I want to raise with the Taoiseach this afternoon the approach of the Government to the provision of home care packages. In particular, why are the two lowest levels of provision registered in community health care organisation, CHO, areas 3 and 5, which encompass north Tipperary and south Tipperary, respectively? All the other seven CHOs have a significantly higher number of persons in receipt of the packages. This cannot be explained simply by reference to population levels.

The information provided to me by the HSE shows that, at the end of December 2017, just 1,149 persons were in receipt of a package in CHO area 3, which covers Clare, Limerick, north Tipperary and east Limerick. The second lowest figure is in CHO area 5, where just 1,242 persons were in receipt of home care packages. This area covers Carlow, Kilkenny, south Tipperary, Waterford and Wexford.

It is deeply frustrating to me that the very low levels of home care package provision are evident in counties that consistently record the highest number of patients on trolleys. Everybody, including a second class student in national school, will know that there must be an impact on the trolley count. South Tipperary General Hospital and University Hospital Limerick consistently record the highest numbers of patients awaiting beds in accident and emergency departments. This is from Irish Nurses and Midwives Organisation, INMO, figures. This echoes what my colleague, Deputy Harty, raised with the Taoiseach yesterday, that is, the need to keep care for people as local as possible and away from our acute hospitals. This is the very purpose of the home care package model.

The circumstances reflect an absence of any co-ordination within the HSE. Surely it would make more sense to prioritise home care packages that keep people out of hospitals in those areas where the hospitals are mostly in difficulty. It is not rocket science but the HSE seems to be totally unable to grapple with this and adapt to any kind of change. It is just trundling along from day to day and from year to year, with endless money being pumped in and fewer outcomes. Since we do not have the approach I advocate, we are creating problems at both ends of the spectrum. That is obvious.

Our CHO now has the lowest level of community care and the highest number of patients in accident and emergency departments, clogging up the corridors. This is completely unsustainable. Added to this is the fact that South Tipperary General Hospital has been unable to de-escalate from the full capacity protocol, making the problem even greater. The hospital has been subject to the full capacity protocol for 18 months now. It is farcical. Why is it subject to the protocol day in, day out?

As requested in the Private Members' motion of the Rural Independent Group last December, will the Taoiseach commit to establishing the home care package scheme in law, thereby giving people an automatic right to participate in it? We called for a re-evaluation of the scheme so it would be targeted at those areas, such as Tipperary, that are simultaneously trying to cope with a chronic lack of capacity at hospital level.

I very much agree that home care resources and provision for home care need to be increased. We need to ensure patients in hospital can get home quicker, thus freeing up beds in hospitals. We also need to ensure those in receipt of home care are less likely to deteriorate and become unwell. It makes sense on so many different levels to provide more home care.

The budget and the 2018 service plan of the HSE provide an additional €37 million across the State for home care. That will provide an extra 750,000 home care hours this year by comparison with last year. That is a very significant increase.

On the question as to whether there should be a statutory scheme, there is public consultation under way. Some 2,600 submissions have been received. We need to study them. We are actively considering the matter. The fair deal scheme was heavily criticised at the time it was introduced, but most people now accept it works reasonably well and assures people that if they need a nursing home space, they can get it within four or five weeks, although they have to make a contribution. What is being considered for home care is similar: a fair deal for home care, giving people the guarantee they will get the home care they need within weeks, even if it means having to pay a contribution if it can be afforded. If that were introduced on a statutory basis, as the Deputy mentioned, it would become a legal right and something that I believe can be delivered on. As I said, there is public consultation under way and we must study the 2,000 submissions and make a decision afterwards.

As the Deputy will know, plans and funding for a 40 bed modular unit in Clonmel have been approved. The project is now under way. We anticipate that the extra 40 beds for Clonmel will be in place this year and before next winter. As the Deputy knows, sometimes additional capacity works and sometimes it does not so it is important that the hospital prepares for the additional 40 beds and ensures it changes and aligns its practices and procedures to ensure the 40 beds improve conditions for patients.

The Taoiseach very much agrees with me, but agreeing with me and doing something about the matter are altogether different. The Taoiseach is aware that the entire system of care in the community is very closely linked to the issue of bed capacity. He said that himself. Another important strand concerns the carers. Statistics provided by the Central Statistics Office, CSO, for Tipperary show carers provide a staggering 250,000 hours of care per week. The findings also record that 7,041 people stated they provided regular unpaid personal help to a friend or family member with a long-term illness, health problem or disability. What is deeply alarming is that the Central Statistics Office found there were 138 carers under the age of 15 in County Tipperary. That is very worrying and I want to be reassured it will be investigated. The carers in question are being forced into these circumstances because of the lack of home care packages. This is directly linked to the first question.

The Taoiseach mentioned the 40-bed unit. We were promised that two winters ago. The Taoiseach said the project is under way. It is not, unless I am blind. The planning permission has not even been finalised for the project, never mind being under way. The spin machine is spinning in the wrong direction. It is jumping ahead of itself. The project is not under way. We are waiting for it, we are looking for it, and it is badly needed. Two winters ago, we were promised it. We will probably face another winter without it. We have promises and spin but no action. It is not fair to the staff or patients.

I am advised by the Minister for Health that it is very much under way. We expect to have it in place in the next couple of months, certainly before next winter. We really hope it works. If the modular build does work and the additional beds do make a difference in terms of overcrowding, efficiency and capacity in the hospital, it is a model we may be able to apply to other places. Just to show we are serious about this, 170 additional beds have already been added this Christmas across a number of hospitals.