health services. The Government is saying on the one hand that it will facilitate people in growing old in their own homes while, on the other, it is restricting the means to do so. Will the Minister of State clarify the reason for the restrictions? Why will no new packages be sanctioned until November? Will home care packages be recycled in the interim? I am led to believe that new contracts have been signed with home support workers. This means that they are now entitled to four hours of travel for every 39 hours worked. Is this the reason for these savage cuts? Must that money be found from the same pot? That is what I am being told. The Minister of State must clarify how many people will be affected by the proposed cuts, given that any reduction in hours will undoubtedly push an already stretched service to the brink.

Will the Minister of State also explain why some community healthcare organisations, CHOs, have no one waiting while other areas are performing badly? If no one is waiting in a certain area, why do other areas not reflect that model? Is this a case of bad management or a lack of funding? Is it simply that a person is receiving one hour of a service when he or she actually requires seven and is classified as having his or her care needs met? We need to tease out this crucial point.

It is important to remember that we are an ageing nation and we should celebrate the fact that we are living longer, can spend more time with our families and friends, contribute to society in our retirement years and get involved in our communities. The warning signs are present, though, and we are not heeding them. We are not planning for the fact that, over the next 30 years, the number of people in Ireland over the age of 65 years will double and the number over the age of 85 years will quadruple. People want to live at home for as long as possible with the correct wrap-around supports. Home care support packages enable them to do that. For some older people, the assistant might be the only person they see all day.

Despite the increase in life expectancy, the incidence of chronic illness is on the rise. As such, people will have to be cared for in their own homes if we are to relieve the pressure on the acute hospital network. Real progress in meeting the challenge of home care must be made. It is the preferred option for older people. It is well acknowledged that care based around the home is vital for keeping people active in their own communities, which in turn has significant health benefits.

Families across the country are angry. They are frustrated by Fine Gael's approach to home help. Instead of allowing people to live and be cared for in their own homes, Fine Gael is forcing them into nursing homes and hospitals. This, in turn, is increasing the strain on our hospital system, which is already overburdened. I have met many family members who are at the end of their tether. They are deeply concerned that their loved ones will not get the care they need. This deeply distressing situation for them simply should not be happening. Home help services are essential. They must be maintained and increased. Any move to reduce home help hours further cannot be countenanced. Measures must be taken to ensure home helps are protected into the future. This is a crisis. Last year, 50,500 people received support and 6,000 people were waiting. This year, 53,000 people are receiving support and 6,310 people are waiting. The figures simply do not stack up. The increase in hours this year is not having an impact on those who are waiting. Many people in acute hospital beds are waiting to be discharged. Many people in nursing homes do not need to be there. Many people in their own homes are not receiving the care they require. The situation is at crisis point. I do not say that lightly. Family carers are at breaking point.

I remind Deputies that following their five-minute contributions, we will move on to six-minute question and answer slots during which they will be able to ask the Minister of State questions. Hopefully he will be able to answer those questions.

The Minister of State spoke in praise of home helps and acknowledged the great work they do. I do not know if I could appeal to his heart, so I might try appealing to his head. The home help service represents good value for money because it is a cost-effective way of keeping people out of hospital, which is an expensive place for them to be. We have learned in recent weeks that the HSE has, in effect, suspended the allocation and recycling of home help hours. I do not know whether the Minister of State's office has issued an instruction that home help hours should not be given out. Perhaps a budgetary constraint means that no home help hours will be recycled or reallocated. The net effect is the same for the person in the hospital bed or for the woman - let us face it that it is usually a woman - who has to tell her boss that unfortunately she must reduce her hours to look after her mother. Her mother may have been written up for a number of home help hours, but those hours are not yet available.

Regardless of whether this cut results from a letter signed by the Minister of State or from a budgetary constraint, the net effect of the impact on those affected is the same. They are not getting the home help they need even though they have been told they need it and are entitled to it. That is where the 6,000 people are waiting. I would say that even more people are in a queue to be assessed. When they are assessed, they will probably be found to need home help. This is having a massive effect on broader society by virtue of the fact that the gap has to be plugged. If someone needs home help to be able to stay in his or her house, that need does not go away purely and simply because of a budgetary constraint. That need is still there and that gap is being plugged somehow. The person is either going without the care or is in hospital inappropriately when he or she could be at home, or somebody within the family is shouldering the burden. That is how it happens. The need does not disappear purely and simply because there is a budgetary issue.

I have heard the Minister of State talking about increasing the funding and the hours, but the current approach is just not meeting the need that exists. It is a false economy because people ultimately end up back in hospital. I have seen it in my own family. I am sure Deputies have seen it in their clinics. I have seen it in my clinics as people come in and out. The net effect is that families have to provide unpaid care, people are left stuck in hospital, or patients who want to be at home are stuck in nursing homes. I cannot imagine what it would be like to have worked all my life and paid PRSI in the belief that I was making contingency for my later years, only to find as an older person that I cannot remain in my own home where I would be happy purely and simply because of a budgetary constraint. I fully accept that the amount of money being spent has increased. The fact that 6,000 people are waiting shows that it is not enough. Some of those who are waiting are waiting in very expensive places. We mean it when we say this is a false economy. It is a case of being penny wise and pound foolish.

The increase in the number of people who are living longer should be something we celebrate. I hope to be one of those people. I have been around for a while and I would like to be around for a lot longer. We should be celebrating that. We should not be requiring people to spend their later years at home without the care they need, or in a nursing home when they do not want to be there. The real measure of the performance here is not in the facts and figures, and the 1% of this and the 5% of that. The Minister of State has quoted all the statistics. The real measure is the 6,000 people who are waiting, 600 of whom live in my constituency, because they are at the business end of this. What do I say to their family members when they come into my clinics in Swords, Lusk and Balbriggan? Am I supposed to tell them to wait? If I say I am sorry that their mothers and fathers cannot be discharged from hospital due to a budgetary constraint, they will ask whether it is not more expensive for their mothers and fathers to be in hospital. The simple answer is that it is more expensive for them to be in hospital. We all know cases of people who cannot leave hospital because they cannot get the home help hours. I am not disputing that more money is being spent, but it is being spent on private providers. It is not giving the best value for money. All the while, the Minister of State is ignoring the possibility of directly employed home helps increasing their hours and making a real contribution to alleviating the budgetary constraints he has mentioned.

The crisis we are discussing was readily predictable. Ireland, like other countries across Europe, is experiencing a rapid demographic change as our population ages. This ageing is set to increase over the coming decades. Since 2006, there has been a 36% increase in our elderly population. The number of people with disabilities has increased by approximately 63%. Consequently, the old-age dependency ratio is increasing, particularly in rural Ireland, as the Minister of State knows. This is leading to a greater demand for home help hours. We can secure a huge return on the resources we expend in this important area. In 2017, an ESRI report highlighted that the anticipated demand for home help hours will increase by between 38% and 58% by 2030, which represents a massive upsurge. It is estimated that by then, one in five people will be a care provider in the home environment, which will represent an increase on the current figure of one in ten. How can we expect to meet the future demand for services when we cannot meet the current demand?

We are all acutely aware of the need to achieve value for money in public expenditure. That has to be done. The substantial cost-benefit return from money expended in this area is an absolute no-brainer. Given the significant growth in demand and the pressure of an ageing population, it is clear that we need to maximise the efficiency of current resources. The Labour Party believes that home care services are valuable in supporting older people to remain in their own homes and stay connected to their own communities. The availability of home help relieves the burden on acute hospitals and allows people who are hospitalised to return home. This was a central theme in a report prepared by the Joint Committee on Social and Family Affairs when I served as its Chairman in the early 2000s. I authored the report in question. It is ridiculous that people who require home help are taking up acute hospital beds while those who need emergency care are forced to sleep in corridors. It is a clear issue. I read about the case of a 92 year old man who spent 70 days in hospital, due to the non-availability of home care help, even though he had been fit for discharge after ten or 12 days. It must be a priority of the Government to take people who require home care out of the acute hospital service. As my colleague, Deputy Kelly, highlighted some time ago, if the Government is serious about the effective and efficient use of hospital resources, including expensive acute beds, home care packages need to play a central role in its plans.

Likewise, there is an imbalance in the provision of nursing home case instead of home care. The Government currently spends more than twice as much on nursing care than it does on home care. Approximately €408 is being spent on care, whereas the average contribution to the fair deal is €824, which is some imbalance. I salute the efforts that were made yesterday with regard to the fair deal. We pay just €219 in respect of carer's allowance. I know everything about this because I wrote a report on it. The payment of €219 is €16 more than the basic rate of social welfare. The care provided within the home is costing us approximately €2.70 an hour. This is never factored into the equation.

Compared to the average contribution of €824, one can see the tremendous value the State gets for the meagre children's care allowance that is given to people. It is critical to abolish the means test for the carers allowance. It would give huge relief as it would be €119 versus €824 and it is a no-brainer. It is one quarter of the cost. I do not blame the Minister because I know he has a heart but no Government thinks. Every Government has silos in Departments, there is no cross-referencing and one hand does not know what the other is doing. If the Government thought about the situation, it would abolish the means test for carers allowance. There are 81,000 people who get it but we have 350,000 people in the State providing care at home, some 25,000 of whom are young, and we have ignored this. Denmark has successfully moved from an over-reliance on nursing home care to more holistic home care and it has had sheltered housing models since the early 1990s. All Danish citizens are now eligible for home help and home care, including round-the-clock care. The critical thing is that this is on the basis of need, rather than means. We should give more consideration to this model by giving it to a committee to consider.

We need the right mixture of organising and providing home care but it is clear that keeping people in their own homes is among the most efficient models. The reality, however, is that the bulk of care that enables people to live at home is provided by informal carers, usually loved ones and friends. One in ten adults, equating to 350,000 people, provide this invaluable service to the State but we had 6,310 people on the nationwide waiting list for a home help service at the end of April. The HSE has all but closed the home help scheme for the short term as it does not have the staff to deal with the demand.

Deputy Kenny is sharing with Deputy Mick Barry.

I speak not as a politician or an activist but as a carer. I was a carer for 15 years before I came into this place and worked as a home care worker for ten years. The service is vital for the family and the client. It has a huge place in primary care and in a health service and the announcement of what is almost a moratorium on home care hours is very unfortunate. This will be detrimental to people who get the service at the moment and to the 6,000 people who are waiting on home care packages and are in vital need. They are coming out of hospitals and need care to stay away from hospitals.

The Minister spoke about putting home care on a statutory footing, which would be good. It would mean people were entitled to a certain number of hours of home care per week under the law of the State. A patchwork of private companies run home care at the moment, which is something I have a problem with because it is disjointed. If we were to put the service on a statutory footing it would be beneficial for the client, the patient, who is the most important person, their family and the workers. I would be grateful if the Minister would say what he means by putting the community care provision on a statutory footing.

Many home care workers are not unionised and are underpaid. A home care worker will probably earn about €10.50 per hour, while a private company charges the HSE double that amount. They make huge amounts of money out of HSE contracts and this needs to be looked at.

What is the Minister of State doing? What is going on on his watch? Home help allocations have been effectively frozen and, despite the Minister trying to spin it otherwise, home help hours have also been effectively frozen. Was this the decision of the Minister of State or was it the decision of a bureaucrat in the HSE, to which he did not object? The Minister of State has responsibility for older people but does he think there are many old or sick people, who are suffering and in need of care, who will agree with this policy? One would be hard put to find a half dozen ordinary people who would agree with it.

Is the Minister of State going to back down or is he going to be stubborn and stand over the policy being debated tonight? Is he going to defend the indefensible or will he back down? I call on him to back down on the freeze in home help allocations and hours. It is a disgraceful decision and if the Minister stands over it, he is a disgrace. He should back down as we need more home helps, not fewer. There are more than 6,000 people on waiting lists and there are delays to people being discharged from hospitals and nursing homes, which tells us we need more home helps and not fewer. The Sláintecare report, informed by a whole range of expert opinion, told us we needed more home helps and not fewer. The Minister needs to back down from this crazy policy.

I also wish to ask about plans to put this on a statutory footing. That is fine but the Minister told the Irish Examiner last week that this would probably involve some form of co-payment. There has never been charge for the home help service and it needs to be kept free of charge. The Minister should take his hands off the home help service and remove the plans to bring in charges. If he tries to go down that road there will be a storm of opposition. He should report back to the Taoiseach and Ministers with this message.

Fine Gael must be living in a parallel universe when the Taoiseach says that additional funding has been provided in the budget for home help hours, while cuts have been announced in the form of a suspension of all approvals to home help applications. The HSE has suspended home help hours and new applications, despite there being more than 6,000 people on the waiting list for home care support. What a sorry state of affairs it is that this is happening during carers' week, when we recognise the Trojan contribution carers make to people. The HSE confirmed that it is to block new applications between now and early November to balance the budget for this year and this is, no doubt, directly related to the constant health overspend, since Fine Gael came to power and before that too. However, the irony is that stopping funding home help for six months will only exacerbate the problem at the other end. The Minister knows this but insists on doing it because the Government constantly states that it has a budget figure and that is that.

One has to spend money to save money and this health service will never work if it does not realise this. At the current rate, numbers are set to increase as demand for services increases and the population ages. The crux of the problem remains a lack of HSE funding to meet current and growing demand for home help hours. The Government is just delaying the inevitable and is, in fact, making it worse. The number waiting for home help hours in Donegal has doubled from last year. Figures from the HSE show that there were 215 clients waiting for home help in Donegal as of January 2019, an increase of 116 on last year. Numbers have been steadily increasing year on year. In December 2016 there were 139 people waiting for home help hour approvals while, in October 2017, there were 340. There are patients lying in hospital in Letterkenny, costing about €8,000 per week while they could be in the community, getting home help hours for maybe €100 per week.

The problem is that no money is saved in that situation. More money is actually spent because as soon as the bed in the hospital becomes free somebody else takes it up and money must be spent treating him or her. Money is actually saved by keeping beds in hospitals blocked up. That is how the HSE is saving the money. That is the only way in which it can be saved. If that bed stays occupied nobody can get into it and, therefore, money does not need to be spent on treatment. Money also does not need to be spent on home help for the person who leaves the bed and the hospital. That is how the money is saved. That is sad because it means we can never get past this situation. This kind of debate will happen every year from now into the future if it is all going to be based on money alone. We in this House need to get over that and to accept that it will cost more to deal with the health service and to get it right. Initially it will cost more to get it right. That is the problem. That is where we are going to be stuck. If we get people through the hospitals and provide them with proper home help as they live in their communities, we will start to see things easing off on the hospital side. Funding pressures on hospitals will drop and money will start to be saved.

The real reason that home help causes problems and is a difficulty is because it cannot be privatised. If the Government and the HSE could figure out a way to give the private sector balls of money to look after home help this would be sorted out in the morning. That is the ultimate problem; that is what is wrong. The Government cannot see a way to privatise it and that is why home help is not being provided. That is sad because it is the cheapest and best form of care. It is what the people in the communities and the families want. Everybody wants it but the Government cannot grasp that and will not provide it.

The HSE in Donegal has a crazy system under which it says it cannot get people to work in home help. It offers a ten-hour contract for the week. For half of what one would get on the dole one can get a contract with the HSE. One cannot sign on because the hours are spread out over the course of the week, so it is a waste of time and the HSE cannot get anybody to do it. If the HSE offered a 20-hour contract people could make a living. They could get family income supplement to make up the difference. They could get a wage and come off the dole. It would be to people's advantage to take up such a contract and to provide the home help but the HSE will not offer it because the money would have to be increased. If the money could be given to the private sector it would be done in the morning. That is the sad thing.

The Minister of State has previously indicated that there will be home support services for 53,000 people. Last year the budget was for 52,500 people. At the same time there were between 6,000 and 7,000 people on waiting lists. If the 52,500 is added to the 6,500, some 59,000 people were looking for home support services at any given time, meaning that providing service for 53,000 will not be anywhere near enough to meet existing need. I do not have to tell the Minister of State that. In a survey it was found that the carers of Tipperary provide a staggering 256,120 hours of care per week. This breaks down to an average of 42.1 hours of care per carer per week. These statistics, which are not my own but which have been provided by the Central Statistics Office, only serve to confirm that heroic efforts are being made each and every day of the week by the carers of County Tipperary. The findings also record that 7,041 stated they provide regular unpaid personal help for a friend or family member with a long-term illness, health problem or disability. This figure comprises 4.4% of the county's population in 2016. Of the carers in the county, 4,225, 60%, were female, and 2,816, 40%, were male. What is deeply concerning is the finding that there are 138 carers aged under 15 years. This situation is appalling. The statistics demonstrate the clear need for the Government to prioritise and fully resource carers' needs and to ensure that they are provided with every level of assistance. When a sector of our society is providing more than 250,000 hours of care every week, it is clear that a lot of work badly needs to be done.

During my contribution to my first Leaders' Questions with then Taoiseach, Deputy Enda Kenny, in March 2016, I spoke of the major shortfalls in our home help service. In spite of promises made by the Taoiseach at that time, nothing has really happened. During negotiations on the programme for Government, in which I was very much involved, discussions took place about providing a seven-day-a-week service. At that time we were promised that this would be provided but the only thing our elderly people can be assured of today is that many of them will receive no service seven days a week. Why is it that this Government will no longer take on new patients? We have to get a very clear answer because we have been advised by this Government all along that patients should be cared for at home. It is now turning its back on people and does not want to bring them home. Why has the HSE instructed district nurses to cut existing hours? Are the allocations of those who receive 20 or 30 minutes going to be cut to five, ten or 15 minutes?

I ask the Minister of State to stop mocking the people who roll out the service and work on the ground. He continuously says that we cannot get people. Has he talked to anyone who provides home help in west Cork? They are crying out for more hours. It is like he is mocking them. They are absolutely furious with him for saying that. I will step back from that as maybe people cannot be got in some other county, but it is certainly not an issue in west Cork. The people rolling out this excellent service are crying out for more hours but the HSE and the Minister of State's Government will not give them.

It is shameful that approximately 600 people in Laois-Offaly alone are waiting for home help and home care packages. On Monday I attended a meeting in Mullingar which was organised by the Carers Association. I spoke to many carers and to people who are just fed up. Many of the carers to whom I spoke are caring not only for one family member, but for a number of them. They are at their wits' end. They are frustrated. In addition to this issue, there are people with disabilities who are not getting fair allocations of home help hours. It is appalling that again it is the most vulnerable who are not being supported and who are being abandoned by this Government. The freeze on home help hours is absolutely unacceptable. Our carers save this State billions of euro every year. The Minister of State knows that. It makes good economic sense to ensure that people are given a fair chance and a fair allocation of home help hours. I call on the Minister of State to make sure that happens and to end the postcode lottery with regard to access to home help hours and home care packages which exists in some regions, of which Laois-Offaly is one of the worst examples in the State.

Here we go again. We were at this point at this stage last year. There was a crisis in home care then and here we are again with another such crisis. What part of home care and community services does the Minister of State not understand? Does he not understand that the best way to provide care for older people is in their own homes? They are happiest there. It is widely recognised that they do best from a health perspective when they are in their own homes. The Minister of State, however, does not seem to have got that message, nor does his senior Minister.

This was outlined very clearly in Sláintecare. The whole thrust of the Sláintecare approach is to ensure that services are provided locally, as close to home as possible. Nowhere is that more true than in respect of services for older people. Nowhere is that more true than in respect of what gets good health outcomes and what represents best value for money with regard to services for older people. At any one time there are now more than 600 people in acute hospital beds who should not be there, who have finished their acute period of care, and who are ready to go to a step-down facility or to go home. They cannot do that however, because there is no funding for it.

The Minister of State should look at the economics of this situation. An average home care package costs €160 per week. The average nursing home costs approximately €1,100 to €1,200 per week. The average acute hospital bed costs in excess of €7,000 per week. This is not rocket science. It is about doing the things that make sense and which achieve the best health outcomes, which ensure people are happiest, and which save money at the same time. Why is it that the Minister of State is not doing this? Let us look at the 600 people who are in acute hospital beds. Deputy Pringle spelt out very clearly why this is allowed to continue; it is because savings are made in hospitals.

Consultants do not need to do operations if beds are taken up by people who are just there on a bed-and-breakfast basis, but the Minister of State will not challenge that and grasp that nettle.

At any one time more than 6,000 people, who are in their own homes and have been approved for a set number of hours of home care even though the bar is set quite high, are on a waiting list. That makes no sense on any level and it is about time the Minister of State sorted out the problem.

Stopping the home help service for the next five months is genuinely shocking and it proves again, if proof were needed, that the Government is out of touch with the real world. A total of 6,310 people are waiting for a home help service and what do we do? We stop the service for five months. It is unbelievable. One would wonder if this is a Third World country. Of course, we are far from it; we are the eighth richest country in the world.

As everybody knows the best place for elderly people is in their own home. It is best from their own point of view, from a social point of view and from a medical-treatment point of view. Home is the place where old people should be. The home help service is a value for money service. Stopping the service is a false economy and will put more pressure on acute hospital and nursing home beds. As Deputy Shortall said, it will cost an enormous amount to keep elderly people in general hospital beds - €7,000 per bed or €1,200 in a nursing home - whereas the average home help service will cost at most €150 or €160 a week. This is madness. I am shocked that the Minister of State would accept this from the HSE. I ask him to get this turned around quickly because this is pure and utter madness.

With the agreement of the House, I propose to give two minutes to Deputy Naughten, who is not aligned. Is that agreed? Agreed.

I thank the Leas-Cheann Comhairle. The maths do not add up when it comes to the HSE home help cuts. Government funding in the budget and the HSE's service plan commit to 50,000 home help hours every day in 2019. However, the decision by the HSE to suspend the allocation of home help hours to older people and their carers for the next five months contradicts this and the all-party Sláintecare report on the reform of the health service.

Government policy and Dáil Éireann are at complete variance with the policy actions taken by the HSE. The Taoiseach advised today that the Minister of State, Deputy Jim Daly, will not meet the HSE managers until next week. The HSE is completely unaccountable and makes up its own policy. This has to stop and the first step is to reverse these cuts immediately. The HSE suggests it will be able to pay home help workers for their time travelling between the homes of older people and still deliver the 50,000 home help hours committed to in its service plan from within the existing allocated budget. This just does not add up.

While the home help budget has increased by 50% since the Government was formed, and rightly so, we have not seen a 50% increase in home help hours. Where has this money gone? According to the Taoiseach, it is not as a result of an increase in the older population or an increase in wages to home help workers. What has happened to the money? Clearly, the maths do not add up and older people are suffering as a result.

The decision by the HSE will trap carers in their homes and leave them unable to access a break from the 24-7 care they provide. It will result in families having no choice but to admit older people to long-term nursing home care.

I thank the Deputy for observing the time. As per the order of the House, we have questions to the Minister of State, starting with three Fianna Fáil Members. I call Deputy Butler, followed by Deputies Rabbitte and O'Rourke.

As the Minister of State will be aware, the home support workers have signed a new contract meaning they will be on a five-over-seven-day rotation to provide home care support. I welcome this and have always supported it. However, issues have already arisen as the HSE does not seem to have an IT system to allow the different CHOs to deal with rostering. Is the Minister of State aware of the issue and does he have plans to solve it?

As I said in my opening statement, for the workers who have signed the new contract, anyone who works 39 hours is entitled to four hours' travel. This funding needs to be found under money allocated already, which is why these savage cuts are happening. Does the Minister of State have any plans to address this?

The rostering arrangements pose a challenge to the HSE. It does not have the IT systems it should have in an ideal world to manage that aspect of it. Putting it in now while we are devising a new scheme will not happen and so they will need to make do with what they have for the remainder of this scheme, which is a year and a half or two years. I want to meet the CHO leaders to hear how they plan to deal with the data capturing element of it and counting the miles. As the Deputy mentioned, a generic approach is currently being taken under which each person receives a couple of hours in mileage irrespective of the mileage they are doing.

The Deputy also asked me about the costs involved. As I outlined, 18 million hours have been funded this year and I expect the HSE to deliver 18 million hours. Any additional costs incurred on travel and so on will need to be funded from alternative sources within the HSE, but not from the 18 million front-line home help hours to be delivered in line with the national service plan agreed with the HSE at the beginning of the year. I expect it to honour that.

We all know the HSE is having a major problem with recruitment to the sector. What will the Government do on training and education? Will it roll out apprenticeship programmes? This will be a never-ending story. Would it not be better if the HSE recruited and trained staff in order that we could provide the service at a cost of €14 or €15 an hour as opposed to outsourcing it at a cost of €25 an hour?

On the four hours, many HSE workers are only working four to five hours a day. How is it proposed to calculate their time for mileage? Will it be over two weeks or something like that?

Recruitment and training pose a very serious challenge for us. There is a shortage of people and we are finding it difficult to attract qualified personnel into the sector. Under Sláintecare, we have committed to have a new scheme by 2021. I have committed to unveil the design of that scheme and answer all these questions in January 2020, six months from now. When I came to office, we carried out extensive consultation involving academics. We also looked abroad at best international practice.

We continue to do in the background considerable work to create a new system in its entirety, guaranteed by statute, mirrored on the fair deal scheme which would guarantee delivery for those who need it. As I have said previously, if I tried to fix it piece by piece, I or my successor would spend the next ten years struggling and trying to react to the issues. We want to introduce an entirely new scheme with training and recruitment as part of that.

It is up to the CHO management to deal with the issue of the hours individually and, working through the unions representing the home help workers, reach an agreement that is acceptable. I take the Deputy's point that someone doing four hours' work will not be paid for four hours' travel. I will tease that issue out with the HSE next week to get further information. A number of local arrangements are being made.

My Kildare North constituency is covered by CHO 7, Kildare-west Wicklow, where 326 people are waiting for a home care package. In Dún Laoghaire, covered by CHO 6, no one is waiting for a home care package.

Why is that the case? Is it down to management, funding or both? Why is the model used in CHO 6 not rolled out to all areas where there are significant waiting lists such as CHO 7?

On hospital discharges, a patient who needs home care will be discharged with a medical team's recommendations, to be implemented by the HSE home care team. Instead of implementation, there is challenge. We get this feedback in the constituency. The recommendations are challenged by the HSE home care team, which leads to delayed discharge and results in the patient being stressed and bed blocking. Can this process be looked into and reviewed?

There were more people waiting for a home help this time last year than this year. That is neither here nor there, but when people talk about-----

How does the Minister of State know?

Because I have the figures.

The Minister of State should answer the questions put by Deputy O'Rourke.

I will. I am quite happy to do so. I would prefer if I could answer one question at a time without interruption.

The figure is just a fact concerning the crisis about which everybody is talking. I am not proud that there are 6,000 people unhappy and waiting, but there were more waiting this time last year. However, that is not the point I wanted to make. To answer the Deputy's question, the difference between CHOs is multifactorial. The management approach is part of it. There is a demographic aspect; there are historical reasons and there is the issue of the availability of staff. Myriad reasons can affect demand and supply. I am anxious to engage with the nine CHOs together to identify some shared practices for dealing with this issue.

Every hospital and home help allocator has been notified that priority is to be given to hospital discharges. It is one of the top three priorities. A person waiting to get out of hospital is prioritised over somebody at home, if required, for available resources. There is tiering in the arrangement.

CHO managers-----

No. We have to move on.

That is not happening in practice. The recommendations are being challenged.

I, too, would appreciate being allowed to speak without interruption.

The Minister of State said there would be 800,000 more hours delivered than in 2018. Later he stated that between January and April, the additionality was actually 144,000 hours. That leaves a figure of 342,000 hours for the year. I am multiplying the figure for four months by three. That leaves us very short of the 800,000 hours target. It is less than half. On the basis that there is a freeze, regardless of how we want to word it and from where the instruction came, there are no hours being added and people are being told that they will have to wait. There will be nothing extra until November. Is it the plan that hundreds of thousands of hours - 458,000 hours - will be delivered between November and December? How does the Minister of State plan on hitting the target of 800,000?

First, there is no freeze in the allocation of home help hours. In my CHO which covers counties Cork and Kerry 1,200 additional hours are being allocated month on month. I hear this confirmed by every other CHO leader or manager. My understanding from the HSE nationally is that there is absolutely no freeze. I do not know how many times I can say it. A number of Members have said there are hours being cut from those who have hours. That is absolutely untrue. There are no hours being taken from anybody who has them.

That is rubbish.

The Deputy will get an opportunity to contribute.

The Deputy will have his chance. He can roar away at me all he likes. Why is he roaring?

I am not roaring; I am stating the facts.

The Minister of State to continue, without interruption.

If the House does not want to hear what I have to say, I will sit down and Members can talk away.

Deputies either want to hear or they do not. I have as much a vested interest in getting this right as anybody else in this House and I have as much desire to do so. I am a practising politician on the ground who has the same experience as everybody else in this Chamber. I am here in a collaborative spirit. I will give the Deputy what information I can and I am open to suggestions and constructive criticism. I have no problem with that, but at least let me say what I want to say.

On a point of order-----

There is no point of order. It is not a point of order.

On a point of order-----

There is no point of order. We must use the time as ordered.

This is my time.

I wish to be fair to the Deputy. I did not answer her question.

If there is a point of order, Deputy Mattie McGrath should tell me what the relevant Standing Order is.

On Deputy O'Reilly's question about the allocation of hours,140,000 additional hours have been allocated in the first three or four months of the year. There is a target of 800,000 additional hours for the entire year. It is up to the HSE to decide how to allocate and decide where it will prioritise allocation. Obviously, there would be the optimum allocation for the winter months. The HSE may well keep a large portion of the hours for the winter months when the pressure is on hospitals and emergency departments. I do not have any control over how it allocates the 800,000 additional hours. All I did was give it the cheque to pay for them.

That does not add up. I did not come here just to shout and roar; I actually came to get an answer. The Minister of State's remark does not make any logical sense to me. The HSE will deliver only 342,000 additional hours for the whole year based on what is happening. It is all going to be allocated towards the end of the year, which just does not make any sense. The Minister of State and I know that, when it comes to the end of the year, the HSE will just not have the money. The Taoiseach said he was not aware that home helps kept people in their homes and out of hospitals, but the Minister of State says home supports enable older people to remain in their homes and communities, as well as facilitating timely discharge from hospital. Who is right?

On the first question, the Deputy said 242,000 hours were allocated in the first few months of the year. There are 800,000 for the entire year. If there were to be a freeze until November, as everybody is trying to suggest, there would be an unmerciful drive to try to allocate 500,000 home help hours between November and December. What the Deputy is saying does not make any sense. There are 800,000 additional hours. There is a total of 18 million hours for the entire year. A freeze between now and November would mean that there would be 15 million hours to be used in November and December. What the Deputy is saying does not make any sense. She can ask the Taoiseach if she has any issue with anything he said. I do not speak for him.

I will take that as the Minister of State not agreeing with the Taoiseach.

I am sorry, but I would prefer if the Deputy did not put words in my mouth.

I am sorry. I withdraw that remark.

The Minister of State must observe the same rules as others.

I am happy to do so, but I do not want to be misquoted.

Based on the figures the Minister of State gave us, the average cost of home help per hour is €23.80. I know because I used to represent the staff that the cost of a directly employed HSE home help is between €13 and €16 per hour. The last time Fianna Fáil was in government, I remember well marching for decency for home help workers. I welcome the party's conversion. The rate is €16 per hour if everything, including holidays, is factored in. How can the Minister of State explain the figure of €23.80? Does he agree that directly employed home helps represent the absolute best value for money? Every single shilling spent is spent directly on home care, rather than the big corporate entities to which the money is being funnelled. These entities are in it to make a profit. The HSE does not have the profit imperative, nor do the not-for-profit bodies, the motive of which is to deliver care. Every cent goes into delivering that care. Does the Minister of State agree that directly employed or voluntary staff are better value for money?

The opposite argument is made about residential care. Some 80% of those in residential care are minded in private nursing homes. They argue that they achieve far better value for money than the HSE. There will be a report making its way to my desk on that very issue very shortly. One could argue the toss all day on the issue of public versus private, but the HSE will use private staff when it does not have staff. I am quite happy with it taking on a private service to provide care if it does not have the staff to provide it. The idea of having a new statutory scheme is that we would have ample staff in the right locations available to deliver the service. That is our ambition. Whether we will achieve it, I do not know. We may always rely on the private sector, but I am not going to denigrate the private contribution to the care of the elderly when 80% of residents in nursing homes are cared for in private nursing homes.

As the Minister of State is aware, care work, whether provided by a loved one or a public or private service, is labour intensive, both physically and mentally. Carers, like everyone, need and deserve respite from time to time. It is critical. Anything that is perceived as a stalling of the provision of additional home help hours will have a considerably detrimental effect on carers. It is inextricably linked with them. Is the Minister of State aware that there is a report on the physical, mental and psychological impact of caring which was prepared by Family Carers Ireland, the College of Psychiatrists of Ireland and the UCD School of Nursing, Midwifery and Health Systems? It states one in every three carers in Ireland is now suffering from depression. Two in every three family carers provide more than 100 hours of care each week. Respite care services are not available to 70% of the nation's carers. The proportion was 43% in 2009. Is there a need, therefore, to provide a statutory entitlement to publicly funded home care, rather than making provision on an arbitrary or ad hoc basis, or on a postcode lottery basis, which has resulted in unfair regional imbalances in provision?

If we deal with the situation with a statutory framework, it underpins the provision of same and takes it out of the discretionary allocation. What is the Minister of State's view on that?

I could not agree with any contribution from any Deputy more than I agree with that last contribution. That is, of course, why we want the delivery of a statutory home care scheme underpinned by statute and guaranteed. That is why I have undertaken that project which began two years ago. As I said previously, it took nine years to bring the fair deal scheme from concept to reality. I have committed to doing this within three years whether I am there to finish it or not and whoever is there will hopefully get it across the line within three years. That is absolutely the preferred model and the only way we will eliminate all of the ills within the current system which is ad hoc, not fully funded, based on a postcode lottery, dependent on the availability of staff and has variables the length and breadth of the country and so on and so forth, as many Deputies know.

There is obviously a recruitment issue in general and many choose to leave the sector to go elsewhere for better pay and conditions, as Deputy Gino Kenny said. Of course, part of the problem is that, similar to the childcare sector, private companies that are providing home care in this country are resistant to working with people who are represented by a union. That is one of the clear issues.

I have always believed in public provision. St. Mary's Hospital in Mullingar provided the very best hospital service and it was closed. I often wonder about HIQA and the way in which it restricted those public provision homes and virtually closed it out and curtailed the numbers.

There has been a vicious cycle of poor pay and conditions which has led to a high turnover rate. We need to stop passing the buck and placing responsibility on individual carers and unions. Would the Minister of State be in favour of a registered agreement being put in place to ensure better pay and conditions for those in the sector? The Minister for Employment Affairs and Social Protection and the Minister for Health, Deputies Regina Doherty and Simon Harris, would help the Minister of State because I know that is not totally his area.

The Deputy has rightly pointed out that much of that is not in my area. We have obviously identified that, in our ambition to have a statutory scheme, the only way that one can attract the quality and supply of staff required is to ensure that there are good conditions attaching to it, good standards and protections for staff. That has all been readily identified in our approach to developing the statutory care and has been outlined in our ambition for same.

What if the 300,000 carers across the country downed tools in the morning? We have problems in accident and emergency departments and in the provision of acute hospital beds. If every one of them brought their loved ones into the hospital environment and abandoned their work in the morning, the country would collapse.

In that context, could the Minister of State raise the following matter at Cabinet level? We should abolish the means test for carer's allowance and increase the 15 hours' employment that they are allowed to work outside the home to 18.5 hours. I know that if that was increased to 19 hours, there would be issues with working family payments. The carers want 18.5 hours. That would be a sensible way to provide additional care within the home environment. It is naked exploitation. Some family members of my own did it but they are all willing to do extra.

The figures are €219 carer's allowance versus the €1,200 Deputy Shortall mentioned as the weekly cost of a nursing home versus €824 which is the average fair deal. Excluding the 80% income and the proportion of the assets, €824 is the precise average fair deal across the country. Let us abolish the means and, for 25% of the cost, more people can be kept within their home environment, where they want to be and where they are happiest.

There is an opportunity for the Minister of State in the forthcoming budget to make a name for himself. He should abolish that means test because that is what the 355,000 carers want. There will be fewer problems. There will be additional home help and the Government will save multiple millions.

I am happy to accept the Deputy's request that I put that forward at budget time.

I want to hit one nail on the head. There can be no comparison, as has been made, between the €240 per week for home care, €1,200 per week for a nursing home and €7,000 per week for an acute hospital bed. It does not make any sense and I am surprised at some of the Deputies who have offered those figures because I thought they would have understood better. Somebody who goes into a nursing home must have a full-time care need - that is, 24 hours a day nursing care with carers on duty 24 hours a day. It would probably be cheaper if that was to be provided in the family home. There would be 24 hours a day nursing care for the person in their home and maybe two carers on duty to take them out and wash them. That would likely cost €700, €800, €900 or €1,000 a week. Let us not mix up those particular sums. I want to make that point though it does not take away from any of Deputy Penrose's submission.

We have a restriction of home help allocations until November. We can debate the extent of the restriction. What was the Minister of State's part in the decision-making process? Was the decision made by someone in the HSE? Was it made by the Minister of State? If the decision was made by a person in the HSE, did that person inform the Minister of State of it? When did he or she inform him and what did he say?

The Minister of State was quoted in the Irish Examiner last week as saying that a statutory scheme will probably involve some form of co-payment. Can he expand and comment further on that?

The decision on the operation of the scheme was made by the HSE. The HSE has, since its inception, always been subject to a budget cap and had to maintain delivery of its services within the budget available. There has been no new decision made or any change of policy. I have not instructed or been involved in any change whatsoever. I allocated the HSE funding for 18 million hours to be delivered this year. I do that every year and that is my role. Last year, the allocation was for 17.2 million hours. This year I allocated the HSE funding for 18 million hours but it has to stay within its budget. It had to do that last year and the year before that, albeit with a smaller budget. Home help had to be kept within a budget of €300 million four years ago. It now has to be kept within a budget of €450 million. It has always been thus. It is a finite budget. The HSE does not have flexibility to give the service to everybody who looks for it. It is up to them to manage it on a month-by-month basis and it knows when the peaks and troughs in demand occur. The HSE will have to ensure that it can manage times when there is extra demand as well as it can. That is my role in the decision.

The Deputy asked about an element of co-payment to which I referred. I have said it on the record of the House. Many people could make a contribution to home care and, if those who could did, we could have 25 million home help hours this year instead of 18 million. That would be the difference if those who could make a contribution did so, just like the fair deal scheme.

I will not labour this point. Could the Minister of State tease out what a model of home care and community care on a statutory footing would look like? It is important and welcome. I know the Minister of State cannot foretell the future but what would such a model look like? Would it be underpinned by legislation? What would it give to the people who are being cared for? Does it give them legal rights? Unfortunately, in Ireland, the Disability Act states that there is a statutory right for children to get assessment of needs but that is broken on a daily basis. One can be sceptical. Can the Minister of State tease out what it would look like in the future for clients, families and the workers?

I was not aware of the Deputy's past connection with this industry. I thank him for sharing that and I appreciate his insights.

We have commissioned a major review of the current home help service with a view to nailing down and identifying flaws in areas such as operations, funding, delivery of service and geographical disparity so as to inform the new scheme. Much of that information will be used in the design of a new scheme.

What I mean by "statutory level" is akin to the fair deal scheme at the moment. Anybody who needs to go into a nursing home and is assessed as needing that level of care can apply to the fair deal scheme and will get it, irrespective of how many people apply for it that year. The same would apply for home help. If one was independently assessed as needing eight hours of home help, the State will guarantee the availability, provision and funding of those eight hours. That is the broad outline but details about services, those delivering it and regulation will obviously have to be teased out along the way.

Whether there will be an element of co-payment will not be my decision although I have a view, to which I am entitled, and I have shared it. I am not one who is known for standing behind doors when it comes to letting my views be known although they are not always right.

The work we commissioned this year to extensively review the current scheme - good and bad - will inform much of that.

Will it be means tested?

A co-payment does not involve charging for home help hours. Rather, it is the case that those who can afford to make a contribution based on their means will do so in a manner similar to how the fair deal scheme is currently processed.

One useful thing to come out of this debate is the revelation of the disparity in the level of home help pay and the number of home help hours across the country. Some Members referred to 39 hours of paid home help in certain areas and indicated that the HSE is paying for travel, etc. In County Donegal, a home help is lucky to get 12 hours. Why is that the case? Should there be a statutory system for the allocation of home help hours? Why is it that in County Donegal in CHO 1, home helps can only get 12 hours whereas in other areas they can get 30 or 35 hours? That leads to a real problem in terms of people getting a service in Donegal.

That is essentially a management issue. A system must be put in place to regulate it. I agree that it must be very annoying for those delivering the service to only be able to get 12 hours if they want to do more. It is possible that there may be three or four home helps in a small area and a limited number of hours in that area, whereas in a more built-up area there may be more hours available. It is a management issue. John Hayes is the manager of CHO 1, which also has home help managers. It is up to them to allocate the available resources. I do not micromanage such issues, although I would be interested to see the disparities between CHOs and the different approaches taken because there are some differences. Good lessons could be learned from the CHOs sharing that information. I accept the Deputy's point that it is difficult to understand the disparity. Any statutory scheme would be on a more standardised footing and would apply across the country.

I will certainly take the matter up with John Hayes, with whom we have a meeting next week. We will try to discover what is the problem. I was unaware that 39 hours are available in certain areas. The disparity needs to be addressed.

Does the Minister of State agree that freeing up beds in general hospitals by allocating home help will not save any money because those beds will be occupied by new patients and there will be a cost involved in treating them?

No, I do not agree. I would not stand over a system that would allow a person to linger in a bed just to avoid it being taken by another patient. There is a cost to the State in terms of pounds, shillings, and pence, but there is a far bigger potential cost in the context of a person's health if he or she is not treated in a timely manner. We must consider our duty of care. To be fair to clinicians, I expect that they discharge patients in a timely manner in the interests of people being in the most appropriate settings. I am on record as stating that acute hospitals are among the most dangerous places for older persons because of their vulnerability to infection. Most clinicians would accept that. One would certainly not leave a person in a bed in an effort to save the money it would cost for another patient to take the bed.

My point is that it would cost extra. Money would not be saved; it would cost more. It might cost €10,000 to keep a person in a bed, but a cost of €15,000 would be incurred by freeing up that bed. That is the reality. Acute hospitals are full of people who cannot get the home help hours necessary to allow them to move home.

I set up a group within the HSE, chaired by Mr. Graham Knowles, to examine the position regarding delayed discharges and I commissioned an independent report on the matter last year. This is a very interesting matter around which we are trying to get our heads because it cuts across the community and acute sectors. We are trying to ensure that timely discharges are a fact of life and trying to be more productive. The Deputy is referring to a money-follows-the-patient system as being ideal. The more throughput there is in a hospital, the more money the hospital can generate. It will have more patients and be able to deliver more procedures and so on.

The Deputy asked about home help and delayed discharges. The numbers involved are not very large. There are 600 delayed discharges in any given week. Many delayed discharges that result from home help difficulties arise because of a time delay rather than a funding delay.

That is not the case.

Depending on the level of acuity, it may take some time to put a package together. It may be necessary to get two or three home helps into a house. The package must be put together. One cannot just flick a switch and make a home help package available at short notice. Obviously, there are also funding implications. There are many other issues which affect delayed discharges, such as clinical decisions not being made in a timely manner. The fair deal scheme is a big contributor to delayed discharges. Often, people are not in a hurry to bring a person home from hospital because adaptation work needs to be done. There are many reasons for delayed discharges, one of which relates to home help.

I am astonished to hear the Minister of State say that there is no embargo on home help hours and that this is not an issue in the Cork and Kerry region. I received an email from a person in the constituency that the Minister of State and I represent. A family member of the constituent wants to come home but cannot do so. The constituent is willing to give up a huge amount of time but also wants a few hours of home help. I will not name anybody, but the person involved received a letter stating that there is a set amount of funding available to provide home support services in the area and that, as the available funding has been fully allocated, the HSE regrets that it is not in a position to provide support at present. The letter also states that applications are being kept on file pending availability of home care supports.

That occurred in Cork South-West, the constituency the Minister of State represents. I have received many similar letters in the past two weeks by people who seeking home help hours. Is the Minister of State indicating that letter to which I refer, which was sent by the HSE, is incorrect?

I have been a practising politician in the constituency of Cork South-West for 15 years and I am very familiar with how the home help system there works. That letter could have been produced last year, the year before or the year before that because-----

This is a disgrace. The Minister of State is questioning what I have-----

If I may answer the question. Such a letter may issue in any month of any year because there are 6,000 people waiting for home help. Its being issued does not mean that there is an embargo or freeze on home help. It is continually the case that when people no longer need home help, it is coming back into the system. Some 800,000 additional hours were added to the system this year. However, letters such as that to which the Deputy refers will issue next month and the month after that. He mentioned an imaginary freeze that will be lifted in November, but those letters will still issue in November and December. They have issued every month since home help was introduced because the budget relating to it is finite and, as we all know, there are 6,000 people on the waiting list. It is probably the case that 6,000 of those letters have been issued to date. However, that has nothing to do with the so-called freeze which the Deputy is creating in his imagination but which does not exist in Cork, Kerry or anywhere else.

Has a letter been sent to public health nurses stating that there is an embargo and asking them to cut home help hours? The letter to which I refer is clear; it issued last week to a person who is in a hospital bed and whose family is trying to get the person home. I have no problem deleting the names of the parties involved and sending a copy to the Minister of State. The letter was issued by the HSE. The Minister of State is speaking out of both sides of his mouth. The letter clearly states that those people will not be getting a home help service. The individual is still in hospital as a result of that decision, but the Minister of State is stating that it is not an issue and that the letter might be 12 months old. The fact is that the person cannot go home because there is no home help service available. There are similar situations across the country, but I can only speak to that which obtains in Cork South-West and on behalf of the individuals who have come to me. Is the Minister of State indicating that the HSE has not issued letters to public health nurses telling them that there is an embargo and to cut the original hours? Is he denying that as well?

There is no cut to home help hours. Nobody who is currently in receipt of home help hours is having them cut or removed. That is a fact. As regards the allocation of new hours, they are coming into the system all the time. However, the demand for them far exceeds the level of supply. Letters such as that referred to by the Deputy issue periodically. Of the 600 delayed discharges, 26 were impacted upon by the lack of home help packages. The lack of availability of home help is responsible for 4.4% of people who are in hospital but who should not be there.

A carers' manager in Tipperary just rang me. There is huge concern about these letters, and the Minister of State needs to control them. I accept his bona fides as to where they are coming from and what is happening. Nurses have been told to halt, to stall the ball. How can the Minister of State stand over the fact that it takes up to four months to get an application for carer's allowance approved? I outlined to the Minister of State earlier the figures and the findings. They are deeply concerning, as I said. These are CSO figures from 2017. They show there were 138 carers under the age of 18 in Tipperary that year. Does the Minister of State condone this? Will he comment on it?

I know the Deputy is not suggesting this, but I am not trying to defend anything. I am only trying to put it as it is. I cannot answer his last two questions because they are outside of my remit. One of the questions he asked me concerned the four-month wait for approval of an application for carer's allowance. That is the responsibility of the Minister for Employment Affairs and Social Protection, so I would have to defer to her on the matter. I do not have any role in carer's allowance or carer's benefit.

As for the number of young carers in Tipperary, I think the Deputy is asking about people in receipt of carer's benefit, which is slightly different from home help. I will have to defer to the Minister, Deputy Regina Doherty, on the question. Does Deputy McGrath have any questions about home help?

These young carers number 138. If this was the case in another sector, there would be prosecutions. If I had them working for me, I would be prosecuted by the National Employment Rights Authority, NERA, and the Department of Justice and Equality or one of the other Departments. We cannot have such a situation pertaining. The Minister of State must get a handle on the letters that go out. They are causing angst and annoyance.

I agree very much with the Deputy on the issue of communications from the HSE. I have spoken to the HSE about this nationally and I am anxious to speak to the executive locally because there are some conflicting accounts and some confusion. It is not the case that everyone in this room is imagining things. We all know there are communications coming from the HSE that are not altogether adding up to the same tune, as far as I can see. I want to speak to the HSE about this and the alignment of communication.

The Minister of State seems to be justifying the fact that 6,000 vulnerable people are waiting for home care in their own homes by saying there were 6,000 last year as well. That is a huge indictment of him as the Minister of State responsible. Why has he not ensured that sufficient funding is available to clear these waiting lists? That is the scandal of this matter. However, not only is there inadequate funding provided for this year, as there was last year, but there is now the added implication of the EU directive on improving the conditions of home care staff, the whole question of travel time and other arrangements. It is only right that these arrangements should come into place. The Government should not have to have been forced to introduce them by the EU. However, given the fact that this directive now applies, it is extremely disingenuous of the Minister of State to suggest that nothing will change. What is the estimated cost of implementing the directive on travel time and other arrangements? The Minister of State said earlier that the number of hours should not change and that the HSE should find the money elsewhere. Where does he suggest the HSE find the money?

The Deputy has asked me why I cannot wipe out the waiting list of 6,000. I am certainly not justifying it. I have made no attempt to do so or to suggest that I have no difficulty with a waiting list of 6,000. It just happens to be a matter of fact that I used in answering-----

The Minister of State is responsible for this and should be doing something about it.

Deputy Shortall will have a further opportunity.

If the Deputy wishes to enter into that kind of debate, I could remind her that the waiting list was also there when she was doing this job. However, I will not go down that-----

I never did the Minister of State's job, actually.

The Deputy was a Minister of State in the Department of Health. Anyway, I am not interested in going down that road with her on the politics side of things. If she wants to lay it on me personally, that is fine, and I have no difficulty-----

The Minister of State should just answer the question.

The clock is ticking, Deputy Shortall.

I will answer if the Deputy allows me. I do not have to hand an estimate of the additional travel costs from the HSE yet. At present the HSE has an ad hoc arrangement in the individual CHOs with the unions. They have agreed blanket hours so they will all have, I imagine, a different cost to submit to me that I will be able to ascertain next week. However, they knew last year about the cost of the travel arrangements coming down the road. When we agreed the national service plan, they agreed to provide 18 million home help hours. That is what I expect the HSE to provide.

This is extraordinary. The Minister of State does not know the cost of this but says it was included in the budget. What has the Minister of State been doing? He should know if there is a directive that has huge cost implications and more significant implications for older people who are vulnerable in their own homes. He should know these answers. He came in here with a meaningless opening statement that made no attempt whatsoever to engage with the issue at hand and showed no empathy whatsoever for the 6,000 people who are dependent on him to do his job properly.

I have another question for him. Why are no performance reports being posted on the HSE website in order that we might see the facts of this situation? There are supposed to be quarterly performance reports. They have not been posted since last September. Why is this the case?

The Deputy will have to address that question to the Minister. I do not have responsibility for the HSE or its performance reports or the publishing of them on the website. Did the Deputy have another question other than her statements? Besides that question, I think she just made statements. The Deputy is entitled-----

Will the Minister of State get the figure for the cost of implementing the directive and share it with us?

Yes. I have no difficulty whatsoever doing that for the Deputy.

I thank the Minister of State. This is fairly basic.

The Minister of State has said a number of times tonight that no hours will be cut. I live in the real world, and what will happen is that there will be a new method of assessment of people for home help hours and, whether the Minister of State wants to call it a cut or a new method of assessment, people will end up with fewer home help hours. That is what will happen in the real world. It is as clear as night follows day that this decision on the part of the HSE, far from saving any money, will cost money. Has the HSE given the Minister of State a report showing the overall breakdown and the rationale for this decision, including the costs associated with it? If he has such a report, has he signed off on it?

We know from hospital nurses that agency staff are significantly more costly than HSE-employed staff. How much of the overall home help budget goes towards paying private operators?

The Minister of State will have no time to answer.

What is the cost per hour of the private operators as against the cost per hour of HSE staff?

We must move on. The Minister of State will not have time to respond. He has ten seconds to answer the Deputy's questions.

Is this my final contribution?

No. The Minister of State will have a few minutes to wind up.

I do not have all the micro-details the Deputy seeks, such as the cost of private staff versus public staff. I would have to come back to the Deputy on that. The Government increased the budget by €30 million and committed to an increase in home help hours of 800,000 this year in addition to what was done last year. I expect that to be delivered by the HSE, and that is my input from a policy level. After that, it is up to the HSE to deliver the service, but I can of course hold the HSE accountable, get the figures for the Deputy and find out the breakdown as to how many of the staff are private and how many are public. As I understand it, though, the HSE only engages private services where it cannot get its own staff to do provide a service. I will get the figures for the Deputy. I am happy to do so.

That concludes the questions and answers. I will give the Minister of State two minutes to make a concluding statement.

I thank all the Deputies for their contributions and for bringing this issue to the floor of the House. I very much welcomed the opportunity to, I hope, add some clarity. If I have not done so, or if I have not answered the questions the Deputies asked, I apologise. I am as eager and as anxious as any Deputy to try to get answers. The Government's principal aim is to ensure that funding is allocated at budget time, and to go from €300 million to €450 million, which is a 50% increase, in three to four years is a very significant recognition of the point Deputies made, that is, that home help is very successful. We are now spending more than €400 million on home help and €1 billion on nursing homes. We plan to increase this again and again in recognition of the outstanding service home help provides and the role it plays in keeping people in their own homes for longer.

They are much better off physically, mentally and in every other way as a result. We recognise the contribution of the carers to their community and we want to continue that but the HSE must operate within a finite budget. We must keep a watchful eye on any steps it takes during the year to manage that budget and it is our job as public representatives to ensure the service does not diminish in any way, shape or form.

I have said there is no freeze or embargo but I will clarify what is available. There are 18 million home help hours funded this year, which is an increase of 800,000 from last year. Nevertheless, 6,000 people are still waiting so everybody will be able to produce the letter that Deputy Michael Collins had today. That is unfortunate and I wish there were not 6,000 people waiting but it is a finite budget of €420 million. I would love to see it increased to €600 million so we could wipe out the waiting list but there are competing needs. Tomorrow, we will be here in this same forum debating some other topic that requires more money. I hope to get more money next year and I am confident I will do so. I will continue to invest in home care in absolute recognition of its value to society and our elderly people.