George Lawlor: Crisis in Wexford Homecare for Disabled

Thank you. Minister, this topical is to discuss supports available to vulnerable children and adults in County Wexford who suffer from a disability and I can tell you that families with children and adults with disabilities are in crisis in terms of the supports and cares that are made available to them. I was contacted by a mother, a distressed mother, an exhausted mother who has three children with serious disabilities and she's literally at her wit's end. She's a 25-year-old, a 22-year-old and a 17-year-old and they all have very complex medical needs, intellectual and physical disabilities. A home nursing package was sanctioned by the HSE many years ago firstly through a nurse on call agency and then transferred to another agency. I won't name the agency but she said she's had the pleasure of meeting and working with many exceptional nurses. But in recent times the quality of nursing has drastically deteriorated overall. She puts it down to a number of factors. Nurses have been put in positions outside their level of expertise. ICU neonatal nurses with a four-week induction being placed to care for her three children, three adult children at this stage with very complex needs. And the HSE passed the book constantly by saying any time she questions, she said that the agency managed the package. They won't interact in any way, shape or form. The management and director of nursing, the HSE will not meet to discuss the issues with the parent. Instead, parents have to speak with the liaison nurse who then refers them to management. There's no governing body over home care packages. She's been asked for example on a few occasions by different nurses how to turn on a portable bottle of oxygen amongst other basic nursing questions. All nurses that she has been supplied with, through the agency, not the nurse's fault, but the HSE's fault in terms of governance, all nurses have never ever used a hoist prior to coming to her house to, as she puts it, allegedly care for her children. She provides the training. She provides the training. She has made recommendations to the agency and the HSE in relation to the training of these nurses prior to coming to work in this area in terms of induction. But, of course, the HSE are washing their hands. Believe it or not, the agency are paid per week 18,650 euro to provide the care package. The nurses get 18.50 an hour. The private company gets 74 euros an hour per nurse. That's just shy of 1 million euro in terms of providing the care. And when they did a risk assessment, the recommendation that came back from the agency was they needed more nurses on top of the 18,650 euros a week they were getting. I think this is indicative of so many of the problems in this country in terms of privatisation, particularly of care. Here we have an agency that's literally creaming off the top and making massive profits. They appear to be the only agency providing this type of care in County Wexford. But just shy of 1 million euro per year for one home for three children but not paying the nurses. And as a result of not paying the nurses a proper wage, they're getting nurses that are not suitable or qualified in this specific area. Excellent nurses in their own right, in their own areas, but not qualified or suitably qualified to provide the level of care. And this is replicated in many, many other instances across County Wexford and this is the information that I have been given. So I think it's something that we really have to investigate because the level of money, public money that's going into these private agencies and this case is indicative. I think it really has to be urgently examined. And thank you, Deputy Lawler, for raising the issue. And you have outlined a specific issue in the floor of the Dáil. I don't have the exact details of the case, but I will speak to it. But I would be, if you could furnish me afterwards with the details, I certainly will do what we can to try and help in it. But, like, we have, the woman you spoke about who's doing extraordinary work, she has a 22, a 25 and a 17 year old, and doing extraordinary work. And, like, if you look at the sums of money that you have quoted there, and, like, we seriously have to ask ourselves about are we getting value for money, and, more importantly, are we getting the care for the people that we are providing it for, or that the state is paying the money for? That's the most important question here. Like, in my time in the last Dáil as Chair of the Disability Committee, we met many, many families, and we've seen many, many challenges that they have on an ongoing basis. And, since I was appointed in the role that I have currently, I sit on the Disability Cabinet Subcommittee, and we have had many discussions in relation to funding mechanisms, in relation to challenges that are there, and in relation to the amount of money that we are paying to private agencies to provide public care. And, the real challenges that we have is, are we getting the, are we getting in the first instance, are we getting the care that is required, and then we can talk about value for money after that, but the most important thing is the care that's required. And, I can hear your frustrations, Deputy, in terms of you speaking about that mother, and, you know, the heist, and the other challenges, and, you know, the oxygen, and so forth. And, like, from what you have described, you have described young adults that have a multiplicity of very complex needs. And, like, that is a vocation for that mother, what she is doing. But, what I will endeavour to do without, I don't have the full details in it, but I certainly will take the details from you, and if you could give us the details, because we have, you know, we have a shortage of respite across the country, we have a shortage of residential across the country, and, like, we are spending a huge amount of money, again, this year, like, the amount of money that's being spent on the disability sector has gone up by, you know, huge amounts of money to try and make sure that we are doing the right thing by people with disabilities, and there is a serious level of engagement at government level on it, but we have to be mindful, as well, of the existing system that we have built up. Now, is that right for families, as well? When you look at a million euros, like, you know, if you stand back from it and you say, what can I get for a million euros? What, like, what can you get for it? That is an extraordinary figure that you've mentioned, extraordinary. And then, and what you have outlined is that there is a serious concern by that woman about the level of care or the quality of the care that they have. That is simply something that I would personally take up and that I would engage with both the HSE and the Minister on your behalf. So, if you could forward me the details privately, I don't want to be commenting on publicly, but I certainly would do it privately. Thank you, Minister. As I said, I didn't mention the family or, indeed, the company involved, but you're quite right when you talk about this lady having a vocation in terms of the care of her children, and I have worked with this lady over many, many years, and her dedication and commitment to her three children with the profound and complex needs that they require is just remarkable. She's now exhausted and distressed. She's been fighting this for a long, long time. She actually did some of the training, would you believe, for some of the nurses who came in. She showed them how to work, various pieces of equipment. So, it is extremely frustrating, given the level of investment to this family. That level of investment could be justified if you were getting the quality care that that figure demands. And not to put a price tag on anything, but if we're paying an agency whose only aim, I think, is to maximise their profits, as we've seen in a myriad of sectors across Ireland, the monies that are involved and are being commanded and almost demanded by these agencies is off the charts. And as you've suggested, the money that's been invested in disabilities has gone up hugely. But it's gone up hugely because we have to meet these bills. Imagine what we, in a state-run, proper, caring agency run by the state, could get for that million euro, by contrast. I think we would be able to pay nurses and train them properly to the highest standard, rather than forcing people into positions. And in many instances, we have no choice because they're not there. And they're not there because we're not renumerating them as we should. As I've said, 74 euro per hour to the agency, 18.50 to the nurse. That is criminal in the context of what we could, as a state, be getting back if it went into a proper, structured, HSE-run agency. Thank you very much. The case that you have outlined is extremely disturbing. And, like, I suppose the core is the care that's being provided and the question that the mother who has a vocation, her concerns about the care that she's getting, that's on one side of it. On the other side of it is the state and the amount of money that it is spending on it and the figures of 74 versus 18.50. And we have, like, as a state, you know, and a lot of organisations around the country, the Section 38 and Section 39 organisations, have invested and have provided care for people with disabilities for many years. And they have provided massive, massive value for money. For every cent they have, they are investing it either into a community facility or into the teams that are working there. And, like, you know, it is not something to have people benefiting financially from the care of very vulnerable people. And the funding that you have outlined, it has come up at number of the meetings in relation to the privatisation or some of the organisations that are, you know, providing the funding and charging an arm and a leg to the state. It has come up because we need to get the best value for money, but also we need to have a level of, I suppose, faith in the system that the care that's being provided and that the family have faith in that system as well. So what I will do is I will take up the issue, and I certainly will engage with you on it because I think it is hugely important that we do follow this up, that we do follow this up for the family that you have mentioned, but also for the state and for other people that would have the same level of care or would be experiencing the same engagement with private companies. I certainly will do that.