There is a crisis in home care services in this State and the Minister's Government refuses to acknowledge it. The level to which older and vulnerable people are being failed has been exposed by a HIQA report published last night. That report makes for concerning reading and it calls for a complete overhaul of home care services. It has highlighted several key areas where the home care scheme is falling down. Waiting lists are sky-high and almost 5,000 people are waiting for access to home care. They have been approved, but they are waiting. These are 5,000 vulnerable people waiting for a carer to be assigned to them. This is unacceptable. The situation causes great stress and worry, not only for the people involved but for their families as well.

This is happening because the Government is not resourcing and staffing home care services adequately. There are simply not enough staff to fill the places available. This Government can allocate all the funds and all the hours and set up all the schemes that it wishes, and I have seen that in the budget, but that will not work for the people who matter if we do not have the staff in the first place to deliver that home care service. The result is that far too many people requiring care in their homes wait and wait and wait. They wait in hospitals when they should be discharged, or they wait at home, struggling and with nobody to help them. The HIQA report also underlines the urgent need for the regulation of home care services. A response I received recently to a parliamentary question I had posed to the Department of Health confirmed that the Government has still not established or developed a plan to regulate home support services.

People will be listening in disbelief today. They will find it incredible that there is no State oversight of home care services, on which so many of our older and most vulnerable people depend. In 2021, there is no minimum standard of care for home care services. That is frightening. The State continues to wash its hands of its responsibility to ensure a high-quality level of care and protection is provided to those most vulnerable people relying on home care. It is a damning indictment of not only this Government, but of successive governments over the years as well. The Government's failure in the area of home care services has real consequences in people's lives. As I said, older people are being left in hospitals or nursing homes for respite, and they cannot get home. In my area, 660 people have been approved for home care packages and are still waiting for them. People in dire need of assistance in their homes feel abandoned. They are left by themselves to struggle through their days while facing real challenges every hour. These are people whose mobility is gone in some cases, those who are suffering from dementia or those who are coping with long-term illness. That is a tough and lonely situation for anyone to be left in.

It is time for the Government to show up for those depending on home care services. The first thing we must do is to get more staff into the system to ensure that vulnerable people are not left waiting on waiting lists. This must start with community employment. There are more than 2,330 vacancies, many of which are related to community health. I ask the Minister to give a commitment on behalf of this Government to ensure these vital roles will be filled with urgency.

I thank the Deputy for raising this important issue. I wish to highlight the ongoing work within the Government and the HSE to address what is an important issue across society. As the Deputy is aware, the Government is committed to establishing a new statutory scheme for the financing and regulation of home support services, which the Department of Health is developing. It is the view of the Government that many older people want to stay in their own homes instead of going into a long-term accommodation setting. It is our job and our duty to facilitate that as best we can, and that is why the Government has provided extensive resources in the last two budgets, in particular, to address this issue.

The new scheme will provide equitable and transparent access to high-quality services for people based on their assessed care needs. As the Deputy will be aware, that is very much based on the assessment of the needs of each individual. It is important to point out that the number of people waiting for funding approval of home support provision or for a carer to be assigned has reduced from more than 9,000 at the start of last year to approximately 5,300 at the end of September of this year. Of course, that is still too many, but it is still a significant reduction in the number of people waiting for funding. What people want, of course, is access to a service and that is what the Government is committing to providing. I acknowledge the enormous efforts of my colleague, the Minister of State, Deputy Butler, in leading on this issue. She has committed to establishing a cross-departmental strategic workforce advisory group to examine workforce challenges in home support services and, indeed, in nursing homes.

It is important to point out the level of additional funding, €150 million, that has been secured by the Minister of State for home support. The HSE's national service plan for this year sets a target to provide 24 million home support hours, which is 5 million more hours than were provided for last year. It was estimated at the end of October this year that some 17 million hours had been provided to approximately 54,000 people, which is about 2.5 million more hours compared to the same period last year. Notwithstanding the undoubted challenges that exist in recruiting home carers and people to provide this vital service, there has been a significant increase in the level of service and the number of hours provided this year relative to last year. The funding secured in budget 2021 to provide these additional 5 million hours has been maintained for 2022.

I acknowledge the point Deputy Kerrane made about staffing. It is an ongoing challenge for the HSE to recruit the staff necessary to provide this service. That can result in delays occurring in the interval between funding approval being given for an individual and the delivery of those home support hours. We accept that the delivery of the service in people's own homes is what really matters to the people concerned. There has been a steady increase in the number of people waiting to receive home support in recent months. It is important to note, however, that the total number of people waiting for home support across both categories, namely, those waiting for funding or for a carer to be assigned, has reduced significantly.

I referred earlier to the cross-departmental strategic workforce advisory group that the Minister of State has committed to establishing. The role of that group will be to facilitate the views of stakeholders and to examine workforce challenges in the home support service and nursing homes. Potential areas to be examined in that context include recruitment, retention, training, career development and the sustainable employment of home care workers for the future. As the Deputy will be aware, a call for submissions to identify key issues and to inform the establishment of the group was announced recently, on Friday, 3 December. The project team in the Department will now analyse the submissions received to inform the setting up of this group in early 2022. We look forward to the support of and engagement by the Deputy regarding how we can make progress on this issue.

I note the Minister has made no reference at all to the HIQA report I referred to, which was published last night.

It makes for really concerning reading. It calls for a complete overhaul of these services. Clearly, it is not working. The Minister said the waiting time for funding has reduced and that is welcome. Although people are getting their funding, which is also welcome, they are then moving from a waiting list for funding to a waiting list to actually get that care. While the funding may be sorted out and there may be reduced waiting times for that, the issue is in actually getting the care. People are being approved for home care and then they are not getting it. They are moving from one waiting list to another.

The Minister mentioned the additional funding and 24 million home support hours. Again, that is welcome but not if we have nobody to provide those hours. Who is going to provide them? I put forward one example regarding community employment. This would be particularly helpful in rural areas in counties Roscommon, Galway and Mayo where we have 660 people who have got their funding but have not got their care.

At this time of year as we approach Christmas, as the Minister said, older people want to be at home. Their families want them to be at home. We have a crisis here. I am not hearing enough from him about what he is going to do about it. The legislation on oversight is absolutely essential and needs to come to the House very quickly.

I assure the Deputy that the Minister of State, Deputy Butler, is working on the legislation on the important issue of oversight. She is examining the HIQA report the Deputy referred to. The Minister of State will engage directly with HIQA on that. She will not fall short in taking the necessary steps to ensure there is a proper system of regulation and standards are upheld at all times.

While I note the points the Deputy has made, we have seen a significant increase in the actual hours provided. The Minister of State has secured an overall budget of €666 million, which is a very significant increase. We want to translate that extra funding into a very significant increase in the number of hours provided. That means identifying people to provide the services. The Minister of State will examine the specific suggestion the Deputy made on community employment scheme participants and what role they might play. We are committed to making further progress on this issue. The new group that has been established by the Minister of State to examine the workforce issues is now the channel through which we can make further progress on this issue and provide people with the services in their homes that they want most and that the Government is very anxious to provide.

I acknowledge the passing of two former Labour Party Deputies, Toddy O'Sullivan and Liam Kavanagh, who died in the past week. It has been a very sad week for our party. They were two fantastic representatives who will be very sadly missed.

I am glad the Minister is here this afternoon and that the Minister of State, Deputy Butler is beside him. I agree with the previous speaker. In my time in politics I have never seen the issues in home care that I am seeing at the moment. It is actually impossible. People are being allocated hours but it is a waste of time. Most people are trying to privately buy in some service on top of whatever small number of hours they can get. It is a labour shortage. A registered employment agreement is badly needed so that people will actually work in this area.

For a change, I want to raise a constituency issue that the Minister and the Minister of State will be well aware of. It is about the Dean Maxwell nursing home in Roscrea. I am raising the matter out of sheer frustration. In Nenagh in the northern end of our county a new nursing home is being built. We have a fantastic nursing home in Roscrea - the Community Hospital of the Assumption. The Dean Maxwell nursing home is the most important issue for the people of Roscrea. I know the Minister and the Minister of State, Deputy Butler, were there. I was not invited to attend.

There are two issues I wish to raise. Under the national development plan, NDP, will funding be provided to deliver on this much-needed home? Considering how we have come through Covid it is quite obvious that we need more publicly funded nursing homes, as I am sure the Minister will agree. That is the larger issue. The more short-term issue is that for a number of nursing homes like the Dean Maxwell, their HIQA registration runs out on 1 January next year and they will not be in a position to take long-stay residents from that date. Will the Minister confirm in respect of the Dean Maxwell nursing home and other homes equally affected that this action will be postponed and will not be implemented until the NDP review is concluded? That will allow us to give certainty to the people of Roscrea over Christmas. I acknowledge that the Minister's colleague, Councillor Michael Smith, has been working very hard on this in Roscrea, in fairness. We want to know so that the people will know over the Christmas and new year period whether a new NDP will facilitate a new Dean Maxwell home where the local authority and others are willing to work with he HSE to develop it. Will the Minister give assurances to the House today that long-stay residents will be accepted from 1 January next year and that the hammer will not come down?

I thank the Deputy and wish to convey condolences from the Government to him, his party and the families of the late Liam Kavanagh and Toddy O'Sullivan, who represented my constituency with distinction for so long. Both of them were Labour Party stalwarts and great servants of their constituents and of their party. Ar dheis Dé go raibh a n-anamacha.

I thank the Deputy for raising the issue of the Dean Maxwell community nursing unit in Roscrea. He is correct that I am familiar with it. It was while I was in opposition that I visited but I would be happy to visit again. I know that the Minister of State, Deputy Butler, did visit in the height of Covid and that is why there was no fanfare or invitations being issued. It was kept low key as I am sure the Deputy can understand.

He mentioned the new HIQA standards in respect of long-term residential care which come into force on 1 January next. They mean the Dean Maxwell community nursing unit will have continued compliance issues regarding the premises. It is important to make the point that existing residents will not be required to leave their home by 1 January 2022. My understanding is that the HSE has given a commitment to continue to admit residents to the Dean Maxwell until such a time as it is directed otherwise by HIQA. That is a positive development. I will certainly work with the Minister of State, Deputy Butler, and the Minister, Deputy Stephen Donnelly, and Deputies Kelly, Lowry and Cahill from the constituency. Deputy Cahill accompanied me during my visit to Dean Maxwell.

We understand the HSE's plan for the Dean Maxwell arising out of these HIQA compliance obligations is to develop a larger respite and short-term care facility for north Tipperary and to retain the current day services. We also recognise that this is not widely supported and there is a determination and a wish for the Dean Maxwell to continue to provide community nursing home services. We acknowledge that is the desire. The Minister of State, Deputy Butler is personally committed to making progress on this issue and will in the new year meet again with the HSE and local stakeholders with a view to making progress.

What is really needed is an agreed plan for the Dean Maxwell. If there is an agreed plan, I do not believe that funding will be the impediment. We have a very large capital envelope set out to 2030 under the NDP, totalling €165 billion. The challenge across a number of Departments will be to make sure that money is spent. I want to see projects brought through the various stages of the project life cycle to the point where they can absorb and spend capital.

The Government recognises the ageing population and the pressures that will place on long-stay facilities in the public and private sectors. I recognise the potential role that the Dean Maxwell can play into the future in meeting those needs.

What we need is an agreed plan that the HSE is willing to support and seek funding for.

It must be the spirit of Christmas but that was a very good response. Could the Minister confirm that HIQA has now agreed not to do what was proposed on 1 January? I presume it will communicate the decision to the Dean Maxwell through the HSE and to other homes similarly affected across the country. The Minister might confirm whether it is just the Dean Maxwell.

I very much welcome the Minister’s statement that funding will not be an issue. That is very good news given the journey we have all been on in this regard. Let me assure him that this is the biggest issue for the people of Roscrea. They want to see a long-stay, fully funded, fully functioning home in the town, similar to those in the other two major towns in the area, namely Thurles and Nenagh. That is what they want and deserve. There will be a comprehensive plan supported by all public representatives, the local parish and the local authority. We will bring that plan to the Minister. I would appreciate it if he could confirm that he will consider and support it. Will he also confirm the position on the HIQA standards, about which I asked a question? Do they apply only to the Dean Maxwell or to all homes that are similarly affected?

Each long-stay setting is different so the position that HIQA and the HSE adopt is particular to each. Therefore, the answer I am giving relates specifically to the Dean Maxwell. The HSE is in constant contact with patients and their families so they can receive updates. It is important that reassurance be given that no resident will be asked to leave the Dean Maxwell in advance of 1 January or shortly thereafter, as I understand it-----

There will be new ones.

There is a commitment given by the HSE to continue to admit residents unless it is instructed otherwise by HIQA. It is important to be clear on that caveat and qualifier. If a direction is issued by HIQA, that will need to be complied with. We take the HIQA reports and regulations extremely seriously. They are there to protect standards and safeguard residents and staff so it is important that points made and issues raised be addressed.

I look forward to the development of an agreed plan by the HSE. I will certainly play my role, along with the Minister for Health, Deputy Stephen Donnelly, and the Minister of State at the Department of Health, Deputy Butler, in addition to Deputy Kelly and other Deputies, in seeking to advance this over the period ahead.

I am going to continue in the same vein, on the issue of the Dean Maxwell home. I am not satisfied with the answer. I thank the Minister of State at the Department of Health, Deputy Butler, for telling me last week that a 12-month extension will be granted. I have communicated this to the residents and management of the home. Therefore, there is no new news in that regard.

The time for sweet talk on the future of this treasured facility is over. It is time that we put our cards on the table and gave people the facts. It is also time for the Government to tell the people of Roscrea whether it will overturn the recommendation of the HSE to rob Roscrea of the security of having a long-stay bed unit.

The Minister’s recently published national development plan provides for expenditure of up to €1 billion, to be invested in 88 existing nursing homes. I repeatedly stated in this House that without direct Government intervention, the Dean Maxwell will continue to be downgraded and will not be included in the HSE’s list of 88 nursing homes. Without a clear directive from the Government, the prospects of a new Dean Maxwell are slim to nil. If the decision is left solely to the HSE, the people of Roscrea will lose their cherished long-stay bed unit.

The HSE has its own agenda when it comes to elderly residential care in north Tipperary. Political manoeuvring in the recent past, which Deputy Kelly will be aware of, ensured that a 50-bed residential unit would be built in Nenagh in the full knowledge that it would lead to a downgrading of the Dean Maxwell unit. Under the plan, the Dean Maxwell’s 25 beds are reallocated to make the Nenagh project viable. With the stroke of a pen, the well-being and happiness of elderly people in Roscrea was dismissed. The attitude involved moving the residents to Nenagh from the place they now call home on the basis that will be fine and will be only 20 miles away from the loved ones who support them. This was done in typical cloak-and-dagger fashion by the HSE. Queries from me and others were met with evasive responses. The HSE stonewalled approaches for information and refused point-blank to admit the true position. It stonewalled approaches for information and refused point-blank to admit the true position. The executive had its plans under way to close the Dean Maxwell by stealth. It had neither the courage nor the honesty to admit it.

As a result of consultation with HIQA, the Dean Maxwell was recently granted a 12-month extension to facilitate the build-out of the Nenagh unit. Importantly, no new residents are being accepted in the Dean Maxwell when a bed is vacated. That tells its own story. The people of Roscrea are being wronged and the elderly are being sacrificed. Roscrea is a town of decent and hard-working people. It is a tight-knit community where people look out for one another. They are fiercely loyal to their older citizens. No one in Roscrea, myself or anyone else begrudges Nenagh a new facility, but the people of Roscrea feel passionately that it should not be at the expense of elderly people in their town.

In my political actions, I have always used reasoned arguments and logic. In the case of the Dean Maxwell, this approach has met with a deaf ear. If this attitude and this policy continue, I will encourage and support the people of Roscrea in protest action. The HSE has sold out on the Dean Maxwell. It is an agent of the Government and exists to implement Government policy. Therefore, it is time for the Government to stand up, act and issue a directive to the HSE to make sure long-stay beds remain in the Dean Maxwell. That is what the issue is.

I thank the Deputy. I acknowledge the work that he continues to do on this issue along with Deputy Cahill and Councillor Michael Smith, who has rightly been acknowledged for his work. It is important to highlight what has been confirmed today, which is that the Dean Maxwell can continue from today to admit new residents. That is a significant and important development. The HSE has made that decision. It is subject to caveat in the sense of HIQA instructing it not to do so. It is important that we work to address the standards issues that have been raised by HIQA. I visited the Dean Maxwell in the past. It is a very fine facility. It undoubtedly needs investment; there is no question about that, but the atmosphere, esprit de corps and the work of the staff were very impressive. I could see it was a very happy environment for the residents, which, at the end of the day, is the most important factor. The residents were very content and happy and seemed to be really well looked after. I commend all the staff working at the Dean Maxwell on the work they continue to do.

It is important to underline that, as a Government, we are fully committed to exploring all available options regarding the Dean Maxwell. We will work with the HSE proactively to identify proposals by the centre’s future. It is evident, as has been demonstrated again this afternoon, that there is strong political support for securing a long-term role with the Dean Maxwell as a community nursing facility. We have heard that message loud and clear, and I am sure that the HSE has also heard it.

It is worth highlighting that, in the Roscrea area, four other nursing homes are funded through the nursing homes support scheme. Two are within the town limits, as the Deputy will know, being so familiar with the town, and the other two are short distance from the town. One is towards Thurles and the other is towards Birr. There is capacity for 110 nursing homes support scheme beds between these four private nursing homes. The two within the town limits have 62 nursing homes support scheme beds between them. This capacity will also be complemented with further public long-stay beds in the planned new facility in Nenagh, which the Deputy has highlighted in his contribution. As he will be aware, the facility is under construction and due for completion in December 2022.

I reiterate, however, that what we need is a long-term solution for the Dean Maxwell. I do not want this issue to be running sore. There is strong support within the Government and across this House for a long-term solution for the Dean Maxwell to enable it to continue to provide nursing-home care to residents in the future. It is significant that it is now in a position to continue to admit new residents from today.

The most important thing the Minister has said is that the Government is waiting for the HSE to deliver a plan to it. We in Tipperary and Roscrea all know what the HSE will deliver to us. It will deliver a short-term unit with no long-stay beds. The future of Dean Maxwell is now a clear-cut political decision. The unit is doomed as it is at present unless there is an explicit and clear directive from the Government to the HSE to develop and bring forward a plan that will include a full range of services and long-stay beds for the town of Roscrea. The HSE will not take the initiative to refurbish or to replace Dean Maxwell unless it is directed by the Government to do so. The Minister's Department, as I said, has provided for up to €1 billion for nursing homes. We want to make sure that an adequate portion of that fund is dedicated to Roscrea. Anything less will be a gross political abandonment of Dean Maxwell and the people of Roscrea. I am almost never militant about issues but I am about this. The Government will not take the 25 long-stay beds out of Roscrea in any plan put forward. We want those beds retained. That is our position and there will be no movement from it.

The Deputy rightly highlighted the HSE's plan and intentions, which are to develop a larger short-term respite care facility for north Tipperary and to retain the current day services, to include dementia services. The Deputy is correct in making that point, but the Government, through the work of the Minister of State, Deputy Butler, will engage further with the HSE and meet with the HSE and the relevant officials early in the new year, working together to come up with what we hope will be a revised plan, which the Government will then be in a position to support. I get funding requests for lots of things, but there has to be an agreed plan and the funding has to be sought. I will work with the Minister of State, Deputy Butler, and the Minister, Deputy Stephen Donnelly, in an effort to deliver on the implementation of an agreed plan, which will require the support of the HSE as the delivery organisation. We will work together now to try to bring that about and to make progress on the issue.