I must now deal with a postponed division relating to amendment No. 2, in the name of the Minister of State at the Department of Health, Deputy Butler, to the motion on home care. Yesterday, on the question, "That the amendment to the motion be agreed to", a division was claimed and in accordance with Standing Order 80(2), that division must be taken now.
Home Care: Motion (Resumed) [Private Members]
The following motion was moved by Deputy David Cullinane on Tuesday, 8 November 2022:
That Dáil Éireann:
notes that:
— the nature and level of care delivered in the home must change to facilitate people staying at home for longer, to reduce periods of stay away from home either at hospital or at other care facilities, and to implement the Right Care, Right Place, Right Time policies;
— the average person in receipt of home care receives approximately eight hours of care a week, and this is likely to grow significantly as higher levels and greater volume of care is delivered in the home;
— to deliver higher complexity care in the home, the home support system must be modernised, and an increase of care delivered in the home will have consequences for the level and complexity of care delivered in nursing homes and other long-term residential care settings;
— as per the report in the Irish Times on the 1st November, 2022, more than 7,800 people have experienced unnecessary and costly delayed discharges from hospital so far this year due to a failure to plan and align community services with hospital need, such as step-down beds and home care packages, including more than 1,000 delayed discharges directly linked to home care shortages, which is directly contributing to the trolley crisis;
— the Health Service Capacity Review 2018 - Review of Health Demand and Capacity Requirements in Ireland to 2031, which was conducted based on lower population growth estimates than transpired, forecasted a minimum of 120 per cent increase in demand for home support from 2016 to 2031, but such demand at that level has already been reached and is expected to increase further;
— 62 per cent of home care is delivered by non-Health Service Executive (HSE) providers, with only 38 per cent of home support services delivered directly by the HSE, amounting to over €400 million in 2021 being paid to non-HSE providers of home care;
— the Minister of State with Reasonability for Mental Health and Older People, committed to the establishment of the full complement of 30 Integrated Care Programme for Older Persons (ICPOP) teams by Q3 2022;
— the Programme for Government: Our Shared Future commits to "introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care" and to "establish a commission to examine care" and the Government's commitment to establish a national home support office; and
— the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on the 15th October, 2022, made 16 recommendations across recruitment, pay and conditions, barriers to employment, training and professional development, and sectoral reform;
condemns:
— the failure of the previous Fine Gael-led Government and then Minister for Health, Simon Harris TD, and his predecessors, to plan for, train, recruit, and retain enough nurses, healthcare assistants, and home carers to sustainably expand home care services, which directly led to the crisis in home care that is being experienced at present;
— the failure of the Minister for Health, Stephen Donnelly TD, to significantly advance proposed legislation such as the Health (Amendment) (Licensing of Professional Home Support Providers) Bill and the Health (Amendment) Bill relating to enhanced governance of nursing homes;
— the failure to deliver 1,000,000 home support hours in 2021 which were owed and budgeted for, as indicated in the HSE's National Service Plan 2022; and
— the overreliance of successive Governments on private home care providers, instead of investing in home care as a public health and social care service and career; and
calls on the Government to:
— expedite the proposed Health (Amendment) (Licensing of Professional Home Support Providers) Bill and new regulations for providers of home support services to construct a modern regulatory framework for home care;
— establish a commission on care and bring together social care sectors and stakeholders to modernise the home care sector and better align care, including family carers, care in the home, nursing home and residential care, and palliative care;
— fully commission the 30 ICPOP teams and transparently publish their staffing complements, with a view to fully staffing all teams;
— integrate adult safeguarding legislation into new regulations for the home care sector with the Health and Quality Information Authority as the regulator;
— establish regional home support offices to be embedded within regional health areas to ensure compatibility with forthcoming organisational reforms;
— develop a career pathway for carers and carers with an advanced skillset, and a greater role for nurses, physiotherapists, and allied health and social care professionals, including at advanced practice grades, in delivering high-quality home care;
— ensure more regular and holistic reviews of the health and care needs of persons receiving home care and home support to ensure they are in receipt of the type, quality, and intensity of care that they need;
— increase funding for home support services generally, with targeted increases in funding for healthy age-friendly homes, housing adaptation grants, personal assistance and assisted living services, and intensive home care packages to enable people to live at home for longer;
— introduce additional access routes to working in home care for people who are interested in additional but less than full-time employment in the sector, particularly in rural and underserved areas;
— invest in home care to ensure it is a viable alternative to nursing homes and residential care, where the choice is appropriate;
— establish a high-level workforce planning group to deliver accountability and joined-up, cross-Government planning for training, recruitment, and retention of health and social care professionals across the entire health sector, including home care; and
— modernise the tendering and funding model for providers of home care to prevent a race-to-the-bottom in costs and quality, to be underpinned by a collective agreement on employment standards in the sector that ensures a level playing field, high care standards, and fair remuneration for workers.
Debate resumed on amendment No. 2:
To delete all words after "Dáil Éireann" and substitute the following:
recognises:
— the invaluable work carried out by Health Care 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);
— 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, since 2020, an additional €207 million has been provided for home support;
— that next year the overall home care budget will be in excess of €700 million, and this will go towards progressing the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and delivering about 24 million hours of home care in 2023; and
— that home support hours are increasing, in line with enhanced investment, and in 2021 some 20.4 million hours were provided to over 55,000 people, which is about 2.9 million more hours compared to 2020, an increase of 17 per cent, and at the end of September 2022, 16.08 million home support hours have been delivered to 56,490 clients in the community. This is about 2 per cent more than the expected activity and 4 per cent more than the same period last year, and the number of hours of home support provision nationally has increased from 17.55 million hours in 2020 to 20.46 million hours in 2021, in tandem with increased investment;
notes that:
— the Irish Government's strategic policy goal is to deliver a new model of integrated, older persons health and social care services, across the care continuum, supporting older people to remain living independently in their own homes and communities for longer, in line with the Sláintecare vision for receiving the right care in the right place and the right time;
— the interRAI assessment will be used to determine the allocation of care depending on the need of an individual and the phased rollout of the interRAI assessment tool for home support has commenced across four pilot areas, and this will be accelerated with the recruitment of 128 interRAI care needs facilitators which is underway and these outputs and the evaluation of the pilot sites for testing of a reformed model of service for the delivery of home support evaluation will be critical to the development of the new home-support scheme;
— the HSE monitors data on Delayed Transfers of Care (DTOC) on a daily, weekly and monthly basis so they can target these patients as early as possible and take appropriate steps to identify suitable post discharge support which will then facilitate their discharge and patients are added and removed from the list on a daily basis;
— as of 1st November, 2022, the HSE reported there were 594 DTOCs of which 103 people were waiting on home supports;
— the HSE National Service Plan 2022 sets a priority action to maintaining, at a minimum of 40 per cent, the proportion of public / private provision of support hours so that the balance is reflected in each area over time. Any increases reflect the workforce requirements of the expected statutory home support scheme. In line with these commitments, the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants' calls for 'a significant increase in the proportion of home support hours and packages provided directly by the HSE' and recommends that 'targets determined by the HSE on a national level should be set out in the National Service Plan 2023' (recommendation No. 11);
— there are currently 21 Integrated Care Programme for Older Persons (ICPOP) teams in place across the country and all Community Health Organisations (CHOs) have at least one team in place, the recruitment for the remaining teams is ongoing and it is planned to have the full complement of 30 ICPOP teams established by Q1 2023;
— the Programme for Government: Our Shared Future commits the Government to 'Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care', and the Department of Health is currently developing a regulatory framework for home-support providers with the aim of ensuring that all service-users are provided with high-quality care that will comprise of (i) primary legislation for the licensing of home support providers, (ii) regulations for home support which will set out the minimum requirements that a provider must meet to obtain a licence, and (iii) Acute and Community Healthcare Services (HIQA) national standards, the Heads of Bill are currently being drafted by the Department with a view to bringing it through the Houses of the Oireachtas at the earliest opportunity, and HIQA are developing standards for home care and home support services which will go out for public consultation early in 2023;
— the Government is committed to supporting healthy and positive ageing throughout the life-course as well as to ensuring that older persons can continue to live independently in their homes and communities for as long as possible. At present, this objective is supported by the National Positive Ageing Strategy (2013), which provides a blueprint for whole-of-Government policymaking and service-delivery in partnership with the community and voluntary sector. Acknowledging the disproportionately negative impact of the Covid-19 pandemic on older persons, the Programme for Government: Our Shared Future commits to the establishment of a commission on care that will 'assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens', learning the lessons from Covid -19 and an initial scoping exercise for the commission on care has been undertaken, it is envisaged that the commission on care will support a whole-of-Government and whole-of-society approach to examining existing policies and strategies which support positive ageing and that it will effectively address the gaps which currently exist in the policy-landscape and it is anticipated that the commission will be established in 2023;
— the Health and Social Care workforce planning and ensuring an appropriate pipeline of suitably qualified healthcare professionals in Ireland is a top priority for the Government, and the Department of Health has commenced a programme of work to deliver a Health and Social Care Workforce Planning Strategy and Action Plan, and a Planning Projection Model, and this work is being undertaken with the support of the European Commission under the auspices of their Technical Support Instrument which will provide the technical expertise to deliver this project and is due to be completed in Autumn 2023; and
— addressing the shortage of care-workers in Ireland is an urgent priority for the Government. To this end, the cross-departmental Strategic Workforce Advisory Group was established in March 2022 to examine, and formulate recommendations to address, the challenges in front-line carer roles in the home-support and long-term residential care sectors. The Group was chaired by the Department of Health and comprised representatives from seven government departments, the HSE, HIQA and SOLAS. Working closely with key stakeholders, the Group examined the recruitment, retention, training, career-development, and pay and conditions of front-line carers. The Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on 15th October, 2022, providing an overview of the work of the Group and its key findings, the report presents a suite of 16 recommendations spanning the areas of areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform, and monitoring and implementation. All of the recommendations have been strongly endorsed by Minister Butler, and work to implement the recommendations has commenced; and
further recognises that:
— the General Scheme of a Health (Amendment) Bill to amend the 2007 Health Act was published in October 2022. This legislation will enhance and modernise the powers of the Chief Inspector of Social Services in HIQA and will provide for the mandatory reporting of key operational data by nursing homes. The General Scheme has been referred to the Oireachtas Health Committee for pre-legislative scrutiny and the Department of Health is engaging with the Office of the Attorney General is relation to the drafting of the Bill;
— the Heads of Licensing of Professional Home Support Providers Bill are currently being drafted by the Department with a view to bringing it through the Houses of the Oireachtas at the earliest opportunity. Regulations are at an advanced stage. The Department has completed a public consultation on the draft regulations which concluded on 4 August. The report on the submissions for the public consultation is currently being compiled by the Institute of Public Health (IPH);
— adult safeguarding has been included in Section 10 of the draft regulations for the licensing of Home Support Providers;
— the HSE will recruit key posts to enable the establishment of a National Home Support Office. Funding is provided for 15 full-time jobs;
— the HSE has acknowledged the importance of a fit for purpose IT system for the delivery of Home Care across all CHOs and are finalising the details. The HSE and Department of Health are jointly working on the structures and systems to enable the creation of the Regional Health Areas and the National Home Support Office will be included as part of this;
— a key recommendation of the Health Service Capacity Review 2018 is the shift of care out of acute hospitals into the community and closer to a person's home, where safely possible. In pursuit of this goal, the HSE commenced the implementation of the Enhanced Community Care programme in 2021. The Enhanced Community Care (ECC) Programme is a strategic reform programme in line with Sláintecare proposals which seeks to deliver new and enhanced services and support the move toward a more community-centric model of healthcare. The ECC programme represents the most significant expansion in Primary Care in the last two decades, with overall recruitment to the ECC targeted at approximately 3,500 WTE, and this Government allocating significant funding to deliver this expansion;
— improving access to home support has been a priority for Government. The Government is working to ensure that People with Disabilities are enabled to live an independent life of their own choosing, like any other person, in line with the disability reform policy - 'transforming lives' and the HSE has consistently, year. on year, increased the number of hours of PA Services delivered to people with a disability. The National Service Plan 2022 outlines the HSE's commitment to deliver 1.7 million hours of PA services to 2,587 people this year. This reflects an additional 120,000 hours of PA services in 2022 to expand and enhance supports for people to live self-directed lives in their own communities;
— the Healthy Age Friendly Homes Programme, an innovative partnership between the local government sector (Age Friendly Ireland) and Sláintecare, commenced in 2021 and saw the introduction of a new person-centric, robust, support co-ordination service. It was announced in Budget 2023 that funding of €5.2 million has been allocated to roll-out the initiative nationally;
— under Housing for All – a new housing plan for Ireland, a review in relation the Housing Adaptation Grants for Older People and People with a Disability Scheme is currently underway. Grant limits and income thresholds are being considered as part of this process;
— the tender process for home support is underway. The HSE is responsible for procuring home support services. Established procurement protocols apply to this process; and
— the recommendations made in the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants includes recommendations on terms and conditions for workers.
- (Minister of State at the Department of Health, Deputy Mary Butler)
Amendment put:
The Dáil divided: Tá, 77; Níl, 58; Staon, 0.
Tá
- Berry, Cathal.
- Brophy, Colm.
- Browne, James.
- Bruton, Richard.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Byrne, Thomas.
- Cahill, Jackie.
- Calleary, Dara.
- Cannon, Ciarán.
- Carey, Joe.
- Chambers, Jack.
- Collins, Niall.
- Costello, Patrick.
- Crowe, Cathal.
- Devlin, Cormac.
- Dillon, Alan.
- Donnelly, Stephen.
- Donohoe, Paschal.
- Duffy, Francis Noel.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frankie.
- Fitzpatrick, Peter.
- Flaherty, Joe.
- Flanagan, Charles.
- Fleming, Sean.
- Foley, Norma.
- Griffin, Brendan.
- Harris, Simon.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Humphreys, Heather.
- Lawless, James.
- Leddin, Brian.
- Lowry, Michael.
- Madigan, Josepha.
- Martin, Catherine.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McEntee, Helen.
- McGrath, Michael.
- McGuinness, John.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Darragh.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Connor, James.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Donovan, Patrick.
- O'Dowd, Fergus.
- O'Gorman, Roderic.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Richmond, Neale.
- Ring, Michael.
- Ryan, Eamon.
- Shanahan, Matt.
- Smith, Brendan.
- Smyth, Niamh.
- Smyth, Ossian.
- Stanton, David.
- Troy, Robert.
- Varadkar, Leo.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Barry, Mick.
- Boyd Barrett, Richard.
- Brady, John.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Canney, Seán.
- Carthy, Matt.
- Clarke, Sorca.
- Collins, Joan.
- Collins, Michael.
- Conway-Walsh, Rose.
- Cronin, Réada.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Funchion, Kathleen.
- Gannon, Gary.
- Gould, Thomas.
- Guirke, Johnny.
- Harkin, Marian.
- Healy-Rae, Danny.
- Healy-Rae, Michael.
- Howlin, Brendan.
- Kenny, Gino.
- Kerrane, Claire.
- Mac Lochlainn, Pádraig.
- MacSharry, Marc.
- McGrath, Mattie.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Verona.
- Mythen, Johnny.
- Nash, Ged.
- Naughten, Denis.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- O'Reilly, Louise.
- O'Rourke, Darren.
- Ó Broin, Eoin.
- Ó Laoghaire, Donnchadh.
- Ó Murchú, Ruairí.
- Ó Ríordáin, Aodhán.
- Ó Snodaigh, Aengus.
- Pringle, Thomas.
- Ryan, Patricia.
- Sherlock, Sean.
- Shortall, Róisín.
- Stanley, Brian.
- Tóibín, Peadar.
- Tully, Pauline.
- Ward, Mark.
Staon
Tellers: Tá, Deputies Jack Chambers and Brendan Griffin; Níl, Deputies Pádraig Mac Lochlainn and Denise Mitchell.
Amendment declared carried.
Motion, as amended, agreed to.
Is féidir teacht ar Cheisteanna Scríofa ar
www.oireachtas.ie
.
Written Answers are published on the Oireachtas website.
Cuireadh an Dáil ar athló ar 8.32 p.m. go dtí 9 a.m., Déardaoin, an 10 Samhain 2022.
The Dáil adjourned at 8.32 p.m. until 9 a.m. on Thursday, 10 November 2022.