Dáil Éireann debate -
Tuesday, 8 Nov 2022

Vol. 1028 No. 6

Home Care: Motion (Resumed) [Private Members]

Debate resumed on the following motion:

That Dáil Éireann:

notes that:

— the nature and level of care delivered in the home must change to facilitate people staying at home for longer, to reduce periods of stay away from home either at hospital or at other care facilities, and to implement the Right Care, Right Place, Right Time policies;

— the average person in receipt of home care receives approximately eight hours of care a week, and this is likely to grow significantly as higher levels and greater volume of care is delivered in the home;

— to deliver higher complexity care in the home, the home support system must be modernised, and an increase of care delivered in the home will have consequences for the level and complexity of care delivered in nursing homes and other long-term residential care settings;

— as per the report in the Irish Times on the 1st November, 2022, more than 7,800 people have experienced unnecessary and costly delayed discharges from hospital so far this year due to a failure to plan and align community services with hospital need, such as step-down beds and home care packages, including more than 1,000 delayed discharges directly linked to home care shortages, which is directly contributing to the trolley crisis;

— the Health Service Capacity Review 2018 - Review of Health Demand and Capacity Requirements in Ireland to 2031, which was conducted based on lower population growth estimates than transpired, forecasted a minimum of 120 per cent increase in demand for home support from 2016 to 2031, but such demand at that level has already been reached and is expected to increase further;

— 62 per cent of home care is delivered by non-Health Service Executive (HSE) providers, with only 38 per cent of home support services delivered directly by the HSE, amounting to over €400 million in 2021 being paid to non-HSE providers of home care;

— the Minister of State with Reasonability for Mental Health and Older People, committed to the establishment of the full complement of 30 Integrated Care Programme for Older Persons (ICPOP) teams by Q3 2022;

— 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" and to "establish a commission to examine care" and the Government's commitment to establish a national home support office; and

— the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on the 15th October, 2022, made 16 recommendations across recruitment, pay and conditions, barriers to employment, training and professional development, and sectoral reform;

condemns:

— the failure of the previous Fine Gael-led Government and then Minister for Health, Simon Harris TD, and his predecessors, to plan for, train, recruit, and retain enough nurses, healthcare assistants, and home carers to sustainably expand home care services, which directly led to the crisis in home care that is being experienced at present;

— the failure of the Minister for Health, Stephen Donnelly TD, to significantly advance proposed legislation such as the Health (Amendment) (Licensing of Professional Home Support Providers) Bill and the Health (Amendment) Bill relating to enhanced governance of nursing homes;

— the failure to deliver 1,000,000 home support hours in 2021 which were owed and budgeted for, as indicated in the HSE's National Service Plan 2022; and

— the overreliance of successive Governments on private home care providers, instead of investing in home care as a public health and social care service and career; and

calls on the Government to:

— expedite the proposed Health (Amendment) (Licensing of Professional Home Support Providers) Bill and new regulations for providers of home support services to construct a modern regulatory framework for home care;

— establish a commission on care and bring together social care sectors and stakeholders to modernise the home care sector and better align care, including family carers, care in the home, nursing home and residential care, and palliative care;

— fully commission the 30 ICPOP teams and transparently publish their staffing complements, with a view to fully staffing all teams;

— integrate adult safeguarding legislation into new regulations for the home care sector with the Health and Quality Information Authority as the regulator;

— establish regional home support offices to be embedded within regional health areas to ensure compatibility with forthcoming organisational reforms;

— develop a career pathway for carers and carers with an advanced skillset, and a greater role for nurses, physiotherapists, and allied health and social care professionals, including at advanced practice grades, in delivering high-quality home care;

— ensure more regular and holistic reviews of the health and care needs of persons receiving home care and home support to ensure they are in receipt of the type, quality, and intensity of care that they need;

— increase funding for home support services generally, with targeted increases in funding for healthy age-friendly homes, housing adaptation grants, personal assistance and assisted living services, and intensive home care packages to enable people to live at home for longer;

— introduce additional access routes to working in home care for people who are interested in additional but less than full-time employment in the sector, particularly in rural and underserved areas;

— invest in home care to ensure it is a viable alternative to nursing homes and residential care, where the choice is appropriate;

— establish a high-level workforce planning group to deliver accountability and joined-up, cross-Government planning for training, recruitment, and retention of health and social care professionals across the entire health sector, including home care; and

— modernise the tendering and funding model for providers of home care to prevent a race-to-the-bottom in costs and quality, to be underpinned by a collective agreement on employment standards in the sector that ensures a level playing field, high care standards, and fair remuneration for workers.

- (Deputy David Cullinane)

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

I move amendment No. 2:

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

recognises:

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

— that the Home Support Service is a core service for older people and is highly valued by service users, their families and by the Health Service Executive (HSE);

— that over the past number of years, improving access to home support has been a priority for the Government, as reflected in the increases in the home support budget which has grown, since 2020, an additional €207 million has been provided for home support;

— that next year the overall home care budget will be in excess of €700 million, and this will go towards progressing the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and delivering about 24 million hours of home care in 2023; and

— that home support hours are increasing, in line with enhanced investment, and in 2021 some 20.4 million hours were provided to over 55,000 people, which is about 2.9 million more hours compared to 2020, an increase of 17 per cent, and at the end of September 2022, 16.08 million home support hours have been delivered to 56,490 clients in the community. This is about 2 per cent more than the expected activity and 4 per cent more than the same period last year, and the number of hours of home support provision nationally has increased from 17.55 million hours in 2020 to 20.46 million hours in 2021, in tandem with increased investment;

notes that:

— the Irish Government's strategic policy goal is to deliver a new model of integrated, older persons health and social care services, across the care continuum, supporting older people to remain living independently in their own homes and communities for longer, in line with the Sláintecare vision for receiving the right care in the right place and the right time;

— the interRAI assessment will be used to determine the allocation of care depending on the need of an individual and the phased rollout of the interRAI assessment tool for home support has commenced across four pilot areas, and this will be accelerated with the recruitment of 128 interRAI care needs facilitators which is underway and these outputs and the evaluation of the pilot sites for testing of a reformed model of service for the delivery of home support evaluation will be critical to the development of the new home-support scheme;

— the HSE monitors data on Delayed Transfers of Care (DTOC) on a daily, weekly and monthly basis so they can target these patients as early as possible and take appropriate steps to identify suitable post discharge support which will then facilitate their discharge and patients are added and removed from the list on a daily basis;

— as of 1st November, 2022, the HSE reported there were 594 DTOCs of which 103 people were waiting on home supports;

— the HSE National Service Plan 2022 sets a priority action to maintaining, at a minimum of 40 per cent, the proportion of public / private provision of support hours so that the balance is reflected in each area over time. Any increases reflect the workforce requirements of the expected statutory home support scheme. In line with these commitments, the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants' calls for 'a significant increase in the proportion of home support hours and packages provided directly by the HSE' and recommends that 'targets determined by the HSE on a national level should be set out in the National Service Plan 2023' (recommendation No. 11);

— there are currently 21 Integrated Care Programme for Older Persons (ICPOP) teams in place across the country and all Community Health Organisations (CHOs) have at least one team in place, the recruitment for the remaining teams is ongoing and it is planned to have the full complement of 30 ICPOP teams established by Q1 2023;

— the Programme for Government: Our Shared Future commits the Government 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', and the Department of Health is currently developing a regulatory framework for home-support providers with the aim of ensuring that all service-users are provided with high-quality care that will comprise of (i) primary legislation for the licensing of home support providers, (ii) regulations for home support which will set out the minimum requirements that a provider must meet to obtain a licence, and (iii) Acute and Community Healthcare Services (HIQA) national standards, the Heads of Bill are currently being drafted by the Department with a view to bringing it through the Houses of the Oireachtas at the earliest opportunity, and HIQA are developing standards for home care and home support services which will go out for public consultation early in 2023;

— the Government is committed to supporting healthy and positive ageing throughout the life-course as well as to ensuring that older persons can continue to live independently in their homes and communities for as long as possible. At present, this objective is supported by the National Positive Ageing Strategy (2013), which provides a blueprint for whole-of-Government policymaking and service-delivery in partnership with the community and voluntary sector. Acknowledging the disproportionately negative impact of the Covid-19 pandemic on older persons, the Programme for Government: Our Shared Future commits to the establishment of a commission on care that will 'assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens', learning the lessons from Covid -19 and an initial scoping exercise for the commission on care has been undertaken, it is envisaged that the commission on care will support a whole-of-Government and whole-of-society approach to examining existing policies and strategies which support positive ageing and that it will effectively address the gaps which currently exist in the policy-landscape and it is anticipated that the commission will be established in 2023;

— the Health and Social Care workforce planning and ensuring an appropriate pipeline of suitably qualified healthcare professionals in Ireland is a top priority for the Government, and the Department of Health has commenced a programme of work to deliver a Health and Social Care Workforce Planning Strategy and Action Plan, and a Planning Projection Model, and this work is being undertaken with the support of the European Commission under the auspices of their Technical Support Instrument which will provide the technical expertise to deliver this project and is due to be completed in Autumn 2023; and

— addressing the shortage of care-workers in Ireland is an urgent priority for the Government. To this end, the cross-departmental Strategic Workforce Advisory Group was established in March 2022 to examine, and formulate recommendations to address, the challenges in front-line carer roles in the home-support and long-term residential care sectors. The Group was chaired by the Department of Health and comprised representatives from seven government departments, the HSE, HIQA and SOLAS. Working closely with key stakeholders, the Group examined the recruitment, retention, training, career-development, and pay and conditions of front-line carers. The Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on 15th October, 2022, providing an overview of the work of the Group and its key findings, the report presents a suite of 16 recommendations spanning the areas of areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform, and monitoring and implementation. All of the recommendations have been strongly endorsed by Minister Butler, and work to implement the recommendations has commenced; and

further recognises that:

— the General Scheme of a Health (Amendment) Bill to amend the 2007 Health Act was published in October 2022. This legislation will enhance and modernise the powers of the Chief Inspector of Social Services in HIQA and will provide for the mandatory reporting of key operational data by nursing homes. The General Scheme has been referred to the Oireachtas Health Committee for pre-legislative scrutiny and the Department of Health is engaging with the Office of the Attorney General is relation to the drafting of the Bill;

— the Heads of Licensing of Professional Home Support Providers Bill are currently being drafted by the Department with a view to bringing it through the Houses of the Oireachtas at the earliest opportunity. Regulations are at an advanced stage. The Department has completed a public consultation on the draft regulations which concluded on 4 August. The report on the submissions for the public consultation is currently being compiled by the Institute of Public Health (IPH);

— adult safeguarding has been included in Section 10 of the draft regulations for the licensing of Home Support Providers;

— the HSE will recruit key posts to enable the establishment of a National Home Support Office. Funding is provided for 15 full-time jobs;

— the HSE has acknowledged the importance of a fit for purpose IT system for the delivery of Home Care across all CHOs and are finalising the details. The HSE and Department of Health are jointly working on the structures and systems to enable the creation of the Regional Health Areas and the National Home Support Office will be included as part of this;

— a key recommendation of the Health Service Capacity Review 2018 is the shift of care out of acute hospitals into the community and closer to a person's home, where safely possible. In pursuit of this goal, the HSE commenced the implementation of the Enhanced Community Care programme in 2021. The Enhanced Community Care (ECC) Programme is a strategic reform programme in line with Sláintecare proposals which seeks to deliver new and enhanced services and support the move toward a more community-centric model of healthcare. The ECC programme represents the most significant expansion in Primary Care in the last two decades, with overall recruitment to the ECC targeted at approximately 3,500 WTE, and this Government allocating significant funding to deliver this expansion;

— improving access to home support has been a priority for Government. The Government is working to ensure that People with Disabilities are enabled to live an independent life of their own choosing, like any other person, in line with the disability reform policy - 'transforming lives' and the HSE has consistently, year. on year, increased the number of hours of PA Services delivered to people with a disability. The National Service Plan 2022 outlines the HSE's commitment to deliver 1.7 million hours of PA services to 2,587 people this year. This reflects an additional 120,000 hours of PA services in 2022 to expand and enhance supports for people to live self-directed lives in their own communities;

— the Healthy Age Friendly Homes Programme, an innovative partnership between the local government sector (Age Friendly Ireland) and Sláintecare, commenced in 2021 and saw the introduction of a new person-centric, robust, support co-ordination service. It was announced in Budget 2023 that funding of €5.2 million has been allocated to roll-out the initiative nationally;

— under Housing for All – a new housing plan for Ireland, a review in relation the Housing Adaptation Grants for Older People and People with a Disability Scheme is currently underway. Grant limits and income thresholds are being considered as part of this process;

— the tender process for home support is underway. The HSE is responsible for procuring home support services. Established procurement protocols apply to this process; and

— the recommendations made in the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants includes recommendations on terms and conditions for workers."

I am delighted to see the Ceann Comhairle back in the Chair and I wish him all the very best. I thank the Deputies for raising this important issue. I am pleased to have the opportunity to speak about the substantial progress under way on supporting people to receive care in their homes as well as the wider home care sector. We know that for most people home is the preferred location for care. The home support service is therefore an essential service for thousands of people across the country. It is highly valued by service users and their families because it enables older people to live independently and with dignity in their own homes for longer. It also enables many older people to return home following acute hospital admission who otherwise would remain there or would be admitted to long-term residential care. For these reasons, improving access to this service is a Government priority.

Many of my colleagues on the other side of the House spoke about what is not being delivered. I will speak about what is being delivered. Home support hours in communities are increasing in line with enhanced investment. We provide more hours of home support to more people than ever before. In 2021 we provided 20.4 million hours to more than 55,000 people, an increase of 17% compared to 2020. As of the end of September, more than 16 million home support hours have already been delivered this year to more than 56,000 people in the community. This is more than 6% more hours than delivered by this time last year. Are there difficulties? Yes there are because more people than ever before are being referred for home care. We have had an increase of 6% already this year and an increase last year of 17%.

I want to speak about delayed transference of care because there has been a lot of talk about this. The HSE monitors data on delayed transfers of care on a daily, weekly and monthly basis so it can target these patients as early as possible and take appropriate steps to identify suitable post-discharge support, which will then facilitate discharge. Patients are added and removed from the list on a daily basis. As of 1 November 2022, the HSE reported there were 594 delayed transfers of care, of which 103 people - not 1,000 - were waiting on home supports.

I was particularly pleased to announce in budget 2023 that the proportion of new home support hours allocated to people with dementia will increase by 4%. This will bring the dementia-specific proportion of new home support hours up from 5% in 2021 to 15% in 2023, valued at €5.2 million. These improvements have been facilitated by increased Government funding. We have provided an additional €200 million for home support since 2021. Next year the overall budget will be in excess of €700 million. What is frustrating for me as Minister of State is that I have a budget and I could provide funding for the 6,000 people waiting today but we do not have the staff. I have the budget and I want to get this message out. This will go towards progressing the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and delivering about 24 million hours of home care in 2023.

The delivery of this service is not without its challenges. Delivering this enhanced capacity requires substantial recruitment. Addressing the strategic workforce challenges in the home support sector is an urgent issue and for this reason, as Deputy Cullinane referred to, in March I established the cross-departmental strategic workforce advisory group. It set out to examine and, most importantly, to propose solutions to the challenges in front-line carer roles in the home support and long-term residential care sectors. The group was chaired by the Department of Health and comprised representatives from seven Departments, the HSE, HIQA and SOLAS. Working closely with key stakeholders, the group worked together to examine the recruitment, retention, training, career development and pay and conditions of front-line carers. The contribution of stakeholders through meetings and facilitated workshops was invaluable, ensuring that deliberations were fully informed by those who provide care every day in the public, private and voluntary sectors.

The report of the strategic workforce advisory group on home carers and nursing home healthcare assistants was published on 15 October 2022. The report presents a suite of 16 recommendations spanning the areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development, sectoral reform, and monitoring and implementation. I will mention three key recommendations on which we are already moving. Somebody providing home care has to be paid a minimum of the living wage of €12.90. We will be announcing very shortly that the critical skills list will be recruiting beyond the EU. Travel expenses should be paid to anyone providing home care. I have strongly endorsed the recommendations and implementation commenced immediately. This will be closely monitored on an ongoing basis to ensure that the recommendations are enacted in full in a timely manner. I anticipate that the implementation of the recommendations will have a lasting, positive impact.

When I took on this role two and a quarter years ago, 9,000 people were waiting for home care, and we managed to reduce that figure to 4,000, as Deputy Tully said. Unfortunately, that figure has grown again because, since Covid, more people are looking for home care than there were before and the cases are more complex. In dealing with waiting lists, one has to prioritise the most complex cases and end-of-life care. That is why it can be challenging. It pains me to see the numbers increase.

Deputy Mythen mentioned Wexford. It was I who put in train the special review for Wexford, where there is the highest number of people waiting for home care in the whole country. I will follow up on that expert report and see what the recommendations are. However, it is quite challenging. I thank home care support assistants for the invaluable work they carry out, and I know everybody is in agreement with us in that regard.

When I took up this position two and a quarter years ago, the split between private and public home care was 50:50, but because we increased home care provision by more than 2 million hours, we had to move to the private sector. The private sector has an agreement with the HSE whereby the average payment is €27 per hour. However, I cannot control the amount the private sector pays its workers. That is why I have recommended the minimum payment in the tender that will be introduced in the new year should be €12.90, which is the living wage rate, plus mileage. That would go a long way to support and encourage other people to work in the home care sector.

Health and social care workforce planning and ensuring an appropriate pipeline of suitably qualified healthcare professionals in Ireland is a top priority for the Government. The Department of Health has commenced a programme of work to deliver a health and social care workforce planning strategy and action plan, as well as a planning projection model. This work is being undertaken with the support of the European Commission under the auspices of the technical support instrument, which will provide the technical expertise to deliver this project. The work is due to be completed in autumn 2023.

Under the integrated care programme for older persons, ICPOP, community specialist teams provide access to multidisciplinary assessments that ultimately enable older people to remain living at home for as long as possible. The teams specifically target those at risk from falls, frailty and dementia. They seek to ensure that older people can access care at, or near, their homes through care pathways specifically designed for them. There are currently 21 ICPOP teams in place across the country and all community healthcare organisations have at least one team. Recruitment for the remaining teams is ongoing. With continued positive recruitment, I expect the full complement of 30 ICPOP teams will be in place by early 2023.

The Government is committed to supporting healthy and positive ageing throughout the life course. Acknowledging the disproportionately negative impact of the Covid-19 pandemic on older people, the programme for Government commits to the establishment of a commission on care that will assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens. An initial scoping exercise for the commission on care has been undertaken. It is envisaged the commission on care will support a whole-of-government and whole-of-society approach to examining existing policies and strategies that support positive ageing and it will effectively address the gaps in the policy landscape.

The healthy age-friendly homes programme, an innovative partnership between the local government sector and Sláintecare, commenced in 2021, and it saw the introduction of a new person-centric and robust support co-ordination service. In budget 2023, I announced funding of €5.2 million to be allocated to the roll-out of the initiative nationally. In addition, under Housing for All - a New Housing Plan for Ireland, a review of the housing adaptation grants for older people and people with a disability scheme is under way. Grant limits and income thresholds are being considered as part of this process.

Once again, I thank the Deputy for tabling the motion. I agree with many parts of it, several of which are currently in train. I know we agree on nearly 90% of the motion. There were a couple of other elements in the motion and the Deputy knows the reason I could not accept it, and that is why I tabled the amendment. I thank him for raising this issue. It is important that we have speaking time on home care, which supports 56,000 people per day.

An Ceann Comhairle

Deputy Andrews will share time with Deputies Seán Crowe, Buckley and Kerrane.

Deputy Chris Andrews

I welcome the Ceann Comhairle back to the Chamber. It is good to see him looking well.

The Minister of State has identified all the challenges and blockages. What we need now is real action and not just observations. We also need a strategy, as throwing money at it is not a strategy. Home care is an essential service, and without a workforce strategy, there will be no improvement in home care delivery. The Government throwing money at it is not a strategy. The failure to put a home care workforce strategy in place is pushing patients into hospitals when they could be cared for in their own homes.

Everyone, including the Minister of State, knows the problems, but we are not getting the action we need. We need delivery. We have had enough of reports and reviews. Our communities need to see the reform of the home care sector. What we have now is effectively a race to the bottom. We need a career pathway that will allow home care staff to develop their skills and train to deliver a quality service, and this needs to be recognised. There needs to be a collective pay agreement for home care workers that takes into account travel times, as mentioned by the Minister of State, so why has she not done this? We all know this needs to be done. We need action.

We also need to see home care workers having access to work visas in the same way as home care workers in hospitals and nursing homes. Unless that is done, there will be a haemorrhaging of home care workers into nursing homes and hospital settings, which will ensure there is never an improvement in home care delivery. Providers are haemorrhaging staff because the Government has not introduced the necessary standards and requirements to ensure people want to work and will work in home care services. There needs to be a level playing field for all providers of home care, such as in hospitals, home care settings and nursing homes. We do not have a level playing field now. Home care workers cannot access visas, which means home care companies are training staff for nursing homes, the HSE and the hospitals.

Deputy Seán Crowe

If we want to pay more than lip service to independent living, delivering care in the home should be one of the highest priorities of our health service and of any government. Demographics suggest that we are all living longer, which is a good thing, but worryingly it is suggested that if people are not well off, they will struggle as they get older and the quality of their extended life will be poor unless supports are increased dramatically. It is an abandonment of our duty to our older and more vulnerable citizens that it is often beyond the ability of many families to afford private home care.

The Minister of State questioned some of the figures referred to in the motion. Some 1,000 people unnecessarily experienced a delayed discharge from hospitals this year because the home care packages are just not there. She mentioned the date of 1 November 2022. We are saying that there has been a problem in that regard since the start of the year. If we want to look at figures, there is a lack of step-down beds, which impacted on 7,000 people being discharged.

By way of an example of some of the challenges being faced, there were 11 ambulances outside Tallaght University Hospital at the weekend. There are 12 ambulances in the Dublin Fire Brigade fleet, ten of which were outside that hospital. There is a problem within the system, and that was unusual. I ask the Minister of State to point out a hospital in the country that does not have people lying on beds because they do not have somewhere else to go. I do not know of any such hospital and that is the experience my colleagues and I are hearing about. We need to do more regarding that. The almost glacial speed of changes to the provision of care in the public service needs to change.

In my area, Tallaght hospital recently commenced the pathfinder service with the National Ambulance Service, which it is hoped will reduce the need for patients to attend the accident and emergency department, but this took years to expand following an experimental pilot programme in Beaumont Hospital. Despites its success, there seems to be a delay. We need to be more proactive, move quicker and realise the benefits of a successful project sooner rather than later.

Deputy Pat Buckley

It is good to see the Ceann Comhairle back - fair play to him. I have listened to what the Members have said, and I will read from a number of papers. An article in the Irish Examiner recently stated, "Low wages, long hours, and insecure working conditions are pushing the largely female workforce out of the caring industry". People who spoke to the paper said there was nothing complex about the crisis with one saying, "Change would have to mean the agencies paying more to the carers, and better conditions for the healthcare workers and more attention to the families".

A number of months ago there was reference in The Irish Times to carers as gig workers. An interdepartmental group on economic migration determines which sectors can tap non-EU workers and is chaired by the Department of the Minister, Deputy Leo Varadkar. It concluded there was no labour shortage in the sector. It instead found that the issue was the terms and conditions home care groups are offering.

The Minister of State mentioned budgets and money. We have heard from people working in the system that they are not being paid and the money is going somewhere else. We know privatisation is for profit, not for care. I raised the issue of home carers in a Topical Issue debate a number of weeks ago. It was horrific. Additional hours had been approved but were not granted because there was nobody there to do the work. In the meantime, the Minister of State, Deputy Rabbitte, discussed incontinence pants. People were rationing them to two a day for a 93-year old woman who cannot get home care help. The family is providing care. The knock-on effect is stress on families. The whole system breaks down and people lose faith in everything.

I again refer to budgets. Let us start hiring and paying our own. The minute we start outsourcing to private companies and moving money out we destroy it. We can hear from witness statements that people have no faith in the system. My mother was a carer for years. She went above and beyond, which most do, for a pittance. That is what we have to address. We have to be fair because if we do not pay and treat people properly they will not work in the service.

Deputy Claire Kerrane

Over 300 people in Roscommon and Galway have been approved for home care and are waiting to receive it. Some have been waiting up to 18 months. They want to and can be cared for in their own homes, but this can only happen where the care is being provided. They and other families are being let down. I raised the crisis in home care during Leader's Questions last December. At the time, the HIQA report had been published. It concluded that home care is currently not sustainable or meeting people's needs and a complete overhaul was needed.

Since then, in March the Minister of State announced the establishment of the workforce advisory group to look at the crisis in the recruitment and retention of home care workers. It was due to report in September and the report was published last month. During those seven months waiting lists continued to grow and time was wasted because there was nothing new in the issues identified or recommendations made in the report that home care providers and workers could not tell the Minister of State themselves. I said that to the Minister of State. We are now at a point where we need to see action on pay, terms and conditions and promoting roles in home care to resolve the recruitment crisis that continues.

I want to suggest to the Minister of State Roscommon's RHS Home Care services, established in 1996, as a blueprint. It pays a living wage and above to its carers and uncapped travel costs and provides an excellent service to our county. It is those very valued home care workers, including those in RHS Home Care services and further afield, who are still waiting for the €1,000 Covid recognition payment. The Minister of State did not mention that in her contribution. These workers deserve far better and are still waiting almost 11 months after the announcement was made. It is a disgrace when we consider what they did during Covid, especially at the start when they did not have PPE or vaccines. They took their lives in their hands and deserve a lot better.

I met two siblings this week. Their brother, who has a number of health conditions, is in hospital. The hospital told him it would do the paperwork for a home care package but there was not a hope of it being received. That is the situation today regarding home care. We need to fix the issues that are there. We need to stop the reports and financially and otherwise support home care workers who were providing care every day of the week.

Deputy Duncan Smith

I thank Deputy Cullinane for this excellent motion. A few weeks ago I was going door-to-door and came across a woman who had just come home and was getting out of her car in her driveway and was taking a moment to compose herself. I had that feeling with which we are all familiar of trying to deliver a leaflet and wondering what to do. She took the leaflet, called me back and asked me to come in. She had come from providing a couple of hours care for her mother - she shares the care with two sisters. Like many people providing care, she finds it a struggle and it is difficult. Her mother has been approved for home help hours, an hour in the morning and an hour in the evening every day. She had been waiting for the service for nine months. I rang around to see why she had been waiting and I found out from one of the providers, which was very helpful, that there were specific times on the request, which is a perfectly understandable request for a family member filling out a form for home help to make. A person who needs home help may need medication at 8 a.m., 9 a.m. or 10 a.m or whatever the case may be. The hours on the form were deemed antisocial off-peak hours. They were not. The hours requested were not 10 a.m. or 6 p.m.; rather, they were specific hours such as 9 a.m. and 5.30 p.m.

When I advised the woman that was the case she told me if she had known that she would not have put times on the application because they could be flexible. She had to go through the process again. If I had not met her, made calls and spoken to a helpful person from a private home care provider who gave me that insight the woman would still be scrambling with the forms on her kitchen table, which she showed me, making phone call after phone call and desperately trying to seek home care for her mother and respite for her and her sisters. That is just one of many examples of how the system as it exists is failing so many people.

The recommendations of the workforce advisory group included a national campaign to raise the profile of home care, promote training opportunities and a national and EU campaign on the benefits of working in the sector. The recommendations mean naught unless recommendations 5 and 6 are implemented.

Recommendation 6, on the living wage, to which the Minister of State referred, is weak. We need an employment regulation order, ERO, similar to what we have in childcare. We need a collective agreement that will set a wage living wage or above for workers in the industry and include travel, which was another recommendation. The principle of the recommendations is not bad, but the language, in particular on an hourly rate, is weak. I would rather a stronger trade union language, using the model we have in childcare, and getting the industry and stakeholders to agree a rate, through the joint labour committees, JLCs. Only then will advertising and recruitment campaigns work in respect of care.

This is not a new or novel issue we are discussing. We all have long experience of dealing with families who wish to avail of home care for their loved ones and workers who are burned out, overstretched and are being paid for one hour rather than two hours' work because they have to travel between locations.

We now have micro-geographic areas through which a home care worker is willing or able to work. Sometimes only half of an area such as Kinsealy, in north county Dublin, is covered because the other half is too far away from workers. It is nowhere near the largest town in north County Dublin. These are the failures.

I want to hammer home that inviting private companies to pay a living wage is not strong enough. We need an ERO. The handful of groups that made submissions on this report included the Irish Congress of Trade Union and SIPTU. The trade unions are engaged and want to be part of the solution. If we set wages appropriately, people will work as home care workers because it is vocational and care work, which people want to do. However, they want recognition not only in their pay but in the esteem in which they are held in the State.

A couple of hours ago I met contract cleaners and security workers who are still awaiting their Covid recognition payment.

Those workers did not mention the amount, the cost-of-living crisis or any of that, as would have been understandable and their right. They just mentioned recognition. It is the same with home care workers. I ask that the Minister of State re-engage with the trade unions and set about a process through which-----

Deputy Mary Butler

The private providers have agreed to it.

Deputy Duncan Smith

Were all private providers involved?

Deputy Mary Butler

They were all involved.

Deputy Duncan Smith

Well, I hope that they deliver and see pay delivered.

Deputy Róisín Shortall

I welcome the motion by Sinn Féin, which the Social Democrats will support. It is a timely debate following the publication of the report by the strategic workforce advisory group last month. I also welcome the strong endorsement by the Minister of State, Deputy Butler, of all 16 of the group's recommendations. I assure the Minister of State that she will have the full support of the Social Democrats if she proceeds to implement those in a timely way. However, I am concerned that there is no clear time line for the implementation. While she talks about getting moving on it straight away, she does not set out a time line. It is a real weakness that needs to be addressed. That is why I have tabled an amendment to the motion calling for the publication of a time line before Christmas or the end of the year.

The issues and solutions have been identified pretty well in the report. We need to accelerate the kind of reform set out in the report because we cannot continue our over-reliance on institutional care, not least in the aftermath of Covid-19 and the devastating impact it had on nursing homes. It also put the issue of institutional care under the spotlight. I can recall Deputy Varadkar, who was Taoiseach at the time, as far as I can recall, talking about us needing to radically change our view of the best model of care for older people. Nothing has happened since then. There was all this talk about things having to change drastically but nothing has happened.

We know that older people, in the main, do not wish to be in nursing homes. We also know there are many people in nursing homes who should not be there at all. They are there because no home care was available for them or for different reasons. However, people should be given choices, the first of which is to be at home, living as independently as possible with home care. We also have to look at the area of housing for older people. I have been talking about this for years. There are good models of housing around. We should ensure that people have some kind of sheltered housing option to which to move when their house is too big or unmanageable. Phased grades of support should be then made available up to nursing home level but nursing homes should be the last option.

More than 6,000 people are on a waiting list for home care. That is a scandal. There have been more than 8,000 delayed discharges so far this year, of which more than 10% were due to a shortfall in home carers. It makes no sense whatsoever to have large numbers of people in such situations. At any one time, there are approximately 600 people in hospital who are ready to be discharged. It is crazy that such a situation is allowed to continue for want of adequate home care, staffing, funding or step-down facilities. It is an example of the dysfunction within the health service, which should change very urgently. We cannot stand over a situation in which there is such a level of waiting lists and inappropriate use of expensive acute hospital beds. However, under the watch of successive Governments, we have seen not the State taking on responsibility for the provision of services directly but creeping privatisation of the home care sector, with funding to private providers increasing from €3 million in 2006 to €176 million in 2019.

Like a great many other aspects of our health and social care system, the State has become disproportionately dependent on outsourcing care. I was at the SIPTU conference a couple of weeks ago where one of the speakers was Dr. Emma Dowling. She is the author of an excellent book, The Care Crisis, which I recommend the Minister of State reads if she has not done so. It is a terrific book. Dr. Dowling made a good point in her presentation to SIPTU, when she said that rather than talking about outsourcing of care, we are talking about extraction of wealth from the care service. That is what it is. It is a model that includes the profit margin. Why are we doing this? Why are we making businesses out of what should be State-provided caring facilities?

I will make another recommendation. A woman in DCU, Professor Kate Irving, has written extensively on caring. She has written specifically on dementia but has also made important points with regard to caring generally. In a recent paper, which I would be happy to share with the Minister of State, Professor Irving made the point that we will continue to place responsibility for any version of person-centred care on the least qualified persons in the chain, that is, the home support workers. It is a very good description. I hope that we will all get to that critical point at our lives late in life but we will all more or less be looking for care at a certain stage. It has been decided by successive Governments that those providing critical care - a sensitive need for proper care - are probably the lowest paid and least qualified of all workers in our economy. That seems to turn logic on its head.

To make matters work, we still have no regulatory framework or independent regulator. All we have is the HSE acting as a proxy regulator of providers to deliver home care on its behalf while home care provided directly by the HSE effectively undergoes no such scrutiny as it cannot be independent of itself. Worst of all, in theory, providers outside of the tender do not have to adhere to any standards whatsoever. That is the current situation which is, frankly, unacceptable.

I think everyone accepts that the current tendering model is not fit for purpose. It has created a race to the bottom with the providers competing solely on price. Not only is this bad for the client, it is completely unsustainable for workers' pay and conditions. It is November and it is still my understanding that the invitation to tender has not been issued. I read the Minister of State's amendment carefully and tried to get around the weasel words but it was not clear whether the tender has been issued. It was supposed to be issued by the end of the third quarter for implementation by 1 January.

I wrote to the Minister of State last April when the plan to dramatically reduce the number of providers was first mooted. Seven months on, providers are still anxiously awaiting clarity, especially smaller, not-for-profit and community providers. Will she, please, update the House on the upcoming home-care tender? The last I heard, Grant Thornton had been hired to assist with the procurement strategy but that was during the summer. I did not understand the need for private, third-party assistance then and I certainly do not see the need now. The Minister of State managed to miss the quarter-3 deadline even though she had employed outside consultants.

At the very least, will she give an assurance that the tender will ensure all home care workers receive a living wage at a minimum? That is the recommendation. She acknowledges that in her amendment but she does not commit to doing so. Will she give an assurance that when the tender document is issued to invite tenders, it will provide for the payment of the living wage, at a minimum, in accordance with the recommendations in the report? I have tabled an amendment to provide for that. Since the advisory group published its report, the living wage for 2022-23 has increased to €13.85.

Will the tender provide for that at a minimum? Further changes are required to address chronic low pay in the sector. A reformed tender model should insist on an incremental pay scale that recognises a worker's length of service, training and qualifications. At the crux of this is a lack of recognition of the vital work of the professional home carer and this should not be the case. It would also be remiss of us not to acknowledge this is a workforce dominated by women and that is certainly a factor in the historical undervaluing of this work. If there were proper pay scales, it would not be as difficult to recruit staff and we would have a lot more men going into the service as well, thus there are strong arguments for this, apart from the right of workers to decent pay.

Ultimately, these workers deserve our respect, not just in the form of positive platitudes but tangible measures that recognise the importance of their work, respect them and recognise the importance of collective bargaining, among other things. Without these reforms we will struggle to retain and recruit staff. I will forward the documentation I have quoted but I ask her to clarify what the situation is with the tender document and the living wage.

Deputy Gino Kenny

I welcome this good motion on home care. It is a good critique of where we are at the moment. There is no argument, here or outside here, but that older people are better off being cared for at home. I have experienced that as a care worker myself and in the past six or seven months of my mother's life when she was cared for at home. Home is where our parents want to be. It is where they grew up, where their family and friends are and it is the best environment, sometimes, for end-of-life care. Sometimes it is not conducive but it is the best place for our loved ones to be at that particular time.

It is better in financial terms because if a person is in hospital for a week, it adds up to approximately €6,000. If a person is in a nursing home, it costs €1,000 per week and, therefore it makes a lot of financial sense to have somebody in that situation in their home. Then there is the matter of age demographics. In the next seven or eight years there will be many more people aged over 65. Whether they need that care will depend on their own situation but demographics will play a part in how we provide for our older citizens.

I understand considerable time has been given to home care hours in the past five to ten years but we have to look at where these hours are going and the private companies involved in private home care work. Probably the best example of the whole structure of this, which the Minister of State referred to in her statement, is how much private companies charge the HSE per hour. If we break this down it does not make sense. The worker who does all the work is getting paid €11.50 or €12 per hour and the company is charging €28 per hour. Somebody is making a lot of money out of this. If we look at what the main private operators got in 2020, it is eye-watering. In 2020, three companies got the following from the HSE: Home Instead Senior Care, €58 million; Bluebird Care, €33 million; and Irish HomeCare, €13 million. I am sure that has gone up incrementally in the past two years. It would be better to put resources into a public system where workers are looked after properly. The private sector is haemorrhaging workers because they are not looked after. If the company is getting that amount, it is hugely profitable but, at the same time, workers are not even paid to travel from A to B. If they are not getting paid for that, then it is no wonder people are leaving the sector. There is also a good angle to this. I worked for the HSE directly and it was a better rate of pay. The executive looked after its workers and that is a better system, considering the huge resources that go into this. It is better for the worker, the person they are going to, the family, society, the taxpayer and everybody. It is not about looking to the private model all the time because that system is not conducive to home care and proper care in the home.

Deputy Bríd Smith

I will follow on from what Deputy Kenny talked about. I know him a long time and knew him when he was a young fellow doing this sort of care work. I know the pride with which he did his job and the type of people he looked after for long periods. He looked after people with whom he built up relationships. There were people who were wheelchair-bound and people who suffered with their mental health. The whole point of the type of care that was delivered, as the Deputy said, through the HSE and the public sector was that the carer built up a relationship with those who they cared for.

I have been involved in a few special committees during my time in the Oireachtas, which is a short time. One of them is currently getting ready to issue its report on the recommendations of the Citizens' Assembly on Gender Equality. For one session we had before us Professor Kathleen Lynch, who has written a brilliant book on capitalism and care. She pointed out a number of strong home truths on the same lines as Deputy Kenny has experienced in his life. One of the things she points out is care itself is not about providing just the physical facilities but about having a relationship and having an affection and a sort of a friendship with person for whom you care. It goes to the heart of what people need in their lives in terms of their need to flourish. We learned a lot about that during Covid.

The other committee I was involved in was the Special Committee on Covid-19 Response that sat I do not know how many times during 2020 and examined the care sector in particular and what was happening in our nursing homes. I remind Deputies that 56% of all Covid deaths in the State at that time took place inside the nursing home system, which was totally disproportionate as this group of elderly people comprise 0.65% of the total population. A recommendation that came out of that long-sitting, long-suffering committee was "that a public inquiry be established to investigate and report on all circumstances relating to each individual death from Covid-19 in nursing homes". We fought for that recommendation to look at what was going on in the private sector because Professor Lynch's statistical study shows 70% of all nursing home beds are now owned by for-profit companies and a huge subsidy takes place in the State. With regard to the overall care relationship between the State and the for-profit sector, the proportion of public expenditure allocated to private for-profit care rose from 5% in 2006 to a handsome 40% in 2019, and that is not the latest figure. Though it is not defined as profitable, it is currently at approximately €718 million annually with 599 businesses registered as delivering care. What is that if not the commercialisation of the most human action one can carry out in one's life, which is to care for another, particularly when they are vulnerable or disabled? That is the corporatisation of care and the State is very much guilty of implementing that.

I welcome the Sinn Féin motion as we need a serious think about how we are delivering it. Approximately ten years ago the HSE was washing its hands locally of the home help system that existed in all our communities. It was so localised we had a special dedicated office in Lower Ballyfermot and another in Upper Ballyfermot. It was mostly run by nuns and voluntary elements of the HSE but they worked closely with mainly local women, and sometimes men, to deliver hours of care to their neighbours. That was real care because those working knew the people. They knew the elderly men and women they were looking after. They had grown up alongside them.

They loved them, had relationships with them and bent over backwards for them. They were available to those people out of hours and were paid a reasonably decent hourly rate to care for them. When the home help system was removed, all of that went under the radar. All of those women and men, if they wanted to stay in the industry, were expected to pay for their own training and uniform and to work for a for-profit company that provided them with an app whereby their work was timed. They were asked why they spent longer than 15 minutes with Mrs. Murphy around the corner when they should have only helped her to shower and take her tablets. I reiterate that what people really need are relationships, affection, care and friendship. If we move away from that model, we are doing society a huge disservice.

As part of my work on the climate committee, I read a lot about the alternatives to our burning of the planet. There are many theories about how we could do things differently in society. Many people have written about what they call the care and repair of society. Central to that is for society to move to spending significant public money on looking after each other, which requires training and paying people properly to give the sort of care our vulnerable and elderly people deserve. We will all get there some day. It would be fruitful and productive to take that approach. This debate helps us to understand that is where we need to go.

Acting Chairman (Deputy Marc Ó Cathasaigh)

We move now to the Regional Group. There are four Deputies sharing time, starting with Deputy Canney.

Deputy Seán Canney

I am delighted we are debating this subject. In my constituency, as is probably also the case for the Minister of State, Deputy Rabbitte, a lot of people come to me who say they or their parents have been assessed for hours, there is an allocation given but the hours are not provided. Nothing happens. I dealt with a man who needs two people to help him because he has had three strokes. He will not get that help because there is somebody else living in the house with him, namely, his wife, who is 82 years of age. That is not right. There are things going on that are just not right. I have plenty of cases of people who have tried to get care privately and do something to keep their family member at home. It flies in the face of the Sláintecare strategy if that cannot be done.

Regarding the private companies providing care services, the reality is there is a tiered system. Some of these elite companies, let us call them, are getting the high rates that were mentioned by a previous speaker. However, small companies that employ people locally are getting the pickings off the bottom of the pot. Their staff get the longest distances to go to care for people. These companies are being told that if they want to get up with the elite, they must have policies in place and everything done to prove for the next tender that they are as good as the big guys, who are deemed to be good just because they have many more people working for them. The reality is reflected in the case of a company I know of, which has done the training and brought all its staff along with it only for the HSE to poach its staff, after all the training is done, and give them a higher rate of pay than the company can give. I am referring to tiers 3 and 4 companies.

It is a crazy system. There cannot be differentiation between one company providing a service and another company when both are giving staff the same training. It is down to the corporate image of the bigger companies. They know exactly how to do things. As the Minister of State, Deputy Rabbitte, knows, 180 beds have been lost from nursing home services in counties Galway and Roscommon for this winter. More will be lost if we do not do something to support private nursing homes in their hour of need.

Deputy Peter Fitzpatrick

There is an acute labour shortage of home care workers in the State. However, the Department of Enterprise, Trade and Employment refuted those labour market shortages in August, suggesting that the recruitment challenges were because of a failure to guarantee hours of work and the lack of travel and subsistence payments. Although it was aware of this reasoning, the Government did not address those long-term pay and conditions issues, which have subsequently harmed recruitment and retention. Instead, the Government is overreliant on private, non-HSE home care providers to fill the gap in the market. Although the national service plan for 2022 makes significant promises in delivering a national service framework that defines a financially and operationally sustainable model for public long-term residential care and intermediate rehabilitation care, only 38% of home support services are delivered directly by the HSE.

As of July, waiting lists for home care support had escalated sixfold in just a few months to 5,000, leaving those with additional needs struggling and unable to stay in the comfort of their own home. On top of this, almost 10% of all older people approved for home support have no carer. If demographic projections for hospital and home care admissions are correct, the demand for such care will grow significantly over the coming years, putting significant pressure on our health system, which cannot and will not cope safely. These failures to provide improved pathways of home care are pushing older people into overcrowded hospitals and nursing homes. The lack of community care alternatives has left more than 7,000 people delayed in a hospital when they should be cared for in their own home, if they had a carer.

A huge number of people have moved to my constituency of Louth and to east Meath in recent years. There are long hospital waiting lists, GP shortages, long waiting times to access child protection and welfare services and now an acute labour shortage of home care workers. I was contacted today by the family of an 88-year-old woman who is currently in hospital after a stroke. Having been granted discharge following treatment, this woman cannot go home as she is still awaiting a care package from the HSE. An 88-year-old stuck in hospital for that long is ridiculous. The members of her family are exhausted fighting for what should be rightfully available for their mother. They are at their wit's end. They are doing everything they can to ensure she gets the required care.

We learned many lessons during the Covid pandemic. One is that care of our older people is far from ideal. These issues are predominant and are only going to get worse. There are poor standards and a lack of authority for safeguarding. The Government says it is committed to ensuring standards and putting safeguarding on a statutory basis. It must advance vital regulation for the home care sector and should make legislation in this regard a priority. Delivering proper home care would reduce the length of hospital stays, the risk of hospitalisation, pressures on emergency departments and delayed discharges.

Deputy Peadar Tóibín

Is deas an rud é a fheiceáil go bhfuil an tAire Stáit ar ais agus tá súil agam go bhfuil an tsláinte go maith aici. This year, we in Aontú have researched the number of people who are medically discharged from hospital but forced to stay there because of a lack of home care or step-down beds. The information we have received is incredible. The HSE told us that on a given day, there are 536 people in hospitals who have been discharged and have no need to be there but are forced to stay because there is no home care package or step-down facility for them. This is shockingly damaging for the patients who must stay in hospital and are not getting ongoing treatment elsewhere, but it is also shockingly damaging for the patients who are stuck on trolleys in hospital emergency departments because they cannot get a bed.

I have done the maths on this. The HSE reckons it costs €878 to put a person in a hospital bed for one day. Taking the 536 people awaiting discharge, it is costing €500,000 on a daily basis for the HSE to provide beds for people who have no need to be in them. If the cost is added for the whole year, it comes to €171 million to provide HSE beds for patients who have been clinically discharged. The doctors can do no more for them. They do not want those patients in the hospital beds; they want them elsewhere in the health service or at home with access to a step-down facility. Not providing the necessary home care and pathways for these patients is costing €171 million a year. No matter what way one looks at it, this is outrageous. That amount would pay for a whole lot of home care. It is beyond time the Government ensures this is no longer the case and that the necessary investment goes into step-down facilities and home care packages to enable people to go home. I know of people who were in hospital for more than two years after being medically discharged. That is wrong for any patient.

Deputy Matt Shanahan

We all understand the importance of the home care model for preserving people's dignity and giving them independence to live as long as they can in their own home, particularly those with additional care needs. We want to preserve people's independence and keep them out of the acute hospital system as long as possible. However, there is a crisis in the sector, as the Ministers of State acknowledged.

The first point to note is that people are living longer and their needs are becoming more complex as they age. We must acknowledge that as a problem within the system. However, we also know the remuneration on offer in the home care and home help sector is largely not attractive for most people.

Workforce planning can be chaotic, particularly in regional rural areas. As both Ministers of State know, people may have to travel 20 or 30 miles between care homes. When their hours are added up, the number of hours they have actually spent in the household giving care is small compared with the time spent travelling. There needs to be a pathway for recruitment and better job progression to try to attract people into the sector. I welcome the work the Ministers of State are doing in regard to the strategic advisory group and ICPOP and also mandating an increase in pay to €12.90 per hour and the payment of expenses. All of that is progressive but beyond that, we need something further. We need to be able to attract healthcare professionals into the sector. Perhaps we do not even need healthcare people. Community care is often given by people who are not qualified. They do it as part of an arrangement in families. In my case, our mother was cared for at home for two years under such an arrangement. We need to try to attract such people into the sector.

Should we ask the Minister for Finance to provide additional credits? For the money that is paid, there are middle-aged people who might be able to provide five, ten or 15 hours of home care in their own area but will not do so because they will pay tax. Some will end up outside a pension threshold. We need to do something. We must understand that younger people working in medicine will probably not choose to work in the home care model where they work in someone's home. They want to work in the dynamic working environment of a hospital or the community care centre where they can expand their abilities and progress. People who are middle-aged are happy where they are. They have finished their working life and would be happy to get involved. An initiative like that would be the best outcome from tonight.

Deputy Michael Healy-Rae

I thank Sinn Féin for facilitating this excellent debate. More than 907,000 people are currently on a public hospital waiting list. The situation is so severe that hospital consultants are constantly warning that these treatment delays in care could put thousands of patients at risk of dying. Earlier this year, it emerged that a staggering 236,000 people are on separate waiting lists for scans and diagnostics. In overall terms this suggests that as many as 1.2 million people or almost one in every four people are currently awaiting hospital treatment. This is frightening and beyond belief.

I also highlight what is happening in the constituency I represent. I do not know about the rest of the country but I know a share about Kerry. We all know the best model of care is to have those who can do so stay at home. That is the best place to be if your body is good enough. However, people need help and assistance. That is why we have home help hours. In Kerry people are being allocated home help hours of one hour a day or half an hour or three quarters of an hour in the morning or the evening but there is nobody to provide it. I am not blaming the Ministers of State or anyone else for that. I mean no disrespect to anyone coming to this country but there are an awful lot of people coming to Ireland every day. Surely be to God, some of them could work in this sector. Surely some of them would be able to take care of older people. Would they not be delighted with the money? Would it not give them a purpose and a place to go to work? There is nothing wrong with work.

I thank the people in Kerry who work in our district hospitals and larger hospitals. I thank the staff and management from the bottom of my heart for the work they do every day on behalf of the good people in County Kerry.

Deputy Michael Collins

In the west Cork region and nationwide a severe shortage of carers is leaving many elderly people with no option but to go into long-term residential care in nursing homes. This is not their choice or the choice of their families. I am aware of many elderly constituents who are in hospital awaiting discharge but because no home care package has been put in place and due to a shortage of home care staff, they are forced to stay in hospital. This in turn puts a strain on the hospital system, creating a shortage of urgently needed medical beds. As the weeks go by, the recruitment process is getting more and more challenging. Part of the problem lies in the fact that home care assistants are required to have a FETAC level 5 qualification or equivalent. In my constituency of Cork South-West there are no opportunities to acquire this qualification in an evening class.

One idea that should be explored is earn as you learn, which describes a concept combining study with practical experience, thus enabling individuals to gain the knowledge and skills required to pursue their chosen occupation. Similar to an apprenticeship, this concept gives the participant the opportunity to gain practical skills in the workplace while earning a wage but also to study towards completing a FETAC or QQI level 5 qualification. I envisage that an apprentice would accompany and shadow a qualified home help on her daily visits to patients, while at the same time freeing up another qualified home help and in this case increasing the home care workforce.

On many occasions when we inquire about a home help for someone, we are told there are no home helps or hours available and then we are told by the home helps themselves that they can do extra hours but will not be given them. Why is this going on within the HSE? Respect would go a long way with home helps because the reason we can get no home helps in many cases is the roster. They need time off but instead they have an hour here and there, day in and day out. In many cases, they do not get a couple of days off. This will not attract young people who would love to do home help but would like to go out a night or two when they are off.

All is not well with home helps but a great deal could be done if everyone was willing to work together towards a solution. This crisis is a national emergency for all of us.

Deputy Danny Healy-Rae

I thank Sinn Féin for this highly relevant motion on an issue we are all concerned about. Elderly people have a natural desire to stay in their homes as long as they can. It would surely benefit the State if they could be treated and minded in their homes as they should be. Many elderly people have a fear of going into a nursing home or a long-stay hospital bed because they fear it is the departure lounge they are going into. They dread that.

There is humanity in people. I have had several people call me to say they have been allocated home help but there is nobody coming out. Family members are also ringing. They are doing their best to keep their elderly relatives at home. I have suggested asking these new arrivals into our country from Ukraine or wherever. People with cars and those with good English should be enticed or at least asked. Goddamn it but they have two hands, two legs and a head like we do.

I worry when elderly people go into hospital and family members cannot go into see them, as has happened. It broke my heart during Covid-19. People died alone in nursing homes and hospitals while their relatives could not go in. I can honestly say that some of them died of hunger because there was nobody to spoon the food into their mouths. That actually happened and I know it. If I am driven to it, I will tell where it happened. I only talk about what I know about. Do not impose restrictions on family members going into hospitals or nursing homes any more, for any reason.

Deputy Carol Nolan

We still have huge issues in the constituency of Laois-Offaly in regard to home help. I am aware of many cases where an elderly person is trying to care for a son or daughter and a home help is out sick. We can all be out from time to time but when there is no replacement for the home help, people are let down very badly.

Something needs to be done in regard to recruitment and retention. If we are to address recruitment and retention issues for home carers, we need to offer better pay and conditions. Mileage, which has been brought to my attention, is a huge issue for home helps. They are doing fantastic work but they are stretched. There are not enough of them. That is the issue and I would like to see it addressed. In community healthcare organisation, CHO, 8 the plan is to deliver more than 2.3 million hours of home support this year, of which 580,542 hours are planned for counties Laois and Offaly. Unfortunately, the reality is much different.

I commend the Carers Association of Ireland and Family Carers Ireland. The latter has pointed out that caring for people in their own homes and maintaining their independence and dignity are important. This is what people want and value and it saves the State money. If pay and conditions were addressed and more home helps were recruited, we might get somewhere.

Deputy Richard O'Donoghue

Some €2.4 billion is being paid to disability services.

Will that fix the massive problem with disability services? How many more people per day have been seen by a case officer or consultant? What service agreements are in place? Are we getting value for money?

The issue around disability services comes from not having a level playing field. Organisations such as St. Joseph’s Foundation, Enable Ireland and St. Gabriel’s Foundation are voluntary agencies funded by the Government. As a consequence, they are constantly competing for the same staff who are acquired by the HSE, where there is a proper progression system.

Other Deputies in the Independent Group spoke about home help. I spoke to a young mother who is a home help. She gets one day off a week in the middle of the week. She works seven days and then gets one off because the organisation she works for is competing with the HSE whose staff are being paid more money for doing the job. The likes of St. Joseph’s Foundation, St. Gabriel’s Foundation and Enable Ireland are possibly doing double the work for less money. They are doing much more on the ground and they are voluntary organisations. Their staff are getting paid less, getting less mileage and everything else and there are fewer improvements in their systems. However, they are doing more work. These people do Trojan work around the country. However, staff are being snapped up by the HSE after being trained by those agencies. That is a big problem. We need to look at recruitment and also retention within those services. They need to be paid well for what they do, the same way HSE staff are being paid.

Deputy Joan Collins

I thank Deputy Cullinane for tabling this motion on home care. It is important that this crisis in home care be discussed openly and as often as possible. It is one of the many areas of healthcare that are affected by the recruitment and retention crisis and it is playing havoc with people’s health, particularly that of elderly mothers and fathers.

I support the 12 demands set out in the motion calling on the Government to resolve the issue, particularly the demand to "modernise the tendering and funding model for providers of home care to prevent a race-to-the-bottom in costs and quality, to be underpinned by a collective agreement on employment standards in the sector that ensures a level playing field, high care standards, and fair remuneration for workers." I also support the amendment from the Social Democrats, which "further calls on the Government to set out, before the 31st December, 2022, a timeline for full implementation of the 16 recommendations in the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants".

A woman contacted me last November when a home care package from the company Care for Me, which had been place since May 2017, for 31.5 hours per week was suddenly withdrawn on 17 September last year. No other agency took up the care package due to lack of capacity. The daughter was given a list of agencies to ring herself to see if she could source private care. Around the same, a number of people rang into a well-known radio show on RTÉ with similar heart-rending stories. She had to get family and private care, etc., to help keep her mother at home. This case was raised with the Minister. Throughout December and into January, the daughter was left abandoned to care for her mother.

I have also just recently been contacted by one of the hundreds of families who have been given caring hours but cannot access them. The email I received was from a daughter, whose name I will not give. She wrote that the biggest problem she has is that her mother is very unwell and in chronic heart failure. At this point in time, she continued, her mother is getting quite anxious and distressed and desperately wants to come home. All the family is asking is that somebody can come in the morning to shower and dress the mother and in the evenings to help her get ready for bedtime. The 21 hours have been approved from the HSE. Surely, she asks, it is in the interest of the HSE not to be paying huge expenses in a nursing home when all the family is looking for is 21 hours. At this point in time, it is a matter of urgency for the mother to come home where she can get palliative care as well. I tabled a parliamentary question on this issue two weeks ago. Yesterday, I got a call from the daughter saying that the only home care the family could get is from one company that is willing to provide 12 hours. They just cannot manage that and really need 21 hours of home care.

This is only one of many families who are desperately waiting for home care hours to come through. The Minister of State has committed to a great deal but these 6,000 people have been allocated hours they are not getting. The situation the families concerned find themselves in is horrendous. I strongly support the motion.

Deputy Catherine Connolly

I thank Sinn Féin for tabling this motion. I also thank the Social Democrats.

I welcome that the Minister of State commissioned the report of the strategic workforce advisory group and that it was published in a relatively quick timeframe. I welcome the work that went into the report and its 16 recommendations. The Social Democrats tabled an amendment simply seeking a timeframe for the implementation of these recommendations. The Minister of State did not address that. Perhaps I missed it when I was listening in my office. Is that not the most basic thing? The report refers to the international problem of recruiting care workers and the multiplicity of reports. Here we have a pretty good report. I do not agree with all of the recommendations, but I will come back to that. I probably do not have time now but perhaps I will discuss that in another forum. It is disappointing not to have a timeframe for the implementation of the report's recommendations. It would be helpful for trust if the Minister of State could tell us when that will be done.

This Government inherited this problem. There is no doubt about that. This model came from the Progressive Democrats. I had the privilege – or torture – of sitting on the health forum for ten years of my life. I watched the dismantling of the public health service and what Deputy Bríd Smith referred to as the commercialisation and corporatisation of our health service. That process was led by the Progressive Democrats. I do not even hesitate in saying that their raison d'être was to privatise everything and that is what we have now as a result. I think the private-public ratio of nursing homes now stands at 80%:20%. This report sets out the percentage in relation to direct and indirect care and of course the higher percentage is for the indirect care. It was confirmed the Government is paying €27 an hour to companies to enable them to make a profit when that money should be going to direct care. That started with the Progressive Democrats and it is now way past time we changed that. Part of the problem was the model.

Some 96% of carers are women and 43% are over 60. If 97% or 96% of carers were men, this problem would simply not exist.

Deputy David Cullinane

Hear, hear.

Deputy Catherine Connolly

We have tolerated a system where women have been treated very badly. I will run out of time very quickly, but the figures are incredible.

I will finish with the example of Clifden District Hospital. We will always need beds, respite beds and step-down facilities. That it could be contemplated that this facility would be closed is simply intolerable. I know things have progressed a tiny bit but we were given many different contradictory excuses, such as that hands were tied by the union, there was a lack of staff and a lack of demand. Yet, all of the time, there were beds in the hospital being occupied.

Deputy Marian Harkin

I thank Sinn Féin for tabling this timely and important motion. For many families, this is a priority. Indeed, many families are trying to provide home care either part time or full time and they find it exceptionally difficult to do so. Many are struggling. As more and more people live longer and demand for home care increases significantly, this is the issue. Everybody wants to remain in their own home. We want it for our parents and elderly relatives and we will want it for ourselves. This is the problem we are facing.

It is great to see the Minister of State this evening. In her intervention, she stated she had increased home care hours. However, she also said demand is increasing at pace and, despite the progress she has made, many people and their families are still unable to access the home care they need to support them.

I commend the Minister of State on her action in regard to the new tender for private home care providers, which she said will include the payment of the living wage and mileage allowance.

I fully endorse the remarks of my colleague, Deputy Connolly, in that regard. It is totally unacceptable, however, that home care workers travel from home to home, sometimes long distances in rural areas, without payment for mileage or an allowance for the time spent travelling. Caring and home care are valuable work and salaries and conditions commensurate with their value must be paid. If that is not done, they will continue to be undervalued and people - men and women - will not enter the profession. I agree it is an overhang of the fact that caring was seen as women's work, carried on behind closed doors. That is the reason salaries are so low. Caring must be seen to be, and be, a fulfilling career. Right now, that is not the case.

As many Deputies have stated, the reality of home care in many cases is that even when a package is allocated - and it is not easy to get an allocation - perhaps of half an hour in the morning and half an hour in the evening, there are no carers to do that work seven days a week. A person might get four or five days. There is often no cover for holidays, such as bank holidays, or if a carer or someone in his or her family has Covid. In many cases, that is the reality and there are many families who are really struggling.

The programme for Government committed to the introduction of a statutory scheme to support people in their own homes. I could be wrong but my understanding was that such a scheme would be in place by the end of the year. When will that scheme be in place? When will there be an entitlement to home care? When will that be put on a statutory footing?

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

I thank Sinn Féin for tabling the motion, which also gives me a chance to speak about disability services. My colleague, the Minister of State, Deputy Butler, will be issuing a timeline in respect of the strategic workforce advisory group recommendations and has already commenced work on some of the recommendations. I acknowledge the input of all Deputies who contributed. It is clear that we all have a strong desire to ensure those who need a safe and regulated home support service in a timely manner have access to it.

I will speak first about what the Government is doing to address some of the immediate challenges we face and then speak more generally about what the Government has achieved so far, with all the extensive reforms that are taking place. Home support is a priority for the Government. The population is growing and ageing, and that means the demand for home support services increases every year. I am pleased to state that funding has kept pace with this demand. As noted by the Minister of State, Deputy Butler, we have provided an additional €200 million for home supports since 2021. This is a 42% increase. Next year, the overall budget will be in excess of €700 million. This will go towards progressing the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services. It will also deliver approximately 24 million hours of home care in 2023, more than ever before.

The Government is working to ensure that people with disabilities are enabled to live an independent life of their choosing, just like any other person, in line with Transforming Lives, the disability reform policy. Year on year, the HSE has consistently increased the number of hours of personal assistant, PA, service delivered to people with a disability. The national service plan for 2022 outlines the HSE's commitment to deliver 1.7 million hours of PA services to 2,587 people. I sought a sixfold increase in the budget of 2022 to ensure we would have such funding for it. This reflects an additional 120,000 hours of PA services in 2022 to expand and enhance supports for people to live self-directed lives in their own communities. This is the single biggest increase in PA hours in the past ten years.

It is not often that I agree with Deputy Bríd Smith but it is important that we reflect on her portrayal of how home care should be delivered. It is how I envisage it within disabilities. Deputy Nolan also spoke in the same vein. It is about giving hours to family carers so that they can support people within their communities while they are awaiting more long-term supports. When people are discharged from hospital or if there is a need or an acuteness within a family setting, they would have a blanket number of hours to support families with disabilities in that manner.

However, it is increasingly difficult to find workers to deliver all this care. Having listened to the commentary this evening, I make the point that it is not just the section 39 organisations that have an issue; the HSE also has an issue in this regard. I make the point to Deputy Cullinane that what I have tried to do in recent months is to look at the whole framework. In the context of disabilities, if it were possible to abolish the current framework, I would throw that framework out the door, start again and make all the recruitment agencies take responsibility in the context of certain things that when we have on the critical skills list, such as a required standard of English, and also the qualifications needed to deliver of PA and home support in disabilities. That work in respect of the skill sets should be done when the provider or recruitment agency is seeking staff abroad rather than when the staff arrive in Ireland or when there is a time lag on it. Another reason for abolishing the whole framework piece is that it is restraining us from making progress. The whole tendering process in that regard is too much of a quagmire. If it was abandoned, and given that we know the requirements in delivering PA and home support within disability, we would see a sizeable cosmic shift in that space. It is something on which I am working with the HSE. It is slow to move but we will get there.

As regards pay and conditions, it is important to recognise that one of the recommendations is for rolling recruitment campaigns by the HSE but, even though the terms and conditions are better, the HSE is struggling to recruit. That is why I speak about the family carers model. It is closest to home for the delivery of care. The Minister of State, Deputy Butler, and I have discussed ad nauseam the possibility of the HSE providing that care in as close a circle as possible. Rather than people travelling 20 miles or 30 miles to deliver care, there would be a far more structured and streamlined delivery of care and it would be far more manageable. It is the way that home care was done back in the day and there were far better outcomes from it.

Preliminary data for September show there are 6,255 people assessed and awaiting a carer to become available and seven people waiting for processing for funding approval. From that, we can see that funding is not the issue; it is actually manpower on the ground. It is important to note that the number of people waiting across both categories was reduced from 9,000 to 6,226. The current waiting lists are predominantly made up of people who have been approved for support but are waiting to be assigned a carer, so it is clear that funding is not an issue.

On the reform of home care supports, the programme for Government commits to the introduction of a statutory scheme to support people to live in their own homes, which 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 that all service users are provided with high quality care. This will comprise primary legislation for the licensing of home support providers, regulation that will set out the minimum requirements a provider must meet to obtain a licence and, last, the HIQA national standards. We have to remember we are delivering this in people's homes. We do not need to over-regulate it from a HIQA point of view, such as requiring that door frames have to be a certain width before we can send in a provider. We have to be realistic, agile and pragmatic in our support. The heads of Bill are currently being drafted by the Department with a view to bringing the Bill through the Houses of the Oireachtas at the earliest opportunity. Regulations are at an advanced stage.

Throughout the development of these regulations, the Department has sought full participation of home care providers, trade unions, NGOs, international colleagues, academics, health and social care professionals, families and, most important, the service users themselves. For example, in August the Department completed a public consultation on the draft regulations. A report on the submissions received is currently being compiled by the Institute of Public Health and will be published shortly. The findings from the consultation will inform amendments to the regulations. This will ensure the regulations are ambitious but achievable.

Moreover, they will put the welfare of the service user at the centre of everything they do. In addition, HIQA is developing standards for home care and home support services that will go out for public consultation early next year.

In parallel to the work of the statutory scheme, a modern needs assessment tool, the interRAI, will be introduced nationwide to determine the prioritisation of the levels of care required. The Department and the HSE have developed a comprehensive operational model for the roll-out of the interRAI tool. This will facilitate efficient, fair and transparent care needs assessment and planning and appropriate service delivery. There has been significant progress in this area and the recruitment of 128 interRAI care needs facilitators has commenced. The HSE is also testing and learning how best to roll out the interRAI through the pilot that is under way in four sites throughout the country. The evaluation of the outputs from the pilot sites will soon commence. This will be critical to the development of a new home support scheme.

The HSE is undertaking a recruitment process for a number of key posts to support the establishment of a national home support office. Funding is provided for 15 full-time jobs, including community healthcare organisations and home support manager posts. A proposed location in Tullamore is currently being explored by the HSE. While we are seeing good progress in the area of home support, all these investments in home support reform will take time to deliver. They are essential, if we are to see sustainable improvement. The proposed reforms are about ensuring that appropriate, high-quality, regulated and safe care is delivered to the population in accordance with the Sláintecare model.

On Deputy O'Donoghue's point on St. Joseph's, St. Gabriel's and Enable Ireland, it is important to again say that while I appreciate that funding is an issue, in this case, the issue is in fact trying to get people and the training of personnel. As Minister of State, I allocate €33 per hour to the HSE; that is not what is paid to staff who are delivering the service. It is time that a living wage is provided to people working in the home care sector. We need to make it attractive. We also need to encourage people who live locally to come back into the sector in order to build that relationship that was spoken about.

Deputy Paul Donnelly

I welcome some of the comments made by the Minister of State on pay and conditions. When we were growing up, we all considered our parents as resilient and reliable people who provided for all our needs and comforted us in all our worries. As we become adults and, in some cases, parents ourselves, we realise the hard work and selflessness that goes into being a parent. We must and should be able to provide a good quality of life for our older citizens and parents, who choose to live out their lives in their own homes and communities in a home they have worked hard for. Many of our older citizens are rightly proud and wish to continue to have that independence of living in the home they have lived in, in many cases, all their lives, and most of the decades of their married lives.

As of July 2022, there are more than 5,000 older people on waiting lists for home care assistants, an increase of more than 10% since January. Almost 10% of older people approved for home support have no carer. No carers are available for them because there has been a failure. There is a general sense that people and our older generation have been let down. Some of them are the most vulnerable in our society. The lack of home care positions is also having a knock-on effect on our hospitals and nursing homes.

In the event that families are lucky enough to have home care in place, in most cases, the hours fall far short of the needs of the people home care assistants are caring for. There needs to be a major investment in recruitment and training in the home care sector. We need a pay agreement. I again welcome some of the comments the Minister of State made regarding a living wage and people getting paid appropriately. It has been and is disgraceful that there are carers who are only paid for the hours they spend in people's homes. I know that first-hand because I have spoken to a number of carers who come to my mother during the day to help her. When we think about it, as the Minister of State said, if one carer, for example, visits my parents in East Wall, he or she may then have to travel to Ballybough and then back to Sheriff Street, or may have to go to Summerhill. Carers do not get paid for all that time they spend travelling, which is absolutely outrageous.

The Minister of State said that she supports the majority of our motion but it is disappointing that she has tabled an amendment to it. It is important we implement what is required to help and support all the people who require help.

Deputy Brian Stanley

Sinn Féin's proposal is to ensure that older people and others who need home support have it, and can stay in their own homes and be cared for there. As the Minister of State said, we have more than 6,200 older people on waiting lists for home care assistants. That is an increase of approximately 11% this year. We also know that many more people have far fewer hours of support than they require. I compliment the Laois-Offaly Carers Association on the work it does but the lack of community care alternatives has left approximately 7,000 to 10,000 people as delayed discharges from hospitals. That is not good enough. We need to increase the number of step-down beds to allow for a timely discharge out of acute hospitals. In this context, it is essential that all 28 beds in Abbeyleix district hospital, which is a matter I have raised with the Minister and the Ministers of State in the Department of Health in the past, are opened without delay. The fact that 21 beds have not been brought back into use more quickly is a scandal.

A 2018 review forecast an 120% increase in the demand for home supports by 2031. Some of that demand has already been reached and is expected to grow. The shortage of home helps is pushing elderly people towards private nursing homes and acute hospitals when they should be in their own homes. Home care is the most cost-effective approach and is also the best for elderly people. Sinn Féin is calling for a proactive and strategic approach to be taken to workforce planning. This is key right across the health and social care sector. We need to train and hire more home carers. The advertising of those positions is an issue I have highlighted to the HSE in the recent past. It is something the Minister of State might look at.

This Government and previous ones have failed to plan for a sufficient workforce pipeline to address this. As the Minister of State correctly said, we also need to address terms of pay and conditions, which have harmed recruitment for home helps. Some 62% of home care is now delivered by non-HSE providers at a cost of more than €400 million in 2021. The use of agency staff has been shown to be more expensive - the Minister of State will have to agree with that - than providing care directly through the HSE, which means better-quality care and better conditions for workers. The over-reliance on private home care providers instead of investing in our public services is poor value for money. We need a new pay agreement for the sector. We must advance vital regulations for the sector and workers in it, modernise social care and improve pay and conditions. Sinn Féin's proposals are designed to improve that sector for workers and the elderly. I hope the Minister of State will take them on board.

Deputy David Cullinane

I thank everybody who contributed to this debate. I also thank both Ministers of State for their contributions. This is one of those areas where we all agree on most of what we are saying. We all agree that people, in the first instance and where possible, should be cared for in the home and that those people doing the caring should be better looked after. It then becomes an issue of speed of delivery, and the reforms and changes that are necessary, in addition to political will.

I welcome the Minister of State's commitment to include in future tendering documents the matter of the living wage for all those who will provide home care, but the question has to be asked why it has taken so long. We have raised the issue of pay and terms and conditions of employment for a long number of years. It seems it is only when it gets to a point of crisis that we are then forced to act when these have been issues for many years. In fact, even the living wage will not be enough in the medium to long term, given the level of work that needs to be done.

I will focus on what the motion actually calls for because it is important that whenever we sit in this House, we do our best to implement changes that we have collectively agreed to, in some instances, or that we may not have in some areas. The Government has agreed to bring forward legislation in the form of the health amendment licensing and professional home support providers Bill, which needs to be expedited, as well as the regulations that are in draft form and will provide a regulatory framework for this sector, which I want to see. That needs to be done as quickly as possible. The programme for Government also committed to a commission of care. That still has not happened.

The logic of that commission is to modernise the home care sector and to better align care, from home care or care in the home to family carers and, then, to nursing home or residential care and palliative care, so aligning all the different strands of care and looking at how we integrate and align all those models. A commission on care would be an opportunity to do all that.

The Minister of State, Deputy Butler, when presenting her countermotion, talked about the ICPOP teams. I fully support those teams. Not all of them are up and running. We need to make sure they all are. In fact, we need more of them because they will be crucial as we roll out a statutory home care scheme and more people with more complex needs are cared for in the home.

One of the things we need to do, as part of new regulations, is to introduce and to integrate safeguarding into the standards and regulations. We need stand-alone adult safeguarding legislation across all strands of care. That came up in the area of nursing homes. I know HIQA has talked about it for some time. Safeguarding for both adults and children is very important, and I want to see legislation in that area with HIQA as the regulator, certainly in the short term.

There is a commitment to home support offices as part of the statutory home care scheme. I advocate that we would have a regional office in all the regional health areas. We now have to look at policy from when we establish regional health areas. That will be a game changer, and everything we do has to align with that strategy. I would like to see regional home support offices, as opposed to one central office, put in place if possible.

We need to develop a career pathway for carers. That has to involve a greater role for nurses, physiotherapists and allied health and social care professionals. That multidisciplinary model of care in the home will be crucial if more people are to be cared for.

We need to do more regular audits and reviews of those who receive care. That means in some cases people will need more or less care, but that is a better way of ensuring we use the resources we have in the most effective way.

We have to increase funding of home support, which includes adaptations of homes and all the other things people need to be cared for in the home. It is not just a carer. Sometimes it can be housing adaptation grants, personal assistance or wraparound services.

The motion calls for a lot more than that. Very often the Government says we do not bring forward solutions. It cannot say that when it comes to this motion. Again, I thank my colleagues, those in government and those in other Opposition parties, for their contributions.

Amendment put.

Acting Chairman (Deputy Alan Dillon)

In accordance with Standing Order 80(2), the division is postponed until the weekly division time on Wednesday, 9 November 2022.