Thursday, 22 July 1971
Dáil Eireann Debate
Mr. Bruton: The matter I wish to raise relates to the implementation of a scheme of home help for the old and infirm which was authorised by section  61 of the 1970 Health Act. The section reads:
I should like to emphasise that I fully agree with the provisions of this section. With many other groups, the Fine Gael Party advocated for some considerable time prior to the enactment of this section the necessity of providing for old and infirm people in their home environment, to ensure that they are looked after in the place in which they live, and with people who have a personal interest in them, rather than that they should be put into institutions where they are in unfamiliar surroundings.
It is unfortunate, therefore, that this very socially progressive section which was passed through all Stages in both Houses of the Oireachtas, in February, 1970, I think, has not as yet, by July, 1971, come into effect. It was in relation to the delay in bringing this section into effect that my questions were put down. On 1st June, 1971, I asked the Minister for Health if there had been any delay in introducing home help for old and invalided persons under section 61 of the Health Act, 1970. The Minister's reply was that the health boards had not, in general, had an opportunity yet of considering the manner in which and the extent to  which home help might be provided in their areas under section 61 of the Health Act. Impliedly he admitted that there was a delay.
Subsequent to that question, I had some discussions with officers of the two health boards concerned in my constituency and I discovered that, in their opinion, the major reason why the health boards did not implement that scheme of home help for old people was that they were awaiting a circular which had been promised by the Department which would give them definitive guidance in relation to the implementation of the scheme. It was pointed out to me that, in relation to such schemes as the old age care allowance, and other schemes administered by other Departments with a view to helping the aged, very detailed regulations had been issued by the Department concerned and that they felt that such regulations, having been promised by the Department, were very essential and necessary before any scheme could be introduced so that they would have proper guidance in relation to the implementation of the scheme and the spending of public money.
... if he had yet issued a definitive circular to the health boards giving them full and final instructions on the operation of the home help scheme for old people, which was authorised by section 61 of the Health Act, 1970, and, if not, if the non-issue of such a circular is a contributory cause of the delay in the introduction of the scheme in some areas.
In other words, he said, no, he had not issued the circular and, no, it was not a cause of delay. This would seem to be contrary to what I have been told by the health authorities. They said the non-issue of the circular was a cause of delay. I cannot see how the Minister could say that it was not at least a contributory cause to the  delay since it is generally accepted that some guidance must be given by the Department through such a circular to the health authorities setting out how they could implement the scheme. The non-issue of the circular is at least a contributory cause to the delay in introducing such a scheme for old people.
We are going to issue a notice later in regard to this, but it will be necessary for the new community programme managers to evaluate the requirements in relation to this with a view to deciding whether the home helps would work under the auspices of the voluntary bodies or whether they would be appointed to work not in relation to the voluntary bodies. The whole matter is still being examined.
I cannot understand why this matter could not have been examined while the Health Bill was going through the House and why we have to wait for more than a year before it is examined. The Minister must have been well aware for a considerable time of the need for such a service.
I do not want to deceive the House in regard to this matter but, as the health boards are still engaged in the recruitment of staff and as the provision of home helps must be done on a basis that is both satisfactory and effective, I could not issue a circular on this subject at the moment.
It is quite possible that this scheme could be operated for the time being at least in a way which would not require the recruitment of additional staff. In rural areas the problem could be coped with not by employing people who were full-time officers of a health board and who would be responsible for actually giving these home help services in the home, but by the health authority advertising for women to apply on a part-time basis to be put on a panel of people who would be prepared to give assistance to old people in their immediate vicinity and who would be paid a certain amount in relation  to each old person they took into their care. This could be operated quite easily without the special recruitment of any additional staff.
In remoter rural areas it might not be possible to obtain the formal services of anybody on a panel of home helps. The best way to do it would be by giving financial assistance to the old people to enable them to employ somebody locally to give the help required. Very often the old people are not only infirm but also very poor and they cannot afford to employ a home help themselves. The problem could be coped with quite adequately by giving them money to provide help for themselves. I do not accept the reasons given by the Minister today for the delay in implementing the scheme. He said:
I should like to point out to the Minister that, if such home helps can be given already, to the best of my knowledge it can only be given out of home assistance. I may be misinterpreting this but, to the best of my knowledge from talking to members of the health boards, they feel that the only way they can give any such assistance in this matter is out of home assistance.
The Minister must be well aware that home assistance comes completely and totally out of the rates whereas, if home help were sanctioned by his Department, it would be paid for in part by his Department under this section of the Act. I think he will understand that very often the health authorities find great difficulty in obtaining the funds to put the scheme into operation, other than under section 61 of the Health Act because, when going to the county council or to the health board, they are conscious that the members who will be asked to vote in favour of such a proposal will be only too well aware that the money will come directly and totally out of rates. The biggest difficulty in regard to the circular is not that the Minister has any difficulties in relation to staff or  to the assessment of the problem; the biggest difficulty is in relation to finance. Apparently the Minister is not in a position to make available money to finance this home help service. In view of the urgency of the service and the large numbers in need of home help, I sincerely trust he will be able to take all the necessary steps as quickly as possible to get the money from the Government. I would ask the Minister to give the House an assurance that any difficulty in regard to delay so far as his Department is concerned will be overcome immediately and if he has any responsibility for the delay in the implementation of the scheme that he will ensure that the delay will not continue and that he will issue at least interim instructions to the health authorities to enable them to implement in part the scheme envisaged under section 61. I hope he will do this without further delay so that the large number of old people living alone in what is almost dire poverty will be looked after. That was the intention when the Act was passed almost 18 months ago. That intention has not, as yet, been fulfilled largely because of bureaucratic delay.
Minister for Health (Mr. Childers): The current health budget includes a sum of £200,000 to enable local health boards to make grants to voluntary bodies providing services for old people, including home help. A certain number of home helps have been appointed by these voluntary bodies. The grant is awarded under section 65 of the 1953 Health Act. The amount of money has been doubled in the course of the past two years. One half of it is a grant which does not require a matching rate in order to have it paid by my Department; in other words, it is a 100 per cent grant.
I have appointed three social welfare officers to my Department whose sole duty it is to tour the country in order to bring existing voluntary associations into touch with health boards. Above all, their function is to encourage the formation of a total social service council in each of the voluntary organisations in an area, without having such organisations lose their identity, so that they can come  together, share their case work and find out what the requirements of the area are in respect of the aged, the sick and other necessitous persons, and also in respect of young people. In that way they will find out how they can expand their activities by individually or collectively raising more money. Such voluntary bodies can receive grants from the local health board, partly through rates provided for that purpose and these grants are matched by a 100 per cent grant from my Department and partly by the additional 100 per cent for which no rate requires to be raised.
I am receiving reports from these social workers and I can assure the House I am establishing a national council for social services consisting of experts in this field to advise me. This is essential if the intention is to keep old people at home. The idea is to form a national service council of the kind established in Kilkenny, Limerick, certain districts in Dublin and in some other areas. I am glad to say some counties have begun to form county social service councils.
We are now assessing the position. I do not want to advise CEOs and programme community managers in the health boards to appoint home helps to work directly under the supervision of the health boards. It is far more satisfactory to work with voluntary organisations which have a far greater personal knowledge of the people concerned. The work of the home help must be linked with the work of other voluntary or paid workers attached to social service councils. It is essential that in every area there should be a growing number of trained social workers who, in turn, will train voluntary workers. Only in such manner will it be possible to ensure that home helps, when they are appointed, will work within the framework of a properly constituted domiciliary care scheme. It may be that I will have to advise community programme managers, in certain circumstances, to appoint home helps who will work directly under the supervision of the health board and not through a voluntary organisation. I am studying the situation. Before I  issue any notice I want to examine the position further. I want the programme managers to acquaint the members of the health boards of this need and to examine the field of domiciliary services in their area and establish priorities. We cannot establish these bodies all at once. They will have to be established gradually.
There are many areas in which there are no social workers operating at all. There are areas in which there is no organised scheme of visitation to old people. There are other areas where organisations, such as the St. Vincent de Paul, the Legion of Mary and similar splendid organisations, are working by themselves in isolation from other organisations. I want to bring the whole lot together and it may be absolutely essential to delay the provision of home helps until we can see clearly how these can be integrated into a proper social service council structure. It is quite true I have not in this year's Budget the money to pay home helps. I am being absolutely frank about this but that does not immediately trouble me because there is the £200,000 grant to voluntary organisations. This sum was barely spent last year in spite of circulars sent out to health boards as to the manner of its spending and the conditions under which grants could be given. I hope the Deputy fully understands that, in my view, and I have made up my mind on this, the establishment of this kind of domiciliary service is linked with the formation of social service councils in every area and, if the Deputy wants the ultimate authorisation for the social service council, he can read the pastoral council section of Vatican Council II, something with which any Christian can agree.
Mr. Bruton: I am surprised at the Minister's attitude. Would the Minister not agree that some areas do not have as many voluntary organisations as others and the grant, therefore, is likely to be more effective in some areas than it is in others?
Mr. Bruton: Further, would the Minister not agree that in some cases the immediate neighbour is the best  person to give this assistance? Such immediate neighbour may not be a member of a voluntary organisation and a system whereby the immediate neighbour could be paid might be more satisfactory in some cases?
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