James Browne (Wexford, Fianna Fail) | Oireachtas source

I welcome the presentations by the witnesses. I have a few questions. On the issue of agency work and privatisation of health care in that sense, a considerable level of home care help has been handed out to agency workers. The HSE pays €33 or €34 per hour for this work but the staff providing that care often get barely over the minimum wage. There seems to be a serious level of inefficiency there and the public are not getting bang for their buck when we know the amount that is being paid by the HSE and the amount that the workers are being paid. Is that practice purely a reaction to meeting the demand for the service or is there an ideology in the HSE to drive on privatisation, with work in this area being an example of that? Tied into that is the issue of monitoring, we are seeing an increasing drive towards decongregation. Ms Patricia King mentioned that we are five or six years behind what is happening in the UK and I would be interested to read about mental health provision in the UK. In some cases, they have gone too far in terms of pushing people back into the community and we are seeing situations here where facilities are being run down in places like Kerry and so forth. The Health Information and Quality Authority monitors what happens in institutions, as does the Mental Health Commission, but there seems to be very little monitoring of what happens in the community. Many agency staff are good workers but some people have told me that some of the people who have been hired to care for people in their homes are not qualified. I would like to hear the witnesses' comments on that.

Any change proposed by this committee would require buy-in from the trade unions and from the staff but even sometimes when that happens those in senior management leave it at that and think their job is done. To bring staff on board with change management and change implementation, how would the witnesses get the staff, who we know are fatigued as are management based on reports we have heard, to once again take another leap of faith and go along the change proposed? Other countries have a strong collaboration between staff and management and I would welcome the witnesses' comments on that.

We do not want this committee to simply produce another report that will gather dust. Do the witnesses believe that the report that will emerge from our deliberations should be underpinned with legislation? We are heading towards another period of instability in terms of future governments, with more coalitions. If it will take ten to 15 years to implement the report produced by this committee, we need not only a clear plan but to know that it will be implemented. Do the witnesses support the report that will be produced by this committee being underpinned by legislation? They would probably want to see what is in the report first but I would like their comments on that.

On a governance ethical model, do the witnesses consider that there should there be an annual assessment of staff and management in terms of capability or their ability to continue doing their job, or in terms of their professional development, as opposed to the current system where the competence of a member of staff or management tends to be only assessed when something goes wrong?