Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I move:

That Dáil Éireann:

recognises:

— the invaluable work carried out by home help workers;

— the contribution made by homecare in assisting with tackling delayed discharges from hospitals;

— that care delivered in the home is the preferred form of care for most people and their families;

— the cost-effective nature of home support by comparison to hospital care and nursing home care:— average weekly cost for home support services is approximately €165;

— weekly cost of a hospital bed is approximately €5,992; and

— weekly cost of a nursing home bed is approximately €1,048;— that the best value for money is provided by directly employed and not-for-profit homecare workers;

— that travelling between clients is work and should be remunerated as such; and

— that any form of co-payment for basic homecare is an additional burden which families should not have to bear in any form;

notes that:

— there are over 6,000 people on waiting lists for home help;

— the number of people over the age of 65 is increasing by over 20,000 persons a year;

— the proportion of people over the age of 85 is projected to double in the next 20 years;

— by 2030 the over 65 cohort will increase by 59 per cent, and the over 85 group by over 95 per cent;

— the Economic and Social Research Institute’s report on Projections of Demand for Healthcare in Ireland, 2015-2030: First Report from the Hippocrates Model noted that demand for homecare packages is projected to increase by between 44-66 per cent by 2030, while the demand for home help hours is projected to increase by between 38-54 per cent in the same period;

— in spite of increases in home support, resources have not kept pace with demand for services;

— the numbers receiving home supports in the community does not provide an accurate reflection of current and future need, with some older people opting not to apply as they know that services are insufficient to meet their need, as noted by Age Action;

— unmet need is associated with a variety of negative consequences that can affect the health and well-being of older people;

— without access to homecare supports many older people have to pay for private care, rely on loved ones to provide unpaid care, or are forced to move to a residential care setting which is often not their first choice thus undermining their human right to live

with dignity and independence; and

— research conducted by the Oireachtas Library and Research Service published in 2018, showed that while the level of funding allocated to home supports was approximately €450 million, the allocation to the Nursing Home Support Scheme, the ‘Fair Deal’ scheme, was significantly higher at €962 million; and

calls for:

— immediate steps to ensure the viability and sustainability of homecare provision;

— no reduction in the provision of home help hours and an end to the effective freeze on the allocation/recycling of hours;

— immediate investment in a recruitment campaign for directly employed home helps;

— an increase in the number of home help hours provided by directly employed homecare workers;

— an investigation into the value for money provided by private homecare providers;

— a Government commitment that any statutory entitlement to homecare will not place an additional burden in the form of co-payment for those who need the service;

— the immediate elimination of any call-out which is below 30 minutes;

— the development of a system of time management and tracking to ensure that payments for travel time are calculated fairly and transparently and related to actual time travelled; and

— the establishment of a working group or task force to examine the job of home help workers to look at:— how the job can be made more attractive to ensure the supply of a welltrained workforce;

— how the job can keep pace with the changing demographics;

— making the job sustainable as a full-time option;

— guaranteeing fair terms of employment and rates of pay across the sector;

— a sectoral employment order; and

— ensuring services are deployed to meet the need of older persons.

I welcome the opportunity to introduce this Private Members' motion on behalf of Sinn Féin and all those people who depend on the home help service. It is very well known that care delivered in the home is the preferred form of care for most people and their families. Care delivered in the home allows older people to live with dignity and respect in their own home and it is known that this has significant mental and physical health benefits as opposed to being unnecessarily stuck in a hospital bed or transferred to nursing home care.

Not only that, the home help service is one of the best value for money services in the health service, a fact to which any health economist will attest. It is timely as we have been discussing the summer economic statement and there is a failure to invest in what is the best value for money service the HSE provides. The average weekly cost to the State for an older person to be looked after under the home help scheme is approximately €165 whereas if someone is stuck in hospital and cannot be discharged home because of a lack of home help services, it costs the health service approximately €5,992 per week. I note that the Minister for Finance is here so perhaps he can assist the Minister for Health in doing those sums because it really adds up to value for money. Likewise, nursing home care costs approximately €1,048 per week as opposed to the €165 per week that home help costs. The Government's approach to the delivery of healthcare is penny wise and pound foolish. Freezing or reducing home help hours means that older people will needlessly end up in hospital and this will cost the health service more.

Age Action, The Alzheimer Society of Ireland and various other organisations have all done good work in this area. They have highlighted how unmet need is associated with a variety of negative consequences that can affect the health and well-being of older people. These range from relatively minor consequences, such as feeling distressed because the housework is not done, to major consequences such as not being able to eat when hungry, or falls, trips, slips and accidents. Older, frail people can often sustain an independent lifestyle at home if they receive the appropriate practical, physical and psycho-social supports. The absence of available home supports fundamentally impacts on the range of choices available to older people in need of home support. Likewise for parents of sick children, this is an absolute lifeline for them. Without access to home care supports, many are forced to pay for private care, or to rely on loved ones to provide unpaid care, or are forced into residential care settings which is very often not their first choice. This undermines their basic human right to live with dignity and independence.

There are a significant number of older people who are now in this exact situation and many more who will drift into this position if these freezes and reductions are not stopped. There are currently over 6,000 people on waiting lists for home help hours. That is 6,000 people whose needs are currently not being met. That is a ridiculous waiting list for a service that actually saves the HSE money in the long run. The actions of the HSE constitute going after low-hanging fruit and need to be called out. The freezing or cutting of home help hours is cutting off one's nose to spite one's face. There are better ways to save money across the health service. Money is being haemorrhaged in areas across the health service, whether the spending of more than €300 million per year on expensive and temporary agency staff, the failure to move care into the community and away from acute hospitals, the failure to roll out a proper IT infrastructure or the failure to move to biosimilar medicines to name just a few examples. Targeting a service such as home help is not the way forward.

I will touch briefly on the future and sustainability of the home help service because it is often less spoken about when this issue is raised. We need immediate steps to ensure the viability and sustainability of home care provision. There must also be proper investment in recruitment. I note, in the Government's statement, the mention of the home help contract. I fought for that contract. I do not know how many times we were at the Labour Court and we protested outside the gates of Leinster House looking for that contract. That campaign was important but there must be a campaign for directly employed home helps in conjunction with making the profession more attractive as a full-time option by guaranteeing fair terms of employment and rates of pay across the sector that are competitive. The best way to do this is to focus on directly employed or not-for-profit home helps. These provide the best value for money to the State and it is here that the future of the home help service resides. Private providers are in the business of healthcare delivery to make a profit. In the cases of directly employed home helps and not-for-profit agencies, every cent that is spent on home care goes directly into home care provision.

I call on the Government to withdraw its amendment and support this Sinn Féin motion and ensure we lay the groundwork for sustainable, fully-funded home care. We all know the way the demographics are going. We absolutely know that the home help service is fantastic and we will hear people this evening talk about how valuable home helps are, that they are valued members of the community, but we need the Government to get behind the home help service. It is good value for money and, when home helps are directly employed, they deliver great value for money.

I know the Minister will talk about the co-payment element of the scheme for statutory provision but, where healthcare has been privatised and there is an element of co-payment, that is asking people to sustain the profits of big corporations. That is not fair. People want to be looked after in their own homes by home helps who are paid decently and who can afford to work in the service. I urge the Minister to support this motion.

Pearse Doherty (Donegal, Sinn Fein)
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Ar dtús báire, gabhaim buíochas le Teachta O'Reilly fá choinne an rún seo a chur os comhair an Tí anocht. Tá an rún seo iontach tábhachtach mar tá a fhios againn go bhfuil an cúram baile a bhí tugtha do dhaoine ar fud an Stáit go dtí seo ciorruithe agus go bhfuil na daoine sin ag cailleadh uaireanta. Tá a fhios againn fosta go bhfuil go leor daoine ann nach bhfuil ag fáil cuidiú ar chor ar bith. Mar a dúirt Teachta O'Reilly, tá daoine ina luí in ospidéil gur chóir dóibh a bheith sa bhaile ach níl siad ábalta dul abhaile toisc nach bhfuil tacaíocht ann dóibh.

This is a very timely debate and we have raised issues about home help cuts and the freeze that has taken place, although he disputes it, with the Minister on numerous occasions. Even the Taoiseach, earlier today, had to admit from his own constituency clinics that what he is being told on paper is not being reflected accurately on the ground. Everyone in this House who holds constituency clinics, deals and interacts with members of the public knows well that there is a serious issue in home help and home care provision in this State. It manifests in different ways. There are situations where older, vulnerable people who are living in their own homes and have been provided with home help have had their home help hours cut despite the fact that their medical conditions have not improved and, in some cases, have deteriorated. There are situations where others who need, and have been allocated, home care packages are not getting them because of the mismanagement and unavailability of staff in certain areas. There is a third cohort who are medically discharged from community hospitals and are not able to go home and live independently because the State has refused to provide the necessary home help supports.

The cost implications of this have been explained in great detail by Deputy O'Reilly. Those implications include costs to the overall health system but also the human cost to the individuals, carers and families because they are not able to live independently in their own home.

It costs, on average, €165 per week to care for somebody in his or her own home, and this can be compared with a cost of nearly €6,000 for an acute hospital bed. That comparison probably sums up this Government's mismanagement of the health budget with specific reference to home help. That is wrong and not only because it does not support these individuals. Those in question want to be at home but are unfortunately stuck in acute or community hospitals,, which leads to more and more people ending up on trolleys and so on.

This matter requires urgent attention. Time and again we have put forward solutions. We produced a detailed and costed plan well before Sláintecare's publication that showed how to reform our health service, meet the needs of the public and ensure that we can answer the demands of those who need care when they are sick. We have shown how increased investment in home care support can save the State and the HSE money in the overall budget. Our proposals last year fell on deaf ears and the Government failed to invest the necessary amounts to ensure the resources will meet demands. When we asked the Taoiseach about this, he initially stated that he thought there was a sufficient budget and referred to a 50% increase. He indicated that we needed to analyse the figures. There is no need to analyse numbers; we should be talking to families. The Ministers of State should speak to the cancer patients who want to return to their homes and families while they undergo treatment but who cannot do so because the necessary home care supports are not there. They should speak to the people who deliver this service about how they feel an impact when they see those for whom they care having services cut from three hours per day to an hour and half. Individuals being cared for may not be able to feed themselves independently but the clock is constantly ticking for their carers. The provision of 30 minutes of care in the evening is not sufficient. These carers face difficulties because, unlike the Government and the HSE, they are not able to walk out the door and simply abandon the those to whom I refer people, as the Government and the HSE has done.

Our proposal is proper and adequate and would meet the needs of the public. I ask the Government to ditch the rhetoric and spin in order that we can get real about this. Let us support those vulnerable and elderly people who are well enough to be in a home environment but who need a little support from the State. The Ministers of State, the Taoiseach and the Government are denying them that support. The Ministers of State should do the right thing by supporting this motion. I appeal to every other Teachta to do likewise.

Gerry Adams (Louth, Sinn Fein)
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Táim buíoch de Teachta O'Reilly fá choinne an rún tábhachtach seo. The home support service is the lifeline on which many families depend. We all know this because we know of elderly relatives and citizens with disabilities. Without it, many of our loved ones are forced into hospitals to occupy desperately needed acute hospital beds or expensive nursing home accommodation, away from the familiarity of their own homes. We all know most people want to be cared for in their homes. That is what I would like and I am sure if the Minister of State were sick, it is what he would like also.

Those providing the home support service are to be commended on their efforts. Many carers would have even greater levels of stress without them and they are an important and sometimes the only regular social contact with the world. Unfortunately, many people rarely have enough time allocated to properly support family members, friends and neighbours who need that help at home. Mar a dúirt Teachtaí Doherty agus O'Reilly, home support is one of the best value services in the health service. The home support service costs approximately €165 per week, which is in sharp contrast to the weekly cost of a hospital bed of almost €6,000 or the cost of a nursing home bed at just over €1,000 per week.

There are 6,000 older people on waiting lists. There is a freeze on new home help applications, although I know the Minister of State will deny this and I have heard him doing it here before. I raised the matter in a parliamentary question to the Minister and was informed that I was wrong in believing no new clients would be allocated home supports until November. The Minister stated, "the recycling of hours will continue in line with budgetary management", but he knows that is not good enough. It is not a policy that will support our cherished and vulnerable citizens. It is Fine Gael ideology writ large in Alice in Wonderland prose. It is a policy that prevents the home support service from expanding in response to need, and no amount of opaque language can disguise that. A constituent in Louth whose mother suffers from dementia is one of the lucky ones in receipt of an intensive home care package. She told us that at a recent meeting in Drogheda, people were told only eight citizens in Louth have this intensive care package, and another eight people are trying to get access to the package.

None of this is news to the Government but it has ignored it all. A Government committed to equality and minding the most vulnerable of its citizens would ensure the next budget would adequately fund home support services, developing a fully funded new statutory scheme and a system of regulation for home support services. Unfortunately, Fine Gael does not offer that type of government and Deputy Harris is not that type of Minister.

Imelda Munster (Louth, Sinn Fein)
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We are all aware of the issues facing people who need home supports, including those who are medically fit to be discharged from hospital but who must stay there because home help has not been provided. People are not receiving adequate care because they are not receiving sufficient home help hours to meet their needs. A slot of 15 minutes or 30 minutes in the morning will not cut it for people who are frail and elderly and have reduced mobility. It is not fair on service users or home help carers. The HSE is wasting money by keeping people in hospital beds at astronomical cost instead of providing decent home care packages, which are much more cost-effective and better suited to the needs of most elderly people.

I was contacted by an 81 year old woman who had an accident in November 2017 and was admitted to hospital. Three months later at a care planning meeting, there was a decision that she needed a home care package consisting of three visits per day from carers as well as back-up care. This was subsequently reduced to five hours per week, and she was told the reduction was due to a lack of funding for home care packages. The lady refused the reduced package because it was totally inadequate for her needs and she would not have been able to function with that low level of care. In August 2018, nine months later, she was still in hospital, despite the fact she was medically stable, fit to go home and desperate to return to her own home. Her unnecessarily long stay in hospital was at this stage affecting her mental health.

Later that month, and out of the blue, she was informed that additional funding had been released and she was offered 12 hours of home help per week on the condition that she would be discharged from hospital by the following day at the very latest. That was the day before the Pope's visit to Ireland and the hospital needed the beds. The following day she was sent home in a taxi to a house that had been empty for nine months. This 81 year old lady had been hospitalised for nine months but nobody had visited or checked her home or offered support in linking her with local services. It was an appalling way to treat any human being but particularly a vulnerable older person. It is a classic example of how dysfunctional and wasteful the system is. I urge the Government to address the matter immediately.

Eoin Ó Broin (Dublin Mid West, Sinn Fein)
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Ms Muriel Slevin is a constituent of mine and her son, Morgan, is awaiting a home care package. I will read a short extract from a letter she sent recently. It states:

I am writing to you once again regarding my son ... who is now 17 years of age. Morgan has been an inpatient in Crumlin Hospital since 7 April 2014. Morgan was granted a home care package earlier this year; only one agency tendered and unfortunately that fell through. My child has spent one quarter of his life in hospital, he deserves to get home. I signed for a house with South Dublin County Council on 15 October 2018, I have spent one night in it. My child has not slept in his own bed.

She further stated:

While Morgan is 17 years of age, he is developmentally delayed and dependent on others for all his personal care.

In her letter his mother further stated:

The reality is Morgan is dying, his lungs are failing and have deteriorated hugely. He needs a Home Care Package from an agency with safe and medically competent staff.

This letter was not sent to me. It was sent to the Minister for Health. In the conclusion of her letter, Morgan's mother stated:

Minister Harris, we are currently living in a diabolical situation. I am asking you as Morgan’s mother to help me bring my child home to be cared for ...

I know the Minister of State cannot intervene in individual cases, and that is not what I am asking him to do, but what he and his Government can do, through legislation, policy and funding, is get Morgan and all of the children like him who so desperately need home care packages the service they require so they can live at home in dignity and peace.

Finian McGrath (Dublin Bay North, Independent)
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I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“recognises:

- the invaluable work carried out by homecare support assistants;

- that the Home Support Service is a core service for older people and is highly valued by service users, their families and by the Health Service Executive (HSE), providing supports which assist older people to live independently in their own homes for longer and enabling large numbers of people to return home following acute hospital admission, who otherwise would remain in hospital or would be admitted to long stay residential care;

- that the core stated objective of this Government is to promote care in the community so that older people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible;

- that the Oireachtas Committee on the Future of Healthcare Sláintecare Report supports a significant shift in our model of care to one that is focussed on prevention and early intervention, which will provide the majority of care in the community, and the Government’s Sláintecare Implementation Strategy sets out an ambitious programme of reform to deliver this vision;

- that over the past number of years, improving access to home support has been a priority for the Government, as reflected in the increases in the home support budget which has grown from a base of €306 million in 2015 to about €446 million in 2019, representing about a 45 per cent increase in the annual budget for this service;

- that the 2019 HSE National Service Plan provides for 17.9 million home support hours to be delivered to over 53,000 people at any time, and the Intensive Home Care Packages to be delivered to approximately 235 people at any time, delivering a further approximately 360,000 hours; and

- that despite this significant level of provision, demand for home support continues to grow;

notes:

- that the HSE reviews people on the waiting list, as funding becomes available, 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;

- that the allocation of funding for home supports, though significant, is finite and services must be delivered within the funding available and in line with the HSE’s budget, delivery plan and the National Service Plan;

- that the HSE has confirmed that there are no cuts to the Home Support Service and that the HSE will meet its service plans target to deliver 18.2 million hours this year;

- that all Community Health Organisations are working to ensure the best use of available funding to support the greatest number of people requiring homecare services;

- that following a Labour Court recommendation in 2014, the HSE implemented new contracts for its directly employed homecare staff, providing each worker with a guaranteed minimum number of hours per week and a guaranteed income each week with actual work assignments, managed in a reasonable way to meet the needs of clients over the course of 12 months, and that this new contract was regarded by staff, unions and management as a positive development for HSE employed staff;

- the future demographic projections and their implications for future service provision;

- that while the existing homecare service is delivering crucial support to many people across the country, it needs to be improved to better meet the changing needs of our citizens;

- that the Programme for a Partnership Government signals the Government’s intention to improve homecare services and to introduce a uniform homecare service; and

- that the Minister for Health has committed to establishing a new stand-alone statutory scheme and system of regulation for homecare services; and

confirms that:

- there are no cuts to the Home Support Service, the HSE will meet the service levels set out in its 2019 National Service Plan this year, the allocation of new hours will continue to be based on clients’ needs and the resources available, and hours that become available will continue to be reallocated within the increased budget provided in 2019;

- a review of existing home support services will be commissioned that will, amongst other things, examine:- the policies and procedures currently in operation at national, regional and local levels pertaining to the administration of services;

- the quantum of services provided by the HSE (through direct service provision), voluntary providers and private providers, and the coordination of these services within this ‘mixed economy of welfare’ at national, regional and local levels;

- the ratio of care workers to service users at national, regional and local levels, and whether the supply of appropriate skilled staff is adequate to meet current and projected demand for home support; and

- the current funding of the Home Support Service, including analysis of the distribution of the budget for home support services at regional and local levels, the calculation of the unit cost of home support services, the proportion of the funding allocated to direct service provision by the HSE, the methodology for the allocation of funding to service providers through the HSE’s tendering processes, and how this relates to the funding of direct service provision by the HSE; and

- a new statutory scheme and new system of regulation for home support, informed by international and national evidence and stakeholders’ engagement, will be developed that will:

- improve access to home support services that people need in an equitable, affordable and sustainable way, ensuring that the system operates in a consistent and fair manner across the country; and

- ensure that the public can be confident that the services provided are of a high standard and will bring Ireland in line with best international practice.

I thank colleagues for their contributions so far in this debate. I am well aware of many cases such as those they have highlighted. I absolutely agree that the home support service is a core service for older people and is highly valued by service users, their families and the Health Service Executive. In line with Government policy, it provides supports that assist older people to live independently in their own homes for longer and enables large numbers of people to return home following acute hospital admission who otherwise would remain in hospital or would be admitted to long-stay residential care.

Many more of our older people with complex care needs are now being supported at home, leading to increased demand for additional levels of service, and for services outside the core hours of Monday to Friday. It is crucial that we develop home support services that are flexible and best support the needs of service users. This contributes to our work towards providing a more viable alternative to nursing home care for a greater number of people.

The home help service was a feature of the Irish health service for more than 40 years, having evolved from what was a "friendly neighbour" service to the professional service it is today. The home care package, HCP, scheme was introduced nationally in 2006 and both evolved over the years such that the distinction between the two became less and less significant.

With the approval of the Department of Health, the HSE moved to a single funded home support service in 2018, combining the home help service and the HCP scheme into a single service - the home support service for older people. The HSE has implemented a single approach across the system to streamline services, and their delivery, to make the service easier to understand and to reduce the complexity of the application process for clients. This has also been done with a view to the development of a statutory home support scheme, which is under development.

Intensive home care packages for people with more complex needs, mainly dementia, were introduced in recent years and these are administered at national level.

There has been much speculation and media attention in recent weeks that there may have been a cut in the funding available for home support or a reduction in the number of hours support to be provided this year. This is not the case, and I am glad to have the opportunity to further clarify the position.

My colleague, the Minister of State with responsibility for mental health and older people, Deputy Jim Daly, recently outlined to this House the priority the Government has placed on improved access to home support services. This is clearly reflected in the ongoing additional investment made in recent years with the budget growing from €306 million in 2015 to almost €446 million in 2019. That is about a 45% increase in the annual budget for home support.

In 2015, the estimated home support hours target, inclusive of home help hours, home care packages and intensive home care packages, was 15.12 million hours. In 2019, the HSE commits to provide 18.26 million home support hours, including intensive home care packages, an increase of 3.14 million hours.

To deliver these hours this year approximately €30 million has been added to the home support budget. When one looks at the year-on-year targets, this means that this year’s national service plan targets to deliver approximately 800,000 more hours than the original 2018 target.

The final reported activity for home care in 2018 was just over 17.5 million hours, which accounts for an additional investment in home support made during 2018, including in the context of adverse weather. This year’s targets and allocation take into consideration 2018 activity, including the carryover of increased activity resulting from adverse weather investment and increased costs. These cost impacts include the revised contract for health care support assistants and costs associated with the 2018 tender for indirect or non-HSE care provision, which equates to approximately €19 million.

Throughout the winter period, additional home support was provided supporting early hospital discharge and preventing hospital admission. Almost 1,100 clients were approved for new home support hours nationally and 857 packages had commenced by the end of March 2019.

The service is not demand led and is therefore operated in line with agreed budgetary limits and targets, as set out in the HSE national service plan.

Preliminary activity data reflect the period to the end of April 2019. The number of people in receipt of home support at any time will vary according to the value of the individual home supports approved and as clients cease and new clients with different needs are approved and commenced. By 30 April 2019, more than 5.6 million hours of home support had been provided and 52,329 people were in receipt of the service, with 5,761 new clients commencing this year.

Services allocated to new clients, and additional hours are provided to existing clients, are dependant on the number of additional hours approved and funded each year; the hours that become available through recycling, and the value of that 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 must manage its service delivery over the course of the year to align with the total funding available. It has a responsibility to ensure that activity is planned to anticipate critical demand pressures, most particularly emergency pressures in the initial and latter parts of the year. The significant roll-out of packages in the first quarter of the year reflects 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. The recycling of hours is ongoing in line with budgetary management.

I acknowledge, and I listened to the debate tonight, that in some cases access to the service may take longer than we would like. Despite the significant level of provision, demand for home support hours continues to grow and, at the end of April, 6,310 people had been assessed and are waiting for new or additional services. However, the HSE has assured the Department that people on the waiting list are reviewed, as funding becomes available, 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 the services being provided remain appropriate. The HSE has a responsibility to ensure that activity is planned to anticipate critical demand pressures, most particularly during the winter period.

As noted, home support is recognised by all of us as an important service. On 20 June, my colleague, the Minister of State, Deputy Daly, convened a meeting with HSE management and community healthcare organisations, CHO, representatives to discuss the issue of home support. He was assured that all community healthcare organisations are working to ensure the best use of available funding to support the greatest number of people requiring home care services. There is no freeze on home support and the HSE will deliver on its service plan targets.

While the existing 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 better meet the changing needs of our citizens. The development of a new, stand-alone statutory scheme and system of regulation for home support services is a long-standing objective of the Government.

This is currently progressing in line with the Sláintecare implementation strategy which commits to the introduction of the new scheme in 2021. It is intended that the new statutory scheme will improve access to adult home support services on an affordable and sustainable basis while the introduction of a system of regulation will ensure public confidence in these services. The new scheme will be designed to support carers and will complement and integrate effectively with other health and social care services.

Building on a review of the home care systems in four EU countries, which was published in April 2017, the Department is engaged in a review of the policy goals, objectives and guiding principles of adult home support service provision in ten countries. This review will assist in identifying international good practices, the learning from which will be incorporated into the new statutory scheme in Ireland.

I welcome the continued strong engagement of service users, their families and health and community care professions and stakeholder organisations and look forward to further dialogue throughout the process of developing the new scheme.

Mary Butler (Waterford, Fianna Fail)
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Is it the case that I cannot move my amendment because the Minister of State has moved an amendment?

Mary Butler (Waterford, Fianna Fail)
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I pay tribute to home support workers and the contribution they make to society. They provide medical care, support and much more. As all Deputies know, they are a lifeline for older people, vulnerable persons and those who want to live safely and securely at home among family, friends and community.

It is important to remember that we are an ageing nation and we should celebrate 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. However, there are warning signs 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 aged over 65 years will double and the number of people aged over 85 years will quadruple. People want to live at home for as long as possible with the correct wraparound supports. Home care support packages enable them to do that. For some older people, the home care support worker might be the only person they see all day.

The home help crisis is hitting the most vulnerable hardest. I acknowledge that the Minister of State, Deputy Finian McGrath, accepted the need to further improve the system. It is cruel that so many people are waiting for home help hours to be allocated. The latest HSE figures 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 figures show that one in ten of those who need supports are waiting to receive them. Some of them have serious issues. In recent years, the number of people waiting for home help hours has increased significantly, despite significant increases in available 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 says on the one hand that it will facilitate people to grow old in their own homes while, on the other hand, it restricts the means to do so.

The HSE service plan 2019 pledged that 17.9 million home support hours would be delivered this year. It has been reported that the service has been largely closed to new applicants until November. I accept the Minister of State's assurance that it is not correct that no new clients will be allocated home supports for the next five months, the allocation of hours will be based on clients' needs and the resources available and the recycling of hours is ongoing in line with budgetary management. Unfortunately, this was contradicted by a HSE spokesperson who stated that the budget increase of 2019 would not allow the HSE to increase the number of hours of care delivered because the cost of delivering hours had increased. The spokesperson noted that to balance the budget for 2019, there will be a reduction in the number of new hours as opposed to existing hours provided compared with early 2019 and that this will continue until early November. The Minister of State's assurance that the number of hours will not be affected is contradicted by the statement from the HSE.

On the number of home care hours allocated, the final reported activity for home care in 2018 was slightly more than 17.5 million hours. In the first quarter of this year, 4,215,754 home support hours were provided. If this figure is repeated in every quarter, provision will fall approximately 1 million hours short of target in 2019. That is very worrying because hours cannot be front-loaded at the beginning of the year. People who need home support and are lucky enough to get it require the service on 365 days of the year.

As demand for services continues to grow and waiting lists become a feature, we are being told on the ground that home support will be closed to new applicants until November, notwithstanding that the Minister of State argues differently. Some restrictions on access will place extra pressure on acute hospital services and aggravate the problem of delayed discharges. We learned that 206,000 bed days were lost last year due to delayed discharges. This has caused great pressure on emergency departments. Given the ageing population, the announcement by the HSE before Christmas 2018 that it would extend home support to an additional 550 people in 2019 was extraordinary.

Will home care packages be recycled? It is important that the Minister of State clarifies the position. In some community healthcare organisation, CHO, areas, no one is waiting for the home support service while other areas are performing badly in this regard. Why is the good practice in some CHO areas not reflected in the poor performing areas? Is this a case of bad management, a lack of funding or mismanagement of funding or is it that some people who need a service for, say, seven hours per week are receiving only one hour of service and are being classified as having their needs met? We need to tease out that issue.

The Fianna Fáil Party amendment is broadly supportive of the amendment tabled by Sinn Féin and would strengthen it. I recognise the introduction of a new five over seven day roster. The last time we debated this issue, I noted that the new roster is not supported by adequate information technology systems and this is causing difficulties, as the Minister of State acknowledged. I also recognise the recent agreement reached on travel expenses for home care support workers. However, a guarantee is needed that it will not impact on delivery of the additional 800,000 home support hours pledged in the 2019 service plan. We have been led to believe that funding must come from the existing hours allocated, which will be difficult.

Most important, as our amendment provides, individual need, not geography or postcode and certainly not funding, must be the decisive determinant of care. The patient must come first at all times. Families across Ireland are angry, worn out and under pressure. Any move to reduce home help hours cannot and will not be tolerated.

Michael Moynihan (Cork North West, Fianna Fail)
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I welcome the opportunity to speak on the home help service, which has played a vital role since it was developed many years ago in ensuring that people who need care are kept in their own homes and provided support. We have a crisis. Many families have contacted Members in recent weeks. There has clearly been a change in policy because there has been a slowdown in the home help services operated by the HSE. I will bring one particular case to the attention of the Minister of State and the HSE. It is one I have raised at every forum available to me and in every contact I have had with the HSE recently.

Home help hours have been approved since the end of April for this person, whose spouse is at home. This involves an elderly relative looking after a patient with Alzheimer's disease. As late as last Friday, senior officials had the same line as quoted by Deputy Butler regarding hours becoming available. This is a critical case for the family and the two elderly people involved. We look at the contribution these people have made to society and then we consider whether we can give half an hour or three quarters of an hour a day to support them through Alzheimer's disease or the illness, condition or disability involved. It behoves the Minister of State, the HSE and everybody else to take account of the crisis that exists and to consider what needs to be done because there are patients like this throughout the country. If it is the case that no new hours will be introduced until November, and it is now the end of June, we will have a serious crisis and it will compound all of the issues in the health service in the context of step-down facilities, etc.

I implore the Minister of State to reflect on what the HSE is doing with regard to home help and home support and ensure that there is a continuation of the service. I also ask him to ensure that the people who are really in need of care at this point are looked on as priorities in order that we might try to find a solution for them immediately.

John Brassil (Kerry, Fianna Fail)
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We can all give the Minister of State stories of individual constituents looking for home help and not getting the required number of hours. One thing I find very difficult to explain to my constituents is that they will get a small package for five days in the week but not for weekends. For example, a 93 year old man in Listowel looking after his 90 year old wife who has dementia gets one and a half hours a day five days a week. The level of need on Saturdays and Sundays is exactly the same as it is on Mondays, Tuesdays, Wednesdays, Thursdays and Fridays. I do not understand why the local team deems it inappropriate to provide weekend support. We need to examine the matter. The needs of our elderly people are the same no matter what day of the week it is and home help support packages should be based on a seven-day week. That is just common sense.

I take this opportunity to again make the point, which I have made on many previous occasions, that when families look for home care support packages - these are rare and it is difficult to get the required number of hours - they are immediately directed by district nurses and community support teams to the fair deal scheme in order to see whether they might consider putting their relatives into full-time care that they really do not want to go into. The cost of the fair deal scheme is approximately four to five times that a home care support package. In financial terms, it makes more sense to keep elderly people where they want to be, which is at home and in their communities. The two budgets for the fair deal scheme and the home help scheme should be dealt with by the same office. Such a practical measure would save the State hundreds of thousands of euro and result in far better value for money. Will the Minister of State look at this suggestion because I cannot see any reason it cannot be done. In practical terms, it makes sense.

The real heroes in all of this are the carers who are at home 24-7 looking after their elderly parents or disabled brothers and sisters. They work 24-7 for approximately €250 a week. They also need to be supported and given the correct remuneration for doing a fantastic job and saving the State millions every year.

Eamon Scanlon (Sligo-Leitrim, Fianna Fail)
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A total of 206,606 bed days were lost in hospitals in 2018 as a direct consequence of delayed discharges. A patient is categorised as a delayed discharge when he or she no longer requires care in an acute hospital setting and there is no access to an appropriate step-down facility. At a time when so many vulnerable people need to be admitted to hospital, such a rate of lost bed days exposes the inadequacy of our health system. Delayed discharges have a significant impact on the number of people left lying on trolleys in emergency departments if beds are occupied by patients who should be cared for at home or in other facilities. It is impossible for emergency department staff already working desperately hard to have the ability to respond to surges in demand in general hospitals. A total of 14,000 people aged over 75 were forced to endure a lengthy wait of more than 24 hours in hospital emergency departments last year. There is no doubt that delayed discharges contribute to waiting times and we need to step up the availability of step-down bands.

A total of 205 people in Sligo and Leitrim are waiting for home help. Of these, 137 have been waiting three months, 25 have been waiting three to six months and 43 have been waiting for six to 12 months. I know for a fact that some of these people are terminally ill. Quite honestly, they deserve to get something. They have worked all their lives and paid their taxes. They and their families need a bit of help at this stage but they are not getting it. The Minister of State made the point that an extra €406 million has been invested this year. I accept that but, unfortunately, much of this money seems to have been taken up with payment in respect of carers' mileage and break times, which they deserve. A lot of the extra money has been soaked up.

As already stated, 205 people in Sligo and Leitrim are waiting for home help hours. In Kerry and the north Cork and north Lee areas, nobody is waiting for home help hours. In south-east area of Dublin and Dún Laoghaire nobody is waiting for home help hours. In Longford and Westmeath, nine people are waiting and in Louth nobody is waiting. I do not know whether these areas get more money or are better managed. It is definitely different in the rest of the country. This is very important for people who, as already stated, are sick and need care and help. They want to get home to be with their families and that is where they should be. As Deputy Brassil indicated, not supporting home helps and carers does not make economic sense They are the unsung heroes who are working so hard to keep people at home and to look after them well.

Fiona O'Loughlin (Kildare South, Fianna Fail)
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Sometimes in life there are many things that we take for granted. We are inclined to take for granted some of the basic tenets, such as the ability to feed ourselves, wash ourselves and be able to care for ourselves. As we get older, these basic rights can be taken away from us. It is incredibly painful when we see the independence and dignity of parents, relatives, friends and neighbours being taken from them. They absolutely need to have access to that extra dignity and independence that home help hours can give them. The restrictions that have been spoken about in terms of home help care are absolutely appalling and they will have many negative consequences for families, carers and the wider health services, including hospital services, for the want of being able to access beds and being able to bring people home. We absolutely have to have home help hours.

The Minister of State mentioned that assessments would be made based on clients' needs and resources available. It really scares me when I hear the phrase "resources available" being used. I would like to think that it would be based on clients' needs. While we obviously have to think of resources the clients' needs should absolutely come first. In Kildare, 326 people are on waiting lists. I am of the view that this is an underestimation. In Laois and Offaly, there are 369 people waiting but in Carlow and Kilkenny nobody is on a waiting list. In Cork or Kerry, nobody is on a waiting list. There is nobody on a waiting list in Dún Laoghaire. It seems to depend on where people reside and that is absolutely not good enough.

I want to follow on from what my colleague stated regarding the need to provide home help hours on Saturdays and Sundays.

Many people are virtually bed-bound on a Saturday and Sunday because they cannot get access to home help hours. I know people, as do many others here, who are given one hour of home help a week. What does that say about our level of commitment to older people?

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Where will my seconds be then?

Aindrias Moynihan (Cork North West, Fianna Fail)
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Home help is key to allowing people to live in the comfort of their home with dignity. Many people who do not need to be in nursing homes and who would be quite capable at home just need an extra little bit of help to get out of hospital earlier. Home help is also a great support to carers and gives them a break as well. It is getting increasingly difficult for people to get access to home help. We are hearing that in all of our constituency offices. I had an opportunity to meet with people from the HSE recently to discuss this problem. While they highlighted that they had an extra €2.3 million in our area in Cork and Kerry to provide home help, they also highlighted that the 2019 budget does not allow the community health organisation, CHO, to deliver the same number of hours as it did last year. There is additional burden in respect of the nationally-agreed contract. It is a struggle for the CHO to provide those supports. It is critical that every effort is made to ensure that families and those who need care have access to home help when they need it.

Alan Kelly (Tipperary, Labour)
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I welcome the Minister of State. This is a topic I have spoken directly to the Minister about on many occasions. I have spoken about it ad nauseam here and in committee as well. This topic is a major part of sorting out many of the issues and problems in our healthcare system. The Labour Party will be supporting this motion, which tallies well with the motion my party will be putting forward tomorrow night regarding carers. The two motions go hand in glove. I acknowledge that. We ended up in a debate on this issue because of reports in the media. I know the Minister of State is well aware of that. I refer to a document sent to the Department with options for savings of €500 million. I know that the new chief executive office of the HSE is under pressure regarding budgets etc.

This option was one of many, I presume. We will find out when the full document is published, one way or the other. The Minister of State might publish it or it might come out some other way. This was an option that I understand was rejected or not even considered. That is fair enough. In real life, however, there was concern about this. In real life as well, issues arose because of this. There also seem to be issues arising in some of the CHOs but not in all of them. I have spoken to representatives from many different CHOs as well as many people who work in them and deal with services. There are different experiences in different CHOs. I ask the Minister of State to examine this issue from a budgetary point of view. I will come back to this point.

I listened to the other Minister speaking about this topic earlier. One phrase jumped straight out at me. That was when he stated that this is not demand led. That is the problem. It should be demand led. The issue here is that provision should not be based on a budget every year. That is the real problem. We know where the demographics are going. I do not expect the Minster of State to be able to quantify the numbers exactly each year but the numbers of people over 65 and over 80 is changing dramatically. This service, therefore, has to be demand led.Ironically, making it demand led will allow us to save a fortune. We will then be able to reinvest that money into the health service in many other ways.

There has also been frequent mention here regarding the difference between home help hours, €150 to €170, versus more than €1,000 for a nursing home and €5,000 to €6,000 for acute care. The strange thing is that we have CHOs being put in a position whereby they have to meet their budgets but there are people in beds in the same corresponding acute area network. I know the Minister of State knows this because he has a report on delayed discharges that he and I have read. The Minister of State has taken an active interest in this area. It is bizarre and perverse that it makes more sense for those in a CHO area to want those patients in an acute setting to be left in those beds. That costs taxpayers five times more than if they were going into elderly care for a while, into recuperation or whatever. The fact that packages cannot be put forward is crazy. It is a perverse situation and changes in this area will actually allow money to be saved.

It is an issue that is going to have to be addressed. I, with some colleagues here, sat through 11 months of working on Sláintecare. This whole area needs to be flipped. It needs to be demand led, proper packages need to be provided and all them need to be orientated towards those who need them. The beds taken up in acute care need to be freed up and the pressure eased. People need to be able to stay in their homes. There are issues concerning how we do that. The significant nut that has to be cracked is the issue of workers. There are not enough of them. Why is that? Despite the continued increase in pay of and continued investment in directly-employed workers, when it comes to non-directly employed workers, their conditions are not good enough. That has to change. We need a recruitment plan and a training plan which is set out for five to ten years. We also need a registered employment agreement for workers in this area to create a standard and to provide pay and conditions to help workers and ensure that they want to work in this area. I know there are people who want to work in this area. They will not, however, because of the craziness of going out for half an hour here and there and having to travel long distances between clients. That is an insane system. This whole service needs to be packaged up and dealt with.

The manner in which the CHOs are currently individually dealing with the three types of packages, home help hours, homecare packages and intense homecare packages, is also insane. It is exceptionally difficult to get intense homecare packages. Conversely, the fact that they are not being put in place is costing the State a fortune. Do we have the skills, resources and the volume of people to be able to go in and be able to carry out those packages? We do not. It gets worse depending on which CHO we look at the statistics from. It is crazy that some CHOs have waiting lists of 300 and 400 people. In other areas, nobody is on a waiting list. The Minister of State's colleague stated earlier that that was based on prioritisation. That is not prioritisation. Those waiting lists are based on what side of a line someone is born on. A person could be a top priority in one area but one mile over the road he or she could number 150 out of 350. This whole system and the way in which it is managed needs to be examined.

There also needs to be an examination of the manner in which allocation amounts are given. Like everyone else here I had dealt with this issue for a long time. I dealt with a couple who lived over the road from me and who have recently passed away.They were allocated 20 hours in total because they were high dependency. They never got more than eight hours. If they did get eight hours, their family members were thrilled. That was because there was never ever going to be a situation where that couple was going to get the full 20 hours. That is not right. By the way, those eight hours only came about after they were fought for, in fairness to those who delivered it.

Hand in glove with this issue is the matter of carers. Due to the way in which we have let this system go, carers pick up the slack. That issue is going to heighten over the coming years. Corresponding with the need to change the whole system governing home help hours - changing it to make it demand led, investing in people for the future of the system, changing the criteria as to how people are being serviced, ensuring we do not promote delayed discharges in acute beds and joining up the thinking between the CHOs and the acute networks - we also need to invest more in carers. That starts with getting rid of the means test for the carer's allowance.

We also need to invest more in carers, which starts with getting rid of the means test for the carer's allowance.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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This was debated at length several weeks ago. The issue of the embargo on home help hours is not going away. The announcement by the HSE on the moratorium on additional hours until November will have a detrimental effect on home help services in the community. This is probably directly linked to the overspend in the health budget and the overspend on the national children's hospital. They are causing a chain reaction which has affected community home help hours.

I worked as a home care worker for ten years. During the last debate I spoke as a care worker about how vital the service is for the client, the family and all that entails. I referred to public health nurses, palliative care and end-of-life care. When somebody is quite ill or coming to the end of their life they want to be in the surroundings of their home. That is the future and that is what we need to do.

I wish to allude to the motion itself. It is a really good motion and points out that directly employed home help is more cost-effective than always looking to the private sector. The private sector has a large slice of this pie and it is very lucrative, even though the workers themselves are non-unionised and are sometimes not that well-paid compared to a directly employed worker. The HSE pays private operators an hourly rate which is almost twice what the workers get. With a directly employed carer the money goes to the worker rather than a private operator. I understand that the Minister of State is setting up a statutory scheme, which is welcome. However, the most controversial part of that is co-payment. We may not agree, but I think that will be quite controversial. Other Deputies have alluded to the waiting list of 6,000 people. I can guarantee that those 6,000 people will need home help provision and intervention. That could mean anything from 24-7 care at the top end to 20 hours or sometimes one or two hours a week. It is very important that we engage in these things.

I welcome the fact that there has been a 45% increase in the budget for home help hours over the last three years. To be non-partisan, that is really welcome. It is really important that the moratorium is lifted and the number of hours budgeted for increases. Primary care in the home is the future. There is no doubt about that. People want be cared for at home. That is better for the clients and for society as a whole.

Mick Barry (Cork North Central, Solidarity)
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A few days ago the Minister for Health, Deputy Harris, said there are no cuts to the home help service and that it is in fact being expanded. Is he telling the truth, the whole truth and nothing but the truth? Let us look at some of the facts. It is a fact that the scheme is effectively being closed until November. The HSE has said so. I presume the Minister of State does not deny that. It is a fact that the list will be longer in November than it is today. There are 6,310 people on the waiting list at the moment; if the scheme is effectively closed for five months the numbers are bound to increase. That is a fact, and people will suffer as a result. The hours have effectively been frozen until November. As I understand it the hours can be increased in extreme cases and there is a little bit of leeway, but in general there is a clampdown. That is a fact; the HSE has said so. People will suffer as a result.

The increase in suffering will be paralleled by at least some increased costs. It costs €165 a week to provide a home care package. It costs more than €1,000 a week to keep someone in a nursing home bed and nearly €6,000 per week to keep someone in a hospital bed. The Taoiseach and the Minister have said that the saving is not as great as some people assume. That may be the case but the idea that no costs are involved has no basis in reality. Of course there will be more people in nursing homes and hospital beds as a result. Costs will increase. That is a fact.

The Department has been in correspondence with the HSE. Some of the correspondence was published in The Irish Times on Saturday. The HSE says that a significant amount of the €500 million its officials describe as "savings" is to come from the home help service. It was in the newspapers on Saturday. I presume the Minister of State does not deny that there has been correspondence between the HSE and the Department in relation to this.

Another fact is that the Minister is trying to kick-start a debate about a revamped scheme to be introduced in 2021, with co-payment as part of the equation. Co-payment is a nice way of saying that for the first time in the history of the State this Government will charge people for the home help service. The Minister is clearly under pressure to rein in the health budget. However instead of cutting back on profiteering in the health service, for example, by construction companies at the national children's hospital, he has picked a soft target and made cuts in the home help service. The Minister shows a soft face to the wealthy and powerful and a hard face to the old, the sick and the most vulnerable in society. That is a fact as well. The message from these benches is this; reverse the home help cuts and take on profiteering in the health service instead.

Catherine Connolly (Galway West, Independent)
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I fully support this motion and I thank Sinn Féin for the detail in it, particularly the recognition that "the best value for money is provided by directly employed and not-for-profit homecare workers".

In that context, particularly on a night when we have just had a two-hour discussion on the summer economic statement, I find the speech read out by the Minister of State disingenuous and worrying. I find it disingenuous because he spoke about hundreds of thousands or millions of hours without putting them in any context whatsoever. I also find I am in agreement with Deputy Kelly on a statement on the second page of the speech which jumped out at me. It read: "The Service is not demand led and is therefore operated in line with agreed budgetary limits and targets, as set out in the HSE National Service Plan". On another page is a sort of collateral damage to that type of budgeting; some 6,310 people have been assessed as needing home help but they are not going to get it. The Minister of State assured us that the Health Service Executive has said that this list will be reviewed "as funding becomes available". That is the nub of it.

As Sinn Féin's motion outlines, directly employed care is much more cost-effective. If the Minister of State can show me that what is set out in that motion is not correct, I will certainly apologise to him. If it is correct, or even if we are out by a few euro, how can a Minister of State come in here tonight, following the summer economic statement, and not set out a vision that will save this country money? Is it not incumbent on him to tell us how he will save money by having a proper statutory scheme that will look after our people by providing home care as a right, with no co-payment?

In 2018 the national risk assessment referred to the fact that our population is getting elderly, which is a positive, as a risk. It noted the need to plan for the implications of that. Organisations on the ground like Age Action and others are also worried. In 2016 more than 637,000 people were over the age of 65. That number will increase to a million by 2031.

I do not cite those figures to frighten; I use them positively and in the way the Government should on foot of its risk assessment to plan properly for home help.

My time is limited so I will finish by putting a human face on those figures. The Government has a duty to save money which it can do by providing a service that is cost-effective through directly-employed people and which is, of course, demand-led. I refer to three people in Galway without identifying even their sex. The first is a person in his or her early 60s and who has dementia. That person has been given a maximum provision of 11.5 hours. After many representations, it appears there will be a review. A person with a serious and progressive disease has been given a maximum provision of ten hours. Another person is aged 96 and has been given ten hours. That is Galway city. I disagree with one aspect of the Fianna Fáil amendment, namely, the roll-out of the single-assessment tool. That was rolled out as a pilot project and it has not been assessed. In my view, it is an integral part of the problem. I ask the Minister of State and Fianna Fáil to withdraw their respective amendments to let us go forward together in a positive way to save the State money while valuing our elderly people.

Maureen O'Sullivan (Dublin Central, Independent)
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Everyone agrees that home help is invaluable. It keeps a person at home and in his or her own community. In the majority of cases, that is much better, in particular psychologically, for the person as well as economically given the cost of home care versus that of a hospital bed or nursing home care. There are people in hospitals and nursing homes who should not be there and would not be if home help provision was available. I have had some positive experiences of where this has been extremely helpful. I think in particular of a friend who suffered with motor neuron disease for six years and received great care. It involved care being provided from different sources, however, which is difficult unless the family is able to address the issue.

Many people in my constituency receive home care, in particular where I live in East Wall. Tremendous work is being done, as every Member has said. I refer in particular to the work of the voluntary community organisation whose service I know best. I put down a parliamentary question on it to which a reply eventually came back from the HSE. The HSE is trying to streamline the service in a certain way which is not positive for some of the community home care providers. As the particular service I know is not part of the HSE's 2018 tender, it is being undermined and undervalued, yet it is doing tremendous work. The staff are from the area which means not much travel is involved. They know the area and all the local services. They know the people they are caring for. As they are from the area and provide more hours than they are paid for, they are available beyond the provided-for hours if there is an emergency. As they are not part of the tender, however, they are not being allocated new clients. That means the generic budget will continue to be reduced and the number of home-support clients will decline. Consequently, the community group providing this valuable service will have to close. This is a real community initiative. However, I am finding recently that the HSE is not supportive of community initiatives where the community identifies needs and responds.

It appears that the HSE's agenda is top-down rather than bottom-up. Unfortunately, we are seeing other examples of that in other parts of Dublin. In reply to my parliamentary question, the HSE said formal arrangements were being made with external providers to ensure fairness and transparency in the selection of service provision. We have a group that is providing that service fairly and transparently as it is and yet it could be replaced by an external provider. I note discussion of streamlining the home help and home care services into a single home-support service. While that sounds fine, I find it difficult to accept that a community service may end while an external provider is brought in. I find danger in the words "streamlining" and "streamlining process" because I feel the smaller community provider will not be part of the process and will not be encouraged to be part of it either. The community service to which I refer has been operating for years. I note the Government's amendment and the recent announcement of an increase in the home-support budget. The Government says the HSE's national service plan will deliver further hours. The Minister of State said that individual cases will be looked at on a priority basis and determined by local front-line staff who know and understand clients' needs. Community home care organisations have been providing that service inside and outside the tender process and I hope they can continue to do so. They are providing a very worthwhile service.

Michael Healy-Rae (Kerry, Independent)
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I acknowledge Sinn Féin for its work on the motion and I thank Deputy Butler and Fianna Fáil for their amendment. This is a terribly important motion to bring before the Dáil. Every Member knows well the tremendous good home help providers do in our communities. We were all very upset last week when home help providers whose payments were stopped were faced with having to put petrol and diesel into their cars themselves. Thankfully, that situation has been resolved. I only know about County Kerry but it might have been the same in other parts of the country. It was affecting my county very badly and I am grateful the payments will be made in ten days' time. The backlog of money owed to these people is terribly important.

I am concerned about the following. When a person needs care, it is proven that it is better if it can be provided in the home. Everyone of us would rather be at home than anywhere else. One could be in the finest hospital or the grandest hotel, but there is nothing like one's own corner of this world, namely, one's own little home which is a nice place to be. When a person needs home care, that need does not cease to exist on Friday evening. That is why home help provision on Saturdays and Sundays is of such great importance. The Minister of State knows that the programme for Government refers to the provision of home help on Saturdays and Sundays where it is deemed necessary. That was put there for a specific purpose, namely, to ensure that when people need care and assistance at home at the weekends, they get it. With people working away from the family home and given emigration, family units may not be as strong as we would like and the help might not be there to care for people at home at weekends. I ask for each case to be looked at individually. These people deserve respect and everything we can do to help them as they get older or when they suffer from a disability and need care and assistance. I commend in the highest possible way the home help providers I know in Kerry who do diligent work. I thank them on the Dáil record for the great work they do.

Michael Collins (Cork South West, Independent)
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The Irish Timesreports that the HSE has proposed cuts to home care packages. Correspondence between the Department of Health and the HSE outlines savings of the order of €500 million in 2019. The Minister insists that any savings will not impact front-line services but Members should mark my words that a €500 million cut in health will definitely affect them. Ireland has an ageing population and the old-age dependency ratio is increasing, in particular in rural Ireland. That is leading in turn to a greater demand for home help hours. How can we expect to meet the future demand for home help hours when we cannot meet the current demand? The demand for home help hours is projected to increase by between 38% and 54% by 2030. The Government must look therefore at providing better home care arrangements as a matter for urgency rather than to wait until the crisis worsens further. Over 6,000 people were on the national waiting list for a home help service at the end of April 2019. We need to see more staff employed to deal with the demand for home help workers to process applications more quickly. The weekly cost of a hospital bed is just under €6,000 while the weekly cost of a nursing home bed is just over €1,000. However, the average weekly cost of a home care support service is approximately only €165. It is a no-brainer that supporting home care services is a much better option for the Government. Certainly, it would be good for the Government's pocket, which is one of the only things it cares about. More importantly, home care services are valuable in the support they provide to enable older people to remain in their homes and to stay connected to their communities. One group escaping any criticism here is the unions which are supposed to be supporting home help workers. I have spoken to these great home help workers across west Cork over the past two or three years and particularly in recent months. They pay their union fees but get little or no support. It is time for the home help unions to wake up and start representing their workers properly.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I appreciate the minute of time that my friends in the Rural Independent Group have shared with me. I have two brief points to make. I acknowledge that the Minister of State, Deputy Jim Daly, is a good advocate for people and a good listener. I am sure he is taking in what is being said this evening.

It has been already pointed out that there are no waiting lists in several counties. There are nine people on the Longford-Westmeath list, 17 people on the north Tipperary-east Limerick list and 31 people on the Waterford list. There is no one on the north Cork waiting list. There are 147 people on the waiting list in Roscommon. People might say that is a low figure, but it is not low by comparison with other counties. Some counties with bigger populations have no waiting lists, or just a few people on the list. There are 307 people on the waiting list in Galway, which admittedly has a larger population. There are 454 people on the list in the Galway-Roscommon region, whereas other regions have no waiting lists. There has been a significant increase in the number of home care packages provided since they were introduced by Fianna Fáil in 2006. We really need them now.

My second point relates to weekend cover. This point has not been made. I know of many cases in which dinners are provided to old people during the week, but there is nobody providing meals on Saturdays and Sundays. We need to look at what is happening in such cases. We should try to get some cover at the weekend. Some people might have got the impression from this evening's debate that families do not do an awful lot. Many families do a lot but they need this home care very urgently.

Mattie McGrath (Tipperary, Independent)
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I am delighted to speak on this motion and I compliment Sinn Féin on bringing it forward. I am particularly struck by the cost analysis in the motion. I compliment Deputy Butler on her amendment, which I will be supporting. The motion outlines the cost-effective nature of home support by comparison with hospital care and nursing home care. It makes stark reading. The average weekly cost for home support services is €165. The average weekly cost of a hospital bed is €5,992. The average weekly cost of a nursing home bed is €1,048. It is clear that the best value for money is provided by directly employed, not-for-profit home care workers. I emphasise the not-for-profit aspect of this approach. I am deeply concerned about the proposals to charge for the home help service, which is currently universal and free. I am not saying that some targeted approaches might not be valid. The Government's track record on this matter is not great. We know how long it has taken to rectify the systematic discrimination towards farm families and business people that was built into the fair deal system. Are we going to see something similar here? What assurances can we receive that any such proposals will receive the most rigorous regulatory impact analysis before they are brought forward?

We need to be serious about this. We cannot make patsies out of the farmers and the self-employed. We need to have fair play. For the past three or four years, we have been trying to drag the Government kicking and screaming to bring equality to the fair deal scheme. We cannot introduce a similar system here. We must support the women and men who go out and provide home help services. As other Deputies have said, we should keep people in their homes because it is a fraction of the cost. This is a no-brainer. We should not even be debating this. We need to see some compassion from the Government. I know the Minister of State, Deputy Jim Daly, is compassionate. Many of his colleagues who are supporting him here tonight are not compassionate. They never had any compassion because they were the Government of the big people whose daffodils line the avenue. I would not call it a bóithrín. They do not care about the small people. They tell them to go to hell or to Connacht. We saw that with big Phil the destroyer when he was a Minister here. He also had the "to hell or to Connacht" attitude. The Government should look after the ordinary people. They will be told to listen very soon with the peann luaidhe at the ballot box. They will be told to be ag éisteacht agus an béal dúnta. They should look after the ordinary people rather than the landed gentry. It is time to see common sense here. We need to look after the ordinary people.

Róisín Shortall (Dublin North West, Social Democrats)
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I commend Deputy O'Reilly and her Sinn Féin colleagues on the introduction of this motion. This is the second time in a very short period of time that we have discussed this issue, which is one of the most pressing issues in the health service. It typifies everything that is wrong with the way health services are provided in this country. I refer again to the principles that underlie the Sláintecare plan, which is about providing services at the lowest level of complexity in the community as close to home as possible. The best place for older people and people who are infirm or disabled in any way to receive services is in their own homes. We know that if we provide the kinds of supports that are necessary for such people to remain in their homes, or to return to live in their homes, we will achieve the best health outcomes. Interestingly enough, it also gives by far the best value for money. Rather than recognising that principle, and its importance for older people in particular, the Minister and the Government are continuing to do things that work against this kind of success.

I will give some examples. In the past week, it has emerged that there are 585 people who are regarded as delayed discharges in our acute hospitals. The majority of them are in the big teaching and voluntary hospitals in the Dublin area. These people are misplaced. They should not be where they are. They have completed the acute phase of their treatment and are ready to move to a nursing home or another stepdown facility, or to go home if the services are available. Unfortunately, they are not available because of the ridiculous and scandalous way our health service operates.

When the chief executive of the mid-west hospital group appeared before the Committee on the Future of Healthcare some years ago, she told us there were approximately 40 delayed discharges in University Hospital Limerick. She said she would give anything to be able to set aside part of her budget to access home care services for the 40 or 44 people in question. She said that if they could move out, it would free up beds in the hospital, thereby allowing the hospital to deal with acute patients and make progress through waiting lists, which is what it is supposed to be doing. Rather than doing that, we have siloed organisation within the health service and we have siloed budgets. This means it is not possible to spend money in the places where it makes most sense to spend it. Health services, like so many other things for which this Government is responsible, are being provided in the most expensive and least effective way possible. The Government has known for years that this makes no sense. Why is it not addressing this issue?

If 585 beds in acute hospitals are being taken up by people who no longer need acute care, those patients are essentially staying in very expensive hospital beds on a bed and breakfast basis. They do not need consultants. They do not need nurses to any great extent. They are staying in beds while they wait for somewhere more appropriate to become available. Nearly 600 beds are not being used for what they should be used for, while the waiting lists continue to grow. There is a massive logjam in elective surgery in our public hospitals. We talk about providing more hospital beds and building new hospitals, etc. The very first thing we should do is ensure there is throughput within the hospital system. The 585 beds I have mentioned should be freed up to enable more people to come in, have their various operations and procedures and move out again. This kind of throughput is needed if we are to make progress through the hospital waiting lists. There are big tailbacks and waiting lists because those beds are not available. Their non-availability is one of the key reasons for the incredible waiting lists that exist at present. It is entirely indefensible that there are 550,000 waiting for outpatient appointments and approximately half as many again waiting for procedures. The solution is facing the Minister - it is right in front of him - but he not taking action.

Sometimes the hospitals do not complain about these arrangements because there is no work to be done to service the 585 beds. Where are the staff who are being paid to service those beds? Where are the consultants who are being paid to do operations and procedures on these 585 people? There is a perverse incentive here. It is certain that we are not getting value for money. We are preventing our highly paid hospital staff, particularly consultants, from doing the work they are being paid to do. Again, this makes no sense whatsoever.

However ridiculous it is that we do not free up those beds and make home care and home help services available, when one looks at what is happening on the community side, one can see that 6,000 people are waiting for home care services. Again, we are talking about very vulnerable people who are being forced to live in circumstances where there is little or no dignity and no respect for them. These people have already been assessed and found to be in need of home support services yet despite the fairly difficult and rigorous test they are put through and despite being told they are approved for home care, none is available. Essentially, they are being told that they must wait for other older people to die before hours are freed up or recycled, as the Minister of State referred to. This is outrageous. Apart from the fact that the Government is denying people the right to live in dignity in their own homes, those people are very much at risk and are much more likely to turn up in emergency departments at the weekends or in the middle of the night when they do not have support services. They are also far more likely to have falls and end up in acute hospitals for long periods. It makes no sense to do this.

When we spoke about this here recently, I asked the Minister of State, who had been twisting and turning so as not to portray it as a cut, how he was going to accommodate the additional travel time required to pay staff. He told me that the HSE would have to find that money elsewhere. I am still waiting for him to tell me where on earth it is going to find it. What he has done is a disgrace. This is a scandal. The Minister of State should get the finger out.

David Cullinane (Waterford, Sinn Fein)
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"I acknowledge that in some cases, access to the service may take longer than we would like" is the only sentence in the Minister of State's speech with which I agree but it understates the position. It is not the case that it may take longer, it will take longer and for some people who need home help, it will not happen at all. The problem with the approach of the Minister of State and Government to this issue is the same problem with Fine Gael's approach to public services. It sees everything through an economic prism and believes that people are here to serve the economy instead of the economy being there to serve the people. The Government sets out its health budget knowing full well that it is understated. We see an overrun or get close to one and what does the Government do? It has to cut back and then says they are not cuts because it does not allocate the money that is needed for all of these services in the first place. The Government does not look at people as people who need to be looked after and cared for and in terms of building a society and fairness. It looks at everything as being driven by economic needs. Members of the Government are almost actuaries. They are not politicians or Ministers who are there to look after the welfare of individuals. They are almost accountants and actuaries who see everything in terms of cents and euros and not in terms of what people actually need.

Even if the Government was to look at this from an economic perspective, it does not make sense. If the Government does not provide the home help that people need, what is the alternative? What is the alternative for somebody who does not get the help he or she needs in his or her home but is taking up in an acute hospital bed and cannot be discharged because the home help hours, home care packages and all of the other supports that should be in place are not there? What is the economic cost? It costs more. The fault line in this Government's approach to this issue from the get go is that every year, and Deputies O'Reilly and Pearse Doherty will say so when it comes to budget time, it does not allocate enough to health. When a Government does not allocate enough to health and prunes back the expenditure that is necessary, it ends up having to tell hospital managers across the State and the home help service that they must come in on budget and cut their services, which is what happened. The victims are people who need home help. The Government should stop looking at an economy as something that people are there to serve. The economy is there to serve people and citizens and if we cannot look after people who need home help - older people who need to be supported in their homes - what can we do? I commend this motion and welcome the fact that Fianna Fáil will at least table its own amendment and give some support. The fact that, again, this Government is not supporting this motion and is turning its face away from it is wrong.

Denise Mitchell (Dublin Bay North, Sinn Fein)
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I welcome the opportunity to speak to this motion. It is a matter that affects people in every city, town and village across the State and is not going anywhere. As our population ages, we need to invest more in home help services to ensure that supply is meeting increasing need but the Government has been failing miserably in this regard. It is very worrying to hear reports that home help hours could face cuts under the HSE's plan to plug a €500 million hole in the health budget. It is not just worrying; it does not make sense. As Deputy O'Reilly noted, this is a case of cutting off your nose to spite your face. Without home help, we will not only have a further backlog in our hospitals as people's discharges are delayed but it also ends up costing the HSE and the State more. The cost of keeping a person in hospital is on average 36 times higher per week than the cost of discharging a person to their home where he or she can avail of home help supports. More than 6,000 people are on waiting lists for home help, almost a quarter of whom are in north Dublin. The reality is that our population is getting older and people are living longer. Instead of cutting these services, we should be looking to expand them.

I see the great work done by home help workers on the ground. They are invaluable in supporting people to live independently and in supporting families who are helping to care for their loved ones. We need to protect home help hours and expand this service. We also need to ensure that workers are protected and properly paid for the important work they do. Elderly people - vulnerable elderly people - deserve to be treated with dignity and respect. At the very least, they deserve to be given adequate home help hours to meet their needs.

Dessie Ellis (Dublin North West, Sinn Fein)
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Society has a duty of care to the elderly in our communities. It also has a duty of care to children with serious illnesses or disabilities as well as their families. Society has a duty to allow people to stay in their homes and be looked after there if they so wish. For many who receive home care supports, this means that they only get personal care and some meal preparation. Most will require a greater level of support and this cannot happen if the current situation continues. I have spoken to those who administer home care packages provided by the HSE throughout Dublin North West and they have told me that there is a reduction in the provision of home care packages that has resulted in a backlog of people looking for these supports. People with disabilities should have access to appropriate home care packages that will allow them to live their lives independently.

There is an obvious operational benefit arising out of the provision of home care packages. Appropriate funding and resourcing and the proper provision of home care packages would result in fewer people taking up valuable hospital beds - often for weeks at a time or sometimes even months - because there is no home care package they can avail of that would allow them to go home and free up a vital hospital bed. Those who work in this field do so more as a vocation than a job. We should recognise their contribution, which often goes beyond the call of duty.

I would like to draw attention to the issue of the loco parentisrule. While this is separate from the issue of the provision of home care packages, this rule is the cause of great frustration for many parents who care for a sick child. It is a contradiction whereby when parents have nursing staff in place for respite, they are unable to leave their home as the loco parentisrule does not allow it. Respite is vital to give parents a break from the strain and stress of caring for a sick child.

It is draining on a person’s physical and mental well-being. Carers in these circumstances need time to recharge their batteries and clear their heads. It makes no sense that parents receiving respite cannot avail of it because of this rule. Home help is an important mechanism allowing people to stay in their homes giving them a decent quality of life.

Denis Naughten (Roscommon-Galway, Independent)
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One would cut home help waiting lists if Google Maps and Eircode postcodes were used instead of the flat-rate method of allocating four hours' travel for every 39 hours worked by home helps, irrespective of the mileage they do. The flat-rate system does not work in large towns or cities. From my research, this flat-rate system overstates the national average time travelled by home helps between calls by approximately 100 minutes. Based on that estimate, the home help waiting list could be slashed by one third by using Google Maps and Eircode postcodes to plan travel for home helps. This would release an extra 2,000 home help hours every single day.

This is just one example of the HSE going for the administrative soft option rather than focusing on the needs of home helps, carers and, more important, those for whom they are caring. In the past three years, the home help budget has increased by half but this has not been reflected in an increase in home help hours. Is it not time we asked why?

Michael Fitzmaurice (Roscommon-Galway, Independent)
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There is a serious crisis with home help hours and people being refused the service. On top of this, over the past few days we have heard that many people are being held in hospital with the fair deal scheme in chaos. If the truth were told, with the fiascoes of the likes of the national children’s hospital, there is penny-pinching going on in other services. HSE staff tell us that they are being told constantly that they must cut.

If that is what we think of those who need home help services, then we, as a country, are failing our people. We should be ashamed of ourselves if we are now attacking the most vulnerable to cover those who did not know how to do their figures when they were adding up the costs of hospitals. We will probably see the same with the broadband scenario. Will the Minister of State sort out the home care, fair deal and home help schemes immediately?

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputies for the opportunity to speak about services for older people. I agree wholeheartedly with the Deputies in highlighting this issue because, despite the significant level of increased investment in service provision, demand for home support continues to grow. I also agree with many of the sentiments expressed in the motion, which in several ways reflect work that is well under way in the Department of Health.

We all share the common objective of improving quality of life for older people. There is an obvious need to provide high-quality and flexible services that not only best meet the needs of individual clients, but also reduce pressures elsewhere on the health system. Social care services, including home care, day care and respite, are important components in enabling people to remain living at home and participating in their local communities. They also provide valuable supports to carers, an important topic to be discussed in the House tomorrow.

The Government’s overarching policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. The 2019 national service plan provides an overall financial allocation of €862 million for older person services, of which €446 million is provided for home supports. A Programme for a Partnership Government signalled the Government’s intention to improve home care services and to introduce a uniform home care service. I have committed to establishing a new stand-alone statutory scheme and system of regulation for home support services.

The Committee on the Future of Healthcare's Sláintecare report supports a significant shift in our model of care to one focused on prevention and early intervention and which will provide the majority of care in the community. The Government’s Sláintecare implementation strategy sets out an ambitious programme of reform to deliver this vision. The Department of Health’s 2018 health service capacity review 2018 and the 2017 report commissioned from the ESRI, Projections of Demand for Healthcare in Ireland, 2015-2030, are key research reports which provide an evidence base to inform investment and policy decisions in the future, including regarding home and community supports. The evidence base provided by these reports is being considered for the future planning, design and delivery of services, including the delivery of reform through the implementation of Sláintecare.

The development of the statutory home care scheme is a complex process which will build on the HSE's continual enhancement of existing service provision and on emerging good practice, both nationally and internationally, across the current system of health and social care delivery. The new scheme will improve access to the home support services that people need in an equitable, affordable and sustainable way, ensuring the system operates in a consistent and fair manner across the country. The model of financing to ensure the sustainability of the scheme will be considered in detail as part of the policy analysis and development process.

The new system of regulation for home support will ensure the public can be confident the services provided are of a high standard and will bring Ireland in line with best international practice. We plan to undertake a comprehensive review of existing services to assist in informing the development of the new scheme. The Department is engaged in a review of the policy goals, objectives and guiding principles of adult home support service provision in ten countries. This will assist in identifying international good practices.

Work is also being progressed on a review of the management, operation and funding of current home care services, another programme for Government commitment. This will provide a baseline for the design of an effective, sustainable service as part of the development of a statutory home care scheme. The review is expected to be concluded in the fourth quarter of 2019.

A standardised single assessment tool, SAT, is a core requirement for the successful planning and modelling of care services, particularly in the context of a shift to community models of care. The roll-out of SAT is a key priority in 2019. The procurement of a new system is well under way and expected to roll out later this year. The Department will work with the HSE to ensure this tool is fully embedded in the assessment of need for older persons, including for home support services.

I fully agree home support staff play a vital role in improving the health and well-being of our older population by supporting and looking after them at home which is usually their preferred environment. As part of the ongoing measures to improve current services, following a Labour Court recommendation in 2014, the HSE implemented new contracts for its directly employed home support staff. These contracts provided each worker with a guaranteed minimum number of hours per week and a guaranteed income each week, with actual work assignments managed in a reasonable way to meet the needs of clients over the course of 12 months. This new contract was regarded by staff, unions and management as a positive development for HSE employed home support staff.

More recently, in 2017, the HSE engaged with SIPTU under a Workplace Relations Commission conciliation to review current home support staff contracts. The aim was to ensure contracted arrangements reflect the needs of the service, to maximise contracted hours for HSE directly employed staff and to take further steps towards professionalising the home support service.

The agreement, under the auspices of the Workplace Relations Commission, will, among other things, provide for an increase in contracted hours for over 90% of home support staff if they choose to accept the HSE offers, a change of title from home help worker to health care support assistant to better reflect the nature of the services being provided, and the introduction of rostered arrangements to give staff greater certainty regarding their hours of attendance with travel time factored into these arrangements.

While I and the Government agree in principle with many of the points made in the motion, it is not possible to offer full support. The motion includes calls on the Government that would likely have a significant immediate financial impact. I am concerned the capacity to deliver some of the actions may not be deliverable in the short term. The Government has a responsibility to manage, in a prudent way, the budgetary space in which we operate and must plan investment and expenditure accordingly.

It is noted, in particular, that several items in the motion relate to policy matters currently being examined by the Department of Health in the context of the development of a sustainable statutory home support scheme. It is important significant policy decisions are undertaken following a considered policy analysis and development process, including engagement with stakeholders, review of national and international evidence, as well as economic analysis and appraisal. This process, including the configuration, content, delivery and financing of a statutory home support scheme is well under way. The Sláintecare implementation strategy commits to the introduction of the scheme in 2021.

Traditionally, home support was viewed as providing a lower level of support than residential care, and not as an alternative to it. Increasingly, it is considered possible to support many people at home who might previously have gone into residential care. This requires an increase in the amount and intensity of home support, along with more effective integration with other services and supports. We want to develop home support services. We are working to provide a more viable alternative to nursing home care for a greater number of people.

The significant work packages contained within Sláintecare provide the framework for the redesign of services to ensure that more care is provided at the right time, by the right people, in the right place. Maximising future home care provision will require increased investment coupled, crucially, with reform and the introduction of a statutory home support scheme, sustainable financing models, and the broader shift to the provision of care in community settings.

I assure the House that all CHOs are working to ensure the best use of available funding to support the greatest number of people requiring home care services. As I stated on the previous occasion on which the House debated this topic, I have met senior HSE staff and CHO representatives. They provided reassurances that there is no freeze on home support and indicated that the HSE will deliver on its service plan commitments in respect of home support. In delivering on these commitments, the HSE has a responsibility to ensure that activity is planned in order to anticipate critical demand pressures, most particularly emergency pressures in the initial and latter parts of the year.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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I commend Deputy O'Reilly on tabling the motion before the House. I also commend the healthcare workers who do such Trojan work for so many people. Unfortunately I cannot commend the Minister of State's efforts in this area. While he may say that there are increased hours, the lived experience of the people who contact me and every other Deputy in this House is that they cannot get these hours because they are not there. Any logical assessment tells us that there is pent-up demand. There is more demand than there are hours available. Our population is ageing so we will have more demand and an increasing number of people who require home help hours, but we do not have the hours to match this demand. The problem is that the demand is growing faster than hours are being put into provision. Every logical person who looks at this issue understands that this is the best investment that can possibly be made in any part of the healthcare system because it immediately ensures that people are kept well rather than being taken care of when they have fallen ill. This is the stitch-in-time model that we all know needs to be introduced.

An example of what is involved relates to a woman whose family contacted me recently. She went into hospital in Sligo in the middle of May, some six weeks ago. Ten days later, she was informed that she could go home with a home care package. The package was approved pending funding. She is still in hospital. The position is the same for many other people. I could pick out several more individuals who are in the same situation. This is an absolute crisis for their families. Saying that more hours are available does not solve the problem for the family of the woman to whom I refer or for other families.

There needs to be recognition of the problem that exists. There are more than 200 people on the waiting list in Sligo-Leitrim. A couple of months ago, I was told that there was nobody on the waiting list. If, however, I rang up looking for home care hours for somebody, I was informed that there were none available because there was a waiting list. There is a lot of inconsistency as to what is happening. Other Deputies referred to parts of the country in which there are no waiting lists. Perhaps if they went back in a month's time they would find that a waiting list has appeared while the numbers on the list in another area have decreased. That is the problem. We cannot trust the numbers coming to us from the Department of Health. That is another issue.

A further issue which clearly needs to be acknowledged immediately is the withdrawal of home help hours for people with mental health issues and intellectual disabilities. We see that all over the place. Unless people are chronically ill, they do not get home care hours. People in these other circumstances deserve and need those home care hours as much as anybody else.

This motion is about coming to a solution. I encourage the Government to support it and to provide the money upfront. Money put into home care hours will pay dividends in the long run.

Martin Ferris (Kerry, Sinn Fein)
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It is an awful indictment of this State that people who are so vulnerable and who want to remain in their own areas and homes are being denied a proper home help service. It is a terrible indictment that 6,500 people are on the waiting list. An even bigger indictment is the amount of money, €6,000 each, spent to keep people in hospital and in valuable beds or in nursing homes at a cost of €1,048 when it would only cost €165 to keep them in their own homes. These individuals could be looked after at home if home help hours were available.

There is not a Deputy who has not experienced, with their constituents or within their own families, the tremendous value of home help to people who receive it. I have a great friend who is paralysed from the waist down. He is 86 years old. He has been paralysed for 12 years and he is in his own home with his wife. He has to be taken out of bed in the morning using a hoist and then washed and put in a wheelchair. He gets taken for a walk in his wheelchair with his wife. He is put back into bed in the evening. He gets a half hour of care in the morning and another half hour in the evening. He is very fortunate because special allowance is made for him and he gets care seven days a week. There are other people who get care five days a week, a half hour in the morning and a half hour in the evening, but there is nobody there for the weekend.

Home care is such a tremendous service and achieves savings for the State. If only the people in charge and who are responsible, by which I mean those in Government, would look at it in that light. I should not be surprised because the culture and ideology of this Government is not about caring, although it should be. The Minister of State should not miss the point Deputy Denis Naughten made regarding geography and home helps having to travel for half an hour to do half an hour's work and then having to travel back for another half hour. A small bit of tweaking in that regard would make a huge difference.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I welcome the support from all parties. We had six speakers from Fianna Fáil. I am not certain as to whether they are going to support the motion. I believe that they are; they just have not said so. I hope they will. We in Sinn Féin, and every other Deputy in this House, deal with the issues caused by the lack of home help support weekly if not daily. We know about it. We see it. We have constituents asking about it in our offices and our advice clinics. The Minister of State does as well. The Minister of State, Deputy Finian McGrath, stated, "The allocation of new hours will be based on clients' needs and the resources available." Which is it? Will it be based on clients' needs or on the resources available? Those two things are not compatible. If a client needs hours, he or she should get them, but if the resources are not provided, he or she will not. There is a contradiction in this. The Minister of State indicated that he absolutely supports the home help service but his actions do not support that. When he states that "The allocation of new hours will be based on clients’ needs and the resources available." we need to know which it is. He needs to be clear with people. There will be people at home watching this who are waiting on home help hours. There are people in hospitals who want to be at home. They do not want to be in hospital. They are in the most expensive bed and breakfast in the State.

Sinn Féin's motion this evening is about putting the home help service on a sustainable footing because given how the demographics in the country are going we know we will need more home helps and not less. The best way to deliver that is to make it attractive for people to work in that area, not to privatise it encouraging big global multinational corporations to chase a profit but to invest in directly employed and not-for-profit home helps which is what elderly people want. I represented home helps for years and contrary to what might have been said, I think I did a half-decent job. Their clients will say they want the person who is coming into their home to be paid a decent wage and to have decent terms and conditions.

The motion also refers to the elimination of any call below 30 minutes. I ask Members to imagine an elderly person in their home who needs assistance with washing, dressing and toileting. What can a home help do in 15 minutes? They certainly cannot give any dignity to that person. They certainly cannot give any comfort to them. They most definitely do not have the time for any companionship if they are only there for 15 minutes. It is not outrageous to ask the Government to make a statement on not supporting any call below 30 minutes. In times gone by home helps would not work for less than an hour but it is now down to 15 minutes, which is an insult. Fifteen minutes for people in their 70s and 80s who have worked all their lives and paid tax all their lives is utterly outrageous.

Sinn Féin believes the future for the home help service is in directly employed home helps and not-for-profit agencies where every shilling that is spent goes directly into home help provision. The Minister of State's co-payment idea introduces a profit motive. That money will go into the pockets of global multinational corporations and the people who will end up paying are the elderly, the infirm and the ones who want to stay in their homes. They deserve to stay in their homes and find dignity in remaining in their homes. If they are in their homes being adequately cared for, they can free up hospital beds. This evening we know that nearly 500 people are on hospital trolleys. We also know that people who are in beds in hospital could be brought home if they had the home help support.

It is a very simple motion. I urge the Minister of State to withdraw his amendment and support the motion.