11. Deputy Louise O’Reilly asked the Minister for Health his views on the difficulties in accessing home care packages in Dublin city and county in which the HSE is only providing palliative care in view of the fact it does not have the funding for extra staff to provide a full range of home care services; and if he will make a statement on the matter. (Question 6369/18 asked on 08 Feb 2018)
Deputy Louise O’Reilly: The question is fairly specific. It is to ask for the views on the difficulties accessing home care packages. I will be very clear with the Minister of State. It is not an opportunity to tell us a lovely story about how there are no difficulties. There are difficulties. I am aware of them and so are my constituency colleagues. The Minister of State must be aware of them as well. Will he spare us a description of what a waiting list is and comment on the fact that there are difficulties?
Deputy Jim Daly: I assure the Deputy story-telling was never my forte and I do not intend to start now.
Since being appointed as Minister of State with responsibility for older people, I have made improved access to home support services a key priority. Progress in this area is reflected in the additional funding made available for winter 2017, the increased funding and level of activity planned for 2018 and in the work being progressed on the development of a statutory home care scheme.
Home support services are a particular area of focus in budget 2018, with an additional €18.25 million allocated. The additional resources bring the budget for the direct provision of home support services to €408 million delivering over 17 million home support hours to about 50,500 people. This compares with the estimated 16.34 million hours delivered to 50,000 people last year. In addition, 235 intensive home care packages will provide 360,000 home support hours for people with complex needs.
There is a high level of demand for home support services in community healthcare organisation 9, which includes Dublin north city and county area and over €55 million was spent on home support in the community healthcare organisation, CHO, last year. Waiting lists for services are managed based on the assessed need and within available resources. Applications are assessed by the HSE and clients are provided with a service having regard to their assessed needs. Cases of individuals with palliative care needs and people discharged from acute hospital settings, who are in a position to return home with home support, are prioritised. The provision of services for the area is delivered primarily by private providers who were selected through the HSE tender process and who demonstrate the capacity to meet HSE requirements. I understand that from time to time, providers are unable to meet the service levels required by the HSE due to staff recruitment difficulties. Therefore, while there is a waiting list for home supports in the area, additional resources have been made available this year.
Deputy Louise O’Reilly: I was looking for a comment on the difficulties. The Minister of State has accurately described the recruitment difficulties and I am sure they exist. I am not convinced, and the Minister of State has probably heard me say this on more than one occasion, that outsourcing this function to the private sector is the best way to do it. In many cases, notwithstanding the good work done by the individuals providing the care, it does not represent good value for money. The prioritisation of people who are being discharged from hospital and people who need palliative care does absolutely nothing to help keep people out of hospital. The Minister of State will be aware of that.
I want to bring two cases to the Minister of State’s attention. A father and son met me last Monday. Their wife and mother has a very severe form of dementia. She is in Beaumont Hospital now and cannot get out to the community. They want to look after her at home. They were offered six hours. After they kicked up, they got another seven hours. They have 13 hours but they need a minimum of 30 hours a week. They cannot access them. Another case is that of an 82-year-old woman with diabetes who is effectively confined to her home. Her daughter is working 16 hours a day to look after her. There are very real cases and they cannot access home care. If the Minister of State is serious about home care the resources have to be put into it and we need to target recruitment. The best way to do that is not by outsourcing.
Deputy Jim Daly: I do not need to go to Dublin to understand the challenges in the provision of home care. I am a practising politician. It is one of the beauties of our democracy that Ministers and Ministers of State also have constituencies to run. I meet people every week in my village who cannot access home care and who need it. I am well aware of the challenges. That is why we have decided the current scheme is not fit for purpose because it will never meet the expectation. If we are spending €408 million on home help hours, we all agree in the House that it does not go far enough and does not meet the demand. We need to radically change how we do what we do. That is why we launched the consultation in July. It was completed in October. The 2,600 responses are now being reviewed and a breakdown of them will be on my desk in the next two to three weeks. We need to build a scheme that mirrors the fair deal scheme where everybody is entitled to home help in their own home by law. We need to do that to ensure there is proper funding for the staff and resourcing of it. We intend to do it but it will take time.
Acting Chairman (Deputy Eugene Murphy): Does the Deputy want to make a final comment?
Deputy Louise O’Reilly: No.
Acting Chairman (Deputy Eugene Murphy): Does Deputy Breathnach wish to make a quick comment on this?
Deputy Declan Breathnach: It will save me asking a question on promised legislation. It has come to my attention-----
Acting Chairman (Deputy Eugene Murphy): I think the Deputy is in the wrong arena.
Deputy Declan Breathnach: My question is about health services.
Acting Chairman (Deputy Eugene Murphy): Does the Deputy wish to comment on Deputy O’Reilly’s question?
Deputy Declan Breathnach: Yes, my question is on home care packages. It has come to my attention in respect of home care packages that different sectors are refusing home care packages that were in existence for people with a disability. They are taking those home care packages from them, telling them the services must be provided by the disability service, and withdrawing the package before the disability service is put in place. That is wrong and I am asking the Minister of State to take it in hand immediately. People are moving budgets from one place to another section in the service and leaving people with a disability with no home care package.
Deputy Jim Daly: I will look into it for the Deputy. I am not aware of it but I will look into it.