Thursday, 8 November 2012

Ceisteanna (2)

Caoimhghín Ó Caoláin


2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the steps he is taking to inform himself of the impact that the recent cuts in home help hours are having; his views on whether these cuts should be withdrawn and that services be restored to the level of support that existed prior to the latest cuts; and if he will make a statement on the matter. [49094/12]

Amharc ar fhreagra

Freagraí ó Béal (7 píosaí cainte) (Ceist ar Health)

Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. This is achieved through a range of community-based services such as mainstream home help, meals-on-wheels, and respite or day care. In more complex cases, enhanced home care packages may be provided. The reductions recently introduced in respect of home help hours relate directly to the critical financial position facing the Health Service Executive towards year end and the statutory responsibility of the executive to live within the budget Voted for it by the Oireachtas.

The target in the HSE service plan for 2012 was to deliver some 10.7 million home help hours to 50,000 people. In addition, just over 15,700 people were targeted to receive a home care package in 2012. As I have indicated on several occasions throughout the year, a key challenge facing the health service is how best to utilise a reduced level of resources in addressing the increasing needs of older people for health and personal social services. This means prioritising those in greatest need and accelerating reform of services overall to maximise such provision in the future.

Most of the measures recently agreed with the HSE to address immediate funding pressures focus on areas that do not have a direct patient impact. It is a priority of the executive to minimise the impact on patients and clients of any spending reductions. The reduction envisaged for the mainstream home help service is €8 million, and approximately €1.2 million for enhanced home care packages. Allocation of home help hours will continue to be based on a review of individual needs and no current recipient of the service, who has an assessed need, will be without a service. The HSE has indicated that it will ensure that any alterations to supports or services will be undertaken in the context of a review of the client's assessed need, documented on client records. While the Government fully appreciates the difference high-quality home care makes to supporting vulnerable older people and their families and the impact the recent reductions will inevitably have in some cases, we must deal with the reality of funding services overall for this and subsequent years.

Additional information not given on the floor of the House

Notwithstanding the recently announced reduction in HSE home support provision for the remainder of 2012, investment in these services remains significant, with provision in the region of €320 million expected for home help and home care packages this year. In addition, in the context of prioritising what was always a limited resource, the HSE has been developing various operational initiatives to improve its approach to all relevant aspects of its home supports services. These include various new guidelines for home care and a new procurement framework for approved agencies providing services on its behalf. While ongoing developments have been designed to standardise and maximise the use of limited resources in the face of increasing demand, they are also intended to enhance quality, safety and other relevant aspects of service for providers and care recipients alike.

Services for older people are monitored on a regular basis by the Department of Health and the HSE to meet evolving circumstances in line with available resources. The executive has been asked to furnish weekly reports to the Minister for Health on home care provision between now and year end, in the light of recently announced measures. The position in respect of 2013 and beyond is subject to the annual Estimates process in the light of evolving resources and services priorities for the overall health sector.

The position taken by the Minister, Deputy James Reilly, on this issue is absolutely untenable. He seems to have no concept of the distress and misery that has been visited on older people as a consequence of the changes he introduced. The impact of cuts in the provision of home help hours and home care packages are being felt today and every day for at least the past two weeks. People have lost precious home help hours and more are losing them every day. Almost 1 million home help hours will have been cut between last December and the end of this year, on the Minister's watch.

How can the Minister of State, Deputy Kathleen Lynch, and her colleagues stand over a situation where an allocation of 15 minutes of home help is described as a service? During a short stay in Cork last week I met home help providers in Youghal and Cork city who are incensed by the cutbacks, as they demonstrated last Saturday by way of a major mobilisation which assembled at Connolly Hall in the city the Minister of State knows so well.

Does the Deputy have a question?

How can this Government stand over the cutting of the solitary hour per week which some older people receive?

Will the Minister of State clarify the figures she indicated in her reply? As I understand it, according to the figures I have been given, 50,139 people are in receipt of home help hours, which represents a reduction of 3,701 in the past 18 months. The Minister of State also gave a figure in regard to home care packages. In a reply I received to another parliamentary question yesterday, it was stated that there are 11,119 people in receipt of home care packages. I acknowledge the increase of 1,159 on the figure 18 months ago, but the net reduction in service beneficiaries across the board is 2,500. The figure of 11,119 tells only part of the story.

Of course the aim of the Government is to ensure that older people remain in their own communities. That is the most sensible and cost-effective solution and also the one which offers the best outcome for individuals. Unfortunately, however, we find ourselves in very straitened circumstances. We will have to make our case very trenchantly in the negotiations leading up to the budget in order to ensure those concerned have the types of supports they need.

It is important to note that figures relating to home care packages can fluctuate, and for very good reasons. We are talking about an enhanced home care package system and there are times when the provision for an individual will need to be further enhanced and other times when it can be reduced. This is the beauty of a home care package, that it is operated on a continuous-assessment basis. More than 10 million home help hours are being provided this year. The number of clients benefiting is 50,000, a reduction of approximately 900 persons. We have no choice but to take a serious look at how we manage the service into the future. There is ongoing research into how we can best maintain supports for older people and others who benefit from home help hours and home care packages.

The Minister of State referred to a reduction of 900 in the number of individuals in receipt of home help hours. In fact, there was a reduction of 847 at the end of July as against the position last December. However, with respect to the Minister of State, over the period of her tenure in office, there has been a reduction of 3,701 in the numbers receiving this service. As I said, this is not even the worst part of the story, nor does it take into account the growing numbers who cannot access home help hours or home care packages.

It is time to cut out the waffle and reverse these savage cuts to the most vulnerable people. We are talking about €8 million. Sinn Féin tabled a Private Members' proposal on this issue only a few weeks ago, the same week the Minister announced savings arising from his negotiations with the pharmaceutical sector of some €16 million before the end of this year.

Yet, on the back of that, he could not ringfence the cuts signalled in relation to older people. He proceeded to impose these savage cutbacks that are causing untold hardship for people in every constituency. The only answer I want to hear is that the Ministers of State will use their good offices to impact on the Minister that he will reverse these cuts, restore the home-help hours and home care packages to our citizenry who absolutely need them.

There is a statutory obligation on the Department of Health and the HSE to bring in a budget that lives within the Vote, which is decided in this House. There are difficulties, there are arguments to be made and there are various ways of doing things. We need to be very conscious of that. In addition, as we speak, a deficit is being run up by the HSE. It is not as if we have an expandable pot of money. Those days are gone and we must live within that budget.