Mr. John Dunne:

Deputy Naughten raised the matter of consistency. We carried out a listening exercise early in the year. I travelled around the country and I met groups. We asked them whether they noted a difference between the two services. It seems to boil down to whoever is delivering the service. If one had a good person it did not matter what hat he or she was wearing when they went into a house and the reverse applied with a person who was not so good. As Mr. Dillon said, there is a lack of consistent management and as a consequence some of the money is being wasted and better results could be achieved. Mr. Dillon also referred to the issue of standards. The Health Information and Quality Authority, HIQA, has stated it will be unable to regulate home care until 2016. In fairness to the authority, it has been very clear in stating what it wishes to do in the meantime. We would be of the view that we are more important but at least it is a considered position. In the meantime, the HSE has begun to put in place its own framework using this competitive tender and applying standards. The difficulty now is that the HSE is cutting across that. The people who won the right to deliver services based on that tender are now being displaced by home helps who are neither qualified nor trained and to whom these standards are not being applied. The system demands certain qualifications but the staff delivering the care are not qualified. This is a fundamental issue but when I raised it with the HSE the response was that it was hoped to sort the problem in the next year or two. If I said to anyone that I would sort something out in the next year or two, I know what the public sector's response would be if that were to be my defence.

On the question of a statutory right, there is a statutory right to residential care but in the current financial climate there is no prospect of a statutory right for community care. For God's sake, legislators have created a statutory right for the most expensive option. If a statutory right for the cheaper option is not created, the State will be condemned to spending money on the most expensive option.

I thank Deputy Byrne for taking the time to read the submission. I was not making a cheap political shot. I made a very deliberate decision that we would put nothing in our pre-budget submission that we could not say how it would be paid for. I refer to the question of the transition period. A carer who has spent a lifetime caring for a person is formally unemployed six weeks after the person dies and the system then forgets about them. It was a question of how to pay this cost. At the time there was the issue of those who had been county councillors who had to forego the dual mandate and were compensated. To be clear, we did not say that those payments should be abolished. We simply argued that a very small allocation from the pot would pay for this transition. I do not apologise but it was not a cheap shot.

On the question of why full-time carers want a free GP card, the carer's strategy highlights the very obvious connection, which is acknowledged by the Government, that carers are doing a job for the State. I do not like the notion that they are working for their social welfare payment. They are saving the State a lot of money. They need their health in order to do the job. Employees, even when unpaid, are entitled to holidays and to a certain level of health and safety consideration. This leads on to the point about physical disability. I can describe a case of a big man who is bedridden and his wife, who is of small build, is the carer. The assessment decided it would take two people to move that person from the bed and the HSE decided it could not spare two people. It left the wife to do it. Patient moving or handling cause physical injury to carers. A body is heavy to move and our system does not even provide training to people on how to do it, never mind to provide help. That is how carers suffer physical ill-health but they also suffer distress and stress.

Carers also suffer in another third way. I can describe a case. A daughter who cares for her mother needed to go into hospital. She was advised to bring her mother to the accident and emergency department and to leave her there. We intervened and the matter was dealt with in a different way. In such situations it is often the case that carers will not go into hospital. They will put their own care on hold and in the long term, the health of both people collapses.