A motion condemning ‘the ’manner in which primary care/ home support decisions are made, with the focus purely on financial measures’, was put forward at the recent ADC. According to the motion, these decisions do not take into account the individual client’s needs.

The motion – put forward by the Waterford Branch – resolved that the Health Minister ‘be called upon to honour his commitment to primary and continuing community care’.

Grainne Walsh, from the branch, was scathing of government’s inaction. She said: “Time and time again the rhetoric from government is that primary care is ‘where it’s all happening’. The Programme for Government identifies primary care as the main channel for health service delivery, ending what they describe as an over reliance on acute healthcare services.

Delegates in Letterkenny pictured listening attentively to the speakers

“As well as reforming the current model of healthcare delivery, colleagues, don’t forget that the money will follow the patient.

“In my area last year, following a budget overrun, management decided to take that money from the most vulnerable, older members of our society when they decided to cut home help hours irrespective of assessed need,” she said.

She added that the anger of those affected was subsequently directed at PHNs.

Ms Walsh spoke of one of her own clients, who was in her 100th year and lived successfully at home who only received seven hours of home help a week and was still cut to just over five hours.

“When public health nurses try to advocate on behalf of this vulnerable group, we are told to adjust our attitude and assist management in bringing in these savings as there is just no money.

“Colleagues, these cuts on home services are a direct assault on the most vulnerable people in our society. As a public health nurse struggling to deliver a quality service in an environment where all decisions are made, not on a needs basis but on a fiscal basis, I urge you to support this motion.”

Essene Cassidy, a public health nurse in the Waterford Branch said that PHN client needs assessment was a valid and accurate tool. “We don’t need to be directed to reassess and change our mind on assessed need. As public health nurses, our focus is and will always remain on health promotion and illness prevention. We will never be instructed to be involved in cost extraction and reduction.

Patricia Barrett-O’Boyle, Castlebar Branch, said that decisions were being taken to reduce home help hours and PHNs were not being informed. She also said that clients were being told by phone rather than letter which meant there was no paper trail to the decision makers.

Jo Tully of the Dublin South West Branch said that these cuts represented “farcical thinking” in the health service and led to patients blocking beds in acute services as they could not be discharged.

“Just last week in my hospital, a teaching hospital in Dublin, we had 120 patients who were fit to be discharged yet could not be discharged. The consequence of that is that we have multiple ICU patients in our recovery area in theatre and we have acute emergency patients on the surgical day ward. It is complete meltdown,” she said.

Mary Keenan, a PHN from the Kildare Branch, gave examples of the kind of patients that were being affected by cuts to home support, such as a woman in her 80s living with a disabled daughter in her 50s who had all care removed and an elderly man who had diabetes and was blind who was reduced to half an hour a week. She spoke about patients being interrogated to the point of tears on their finances and family situations.

“I’m a public health nurse and I’d be in tears. I’ve been in tears for 10 years over home help and home care assistance,” she said.

The motion was carried.

ADC - Debates & Motions - Home help must be assessed on needs basis