Home Care Workers and Home Support Scheme: Motion [Private Members]

Deputy Duncan Smith

I move:

That Dáil Éireann:

acknowledges that:

— there is still no statutory right to home help or legislative underpinning for the home support scheme despite long standing commitments to act;

— the delayed referendum to replace Article 41.2 of Bunreacht na hÉireann, if passed, will finally insert language that recognises and values care within the home and the wider community; and

— the Commission on Care for Older Persons is due to finally get underway in January 2024, and while Ireland has a growing population, it also has an ageing demographic profile requiring increased resourcing of elder care;

recognises that:

— the State has a central role in providing care for people in the community and in their home, but there is growing healthcare privatisation through the outsourcing of more and more care, diagnostics, treatments, employment and services instead of investing in the permanent capacity of our public health service;

— over 60 per cent of State-funded home care is provided by private and voluntary providers, but there is no requirement for these contractors to engage in collective bargaining, despite a long-standing recruitment crisis in the sector; and

— home carers directly employed by the Health Service Executive (HSE) as Health Care Support Assistants (HCSAs) have better pay, and stronger terms and conditions compared to those working for private providers, creating a two-tier workforce and pay disparity for people doing the same job;

notes that:

— the health budget for 2023 originally funded over 23.9 million hours of home support in the HSE National Service Plan 2023, with a total budget of €723 million, but this was cut to 22 million hours in July in order to fund an increased rate of €31 per hour for providers, a so-called "living wage" floor of €13.10 per hour for workers and payment for travel time;

— Budget 2024 provides again for only 22 million home support hours, and allocated just an extra €2.8 million in funding for inflationary pressures, a 0.4 per cent increase;

— as of the end of June 2023, 10.55 million home support hours were delivered nationally to 53,579 people with a further 6,020 people assessed and waiting for a carer to be assigned, but no data is collected on how long people must wait;

— before the new tender 40,000 people over the previous year received care through private providers charged to the HSE at a rate of €26.50 per hour, while workers still had no predictable income;

— under the new HSE Home Support Authorisation Scheme 2023, the day rate for providers is now €31 per hour, but payments to workers are not indexed to increases in the Living Wage, which is now at €14.80 per hour;

— in the public service a HCSA can start on more than €16 per hour rising to over €20 on their salary scale, while privately employed home carers are paid €13.10 per hour, with providers funded at a rate more than twice that;

— the HSE, in October, abandoned a cost saving plan that would have cut 15 minutes from an hour of private home help, reducing it to just 45 minutes; and

— it is a year since the publication of the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants and while some recommendations have been partially acted on, there is no fully resourced implementation plan;

further notes that:

— the failure to fully resource the home support service and waiting lists for homecare packages leads to discharge delays in acute hospitals, and at the end of June there were nearly 500 delayed transfer of care patients;

— there is a postcode lottery when it comes to home care waiting lists, and evidence that those in rural areas wait longer due to a lack of mileage and travel costs for carers;

— social welfare rules create disincentives for part time work by home carers, reducing the hours they can work;

— the lack of progress on employment terms and conditions, including travel expenses, a competency framework, recognition of training, and a pension scheme, are further barriers to recruitment; and

— there has been a shocking inconsistency in the payment of the Covid-19 Pandemic Special Recognition Payment to home carers and other healthcare workers; and

calls for:

— the adequate funding of our health service, the immediate reversal of the recruitment embargo on health workers, and a commitment not to block the hiring of public service HCSAs;

— restoration of the 1.9 million hours of home help support cut in July 2023, and no cuts to the duration of home support hours;

— a guarantee that home carers are paid, at a minimum, the new Living Wage rate of €14.80, and payment to be provided for mileage expenses and travel time between care locations, along with guaranteed hours and continuity of income for HCSAs;

— a commitment in outsourced State contracts that private home care providers engage in collective bargaining with recognised trade unions, and the introduction of a Joint Labour Committee for workers in the private care sector to set employment standards;

— a published and resourced implementation plan for the recommendations of the Strategic Workforce Advisory Group report, to deliver on the recruitment needed to clear the current waiting list for home care and support before Christmas, and sufficient resources to be put in place to address the winter health crisis;

— annual targets to increase the proportion of home support hours provided directly by the HSE, in order to achieve a publicly provided service;

— the collection of data by the HSE on how long people are waiting for home care and the adequacy of the hours granted;

— the payment of the Covid-19 Pandemic Special Recognition Payment to those home and family carers, and all those other health workers in Health Information and Quality Authority registered settings excluded to date;

— an end to the payment disparity between home support for older people, and those with disabilities; and

— a commitment to the referendum to recognise care work in 2024.

I am sharing the opening slot with my party leader, Deputy Bacik. We bring this motion today because home care and home help are a core pillar of what the Labour Party is trying to promote and support from opposition, namely, the improvement of the levels of care throughout our society. We feel that in the area of health, budget 2024 has let people down on many levels. One area that has not received the level of notice it deserves is how the budget has let down home help, both the workers and those who need the care.

Home care workers are some of the many unsung heroes in our health service. They are underpaid, overworked and there is not enough of them. The people who are in need of home help, those who receive it and the 6,000 who remain on waiting lists, are crucially important in terms of health delivery in our country. In many ways, they are unseen and invisible. They are not in a waiting room or on a trolley. They are not being counted.

Some are in wards awaiting delayed discharge. Many are at home being cared for by overstretched family members and friends. This area of care needs focus and funding, but this is not what happened with budget 2024. We need urgent action from the Government to lift the health service recruitment embargo and to provide increased funding for our health service. Our health service is symbiotic: underfunding in one aspect of our healthcare system reverberates across the entire system.

This is why we need to see a reversal of the recent cut of 1.9 million home support hours immediately and to see an increase in the funding for hours from the €23.9 million that was originally planned for in 2022. Providing adequate funding for home support hours will allow people to transition from hospital settings to the requisite care provided in their homes. In June of this year, there were nearly 500 delayed discharges from our hospitals. I have raised many times our hospital trolley crisis, which is now a year-round crisis and averages about 500 people per day. While it is not directly related, if 500 people are delayed getting into the hospital system and an average of 500 people are being delayed in getting out of the hospital system, unless we have the measures downstream beyond the hospital setting in the form of home help, we will never truly be able to tackle or beat our trolley crisis.

One of the main areas of concern with home help relates to the level of outsourcing. Currently, there are 18,000 home care workers in our country. The HSE employees over 5,300 HCSAs but with the recent recruitment embargo applying to them, any future growth in that area will have to come from the 13,000 who are currently employed by the private and voluntary sector and not from the public service. This is something we cannot tolerate. The Government and the HSE have stated that the reduction in hours from 23.9 million to 22 million was to allow providers to deliver a living wage for workers. However, we have not seen that happen. Alone, the rights group for older people, has labelled this move as "shrinkflation".

The Government knows that this move has also resulted in care cramming where, due to the demand of care, care in the home is being rushed and delivered by providers who are overstretched and do not have the workforce to meet the level of demand. Part of the reason for this relates to the recruitment and retention crisis. Because the pay remains below the living wage, the pay is too low. Despite the Government's efforts in recent years and despite the efforts of the Minister of State, this has not been delivered. The living wage will increase next year to €14.80. Wages in the private and voluntary sector of home care do not match that and therefore, these organisations are struggling to get the staff required. When these organisations are providing 60% of home care, we know this is a core reason for the crisis.

The level of demand on the service is increasing every year. We have seen a 3.7% increase in people needing home care from 2022 to 2023 so far. Our ageing population is a key factor in this. It is a great testament to many aspects of our society that our population is growing and people are living longer. However, if people are living longer, they will contract more chronic illnesses and will get sicker, therefore requiring more care at home. Unless we have a structure driven and delivered by the State, we will not be able to meet our basic demographic demands.

Regarding the increased demand for care, according to the HSE service plan for 2022, we have an acute shortage of care workers. HSE data indicated that as of July 2022, a total of 5,312 people were waiting for home support from HSE services for older people because no care workers were available to provide them. We know that has now increased to 6,020, an increase of 800 in the course of a year, which is absolutely unacceptable.

The HSE service plan report suggested a number of actions the Government could take to improve recruitment in the care sector that we would welcome. These include: a national campaign to raise the profile and promote the training opportunities available for a career as healthcare assistant and home care worker; a public employment services review with a view to further increasing the number of jobseekers who become healthcare assistants or home support workers; the continuation of a rolling recruitment campaign in each community healthcare organisation for as long as the positions remain unfilled; and a review to be undertaken on the eligibility criteria for State benefits with a view to ensuring that they do not unnecessarily disincentivise engagement in part-time employment. Implementing these suggestions alongside the core request of improving the wages, as we have previously outlined, would significantly alleviate the current pressures on the home care sector.

Home care is an issue close to the hearts of people throughout the country and close to the hearts of those of us in the Labour Party. We believe that home care providers and the issue of care deserve to be recognised in our Constitution. The delayed referendum to replace Article 41.2 of Bunreacht na hÉireann, if passed, will insert language that recognises the value of home care. We ask the Government to commit to advancing this referendum as soon as possible and to promise that we will see no more unnecessary delays. It is November 2023. This is the month in which we expected to be campaigning on a referendum and we seem further away from that referendum than ever.

A couple of days ago, Sage Advocacy, the national advocacy service for older people, released the results of a RED C poll, which showed that more than 80% of people believe that care for older people is too concentrated in private providers and that more State involvement is needed. The results of this survey show that home care is an important issue for people in this country. As we know in politics, it is extremely rare to get 80% agreement on anything, which highlights just how highly people value this. The survey, which was initiated by Sage Advocacy in advance of the establishment of the commission on care for older persons, has provided a very clear message which we hope the Government well take on board when the commission finally gets under way in January 2024.

People who have worked hard for their whole life deserve proper care as they age. Those who are sick and vulnerable and are able to be cared for in the home deserve this. The Government must be reminded in the starkest possible terms that those providing care and rehabilitation in the home ultimately save the State millions of euro. It is where people want to be cared for and made healthy again. It is the cheapest and most cost-effective way of doing it and yet the State continues to fail. Those workers who are underpaid, undervalued and overstretched are shouldering a burden that is beyond them in many ways. Those who require the care but are not getting their full hours every week and those who remain on waiting lists deserve so much more than they are getting. We call on the Government to support our motion.

Deputy Ivana Bacik

I will be sharing time with Deputy Nash. I commend our colleague, Deputy Duncan Smith, on introducing this very important motion which I know is close to his own heart and to all of our hearts. It is vital that we give recognition for home care workers and home helps who, as Deputy Smith has said, are indeed the unsung heroes of our healthcare system. I think we can all agree on that. They provide an incredible service and those who receive care from them are deeply appreciative of the work they do.

They are mostly women and all of us know many women who provide home care services. I recently met one woman who had been doing home help work for decades, as so many have. She started out, as so many did, almost as a voluntary sort of charity worker. I think the amount being paid that was £1 an hour and it was a sort of gratuity system. Over the years I have met groups representing home helps who wanted to move the recognition of their work from that sort of gratuity-based almost voluntary system to the more professional service we have today. However, unfortunately that cultural view of home helps still remains. One woman who has been working as a home help for years says that she has to race between clients, that she is on the clock, and that she does not feel she has the time to give her clients the warmth and the social connection which is such an integral part of home help work. Deputy Duncan Smith spoke about the recruitment and retention crisis. That is how it is felt at the sharp end by those, mostly women, who are providing care in the home.

The figures speak for themselves and the Minister of State is well aware of them. Some 6,000 people on the waiting list have been assessed for home support but simply cannot access it.

There are 18,000 care home carers but only 5,300 of them are directly employed by the HSE. The majority of home carers work in the private sector, often with poor pay and conditions. We need to see a real rewrite of our system of home care. The Labour Party's motion seeks to provide for the essential reforms required. In my work last year chairing the Joint Committee on Gender Equality, the experience of hearing those who provide care and their representatives and from those who need care really brought home to me the need for a really serious reform of our system. We need a better way, a new system that can put an end to unfair pay and conditions that leave workers like the woman I met burned out and struggling to make ends meet - the kind of system that could keep our older people and friends and relatives with disabilities out of hospitals and care homes and in the comfort of their homes. We need a system that will enable families to be assured that the funding will be available for what should be an essential State service. A reformed system would also bridge the gender gap between women and men in terms of work in the care economy and for those who require care. Our motion seeks to achieve real reform.

It is disappointing that the Government tabled an amendment to the motion. Reading the text of the Government amendment might lead someone to believe nothing is wrong with the system and that no one is on a waiting list. We all know that is not true. I know the Minister of State is well aware of that. She has been critical of shortcomings in the system. The Labour Party cannot accept the countermotion. We will press our motion and I am proud to second it. We do not suggest that fixing the broken and patchwork system will be easy but it is not helpful to pretend the problem does not exist or that the system is working for everyone when it is not.

My colleagues in the Labour Party will speak to other aspects of the motion such as some of the key ways the system needs to be fixed. In the brief time left, I will focus on the need for a referendum to recognise care work. We in this House accepted and the Joint Committee on Gender Equality unanimously accepted that it is required, yet the Government amendment does not even mention the referendum on care work. As Deputy Duncan Smith said, the Government committed to the referendum to amend Article 41 of the Constitution to delete the sexist language around women and mothers and replace it with an important text that would recognise the value of care and acknowledge the State's role in supporting care inside and outside the home. It is frustrating that the Government has apparently abandoned plans to hold the referendum this year. On International Women's Day in March, the Taoiseach announced it would take place in 2023, as the Minister of State will be aware, yet we have heard nothing since. The Government has failed to honour its commitment to hold a vote and that failure and that delay emphasises the Government's undervaluing of care. It is no coincidence that we see the work of carers so denigrated by State policies. Most carers, as I have said, are women and many are also from migrant backgrounds. They feel undervalued by the Government and the delay in holding the referendum and the failure of the Government to even say when it will be held contributes to the sense of being undervalued. The Labour Party's motion would address that and ensure the work carers do is truly valued by the State and it clearly sets out a pathway to achieving the valuing of care work. We urge the Government to accept it.

Deputy Ged Nash

The elephant in the room in the area of recruitment and retention of vital workers in the home care sector is pay, terms and conditions. It is that simple. Some of the best people I know work as healthcare assistants, HCAs, and healthcare support assistants, HCSAs. They are the best of people, but they are among the least valued by employers and the State. As the Minister of State knows only too well, they deliver vital services across every community to, by definition, the most vulnerable in society. Earlier this year, as was referred to earlier, we saw Ministers and the HSE perform what I would describe as a sleight of hand that was breathtaking in its arrogance. The floor for the hourly rate of pay for HCSAs employed in the private sector was increased to €13.10 per hour, packaged and branded as a living wage, but how was it paid for? It was paid for by sneakily cutting committed home support hours by 1.9 million hours. That is straight out of the Minister for Health's management consultancy for beginners handbook. There was no additional funding and no plan to index hourly wage rates as the living wage rate rises. The plan includes some provision for travel time but not for mileage and mileage is what matters, especially for home care support workers trying to keep a car on the road to enable them to service their clients and deliver a service to citizens in rural Ireland in particular.

We have a two-tier employment system. As Deputy Duncan Smith said, there are more than 18,000 home carers in the system. The 5,300 HCSAs who work for the HSE have the benefit of collective bargaining and recognition of their union, SIPTU, which has helped to make the sector work much better in recent years. Thanks to trade unions, a HCSA can start on an hourly salary of more than €16 and receive other basic entitlements such as pension provision. It is quite a jump from the €13.10 per hour offered as a floor by private sector employers. It is no wonder the ambition of many who work in the private sector is to get a job with the HSE. Why? They will get paid sick leave, sufficient contracted hours to allow them to plan and have a decent life and premium payments for unsociable hours; in other words, basic decency. That is what it is.

Until the Minister of State decides that this particular bull is to be taken by the horns, we will continue to have a crisis in care, a crisis in recruitment and retention and a failure to plan for the future. There is only one tried and tested way to ensure we address this comprehensively and permanently. A joint labour committee, JLC, for the sector is needed to bring trade unions and companies who are representative of the industry together under the aegis of the Labour Court to customise a solution on pay, terms and conditions for a sector that is growing by the day and is growing fat on State money. The sector now provides 60% of home care with few employment standards and conditions attached beyond the statutory legal minimum. There should not be any cash without conditions. The Minister for Children, Equality, Disability, Integration and Youth used the JLC employment regulation order, ERO, system of decency the Labour Party revived to ensure better pay and conditions for skilled early years professionals as a condition of substantial State investment in private firms that deliver a crucial service. What is so different about the home support system? Why should it be treated differently?

Last year's report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants skirted around the issue. Recommendation 6 neatly says that all home care providers should be "invited" to pay a living wage. Recommendation 7 states: "An appropriate mechanism to reach agreement in the private and voluntary sector in respect of pay and pensions for home-support workers and healthcare assistants shall be investigated [investigated] and reported on by an Expert Working Group". Jesus wept, honestly.

It is called a joint labour committee. The approach is called sectoral bargaining. No one will be struck by lightning for uttering those words. The legislation is rock solid. Incredibly, the only recommendation made in the report published last year that has been implemented thus far is the one on employment permits for home support workers. That is the easy option. It is not the transformational one. The easy option is to revise the permit system and allow people to come to the country to work in the sector. That is not the permanent transformational process we have been calling for. The JLC system is the answer. It was the answer for the childcare sector. The answer is not another working group. It is blindingly obvious and all that is lacking is the political will. We need a JLC system. We need an ERO for decency for all workers in the sector, private and public.

Minister of State at the Department of Health (Deputy Mary Butler)

I move amendment No. 1:

To delete all words after "Dáil Eireann" and substitute the following:

"recognises and notes:

— the invaluable work carried out by Home Care Support Assistants;

— that the Home Support Service is a core service for older people and is highly valued by service users;

— improving access to home support is a priority for the Government, with €723 million allocated in Budget 2023, up €228 million since 2021;

— delivery of home support hours in communities is increasing, in line with enhanced investment;

— almost 20.8 million hours of home support was provided across the country in 2022, and this is 3 million more hours than were delivered in 2020;

— as of 31st August, 2023, over 14.3 million hours have been provided this year to date, and this is almost 600,000 hours more compared to the same period last year;

— addressing the shortage of care workers in Ireland is an urgent priority for the Government, with an implementation group established to implement the report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants, in areas including pay and conditions of employment;

— a new tender for Home Support Services has been in place since August 2023, and this provides for a revised, increased rate to ensure that home support workers are paid appropriately, and to help address some of the key issues impacting the waiting lists and recruitment and retention;

— the Programme for Government: Our Shared Future commits to introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high quality, regulated home care;

— the heads of Bill are currently being drafted by the Department of Health, with a view to bringing the heads of Bill to Government for approval before the end of the year, and primary legislation has been prioritised for drafting in the Autumn Legislative Programme and the Department is engaging with key stakeholders;

— the draft regulations are at an advanced stage, informed by a public consultation, and legal advice and engagement with key stakeholders will assist with final revisions to regulations for providers of Home Support Services in 2023;

— the Health Information and Quality Authority is in the process of developing standards for home care and Home Support Services, which are in the early stages of development; and

— the new system of regulation for home support will ensure that the public can be confident that the services provided are of a high standard and will bring Ireland in line with best international practice.".

I welcome the opportunity to discuss home support services. I thank the Deputies from the Labour Party, especially Deputy Duncan Smith, for using their time to discuss home care, which is important.

Most people prefer being cared for at home. I hope I will be able to respond to many of the issues the Labour Party raised in my speech. The Minister of State, Deputy Rabbitte, will close later. Home support is an essential service for thousands of people each day. It is highly valued by service users and their families because it enables older people to live independently and with dignity in their homes for longer. It also enables many older people to return home following acute hospital admission. Otherwise, they may remain in hospital or be admitted to long-term residential care. For the record, of the 550 late discharges of care at the moment, the figure for those awaiting home support is 70.

We are working hard to make sure that those late discharges of care are not having home care held up. Some 70 of the 550 are waiting for support.

For these reasons, improving access to this service is a Government priority. Home support hours in communities are increasing in line with enhanced investment. We currently provide more hours of home support to more people than ever before. More than 54,000 people are receiving home support services today, with almost 75,000 benefiting from the service last year. I take this opportunity to recognise the hard work of healthcare workers and healthcare support assistants in delivering this unprecedented care and thank them for their commitment and the care that they deliver in the homes of older people every day.

We, as a nation, are investing €723 million in home care in 2023, representing an increase of €228 million from 2020. In 2022, we provided 20.78 million hours, an increase of 3.2 million hours on 2020. In 2023, we expect to deliver 21.5 million home support hours. As of August 2023, preliminary data show that more than 14 million hours of home support have been provided this year to date. This represents an increase of approximately 600,000 hours compared to the same period last year. All home support hours for 2023 are fully funded, including those on the waiting list. The delivery of home support hours is increasing year-on-year. In 2024, we expect to deliver 22 million hours of home support. This is more than has ever been delivered.

Regarding waiting lists, the latest figures show that 3,151 new applicants are approved for funding and awaiting a carer. In addition, 2,841 people are receiving supports but are not yet receiving the maximum hours advised. I think that is important. They probably have supports from Monday to Friday but have challenges at the weekend, especially in rural areas. This is down considerably from the start of 2020, when the total number of people waiting was 9,000.

There are challenges in the sector, particularly on the workforce side. Although progress has been made, the waiting list has reduced, and we are delivering more support hours than ever, it is frustrating for me that we currently have sufficient funding for home support hours but do not have the carers to deliver it.

Deputy Brendan Howlin

Well, pay them.

Deputy Mary Butler

I am glad that workforce is a focus of today's motion. The Government is committed to improving recruitment and retention.

In March 2022, I established the strategic workforce advisory group on home carers and nursing home healthcare assistants. It set out to examine and, most importantly, propose solutions. The group was chaired by the Department of Health and comprised representatives from seven Departments, the HSE, HIQA and SOLAS. The report of the advisory group was published on 15 October. It presented 16 recommendations, which I fully endorse, spanning the areas of recruitment, pay and conditions, barriers to employment, training and professional development, sectoral reform and monitoring and implementation. I am pleased that significant progress has been made in implementing these recommendations. A group has been established to drive their timely implementation. The group’s most recent meeting took place in October. This week, my Department will publish a progress update, following the publication of the group's terms of reference and a schedule of meetings. It will go live on the website in the next 24 hours or so.

Recommendation 9 has been fully implemented. The statutory instrument authorising the issuance of 1,000 employment permits for home care workers was signed in December 2022. These permits will be for full-time positions with a minimum salary of €27,000 per year. Some 330 permits have been availed of to date. The implementation of the 16 recommendations will have a lasting, positive impact on waiting lists.

As Deputies will be aware, 60% of home support is provided by private and voluntary agencies. A new HSE tender with these agencies was agreed in August 2023. The new tender rate was backdated to July as a gesture of goodwill. The new tender provides for a core rate of €31 per hour for providers, which works out at an average rate of €34 per hour when taking into account weekends, evening premiums and so on. The new HSE tender for home support providers also commits private and voluntary providers to paying their staff the living wage, which was €13.10 per hour at the time, travel time between appointments, which is €2.99 per hour, and reform of legacy rates. The new HSE home support tender has an in-built review process relating to the national living wage after 12 months so that will be revisited in July and August of next year. There is no evidence that this rate is not being paid. I have met Home and Community Care Ireland, HCCI, every quarter since I became Minister. I meet it regularly. The Department has not had any correspondence that this rate is not being paid by the private providers. I am not saying that other Deputies may not have received correspondence.

The tender will deliver some significant reforms that will directly improve conditions for home care workers. The terms and conditions of each private and voluntary organisation are a matter for themselves. However, they must abide by the minimum payments agreed in the tender, which includes €2.99 per hour for travel time incurred by the home support worker. This is the first time ever that all home support workers delivering care are entitled to receive payment for their travel time. I have to admit that some companies paid that previously, though not all. As per the request of the sector, more than 110 legacy rates dating back over numerous years were also addressed, resulting in the agreed core rate of €31 per hour. It is expected that the new tender should assist in the sourcing of additional hours.

Two core rates are prescribed in the home support authorisation scheme tender, which are a 60-minute rate and a 30-minute rate. Tender 2023, the authorisation scheme, does not provide for a 45-minute rate. A pro rata hourly rate will apply to 45 minute call-outs for new clients commencing a service after the commencement date of the authorisation scheme. However, the range and volume of hours allocated to home support clients is based on their individual assessed care needs.

The motion refers to the pandemic recognition payment. It is important to recognise the efforts of healthcare workers during Covid-19. The pandemic recognition payment was open to applications from public, private and voluntary home support providers. I am pleased that all 136 home support agencies that submitted a claim for eligible staff have been paid. In the programme for Government, we committed to introducing a statutory scheme for home care. A key step in this process is to regulate home support services so that no matter where or how care is provided, everyone can be assured that their provider meets minimum standards of quality, safeguarding and governance. Progress continues on this front.

My Department is currently preparing primary legislation to accompany the regulations. This has been prioritised for drafting in the autumn programme and I will bring the Bill to the Oireachtas this year. As per the programme for Government, the Government is committed to establishing a commission on care for older persons. The proposal for the commission that the Minister, Deputy Donnelly, and I brought forward was approved by the Government on 3 October and in budget 2024, we secured €1.24 million to support the commission's work. The commission will examine the provision of health and social care services and supports for older people and make recommendations to the Government for their strategic development. A cross-departmental group will be established under the commission to consider whether the supports for positive ageing across the life course are fit for purpose and to develop a costed implementation plan to optimise these supports.

Ireland is deemed by the World Health Organization to have the highest life expectancy in the EU. We were also the first country to be designated age friendly status in 2019. This did not happen by accident. The triangle of supports of home care, day care and meals on wheels, including dementia-specific supports, are a key factor in supporting older people to age well in their own homes. With home care, these wraparound supports are vital to prevent loneliness and social isolation, and to maintain positive overall health and well-being. This is why I have allocated increased funding for this every year since the formation of this Government. Significant reform and investment in home support services is underway and is delivering more hours and more funding than ever before, and better terms and conditions for all who work hard to deliver home supports up and down the country every day. This Government is committed to supporting healthy and positive ageing.

Deputy Brendan Howlin

I compliment my colleague, Deputy Duncan Smith, on his long advocacy for home care workers and home care support, and for tabling the motion. No Member of this House has not struggled with difficult cases from constituents desperate to continue living at home or families desperate to have loved ones come home from long-term hospital care, only to be told again and again that there is no home help service or that what is available is inadequate to allow the loved one to be treated at home or to remain living at home.

The unfolding disaster of next year's health budget stems from a clear showdown between the Department of Health and the Department of Public Expenditure, National Development Plan Delivery and Reform, where trust has quite frankly broken down and the funding Minister in the latter Department has clearly and publicly signalled he simply does not accept the costings of his colleague, the Minister for Health, and has, therefore, underprovided for healthcare for next year. This power play will make a difficult situation that exists at present, which the Minister has acknowledged, immensely more difficult next year.

The 5,300 healthcare support assistants employed by the HSE cannot meet current demand, as the Minister of State knows. Giving people 30 minutes of home support is wholly inadequate and further recruitment to that cohort of 5,300 is now embargoed. It makes no sense. It makes no sense to keep people in acute hospital beds when they want to be at home and when, if the resources were there, they could be at home. Meanwhile, the HSE is contracting in 13,000 or so home care workers from private providers at an enormously more significant cost. The whole thrust of Sláintecare is the creation of an integrated, single-tier, universal public health system. The direction of travel of Government is to increase dependence on private providers for nursing home care and home support care. Less than 40% of home support is now directly provided by the HSE; it is 60% privatised. The basic philosophy underpinning the agreed all-party approach to the provision of healthcare, Sláintecare, the health system of the future, is being systematically undermined by Government policy. The increase in funding for home support next year is 0.4%, which is less than half of 1%, at a time inflation, not to mention wage inflation, is expected next year to be in excess of 3%. Add that to an ageing and growing population and we know what is now inadequate provision will be grossly inadequate next year.

The CEO of the HSE has said, in essence, that he is going to produce a service plan to meet projected need. I have never heard the head of any State agency say he is going to provide for a deficit, that is, to ignore the inadequate budget he has been provided because it is so patently inadequate. This is extraordinary and is an extraordinary way to run our most important public service. The long-promised statutory underpinning of home support, which the Minister of State referenced, needs to be produced. The programme for Government promised this but we still await its introduction. Such a vital service cannot be run in such an ad hoc manner where location and availability of staff determines whether a person can be provided with an essential public service. We would not tolerate that in education, for example. Why would we not demand the same level of support for our elderly as we do for our young? We have had a cross-departmental strategic workforce advisory group set up by the Minister of State and it has made recommendations but as my colleague, Deputy Nash, has so clearly said, the most fundamental is to have a joint labour committee to determine proper pay across public and private to ensure there is proper recruitment. Our health service has grown in an unstructured way into public health, voluntary health and private health. The strains on this disjointed service have long been recognised, namely, different terms of pay, different types of service and geographical inequalities. We had hoped we would resolve that now. The Minister of State can do that for home care if she accepts the motion.

Deputy Sean Sherlock

I wish to raise a very practical case with the Minister of State. I spoke to my colleague, Senator Wall, this morning and he informed me he is aware of at least four home care workers in the south Kildare area who are coming up to retirement age. The families who are being cared for contacted him to say there has been a dramatic reduction in the number of hours they are receiving. In this retention and recruitment crisis, the question arises of why, if those carers wanted to continue in employment under the HSE, they could not continue to give the care to those families they are providing at present. There is a very arbitrary retirement age and that needs to be examined by the Minister of State because it is having such an impact for those families. These workers are women who have been providing care for a long time and doing an excellent job, according to Senator Wall. Why can they not continue to do so? That is something that needs to be looked at. I fully appreciate that the Minister of State has been able to secure €700 million-plus for the Department for this budget line, but – and I share this view with my colleagues – why do we find ourselves as a country having to go out to the world to recruit 1,000 people to provide care in this day and age? The reason is the rates of pay are not competitive enough for people locally to want to be employed in the service. If the Government makes the terms and conditions competitive and ensures the wage rates are strong, it will entice more and more people locally into the service. That is something that must be addressed and an ERO is the way to do this. As Deputy Nash said, if that can be done for the childcare sector it can be done for this sector as well.

I am fearful that we are on an inexorable journey towards 100% privatisation of home care services and that while we in this House can lobby and advocate for families at present, there will come a time that will no longer be the case. The person at the other end of the line in the HSE will no longer be doing that job because that job will be made redundant and the ability of individual Deputies and public representatives to make cases for families for additional home care packages or hours will be rendered redundant because it will be privatised. That is the fear. The State always and ever played a vital role and was able to police and regulate the service and provide the resources to the families at the most local level. My fear is we are reaching a point where if the service becomes wholly privatised, the ability of individual Deputies to lobby on behalf of families will be rendered redundant and we need to be very careful about that. We need to ensure there is State provision to act as a counterbalance to privatisation of services because if I have pick up the phone to a private entity to lobby on behalf of a family, the private entity will not care one jot who I am or what I represent or the mandate I have, so I urge caution in that regard. We want State provision, a State-regulated service so at least Deputies across this House, whoever they may be, can at least advocate on behalf of their constituents. I move to the terms of reference of the commission on care and note the words of the Minister of State in respect of setting that up. We need a statutory home care scheme. If we do not have such a scheme, the accountability mechanism will reduce dramatically. We also need a national care strategy on this. I am hearing a legal entitlement to assessment is one of the provisions that will be looked at by the commission on care, but we also need a legal entitlement to provision.

Deputy David Cullinane

I thank the Labour Party for tabling the motion. The backdrop to any discussion we have on healthcare and healthcare delivery is obviously tainted by the fact that in the recent budget there was very little, if any, new funding for new measures across the healthcare system.

The Government took a deliberate decision in the budget not to provide additional funding for new measures or even to provide enough money for the health service to stand still. We know that will have consequences. We can see it with a recruitment embargo in some areas of the front line already. During the summer months, 2 million hours of home care were sacrificed because of changes to the home support tender. There has not been any significant increase in home-help hours either in last year's budget or this year's budget. Many of the 5,000 people waiting for home-care support are waiting for intensive home-care packages, which they cannot get.

I will pick up on a point made by Deputy Sherlock because it is one I also want to make very forcefully. How did we arrive at the position where the vast majority of care for older people outside of hospitals is delivered by the private sector? That is not a reflection on the private sector. People who operate and work in it are trying to provide the best services for older people and they do their best. I am not calling into question the quality of the care. However, there is a responsibility on the State to provide adequate infrastructure, capacity and supports for older people.

Not long ago, Sinn Féin introduced a motion on nursing homes. The vast majority of nursing home beds are private rather than public. We have not provided anywhere near the number of public beds we need and the same applies to home care. The vast majority of home support is not delivered by HSE personnel but by non-HSE community, voluntary and private for-profit organisations. All the problems are the same. Whether it is nursing homes or home care support, one of the big challenges is recruitment and retention of staff. We have this merry-go-round where we talk about this issue all the time, going around in circles and failing to solving the problem. We need to rebalance the scales as regards public versus private capacity because the best way for the State to control care and ensure older people have the best care and the care they need is to have more public capacity. I support my colleagues in the Labour Party who spoke using very similar language.

Another issue with home support is the number of hours that are available and whether people are getting what they need. There is a big difference between what the established need for a person is and what that person gets. There are many people on waiting lists but many of those who are getting home-care support are not getting the support they need due to staff shortages and because organisations, including the HSE, are trying to cut their cloth according to measure. That flies in the face of Sláintecare and what we need to do to better manage our healthcare services and ensure we are getting bang for buck for the money we spend.

The Labour Party motion notes that we do not have a statutory home-care scheme. Such a scheme was clearly provided for in the programme for Government. I have no idea when it will be brought in but I want it to be brought in-----

Deputy Mary Butler

It is coming.

Deputy David Cullinane

Even if a statutory home-care scheme is brought in, the first questions we need to ask are whether we have the capacity to deliver it and what will actually change for people. I do not believe we have the capacity to deliver a scheme in the way it was originally envisaged. Maybe that is the reason it has not happened. I have a real fear that we will, in very cosmetic ways, bring in a statutory home-care scheme and tick that box without changing anything in reality for older people. If we bring in a statutory scheme in the way we intended, we will have to completely rethink this whole area, including the types of people who will be in nursing homes, for example, those who will be higher dependency and have greater needs, and also ask what it will mean for staff, capacity and so if we have more people being cared for in the home. We have not done any of that groundwork. That is the real challenge we have.

I support the motion. Sinn Féin made similar proposals in our alternative budget. I welcome the fact that this Government moved on the expert review of pay and remuneration for home-care support, including a living wage, but travel expenses were not addressed. I took a simple view that we should just do it all as quickly as possible and not drag this out. Recommendations were made on travel and subsistence as well as the living wage. It should have been dealt with in the recent budget but it was not because of the decision the Government made to underfund the health service.

Deputy Patricia Ryan

I thank the Labour Party for tabling this motion and welcome the opportunity to speak on it and give it my full support. As Sinn Féin’s spokesperson for older people, the health and well-being of our senior citizens is very close to my heart, as the Minister of State will be aware. I firmly believe our elderly deserve the very best care possible in order that they can enjoy their golden years with dignity and comfort. However, the continued failure of Fianna Fáil and Fine Gael to adequately invest in home care, public nursing capacity and step-down community care has left dignity and comfort by the wayside, with disastrous consequences for our elderly citizens. It has had consequences such as home-care packages being granted without the staff to deliver them, urgently needed home adaptations left with no budget to complete them and a community care system that is not adequately staffed. Our elderly deserve better.

There are over 5,000 people on waiting lists for home care. Even those lucky enough to have it cannot be guaranteed they will receive their fully allocation of hours because there are no staff. Each undelivered home-care package is one more older person suffering unnecessarily and one more family forced to shoulder the burden of care. It is all down to the failure of this Government and its predecessors. The Government needs to adequately invest in these services.

Nearly 3 million HSE home-care hours were lost in 2023. That is absolutely disgraceful. The Minister of State knows well that pay levels and lack of pay parity in the home-care sector are the root cause of the recruitment and retention crisis, yet the budget did nothing to resolve this. Deputy Sherlock spoke about his colleague in Kildare South and all the issues in the constituency. I am well aware of those issues because they come to my door.

Sinn Féin’s alternative budget put forward a solution that would provide basic and sufficient standards not only to recruit staff but also to incentivise staff to remain and even train staff. It would make home care an attractive career choice with progression prospects. Home-care workers deserve a living wage and travel expenses, especially in rural Ireland. They travel for ages to get to one client. They need to have some travel expenses. Who bears the brunt of this? It is not members of the Government but older people and their families who are stepping in to look after older people. That includes older people who are sick themselves. An elderly lady in my constituency was approved for a full home-care package but there were no staff to deliver it. This left her elderly husband, a cancer sufferer, with no alternative but to try to tend to her personal care needs. That is totally unacceptable. She ended up with bedsores and had to be brought into hospital to be looked after because the home care was not adequate.

What if home care is not an option and a nursing home place is the best solution? There are no beds, thanks to more Fianna Fáil and Fine Gael failures. These are public and political choices. There are 1,000 fewer public nursing home beds today than we had in 2014. The bed capacity is simply not in place. The over-reliance on private beds is also very concerning. Some 40% of all private nursing home beds - more than 10,000 beds - are owned by global investment funds. Sinn Féin wants to redress that balance. Our alternative budget does so by making provision for over 600 more beds in public nursing homes. It would increase public nursing home capacity and prioritise direct public provision in the sector, with additional funding to private nursing homes pending the increase in public beds coming on stream.

Joined-up thinking is necessary here. Significant investment in the support and care systems for our older people is paramount to future-proof the quality and availability of that care. Otherwise, we face a disaster for older generations with ever-increasing waiting lists and suffering for older citizens. Some 15% of our population are over 65 years. This figure is predicted to rise to 26% by 2050. Urgent and decisive action is not only needed; it is mandatory for future generations. We are all getting older and we must not be left to face the disastrous consequences of this Government’s continuing failure to properly address falling bed capacity, the staff recruitment and retention crisis, lost home-care hours and huge waiting lists for home care.

Sinn Féin has specified investment of €100 million in older persons' services. That is €100 million more than the sum allocated by the Government. People see that difference. Sinn Féin would fund an additional 600 public nursing home beds; invest in community beds for recovery and convalescence to take pressure off hospitals; fund a living wage and travel expenses initiative to help recruit more home-care workers; make home care more career progression orientated to encourage people to stay in the sector; provide training opportunities; provide more home-care and community care supports to allow our older citizens to live independently in their own homes and communities for as long as possible; and double funding for the housing adaptation grant.

That is absolutely necessary.

The Government has dropped the ball in respect of care. A Sinn Féin government would put an end to that. I say to the Minister of State that we need to do better.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

I ask Deputies not to be taking each other's time. I am going to call the time up when it is up.

Deputy Martin Browne

I thank the Labour Party for bringing the motion to the House. I welcome the opportunity to discuss the work done and the challenges faced by our home care and home support workers in the face of a Government that speaks about the importance of community care but fails to invest in the way it should. The Government's underfunding of the health service has been met with dismay by service providers and, indeed, by hospital managers whose ability to address the high numbers presenting to emergency departments is dependent upon community care. I have been told by management at University Hospital Limerick, UHL, that the recruitment freeze on home care assistants, which is the result of underfunding, will affect care in the community. Record numbers are presenting at UHL and care in the community is an important part of addressing that issue but the Government has thrown in the towel. Representatives of Tipperary University Hospital have told me that the recruitment freeze has the potential to impact patient safety. They are making every effort to mitigate risk. This is where the Government has led us.

For south Tipperary and the adjoining hinterlands, a vital resource of care in the community was shut by the HSE in a way that can only be described as underhand. St. Brigid's Hospital had three palliative, two respite and 11 convalescent beds that were scrapped. The private sector is being relied upon for some beds while to access others, families who wish to see their loved ones must travel further. This is just another example of the lack of joined-up thinking on the part of the HSE and, ultimately, the Department of Health.

We also note that there continues to be a lack of home care support packages in south and north Tipperary. Take community healthcare organisation 5, CHO 5, for example. In the middle of 2023, there were 1,003 clients waiting for home support hours. Imagine if they were to know that a matter of months later, in addition to the already insufficient number of home care hours, the recruitment of healthcare and home care assistants would be halted and the service underfunded. The capacity to deliver care in people's own homes or local communities simply does not exist because of political choices. We have 1,000 fewer public nursing home beds today than we had in 2014. The Government watches on while 6,000 people are on waiting lists for home care and while thousands do not receive their full allocation of hours. This Government has given up on families who are left bearing the consequences.

Deputy Paul Donnelly

I also thank the Labour Party for bringing forward this motion. I thank all the workers who are going into people's homes as we speak and providing incredible support to those who need that help. I know that from personal experience. I talked to such a worker in my mother's home yesterday morning. She was coming into the house to help my mother. The work they do is absolutely incredible and we need to support them as much as we possibly can. It is clear, however, that the Government is, unfortunately, not dealing with this issue in the correct way.

The current situation is that some 60% of people are being provided care by private, for-profit companies. I have personal experience in this area because I used to work for Tusla, which used to directly employ family support workers. At one stage, up to 47 family support workers were employed directly in the area in which I worked. They were employed directly by the HSE before responsibility broke off to Tusla. Somewhere in the region of five are now left. There are only five directly employed family support workers. That support is now provided by some not-for-profit and some for-profit organisations. The money for family support is going out from that service. I am absolutely not disparaging the work that people do in the not-for-profit or for-profit organisations. I do not think anyone would do that. It is the same people doing the same work. However, at the same time, we need the State to provide a service so that we can have control, a say and an input to the service that is being provided for people.

I read a report the other day which showed that nearly 3 million hours of home care promised by the HSE could not be provided last year due to a shortage of staff. Although we set a target of 23.67 million hours, only 20.79 million were provided, despite the presence of more than 6,000 people on the waiting list.

The Minister of State is genuine and her heart is in the right place. However, the Government has failed to provide healthcare. We are talking about older people who may be in hospital and cannot get home. That is devastating for those people. They do not want to be in nursing homes. Some people do want to be in homes and love it there. However, there are others, such as my mother, who want to be at home. When people go into hospital, the care package moves off and it is sometimes a struggle to get the workers back in to cater for the person who wants to, and can, live at home. We want to get them back home. We need to do our best. The money needs to be provided. The employment opportunities need to be provided.

Over the summer, I was inundated with contacts from people who are looking to work in home care and nursing in this country. The situation has improved but some of the barriers we hit while trying to deal with the Department were incredible. There are very simple things that could be done. For example, somebody could look at the documentation coming in at the very beginning and could run through a checklist to see if all the necessary documentation has been provided. In many cases, people are delayed because one piece of documentation is missing from their applications. They are left waiting for weeks and weeks before they know that. It could be months before they are told they need to reapply because a certain piece of documentation is required. That is something simple that could be done. When the documentation comes in from people who are coming in and want to work - and we are looking for such people to come here - we could have a checklist at the beginning to tell those applicants that a piece of documentation is missing. We can tell them to go off and get the relevant documentation and come back to us. That will stop an awful lot of the delays for people who are trying to come into the country. I will come back to the Minister of State on that point. I will email her.

Deputy Pauline Tully

The Government seems to have thrown in the towel on the commitment it gave in the programme for Government to implement a statutory home support scheme over its term in government. It appears very unlikely at this stage. The failure to do that is pushing older and disabled people into hospitals and nursing homes, or into early admission to long-term residential care, when they should be cared for in their own homes. This was highlighted by the ombudsman in the report, Wasted Lives, which stated that the implementation of this scheme is necessary "to address the current bias in favour of [placing people in] institutional settings". As of June, over 6,000 people were on waiting lists for home care, half of whom were looking for new care and 2,900 of whom were looking for additional hours. Hundreds of people experienced delayed transfer from acute settings as a result either of home care packages not being approved or of home care packages being approved but awaiting carer availability. There are no carers available to them because the Government has failed to plan for a sufficient workforce or to address long-term pay and condition issues. That has harmed recruitment and retention. Family carers are being left to carry the burden on their own. I am constantly contacted by families who do not have sufficient carers. Sometimes weekends are not covered. People who need to be changed cannot be changed for the whole weekend. Perhaps their treatment requires two people to come in and operate a hoist. It is not fair on people and families and needs to be addressed. It is inevitable that this crisis will only get worse as the HSE has included home care staff in the recruitment freeze.

I previously raised with the Minister of State the issue of boarding out providers and the regulations around boarding out as an alternative to nursing home care. It is a much cheaper alternative that allows people to stay in the community. The relevant statutory instrument needs to be updated because the scheme has not been updated in many years. People are leaving the sector because they cannot afford to remain in it any more.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

Deputy Ó Murchú has only 27 seconds for his contribution.

Deputy Ruairí Ó Murchú

I want to deal with particular issues in north Louth. People are going without home care in the harder-to-reach areas of north County Louth. We need to deal with the issues of pay and expenses. We cannot look at home care in isolation. It is part of the overall situation in respect of acute care. The hospital system does not work because home care packages take too long to put in place. We need to ensure we have more stepdown facilities, particularly in County Louth, because the RCSI hospital group is under severe pressure.

It provides the supports when it can but we really need to look at this.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

Your time is up, Deputy. Your colleagues took your time. Deputy Shortall is next.

Deputy Róisín Shortall

I thank the Labour Party for tabling this motion. It is a very topical motion on what is a very pressing issue to which the Government needs to give urgent attention. The Social Democrats are very happy to support the motion.

For over five years, a statutory right to home care has been promised and yet it still has not been delivered. We are told that work is ongoing but we still have no idea when the legislation will be published. It is becoming clear that there is no real sense of urgency about getting this over the line. In fact, it seems to be getting pushed further and further down this Government's agenda. I regularly request updates on the statutory scheme but all I ever seem to get are stock responses about progressing regulation. There is no question but that a regulatory framework is desperately needed. However, that is only one part of the broader reform programme.

Reading between the lines, one cannot help thinking that there is not much appetite for legislating for a statutory scheme, or at least not this side of the general election, it would appear. Publicly, this Government may espouse the importance of home care but the waiting lists tell a very different story. As of last June, almost 6,200 people were on a home care waiting list, an increase of 1,500 since May 2022. Clearly action is needed to reverse these spiralling waiting lists but, instead, home-care hours are being cut by almost 2 million this year to 22 million hours and there will be no increase next year, we are told. We know that home-care hours were reduced in order to deliver a so-called living wage for workers. However, it must be said that this Government is using the term "living wage" somewhat loosely. A €13.10 per hour rate is not a living wage; it is €1.70 below it and the Minister knows that. Furthermore, there is no commitment to maintaining parity with the recommended living wage going forward. There is no question that home-care workers deserve a pay increase and much better terms and conditions but that should not have come at a cost to patient care. The funding should have been provided to deliver on both commitments - to a real living wage and to the full 23.9 million home-care hours already contained in the national service plan for this year - but this Government is so short of ambition that it could not honour either one.

In terms of the other strategic workforce advisory group recommendations, progress has been painfully slow. A response to a parliamentary question in September indicates that of the 16 recommendations, only one had been implemented, four were at an advanced stage and the status of the remaining 11 was not provided. It is completely unacceptable that over a year since the report was published, we still do not have an implementation plan. What is the hold-up? The Minister of State, Deputy Butler, has talked about her commitment to this, and many people feel she has a personal commitment, but she is simply not delivering in terms of getting all of the ducks in a row and ensuring that adequate funding is provided and the political support is there.

The cross-departmental implementation group met again almost a month ago, yet there is still no sign of a plan. As we head into the winter months, this should be an absolute priority, not least given the HSE's latest plan to tackle delayed discharges. Transferring patients to nursing homes, possibly miles away from their homes, has been described as a dysfunctional response by Professor Des O'Neill, the chairperson of the Irish Society of Physicians in Geriatric Medicine. On Sunday, he said that the HSE directive amounted to the warehousing of older people, potentially in settings that cannot meet their needs. There is no denying that delayed discharges are a major issue in our hospitals. At any one time, around 600 patients are ready to leave their hospital bed but there is no step-down facility or home care available for them. This is a major concern for the system but, much more importantly, for patients. However, the answer is not to force older people into nursing homes or strip them of their own agency. We have known for years that this is a problem and that there are logjams and blockages in the system but the whole emphasis is on acute beds, without having dealt with the upstream issues that cause these blockages. The answer is alternative models of care like home care and temporary rehabilitation beds along with, of course, increased hospital capacity. After all, most older people would much prefer to remain in their own home and be cared for there but the State is continuing with its over-reliance on the nursing home sector instead of scaling up home care, despite all of the evidence to support this as the optimal model of care.

In terms of beds, the Government has repeatedly failed to deliver. Not one new bed was provided for in this year's HSE service plan. Every single one of the additional 184 acute beds and 26 critical care beds mentioned in the plan was actually an overdue bed. Each one has been committed to in previous winter and service plans. As of August, only four of those 184 overdue acute beds had been delivered, while not even one of the critical care beds had been provided. What is happening here? It seems that lip service is just being paid. When it comes to critical care beds, we know the huge problems that existed during the Covid period. We also know that we are at a point where beds were promised years ago but the promises that were made have still not been met. Clearly the issue of overcrowding and delayed discharges is one of poor planning and delivery. Pitting patients against each other will not change that and it is deeply unfair for the Government to engage in that.

Before concluding I would like to make some points about care. Historically, care has been undervalued and under-recognised by the State, be it paid or unpaid. When this Government finally holds a referendum on Article 41.2 at some point in the future, the replacement article must address this by enshrining the value of care work in the Constitution. In terms of social care, it is also imperative that the commission on care examines, in detail, the increasing privatisation of care and the impact this has on the quality of care provided. In 2020, the Taoiseach and the Minister for Health said very clearly, based on the experience of Covid in nursing homes, that we need a new model of care. We are still waiting for that new model of care to be announced by this Government. The arrangements at the moment do nobody any service.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

The next grouping is People Before Profit-Solidarity. Is Deputy Bríd Smith sharing her time?

Deputy Bríd Smith

No, nobody is getting any of it. It is all mine.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

That is fine.

Deputy Bríd Smith

I thank the Labour Party for tabling this motion, which highlights the problem with our two-tier health system and the specific impact on the provision of care for the elderly in regard to home-help hours. Indeed, the facts and stark statistics laid out in the motion illustrate that we are dealing with a scandal of historic proportions when it comes to the care of our elderly. That scandal is not just in home help but right across the system. We now have a system that has moved from 80% of care of the elderly being in public facilities and 20% in private facilities to the absolute opposite, namely, 80% in private care homes and only 20% in public care homes.

Last month was the month to raise awareness of older people's needs but our awareness does not seem to have been raised very high. We are currently facing a situation in the public system where Cherry Orchard Hospital is going to empty two wards and move 68 people out in the next two weeks. It is not acceptable and it will not be allowed to happen, as far as the workers and families are concerned.

I say that as a by-the-by. In 2012, the home care system was dismantled. I live in the Ballyfermot community and the home help system that existed there was very strong. Neighbours knew each other and looked after one another. They were able to visit each other frequently. It had its problems, in that people were not trained properly and it needed upgrading but it certainly did not need the massive privatisation that followed and which put a focus on time pressure, low pay and the profits of companies that moved in. People who suffer from dementia and need care often get four or five different people visiting them in one week. That still happens. We do not know who is monitoring all this privatised care.

There is a deep irony in the Labour Party tabling this motion and highlighting the issue, given that it was in government with Fine Gael, under the then Minister, James Reilly, when that system was dismantled and privatised in 2012. That said, the motion needs to say something further, namely, that we need a nationalised healthcare system, especially when it comes to the care of the elderly in society. That must cover both home care and nursing home care. The staff should be public servants with sick pay schemes, union representation and career paths. They should not be working for a provider that is privatised and puts them under time pressure, all for the profit they make. That is the least the workers and the elderly deserve and will be an absolute minimum demand of any left government in the future.

The proliferation of private care of the elderly was a conscious decision of successive Governments of Fianna Fáil and Fine Gael since the foundation of the State and in the past three decades, with the adoption of privatisation and a neoliberal model. Of course, they have been helped by others who joined them in coalition Governments. In recent decades, however, they have been encouraging the privatised firms to provide care for the elderly and general health on a for-profit basis. The justification for this is absolute rubbish. They say it is more efficient but it is not cheaper for the public purse and it does not provide better services or care for elderly people. I have heard the Minister of State, Deputy Butler, eulogise the spending on this aspect of health and the expansion of home care hours but the historic reality is one of underfunding, with a reliance on voluntary and religious provision of essential care. It is no accident that sections 38 and 39 workers have been forced to repeatedly demand pay parity and basic rights.

Under the OECD average, Irish health spending per person under the public component is lower than that in many other countries. It is 73% in Ireland, 86% in Norway, 84% in Sweden, 84% in Denmark and 82% in the Netherlands. In other words, the public part of what we spend is much lower than it is in other countries, including in the UK, where it is 79%. In 2019, the HSE spent 31% of its budget on outsourcing to outside agencies, including religious and for-profit organisations, home care providers and non-religious voluntary hospitals. Since the 1980s, the subsidised expansion of the private healthcare industry has created a powerful lobby of private hospitals, insurance companies, nursing homes, home care providers and their owners and they are determined to block reform. Uniting them all is a shared class interest in perpetuating private ownership and control of healthcare and the right to profit from it. In 2019, Julien Mercille produced a report titled The Growth of Private Home Care Providers in Europe: The Case of Ireland. He showed the effect of State policies in the area of home care provision and noted that the amount of money received by private providers increased from €3 million in 2006 to €176 million in 2019. Private providers had more than 80 members, employing a total of 14,000 carers. Industry sources estimated that approximately 75% of the revenue of private providers is obtained from public sources. How is that more efficient, cheaper, better for workers or better for the elderly?

The funding for private home care provision has shifted from the HSE to private operators in a big way. The top five home care providers received grants of €128 million and accumulated profits of €2.3 million. The parent companies of the top three providers received HSE grants and are based outside Ireland, in Switzerland, France and the United States. The previous owners of Bluebird, who now run Clemac Home Care Services, were paid nearly €1 million by the State in 2018. During the pandemic, a survey carried out by carers in Ireland found that 450 qualified public and private carers who responded to the survey said they were earning €12 per hour or less. I met many of them during the pandemic. They put themselves at great risk to continue to do their work of caring for the elderly at home. I, too, thank and praise them for doing that.

What we have is a private for-profit sector that absolutely needs a dysfunctional public system to survive and profit. This State has continually abdicated its responsibility for providing basic and fundamental services in healthcare for the people of this country under successive Fianna Fáil and Fine Gael Governments, which we have had since the foundation of the State. That, too, needs to change.

Deputy Seán Canney

I thank the Labour Party for bringing forward the motion. It is important that we look at this in the context of what is happening on the ground. People are being assessed for 14 hours of home care help but are getting five hours. An 85-year-old man rang me last Friday evening to say his home care worker was not available last weekend and there was no replacement. He was left on his own. He needs somebody there to feed him medicine a certain number of times per day but that is being left in God's hands at weekends. That probably sets out that something has fundamentally gone wrong.

The Department has done a report on recruitment and retention within home care services. I ask the Government to consider recommendation No. 8 of that report. I come across this a lot in my constituency of Galway East. The threshold of working 18 hours per week before one can qualify is not working. We need to bring it to 21.5 hours a week, as recommended in the report. Can the Government do that in the context of this budget in order to allow people to work and not to disenfranchise them in terms of their social welfare? In terms of the impact of working an extra 3.5 hours, there is tax coming in on that and it allows people to do the home care hours such that there is less reliance on the State putting people into long-term care. The second thing is we should reform jobseeker's allowance to move it from a days worked model to an hours worked model. That is also in the recommendation to which I referred. There is a need to explore the impact of working on income limits on employers and social welfare recipients through the Oireachtas Joint Committee on Social Protection, Community and Rural Development and the Islands. These are recommendations the Department has put forward. What is happening with those recommendations? Will they be sent into the ether in terms of committees, strategies, policies and whatever else or will we take direct action?

There are people working every day of the week and at the same time ensuring their loved one is being cared for at home. Sláintecare states that people should be kept out of long-term care for as long as possible. The way it is being done at the moment is driving people into long-term care. I know that is a concern for the Minister of State, Deputy Butler. She raised it previously in the context of vacant houses. This is an opportunity for her and the Government to take this by the scruff of the neck. There should be particular consideration given to people in rural areas. where there is isolation and a person may see nobody other than the postman during the day. It is time to look at this in a practical way. It is not scientific. It does not need any reports to be written up. It takes direct action to allow people to work 21.5 hours and still be able to act as carers without any impact on their social welfare benefits. That will help private providers, the HSE and home care hours. Let us keep it simple, support those who need help and do it now.

Deputy Peadar Tóibín

Last year, the HSE confirmed to me in response to a parliamentary question that 600 people were in hospitals across the State who had been clinically discharged. On any given day, 600 people who the doctors can do no more for are languishing in hospital, and the only reason that they are in hospital is because step-down care is not available to them. In many cases, that is due to a lack of home care for those people. It is horrendous for the patients themselves. Being stuck in hospital even when they cannot get treatment there is very difficult for patients. It is also very difficult for hospital capacity. It is one of the major contributors to the number of people who are on trolleys in this country. Oftentimes, the number of people who are clinically discharged but cannot be released is actually the same as the number of people on trolleys in the country, which is quite amazing. We also have the issue where a large number of people are being put in nursing homes at a time when they could be living at home. Obviously, nursing homes do fantastic and wonderful work and they are key and pivotal in the lives of so many people, but often older people do far better when they are actually at home in their own location and in environs they know well etc.

There is a major problem in this country in terms of the lack of home care, and there is nearly a fool's economics to it. While home care can be seen as expensive by the State, in actual fact the lack of home care is far more expensive to the State both in human terms and in financial terms. It is really important to say that. While the Minister of State is here, I should say that the Covid crisis underlined even further the wonderful benefits of home care vis-à-vis older people being put in nursing homes. I also want to mention briefly that we know that nursing homes are still in crisis. In fairness to her, the Minister of State has been active in trying to bridge the gap that exists but a lot of the nursing homes that are negotiating with the HSE through the National Treatment Purchase Fund still have not got the income they need to be able to cover the inflation costs and their wage costs. It is the case that more and more nursing homes are looking to close over the next while, and are looking to move patients out. We need to find a way of making sure that those clients have alternative locations or alternative home care packages.

I pay considerable respect to all the people who are involved in home care across the country, whether they work in the public or private sector. They do massive work and it is one of the most important jobs. These are the most valuable people to us and the fact that these individuals and carers are looking after these people is very important to us. However, a couple of problems that have been raised with me recently. I understand that State home care services are now refusing to bring clients for walks. Movement is medicine for older people. For physical and mental health purposes, walking is a really important part of their daily life. If an older person under the care of a public sector provider wants to go for a walk, the public sector home care provider will not bring them for a walk. They will actually let the older person go out by themselves, unaccompanied into the town or village where they live, which is an incredible situation. Often, the carer will just go home if the older person is gone. Also, in some of those packages what is happening is that the carer rings the office rather than the family if there is a difficulty at home. Where the family live in the environs and could get there to it very fast to resolve whatever the problem is, they are not being told about it perhaps until a day later because of bureaucracy involved. The job of the carer is to prompt the client to take food or medicine, but not necessarily to really make sure that the client takes their medicine or food. I know that HIQA is reviewing this. All I ask is that there is some level of public consultation to the HIQA review of the regulations in order that families can feed into what regulations are put in place in future.

Deputy Michael Collins

In my view, elder care is at a very low ebb. As such, I commend Labour on putting forward this motion, which is an important one. It is impossible to get home help for many of my own constituents. People who are trying to get out of hospital cannot get out of hospital. It is a sad situation that they find themselves in, having to stay in hospital before a home care package can be put in place. It leaves them in hospital even though they are able-bodied enough medically to be able to leave, but need help at home that is not available to them. We see situations where they cannot get nursing home beds and community hospital beds. It is impossible for families to get long-term beds for their loved ones.

We have to look at the carer's allowance. The carer's allowance is not a living wage. If it was increased to at least €350 a week, it would enable more families to stay at home and provide full-time for elderly people. I also have a big issue with the fact that the carer's allowance is means-tested. It means that if a husband, as in most cases, has a good income, the wife or partner at home is not able to pick up a carer's allowance even though she is carrying out the duties of a hospital, and saving the State a fortune. Organisations like CoAction in west Cork are unable to provide long-term residential place for their adult service users. Respite for these adults is also difficult to come by. There are so many areas of concern. I spoke to the Minister of State in an angry enough tone in relation to the nursing home in Belgooly. It was closed down last week following the publication of the HIQA report. There has to be a system in place so that if a nursing home or a community hospital for that matter - it is mostly nursing homes we are looking at - does not come up to compliance, the HSE can step in, run that hospital, bring it up to compliance and not shut the door. The Minister of State has no idea what will happened to these people in Belgooly and its surrounds, and they way they were treated. The nursing home was shut in a quick manner and they were told to get the patients out, even though they were told they had six months initially. My time is up.

Deputy Danny Healy-Rae

First, I thank Labour for putting forward this very important motion today. Since I came up here, one of the things I have been consistently raising is the fact that we need more home helps and people need to be helped to stay in their homes as long as possible. They treat going into nursing homes as being the departure lounge and they feel they still have a chance if they stay at home. I thank our home helps for the wonderful work that they do. Some of them feel they are not being paid properly and that they are not being paid for overtime.

The fair deal scheme is another area that I have a serious problem with at present. Elderly people who go into the hospital, maybe 13 or 12 times, and are sent back home in a taxi when they are clearly not fit for it. They want to go into nursing homes. I know at least half a dozen of them at the present time. The HSE will not sign off to give them the green light to go forward for the fair deal scheme. I am asking the Minister of State today whether there is enough funding for the fair deal scheme for the rest of the year. It seems to me that there is not.

Deputy Mary Butler

There is.

Deputy Danny Healy-Rae

Doctors used to refer patients to the district hospital if they had a serious cold or whatever. The only way that they can get into the district or community hospital now is through University Hospital Kerry. I think that area needs to be visited because when people want a bit of help, they have to go through this rigmarole of having to go into the general hospital first.

Deputy Richard O'Donoghue

First, I thank Labour for the motion being brought before us today. I am so thankful for home help. My father managed to live to the ripe old age of 98, and would have been 99 if he had lived to his next birthday. He would not have done that only for the care of the home help. I am from a large family, and we were lucky enough that between our own family and the home help, that was the age he lived to in the comfort of his own home. I am so thankful for that. I look at the home help today and the struggles they have in going to help the vulnerable, with the inflation costs involved with travelling to provide home help. They are not getting the right supports and funding. What it boils down to is that the carers are our family. They are our extended family members that go out and do the work to help us so that we can have an equal type of life. They help to make us better people for what we do and raise our families within our own homes. The Government has not done enough to help them.

The Government has not done enough to fund them properly so they can help. If it was a business case, I have been in business all of my life, what they provide at home is only a fraction of what it would cost the State if people had to go to different settings. The Government does not seem to recognise that by putting in a little more funding, the better quality of life that people could have and the better care they could have. People would even look at helping people in their own homes as a career, if the Government funded it properly. That is all we ask, namely, that the carers are funded properly.

Deputy Mattie McGrath

I compliment the Independent Group on putting down this very timely and important motion.

Deputy Danny Healy-Rae

It was the Labour Party.

Deputy Mattie McGrath

The Labour Party, excuse me. Gabh mo leithscéal. It could not be more timely, facing into the winter with the long nights, the loneliness and the isolation, especially for people with disabilities. When I see what goes on in the HSE, I saw a headline this morning that it has hired 800 managers and administration people this year already despite the ban. That is where the problem is. We cannot hire home helps. In recent times, during the past eight months, one could get a home help approved with no bother but there is no one there to do it. It is simpler just to let it off as having been approved and it is then not our problem. We are fundamentally wrong. We have too many managers and too many administrators. It is the same in the hospitals, there are not enough nurses, front-line people or domestic staff. We do not have them. The HSE has cannibalised itself on the Government's watch because the Government has been in place for a couple of years now, as have senior Ministers and several Ministers. I am not saying that this has been the start of it.

We need to, first of all, get down and emphasise, as Deputy O'Donoghue said, the work they do and the value they give to people. When people can stay in their own homes, they are happier and more comfortable and feel more secure. In most cases, they have no issues with any kind of language problems and they receive visits from neighbours and families. We need to make a seismic shift here and to have a policy that is more understanding because of the cost to the hospitals and of having to go through to Tipperary University Hospital or University Hospital Kerry, as Deputy Danny Healy-Rae said. At one time, doctors could do this through the managers in the hospital if a person needed respite or whatever, and they were not clogging up the system inside because big is not wonderful. We thought it was, with centres of excellence, but look at University Hospital Limerick and that will be dispelled straight away. We are putting too many people into those settings. Look after them at home, keep the home fires burning. I salute the home help people and carers from the bottom of my heart because for the pittance they get, they do tremendous work and bring solace and support to the elderly and vulnerable and to people with disabilities.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

The next grouping is the Independent Group, which will have eight minutes. Deputy Harkin and Deputy Pringle will have four minutes each.

Deputy Thomas Pringle

Deputy Michael McNamara will speak as well, so the three of us will have three minutes each.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

The Independent Group has eight minutes in total and they can share it whatever way they want.

Deputy Thomas Pringle

I thank the Labour Party for bringing this important motion forward. I support this motion and in particular, its calls for the immediate reversal of the recruitment embargo on health workers for a guarantee that home carers are paid, at a minimum, the new living wage rate of €14.80, for payment for mileage expenses and travel time between care locations; as well as for guaranteed hours and continuity of income for healthcare support assistants. The reality is that being a healthcare support assistant in this country does not pay. Sadly, it is a profession that is not worth pursuing due to the lack of contracted hours, the inadequate pay, and the expectation to continuously engage in unpaid work and travel. Why would people leave a job or give up a social welfare payment for two hours of contracted work per week? This is the situation faced by many home care workers today. Not only that but they are expected to travel between homes without getting paid for travel time due to the fact that the HSE-funded home care packages, which are subcontracted out to private companies, do not include travel time pay. People in rural parts of the country are often in isolated areas with little access to facilities or assistance and are left most vulnerable when home care workers are not available. There is no doubt that, as the motion states, there is a postcode lottery when it comes to home care waiting lists and there is evidence that those in rural areas wait longer due to a lack of mileage and travel costs for carers.

I believe we should provide full-time or 50% contracts to ensure predictable income for home care workers and to ensure it is an attractive job opportunity in the first place. I do not see why there should be a problem in providing such contracts. The demand for home care workers is there and there should be a situation where if there are not enough hours to fill a contract, workers could then be given hours in a local community hospital as well. This is the type of integration that needs to happen for our health system to function. We can no longer rely on private contracts and the underpayment of healthcare workers. Sadly, we know that if private companies were able to profit from this, the system would already be in place in this country.

We know Ireland has a rapidly ageing population and pressures on the healthcare system will only increase. We are already at breaking point. We need to make Ireland and our healthcare system not only an attractive place to work but a viable place to work because as it stands right now, it is not, and young people know this. The brain drain of healthcare workers going to Australia is devastating to witness but also understandable. We need to ensure our home care workers are enabled to do more and that they are given the opportunity to have a predictable income and a decent life. They should at the very least be paid the living wage, as well as travel time and mileage. Home care workers do vital work in our communities every single day and they have to be valued and respected for that.

Deputy Marian Harkin

First, I thank the Labour Party for a most comprehensive and clearly thought out motion on the need to radically improve our home support service in order that those who avail of the service and those who provide the service can work together to ensure a much more sustainable and accessible service for all of those in our communities who need care. I am disappointed that the Minister for Health, Deputy Stephen Donnelly, and the Government could not see their way to supporting this motion or at least to not opposing it. I personally cannot find any proposal in this motion that is not needed urgently to support the home support service.

A cause of immediate concern is the need to reverse the recruitment embargo on health workers and the need for a commitment not to block the hiring of public service HCSAs. There seems to be some ambiguity as to the impact of this embargo but the Minister of State, Deputy Butler, assured us previously that there would be no cuts to the duration of home support hours and that is absolutely crucial because the time allocated for home support hours is already cut to the bone. There is absolutely nothing extra there to be cut back because what we often find is that there is 30 minutes to help people to get up, get dressed and get their breakfast. It is virtually impossible to manage, both for the person who needs the care and for the person who is giving the care. People need to be treated with respect and with dignity and very often it is a case of constant rushing, out of bed, into the bathroom etc. That is the reality of home care provision and what we need to see is an expansion of these services and not in any circumstances a diminution of these crucial supports. I, like others, fully support the call that home carers be paid at a minimum a living wage rate of €14.80 per hour with reasonable payment for mileage expenses and travel time between the care locations. As I said earlier, many home care support workers are jumping out of their cars, often in the rain, into somebody's house, trying to manage an hour's care work in a bare 30 minutes and running in and out again to another house and just moving on all of the time trying to support care work together with a little bit of human contact and that is just crucial for so many people. That kind of work is demanding and time consuming and it is hugely valuable work. It allows people to remain in their homes, to live independently, and crucially it supports family carers who literally keep the show on the road.

Finally, in that context I would like to mention that the carer of the year ceremony is taking place today in Sligo where the Sligo carer of the year will be acknowledged for the incredible and invaluable work they do. What we find is that home care support services and family carers together are both the foundation and the structure that allows people to live at home, in dignity, and in their own place.

Deputy Michael McNamara

I thank Deputy Kelly and the Labour Party for this very timely motion which I have no hesitation whatsoever in supporting. There has been a lot of focus of late on the necessity of moving elderly people out of acute hospitals, it is a pity there is not the same focus on keeping elderly people out of acute hospitals. The last tie we had such a focus on moving elderly people out of acute hospitals was when we were trying to push them out, notwithstanding the fact they were bringing Covid-19 into nursing homes with them. I really think the HSE and the Department should carry out an inquiry into that, because there are a lot of deaths that need to be accounted for, and second, focus on that a little but and on keeping elderly people out of nursing homes and ensure they have a place to go which is not a nursing home and which is their home.

I do not doubt the Minister of State's personal commitment to this. We sat in a studio in RTÉ. Does the Minister of State remember that place? I have no doubt about her personal commitment, but I doubt she is making any advances on those commitments because it is backwards we are going. It is backwards the Government, which the Minister of State is a junior Minister in, is going with regard to home help.

I do not understand how she could disagree with these measures that the Labour Party has called for. I would add, of course, the necessity to look at social welfare and to ensure that is not a disincentive and there is not a cliff edge with regard to benefits for people who want to work in home care.

Lastly, I notice that heads of Bill are being drafted and regulations will be drafted.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

The Deputy's time is up.

Deputy Michael McNamara

It is entirely understandable that the parliamentary draftsman might want some time to recover from the previous Attorney General but all good things must come to an end.

An Cathaoirleach Gníomhach (Deputy Michael Ring)

Deputy McNamara is taking from the next speaker's time. I call Deputy Wynne.

Deputy Michael McNamara

What is the delay and when will we see this legislation?

Deputy Violet-Anne Wynne

I commend the Labour Party on bringing forward this terrific motion and I am happy to support it. The Minister of State, Deputy Butler, has committed to delivering 22 million hours of home care support next year and that she has lauded that this will be the most ever delivered. The question is: will it be delivered? Will the fundamental issues around payment, social welfare payments as well, and also the treatment of these home care staff, be delivered. I meet with older people and their families throughout County Clare on a constant basis who tell me that, after fighting for approval, they still have not been able to get the hours that they have been approved for and there is no sign of getting them either.

The Minister of State is promising 22 million hours in the next year. She may as well have promised 1 billion hours because more than 3,000 newly approved applicants are waiting across the country.

The HSE only employs a quarter of the home support workers in the country and that overreliance on the private sector means the vast majority of home care support workers in the country are on less favourable terms. According to the Clare Public Participation Network anti-poverty report last year, only 4.4% of home care hours in Clare are delivered directly by the HSE. That compares with 49.6% in Limerick and 56% in north Tipperary-east Limerick. There is a huge disparity there and that needs to be addressed.

The Minister of State, Deputy Butler, mentioned difficulties in providing weekend hours in rural areas. That is because she gave HSE staff Monday to Friday contracts and the shortfall must be made up by the private sector, and that issue could have been forecasted.

Finally, on the point of delivery, I raised with her previously my constituent, Martin, who was stuck in a nursing home because his hours were redistributed when he went to hospital for a procedure. I am delighted to confirm that he is back home now for the past five weeks, but it took, in total, 12 months.

It is essential that the referendum on care happens before the Government runs out of road.

In Ireland, in 2023, I despair for people who have worked hard all of their lives, who now need support and who are now afraid to go into a hospital for a procedure, such as a hip or knee replacement, because they are afraid that they will lose their home care support.

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I welcome the opportunity to address the House on the issues raised by Deputies tabling the motion. I would like to begin by echoing my colleague, the Minister of State, Deputy Butler, in her opening remarks and to thank the Deputies for their constructive and positive contributions to this important motion on the issue of home support.

I want to acknowledge the input of all Deputies this morning. It is clear to me and the Minister of State, Deputy Butler, that we are all motivated to ensure that our population have access to safe, high-quality and regulated home support services in a timely manner.

Initially, I will speak about what the Government is doing to address some of the immediate challenges we face in home support. Then I will speak more generally about the extensive reforms occurring in social care.

However, before I do so, I would like to take the opportunity to acknowledge the outstanding efforts of front-line carers and all those who work right across our health and social services. They have stepped up and demonstrated their commitment to meeting the needs of service users in our communities throughout the country. They provide millions of hours of care to service users every year. In recent years especially, they have demonstrated incredible commitment and perseverance. As a result of their work, some of the most vulnerable members of our society have received compassionate and expert care in the comfort of their homes. I wish to acknowledge this and thank the carers for their effort and expert care.

Home support is a priority for the Government. Our population is growing and it is also ageing. This means that the demand for home support services is projected to increase substantially. Older people want to age well at home and it is important that the supports that they need are in place, including home support, day service, meals on wheels. I am pleased that funding has kept up with this demand. The Government has delivered unprecedented levels of investment in our home support service in recent years.

As referenced earlier by the Minister of State, Deputy Butler, we had provided an additional €228 million for home support since 2021. This is a 46% increase. This brings the overall budget to €723 million. There should be no doubt that investment in social care and home support has been a substantial priority for the Government but we know it is not only about investment and that meaningful reform is vital. This increased funding is going towards increased supply of home support hours as well as the wider reform of service, including delivery of a statutory scheme for home support services.

We are delivering more hours of home support than ever before. As of April 2023, preliminary data indicate that there are more than 54,000 people receiving home support. More than 50 million hours have been provided in the year to date. This represents an increase of 600,000 hours compared to the same period in 2022.

We have witnessed a significant increase in the number of home support hours being delivered over the past number of years. Last year, 75,000 people benefited from home support services. The service is highly valued by service users and their families because it enables older people to live independently with dignity in their own homes for longer, which is what we all want.

As detailed by the Minister of State, Deputy Butler, work is ongoing to address the waiting list and the HSE is endeavouring to prioritise service for clients with the highest care needs. Currently, the waiting list is predominantly made up of people who have been approved for support but are waiting for a carer to be assigned. To be clear, this is not a funding issue; it is a workforce one.

I will briefly talk about the disability sector. As Deputies will be aware, responsibility for specialist disability service now falls under the remit of the Department of Children, Equality, Disability, Integration and Youth. It is envisaged that the new disability service home support procurement framework will closely align to the older persons service home support procurement framework for consistency across the commissioning agencies and for greater clarity for service providers. The HSE is currently progressing the development of a new disability service procurement framework with the expectation of finalising the framework in quarter 1 2024. Any amendment to the disability service home support rates will be considered in the context of the procurement exercise and officials of my Department are liaising with colleagues in the Department of Health to learn from the authorisation scheme of home support services.

On the reform of home care, the programme for Government commits the Government to introduce a statutory scheme to support people to live in their own homes that will provide equitable access to high-quality regulated home care. The Department of Health is currently developing a regulatory framework for home support providers with the aim of ensuring all service users are provided with high-quality care. This will comprise of primary legislation for the licensing of home support providers, regulations that will set out the minimum requirements that a provider must meet to obtain a licence, and HIQA national standards. The heads of the Bill are currently being drafted by the Department with a view to bringing it before the Houses of the Oireachtas in quarter 4 2023. Regulations are at an advanced stage. Throughout the development of these regulations, the Department has sought the full participation of home care providers, trade unions, NGOs, international colleagues, academics, health and social care professionals, families and, most importantly, service users. The draft regulations have been informed by a public consultation. Legal advice and engagement with key stakeholders will assist with final revision to regulations for providers of home support services.

In parallel to the work of the statutory scheme, a modern needs assessment tool, the interRAI, will be introduced nationwide to determine the appropriate levels of care required. This will facilitate efficient, fair and transparent care needs assessment and planning and appropriate service delivery. Related to this development of a new information technology, IT, system for home support, the process for the development of a home support IT system is under way in the HSE. This significant project is vital to deliver reform in the sector. The business case has been submitted to the digital government oversight unit and was approved by peer-review group. The HSE has established a procurement evaluation group to progress procurement and implementation of the system and it is a fundamental enabler for all other reforms we will deliver.

I am pleased that the proposed referendum is mentioned in the motion. On 8 March 2023, the Government announced its intention to hold a referendum on gender equality as recommended by the citizens' assembly and the Oireachtas Joint Committee on Gender Equality. An interdepartmental working group chaired by my Department was subsequently established to further examine in advance the recommendations. The work of the working group is ongoing. It is important to note that while the interdepartmental group supports the development of proposals, any decision on policy and any wording is for the Government.

It is important to reiterate what the Minister of State, Deputy Butler, said in her opening remarks, namely, that the new tender rate was backdated to July as a gesture of goodwill. The new tender provides for a core rate of €31 per hour for providers, which works out an at average rate of €34 per hour taking into account weekends and evening premiums. The HSE tender for home support providers also commits private and voluntary providers to pay the national living wage of €13.10 per hour, which was set in August, travel time between appointments and reform of legacy rates. The new HSE home support tender has a built-in review process, which will happen every August. Travel time has been included in this at €2.99 per hour. We are paying private providers an average rate of €34 per hour. The issue is how they pass it on.

Deputy Alan Kelly

What about an employment regulation order?

Deputy Anne Rabbitte

I acknowledge it is an issue but at the end of the day, that is the rate set out in the tender document that was recently reviewed and agreed. Regarding the Deputy hauling me over the coals on disability, I have not yet reached that rate whereas at least in the case of older people, the tender document has been produced and agreed at €34 per hour. Unfortunately, it is not being passed on.

Deputy Aodhán Ó Ríordáin

I thank Deputy Duncan Smith for tabling the motion, which has been lauded across the House as timely. It has even been termed "fantastic". It is a very important motion. As the Minister of State will be aware, the Labour Party only gets this time to raise an issue every six weeks so we always pick something that is close to our hearts. In this respect, it is doubly disappointing that the senior Minister is not here to listen to the debate and that the Government has decided not to accept the motion or effectively put it to a vote because there have been any number of motions or recent legislation that Government has seen fit to allow pass through. However, the Government has tabled an amendment to our motion, which we find very disappointing because this motion has been put forward in good faith.

Dealing with elderly parents and finding support for them constitute the biggest heartbreak in any family. It is something most families go through. The fact that 6,000 families have to sit on the waiting list is a disgrace. Regarding the presentation of health figures in the budget, we considered that we went through a fraudulent process. The Minister for Health stood over figures he could not stand over a number of days later and the CEO of the HSE told us he could not work within the figures provided. The Minister of State said she was disappointed by the provision for mental health services. We now have a scenario where we cannot provide effectively for citizens at the end of their lives.

What is most disappointing is the narrative from the Government at budget time, particularly from Fine Gael, is about tax cuts. Four junior Ministers clubbed together to write an op-ed for the Irish Independent and did not talk about care, justice, the provision of the State for those who need it most and end-of-life care. They wrote about selfishness. They wrote an article for the Irish Independent that really tried to touch the nerve of the selfish instinct within Irish people. What we are trying to do here is the opposite. We are trying to ask collectively what we can do for those at the end of their lives. Home care is it and we are failing spectacularly. What the Government is effectively doing is overseeing the privatisation of a service. This country needs much better than that for those at the end of their lives who need this human contact and care.

We are also dealing with people who generally cannot stand up for themselves. They are at a stage in their lives when they do not feel they have access to that sort of platform to speak to their experiences and sometimes the Department depends on that. I am glad that today at least we have given voice to these figures and I again express my disappointment that the Government has not seen fit to support this motion or to allow it to go forward without opposition.

Deputy Alan Kelly

This motion is very important. I thank Deputy Duncan Smith and my other Labour Party colleagues for bringing it forward. I am speaking about this because I have elderly parents and my elderly uncle passed away recently. This is very personal to me and is related to my work because I deal with it all the time. I will make three points to the Ministers of State that all fall into one another.

Demographics in Ireland are changing substantially. We will have far more people over the age of 65 in the coming years. This number is growing exponentially. I can stand here and say that I do not believe there is a hope in hell of the statutory home care scheme that was promised in the programme for Government being implemented by this Government. We are approximately a year away from a general election. This is a failure. It would have been a great legacy for the Government and I would encourage it to do it but I do not think it will happen.

The second issue involves the recruitment and retention of staff. This is the most important issue Deputy Nash spoke about. The reason 500 people are waiting to be discharged from hospital is people will not work in this sector because they are not being paid properly. We need a JLC and an ERO that sets the rate of pay, travel expenses, travel time and the minimum number of hours per hour. Then there will be people will work in this sector because it will suit them. Dare I say it, many women want to do it but also many men want to do it and we need more men given people's requirements.

When the HSE is paying €16 per hour, €13.10 is the floor in the private sector and people do not get the same allowances, is it any wonder all these workers want to end up working for the HSE? This is where the recruitment ban is a disgrace. What is wrong with these workers wanting to end up working for the HSE? The bit people fail to see here is that not alone is this the best for our elderly people, it is the best for our pocket. This is like an accordion. The longer people can be kept at home, the longer they can be kept out of nursing homes and the longer they can be kept from going from nursing homes into acute care. Every step up is far more expensive for the Irish taxpayer but also the best solution is for people to stay at home for as long as possible. This is what we should be facilitating. Unfortunately, unless we deal with pay, working conditions and payments for allowances, we will never be able to deal with this.

The Minister of State will be a failure in this position if she cannot deal with this. This is the most important issue she must deal with. If she cannot honour what is in the programme for Government, for the love of God she should at least deal with the JLC and ensure people are paid enough because if they are paid enough, what happens? They will work. We will have people who will work in this sector.

It is the most important thing to unlock this situation where so many people are looking for hours. I know of a couple who have been allocated 24 hours but are getting eight. I know of another person aged 95 who is entitled to more than 20 hours but is only getting six. The HSE will beg, borrow and steal for them but it cannot get people. What is not said in this Chamber is that many people are paying privately because it is the only way they will get some help for their loved ones.

An issue that has not been brought up is the reason so many people are stuck in limbo, costing the taxpayer so much and taking up acute beds. The discharge policy about which Bernard Gloster spoke earlier this week is concerning to a degree but I can understand it to a degree.

What is going on in this country is a disgrace. I will provide some figures that have never been stated previously. Between 2012 and 2021, in 15 of our 24 acute hospitals, 786 people spent more than a year in an acute setting. In some cases, the stay was multiples of that. I do not have the figures for the other nine hospitals because they came to less than five each but we are probably approaching 1,000 people spending more than a year in hospital because there was no step-down facility, nursing home or facility in the community to deal with them. Is that not an indictment of where we are going? With the country's demographic profile, that number will only multiply. It is shambolic and disgraceful. These people were stuck in an acute setting. In St. James's Hospital, there were 105 such cases. There were 134 in St. Vincent's, 74 in the Mater, 93 in Beaumont, only ten in Waterford and 44 in Galway. These figures relate to people who were in an acute setting for more than a year because they could not get out. Is it not an indictment of our country that people are left to rot in acute settings because they cannot get out? I have to reveal those figures to the House. I am sure the Minister of State is aware of these data. If she is not, it is even more worrying. This taking away of people's consent and this warehousing of people has to stop. It is not humane and it is completely wrong.

This is one of the most important motions we will bring forward in this Dáil. We need a joint labour committee and we need to improve the pay of workers. We need the statutory scheme the Minister of State and her Government have promised. Finally, we need a process whereby people are treated with dignity and not locked into acute settings for years on years on years.

Amendment put.

Deputy Aodhán Ó Ríordáin

Vótáil.

An Ceann Comhairle

A division has been demanded and is deferred until the voting time later this evening.

Dáil Éireann debate - Wednesday, 8 Nov 2023

Home Care Workers and Home Support Scheme: Motion [Private Members]

Dáil Éireann debate -
Wednesday, 8 Nov 2023