Batt O'Keeffe
Question:18 Mr. B. O'Keeffe asked the Minister for Health if he will recommend a common scale of payment for home helps throughout all the Health Boards.
Ceisteanna—Questions. Oral Answers. - Home Help Scheme.
Máirín Quill
Question:25 Miss Quill asked the Minister for Health the reason for the different rates of pay for home helps in different areas of the country; his views on the fact that in some areas the rate per hour is £1.50; and if he will make a statement on the matter.
Martin Cullen
Question:43 Mr. Cullen asked the Minister for Health the reason for the different rates of pay for home helps in different areas of the country; his views on the fact that in some areas the rate per hour is £1.50; and if he will make a statement on the matter.
I propose to take Questions Nos. 18, 25 and 43 together. The underlying philosophy governing the operation of the home help scheme is that it is a community-based good neighbour scheme which would attract people primarily motivated by the desire to engage in community services. The voluntary nature of the service is underlined by the fact that a significant proportion of part-time home helps are engaged by voluntary bodies. In the Eastern Health Board region, for example, the service is provided wholly by voluntary groups.
The salary scale for full-time home helps with effect from 1 January, 1993 is in the range £182.18 - £193.18 per week. This scale is increased in accordance with the increases granted to non-nursing personnel.
With regard to persons engaged in the home help service on a part-time basis, the rate of remuneration varies throughout the country and the rates are determined by the requirements and type of task undertaken in individual cases. It should be noted that payments made to part-time home helps do not come within the scope of the PAYE code. Neither is such income taken into account for the purposes of a means test where a part-time home help for the spouse of a part-time home help is in receipt of a means tested social welfare payment.
It is a matter for each board to decide on the level of home help service required and the payments to be made to part-time home helps in respect of this service. The Chief Executive Officer of each health board is in the best position to decide on these issues.
I am concerned that the home help scheme is developing in an ad hoc way. There is wide variety in the rates paid. In the North Western Health Board it is £4 per hour, in the South Eastern Health Board it is £3 per hour, in urban areas of the Eastern Health Board it is £2.50 per hour and in rural areas of the Eastern Health Board it is £1.50 per hour. The Minister will agree that there is a danger that this scheme will develop on the backs of badly paid women. I know this relates to a community neighbourhood policy and that an aura of charity and altruism is there because women who have worked for a long time in the voluntary sector are involved but there is a danger that their altruism will be abused. Women doing this valuable work deserve to be paid appropriate wages uniformly throughout the country.
There is merit in what the Deputy says. I do not want to confuse two issues. Some people want to be good neighbours and informally support elderly people in their own communities. There is a token appreciation for that, not a significant financial payment. It is interesting that the rate of remuneration varies widely throughout the country. Individual health boards have the authority under the Health Acts to make those determinations, and the standard is not set by my Department. From health board to health board the type of work varies greatly. Some home helps are full-time paid professionals and others are good neighbours offering an hour a day to an elderly person in the locality. I would be concerned if women were seen to be exploited. It is something that certainly needs to be taken on board.
(Carlow-Kilkenny): In view of our discussion on the financial strictures on health boards, would it not be a good investment to pay women a decent hourly rate to look after the elderly, as that would keep them out of expensive hospital beds? Is this not worthy of serious consideration?
There is merit in that. The carer's allowance is based on that philosophy and it is something the Government would like to build on. Here we are talking about a different concept, the case of an elderly person living alone who needs somebody to come in and light the fire and to keep an eye on him for perhaps an hour a day. Many people do not want that formalised. They do not want to become involved in the PAYE system and they do not want it to impact on social welfare payments and so on. We need flexibility here and the chief executive officer of the health board is probably the best person to make the determination in each case.
Would the Minister not accept that this is a remarkably cheap way to keep elderly people in the community and that it requires greater investment? I accept what the Minister says in relation to this work being outside of the PAYE code and that people are not being paid as they would be paid for a job. If it is not an ordinary job would the Minister not accept that there should be greater flexibility in the scheme? There are many cases in which people would look after elderly relatives if they could qualify under the home help scheme or for the carer's allowance. I know of a person who is being paid to mind someones else's relative, even though her father would much prefer if she was minding him. If it is not an ordinary job surely it can be more flexible in order to cater for such cases. Would the Minister not accept that there must be a basic minimum below which the payments may not go? At the moment payments being made in some health boards are less than some young people are getting for baby-sitting. A payment of £1.50 per hour is simply not enough. A standard must be set. Very often women doing this work are doing a tremendous job, even more than they are asked to do.
Brevity please, Deputy.
That deserves recognition because it is a very cost effective way of keeping elderly people in the community.
We always have a conflict between devolving authority to the local health board or the local authority, and most people in the Oireachtas wish to devolve more and more authority. However, when there is disparity in relation to the provision of a service people want uniformity. I am concerned at the very low levels of remuneration but this should not be seen in strict terms as remuneration for a job, for the reasons I have outlined.
Does the Minister want to get it for nothing?
No, but obviously if we are recruiting people for a job it must come within the PAYE code and payments will be assessed in relation to social welfare and so on. If that was done a lot of people who are doing a good job looking after neighbours would back away from it. It is important to leave flexibility for people who want to do this work in an informal way without getting into the PAYE code. It suits many people to have this on an informal basis and a great deal of good is being done.
There is no excuse for the rate.
The Minister is taking advantage of their position.
There is a down side. I accept that the very low rates of pay should be addressed but it is a matter for the health boards. In view of the representations made by Deputies I will raise it with the chief executive officers.
Will the Minister distinguish the difference between leaving flexibility with different health boards and abusing the generosity and loyalty of the many women who give this home help caring service at the moment? Different rates have been quoted but is the Minister aware that in Wexford town home helps are working for £1 an hour? I have correspondence from them. I would ask the Minister not to allow the generosity of these women to be abused. I agree that we should have flexibility but we should have some sort of general code by which health boards operate in terms of the wonderful value they get from women who look after elderly people and save health boards hundreds of pounds a week by keeping old people out of institutions.
Will the Minister indicate also when we might have some general standardisation, while allowing some health boards to be more generous than others if they wish? There should be a bottom line below which no person's generosity is abused. Those voluntary workers give much more than one hour of their time to caring for the elderly. They prepare breakfast and light a fire in the morning for the person for whom they are caring, but in most cases they go back at night to ensure the old person is in bed and they do not claim for that second hour.
The Deputy will be aware that many such people work for nothing and will not accept remuneration.
(Carlow-Kilkenny): Slave labour ended years ago.
There is such a thing as voluntary work.
(Carlow-Kilkenny): Of course there is.
The Minister, without interruption, please.
Deputies opposite tend to confuse the carer's allowance with this scheme.
(Carlow-Kilkenny): That is a different matter altogether.
A person who looks after an old person in the home may qualify for a carer's allowance but that is the responsibility of another Minister. I am talking about the home help service which varies immeasurably.
(Carlow-Kilkenny): That is what we are talking about.
Some home helps have one client whom they call on for one hour a day to ensure that everything is in order, make a cup of tea and have a chat. Others have to do heavy manual work and are employed full-time earning a specific rate of pay. There must be flexibility in regard to the home help scheme, but my main concern is that the scheme is not exploited. For that reason I will raise Deputies' concerns with the chief executive officers who have ultimate responsibility for the matter.
In view of the merits of this scheme and the fact that it is very helpful economically to health boards in that it releases a number of hospital beds, has the Minister considered the negative aspects of not having a common scale of payments or adequate payment for the service? Would he not accept that many more people would volunteer to become home helps if the rate of pay was higher?
I am not sure that would be the case. A total of 8,500 home helps are already involved in the service. A spirit of good neighbourliness is an intrinsic part of the Irish social fabric and many people are willing to participate in the scheme, some on a voluntary basis. We need to strike a balance in this regard. We should not have to decide instantly that everyone who carries out a good deed must be remunerated or be regarded as a slave, as stated by a Deputy opposite. That is not a proper way of looking at the system and most people involved in providing the vast range of social supports and services do not look at it in that light. However, many people because of an ongoing commitment to the elderly deserve financial remuneration. This is the case at present. Perhaps the rate is inadequate but we will reconsider the matter.
Will the Minister respond to a question raised earlier by Deputy McManus which relates to the anomaly which prohibits the payment of an allowance to a relative? That anomaly needs to be addressed because we are all aware of relatives who do excellent work in the home help field, but are refused payment. That anomaly could be rectified at a minimal cost to the Exchequer and would be beneficial from a cost point of view in the long term.
We would need to reflect on whether that would involve a son or daughter being paid for caring for an elderly parent.
I am talking about where they live in different houses.
Even if they live in different houses, we should encourage people to have social responsibility for their immediate relatives without demanding remuneration.
It need not be an immediate relative.
The response to everything should not be to pay out more money. There is a finite pool of resources from which I can extract money through a vote of this House to provide a quality service, but I want to channel that to the best effect and I do not accept that in all cases people should be paid to care for their immediate relatives.
Is the Minister aware that many of the 8,500 women involved in this service depend on that income in order to live? It is not simply a matter of exercising some goodwill towards their neighbours. They depend on the money.
Not all of them.
Many women in my home town depend on that money to meet the weekly grocery bills. If the Minister seeks a basic income for such women will he assure us that it will not be done at the cost of cutting back on the number of people in the home help service? It would be simple for the CMO to say that the rate of pay will be increased and subsequently reduce the number of people on the scheme. This will require extra investment and I hope the Minister will answer in the affirmative in that regard.
Many people in our society look after their relatives, but those are not the people about whom we are talking. We are talking about people for whom this small income per week would enable them to care for their elderly relatives rather than have to go to work or provide a home help service for some other person. This would be an enabling process whereby people could look after their elderly relatives.
We cannot make fish of one and fowl of another. If we establish an entitlement, everyone must be entitled to it. We cannot give it to certain categories and not to others. We must reflect on the matter of paying people to take care of their immediate families. We should not need to do that. The reality is that I have a finite sum of money available to me and if more money is expended on the home help service it will have consequences for other areas.
The Minister cannot get better value than £1.50 per hour.
We are trying to get the best value for people but my main concern is to avoid the perception of exploitation. For that reason I will raise the matter with the chief executive officers.
I agree that every act of charity should not be paid for. Some unskilled women are attracted to this form of work because it allows them to earn money outside the usual tax and PRSI systems and it does not interfere with the earnings of their husbands. At the same time there is a danger that the position of those women might be abused. They are people who need a little income but the Minister should be careful that their position is not abused.
I agree with the Deputy's remarks. This involves a fine balance between encouraging voluntarism and the home help service. I have stated frequently in this House that our health and social services could not function to the high degree of quality which they do without a huge input from voluntary organisations and individuals. I do not wish to distort that level of voluntarism. I agree with Deputy O'Donnell that every act of charity and voluntary effort to help in the community should not be accompanied by a demand for remuneration. We must strike a balance. We will examine the diversity of rates available and raise it with the chief executive officers.
(Carlow-Kilkenny): I accept the principle of voluntary work, but we must cater for a woman who may have to travel 20 miles per day to take care of her mother because she will not allow anybody else take care of her. I hope the Minister will cater for such exceptions. The Minister's concern regarding people paying tax because they earn £3 per hour might be overcome by giving people the option to carry out a home help service voluntarily. However, people doing a good job should be paid a reasonable rate of remuneration. It should not border on slave labour.
I am anxious to allow flexibility to be maintained. As individual health boards know their areas better than anyone else it should be left to them and their chief executive officer to make specific determinations. However, given the disparity between the rates which has been highlighted I will raise the matter with the chief executive officers.
A pound an hour is an abuse.
That disposes of questions for today.
We did not reach a number of questions in my name. I am anxious to have them carried over rather than to receive a written answer.
That is in order.