Mr. Ed Murphy:

I got into the sector about eight years ago because my mother needed a particular type of home care when she lived in Wexford but her needs were not satisfied by the prevailing system. I have worked in the sector eight years and I am passionate about it. I have taken thousands of people out of hospitals and nursing homes and looked after them for long periods until death. Our care model is not the old style home help. We provide a more managed and professional service which deals with the complex needs of older people in their homes.

We examined the following challenges and opportunities and commissioned an independent report that was published in March 2013. The report found that more people will need support as the elderly population increases. Between now and 2021, the number of people over 65 years is set to rise to nearly 800,000, a 40% increase on 2006 levels. The Central Statistics Office produced a startling statistic that between now and 2026, which is 13 years, the amount of people over the age of 75 will double from 207,000 to 414,000 people. If we are experiencing problems now then they will double within the next ten to 12 years. As the population grows older people will require support. Dependency rates are projected to increase from the current level of 16% to over 24% by 2012. Therefore, thousands more people will need care.

The current cost of HSE section 39 funded home care is 30% more expensive than private sector rates. The report also found that €117 million could be saved each year if all home help and home care package provision was outsourced via tender for an open and honest commissioning of services.

An additional saving of €256 million per year could result if 30% of patients with low and medium dependency under the fair deal scheme were provided 21 hours of intensive care at home under an enhances home care package. In other words, additional savings could be made if the fair deal scheme was opened up instead of ring-fenced. Many pundits believe that 30% of people in nursing homes would not need to reside there if the relevant care was provided in a home scenario. Relocating 30% of those residents would achieve great savings.

The cumulative savings between now and 2021 should reach €2 billion with a potential of creating 8,600 jobs through reform and growth in the sector. There is a great opportunity for job creation and savings in the sector.

There are four major challenges and opportunities for creating jobs and making savings. The first challenge and opportunity is regulation and professionalism. At present the home care sector is unregulated and Government regulation is unlikely to be implemented until 2016. In the interim my organisation, the HCCI, has dedicated considerable resources to ensure that all of its members undertake best practice recruitment, supervision and training procedures for all employees. The professionalism of home care is a key HCCI objective to ensure trained and motivated staff are given access to career development. Increased regulation and professionalism are also important to ensure high standards of care. It will give medical staff and hospital staff the confidence to discharge people home quicker rather than keep them in hospitals and nursing homes. This is a genuine and real issue and that is why we are pushing for regulation. If we have regulation then we will have standards and with standards comes the proper training of care givers.

With regard to the current home help system, we want to make sure that home help care is not regarded as the lower rung of the ladder and home helps are given a chance to create real careers all over the country. Regulation will mean training at FETAC level 5 which will give people a career and opportunity. I have visited many hospitals and talked to many consultants, GPs or whatever. Their biggest issue with home care is that they view it as being at the bottom rung of the ladder. They view home care providers as being quite unregulated, not necessarily well trained and incapable of providing professional and holistic care in the home. Regulation and properly trained care givers will give confidence to doctors, consultants and social workers to discharge people quicker, and more often, to the home rather than to a nursing home or remaining in a hospital. That is a very important point.

The HCCI seeks two things from the committee. First, recognition of the role that regulation and making home care a profession can play in developing the home care sector as a desirable career. Second, the first national home care tender occurred this time last year but only €50 million was tendered out of the Government's total home care expenditure of €340 million. Most of the money, as Mr. Meldrum has said, centred on not-for-profit organisations under section 39 funding. The Government will re-tender again next September and we hope, with some influence and prompting, that more money will be spent on a tender for home care and in a very open, honest and transparent system that will allow for cost savings and development. We estimate that there will be 30% less in the private care sector which will lead to overall savings of €117 million. Such savings will give an opportunity for growth and about 500 extra jobs can be created immediately when the new home care tender commences.

That is something that can be done now to create jobs. The tender is happening anyway. All we are asking is that the scope of the tender be widened.

The third challenge and opportunity is the fair deal scheme. The fair deal scheme, which provides a funding mechanism for those who receive residential care in nursing homes, currently provides places for 22,761 persons and costs €998 million per annum. There is a significant proportion of persons currently in nursing homes who, with the right support, could be cared for in their own homes, as is their preference and the preference of the majority of the population. With Ireland having 35% more persons per head of population in nursing homes than the EU average, there is a reasonable working assumption that one third of fair deal patients could be better off in terms of well-being if they remained in their home, until dependency requirements increase, and availed of enhanced home-care packages. In addition to it being the preference of most, it is a much more cost-effective way to provide care. The cost of providing care for low to medium-dependency persons with an enhanced home-care package of 21 hours per week compared to a full-time nursing home could save the fair deal scheme approximately €159 million and create up to 700 jobs in the community. While we advocate the movement of many of those in nursing homes to home care, we are fully aware that nursing homes will continue to be required at current levels because of the doubling in the number of those over 75 years in the next 13 years. We encourage the committee to engage with the Joint Committee on Health and Children and the Minister for Health in looking at the review of the fair deal scheme as giving a significant opportunity for job creation.

I will make one point about job creation. We provide care for persons all over the country, both in rural and urban environments. We have 17 offices throughout Ireland. What is important here is that jobs can be created in every parish in Ireland. We, just one organisation, look after seven or eight persons in a little parish where I am from in Wexford. That means we are giving a job of 20 or 21 hours a week to seven or eight persons in that locality. It is keeping the community together. It is keeping the older persons at home in the community but instead of carers having to go to towns to work, it is keeping them working in the parish as well. We are talking not only about creating careers, but about careers for workers in their local parishes in every corner of Ireland. There were many older persons in communities in Ireland who are living alone or whatever and it is a great opportunity to keep them at home and provide jobs for local persons.

The last area of challenge and opportunity is live-in care. We would hope that the committee might help us on this. It is only in the past three or four years that members of this association started providing a live-in service. It is an invaluable service offered by members who are directly employing 400 carers. From a standing start, we are employing 400 full-time carers. There is a significant opportunity to increase these full-time jobs. Unfortunately, our members' ability to continue to offer the service is now at risk due to the unintended consequences of EU employment legislation under the working time directive. While there is an ongoing review of the working time directive at European level regarding the accrual of rest periods and definition of on-call time and sleeping hours, the HSE and employers such as ourselves in Ireland are subject to the Organisation of Working Time Act 1997 and the National Minimum Wage Act 2000 which, upon strict interpretation, preclude affordable home care. If the current regulatory system is not updated to take account of the specific nature of the home care sector, some HCCI members will be forced to stop providing this service and close down with the loss of jobs and home care provision. Failure to address this issue will also force clients to employ. That is what was happening up until now. Anybody who did get home care was employing only black market workers for the live-in needs at a considerable risk to the patient and loss of revenue to the State. HCCI has engaged with the National Employment Rights Authority, NERA, and Department of Jobs, Enterprise and Innovation officials on this issue and is committed to working with the relevant bodies to find a workable solution to ensure that workers' rights are protected and vulnerable clients have access to an affordable service enabling them to remain at home for as long as possible. We would appreciate it if the committee would support us and provide help in coming up with a workable solution on this issue.

Those are the four areas. I do not want to dwell on them but to summarise they are first, regulation; second, the new tender; third, the review of the fair deal scheme; and fourth, live-in care.