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 Header Item Home Help Service Provision (Continued)
 Header Item Maternal Mortality

Wednesday, 19 December 2012

Dáil Éireann Debate
Vol. 787 No. 4

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(Speaker Continuing)

[Deputy James Reilly: Information on James Reilly Zoom on James Reilly] These services meet the preferred wishes of many vulnerable older people and reduce pressures elsewhere in the wider care system. Demand for them will increase as the demographics and complex needs of older people change.

The Health Service Executive has developed various operational initiatives to improve nationally its approach to all relevant aspects of its home support services. These include new guidelines for home care and a new procurement framework for approved agencies providing services on its behalf. While ongoing developments have been designed to standardise and maximise the use of limited resources, they also promote quality, safety and equity for providers and care recipients alike. Approximately 100,000 people or 20% of the population aged more than 65 years receive some form of HSE community based supports each year, including home, day and respite care.

I will provide some figures on the outturn for the 2012 target for mainstream home help. Between 2006 and 2011, the number of home help hours provided by the State increased from 8 million to 11.1 million, while the 2012 target for home help hours was 10.7 million. The number of clients benefiting as at 31 December each year has increased from 49,578 in 2006 to 54,000 in 2007, 55,000 in 2008 and 2009, 54,000 in 2010, 50,986 in 2011 and 50,000 in 2012. Funding increased from €185 million to €211 million last year and €205 million will be provided to the service this year. It is our intention to maintain the budget for 2012 in 2013.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin In her post-budget speech, the Minister of State at the Department of Health, Deputy Kathleen Lynch, made a vague claim that there is a commitment on the part of the Government to restore home help hours and home care packages. Questioned by me at a recent meeting of the committee on health, the Minister indicated he intended to restore funding in 2013 to the 2012 level. My core objective is to establish whether the hours that have been cut from people across the board will be restored. This critical question has not been answered. When the Minister indicates funding levels will be restored to the 2012 level, does he have in mind the position that applied at the end of 2011, the position that applied after the loss of 500,000 home help hours in January 2012 or the position that applied after a further reduction of 450,000 hours was introduced on the back of the €130 million in cuts announced at the end of August 2012? The overwhelming majority of those affected by these measures want to know what will be their personal circumstances.

I have cited previously the case of a 94 year old man in my constituency whose 11 home help hours were cut to five hours. In another case, an 82 year old woman in Cork who is acutely ill with clots on her lungs and requires oxygen on a 24 hour basis has had her four weekly home help visits of one hour cut by 15 minutes per day. Her night visits have been removed entirely. In Galway, a mother trying to provide full-time care for her severely disabled six year old son has been robbed of five hours of home help care per week. These are only three cases. The issue here is not only the level of resourcing but also whether the hours that have been removed from deserving people will be restored. Will the Minister provide a categorical assurance that they will be restored as early as possible in the new year?

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly I restate for the information of the House that the budget for 2012 will be restored for 2013. Given that the circumstances in individual cases change as needs change, it would be inappropriate to state that the hours of every individual will remain the same next year. As circumstances change, some people will need more hours while others will need fewer hours. In terms of home care packages, which are different from home help, it was always the intention to change and rotate them. The classic case is that of a 70 year old gentleman who is discharged from hospital following a hip replacement operation. If his wife has arthritis and finds it difficult to look after him in the early stages, the gentleman will have a nurse visiting as well as physiotherapy and home help. As he makes progress and starts to use one instead of two crutches, the nurse may no longer be needed and after four or five weeks, he will no longer need a physiotherapist and the home help hours can be reduced. The nature of home care is to provide a service to patients at the right time and in the right place and monitor their progress or, in some cases, deterioration.

It is our intention to restore the budget and while I am pleased this will be the case, it does not mean I will not seek greater efficiencies from or look long and hard at the budget. I have asked the Health Service Executive to examine the reason for an apparent differential between the payments made to some private providers and those made to public providers.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin I can only interpret from the Minister's reply that he intends to restore the budget to the funding level that pertained prior to 30 August 2012. One can only presume that while he is not saying this clearly, the cuts announced in the Budget Statement of December 2011 for 2012 will stand. Does the Minister accept that the home help hours and home supports being provided are among the most cost-effective elements in the broad health service and that care in the home for people in need of such support generates phenomenal savings? Does he also accept that any deterioration or diminution of this support and service will lead to earlier demand for access to nursing home or similar institutional support, with all the consequential additional costs this will entail? Will he not find in the overall budget the funding required to restore it to the level that pertained prior to January 2012? This would result in the restoration of the 950,000 hours that were taken from home helps in 2012. Ultimately, this issue is one of hours and the hopes and expectations of the many people who have been hurting greatly in recent times.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly I am aware of the value of home help and home care services and the need to support people at home. I do not know anybody who wants to go into long-term care before it is necessary to do so. I am also aware that the way in which hospitals are run means people who have finished their acute phase of care are sometimes left in a hospital bed because they do not have anywhere else to go. We introduced a transitional care programme which will address this issue. People who are older and frail will be admitted to specialist wards, have their medical conditions addressed urgently and start rehabilitation immediately. If it is found that this phase is likely to last for four or five days, the individuals in question will be transferred to another facility in the community where their rehabilitation will continue for up to ten weeks. If, during this period, it becomes obvious that they need long-term care, they will be able to go to a transitional long-term care facility until the place of their choice becomes available. This will alleviate much of the congestion in hospitals caused by delayed discharges.

I have issued an instruction to the Health Service Executive that people must be assessed before their hours change. If hours are to change, the assessment should not be such that it results in a person ending up in an institution, whether a nursing home or hospital, as a consequence of the reduction in home help or home care package hours.

Maternal Mortality

 3. Deputy Mick Wallace Information on Mick Wallace Zoom on Mick Wallace asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his views on the confidential maternal death inquiry in Ireland report for the triennium 2009-2011, which shows that the maternal mortality rate here is double the official figure from the Central Statistics Office; his plans to implement the recommendations of the maternal death inquiry Ireland; and if he will make a statement on the matter.  [57136/12]

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly Statistics on the causes of death are based on civil registration and compiled internationally by the World Health Organisation, WHO. In the WHO's most recent world health statistics annual report 2012, Ireland had the 13th lowest rate of maternal mortality out of 178 countries reporting data. Maternal mortality is a rare occurrence in Ireland. It must be understood that since there are usually fewer than five such deaths per annum, rates can appear to fluctuate significantly from year to year.

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