Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

There is a hybrid model in operation involving public, private and voluntary actors. Let us consider the value for money argument. For example, let us suppose every penny spent by the HSE was invested in front-line care.

The same would be true of voluntary bodies, most of which are run on a shoestring and they do not have fancy offices or cars, though the large private agencies have shiny corporate headquarters and all that goes along with that. According to the Department of Public Expenditure and Reform, the average cost of a home help hour is €24.20 but it is considerably less for the HSE to provide it directly. What accounts for this increase? Ms Spillane said that private providers were responsible for 40% of care so are they exerting an undue influence? I have heard figures of up to €40 per hour but I presume that is for specialist intervention. Can the witnesses comment on the question of value for money in this regard?

On the question of regulation and standards, we are all looking forward to many happy years of retirement so we all want sufficient checks and balances to be in place for a time when we are more vulnerable. Regulation would be much easier if there was one single employer. Mr. Deegan referred to regulation by service level agreements. How do these work? I know how the system works when one applies for the tender but how does it work from the point of view of regulation?

Dr. Long said that Scotland had double the budget with a similar population. Can she talk about the model they use in Scotland and the mix between residential care and home care? If Scotland spent more on the latter, the assumption must be that less would be spent on residential care. Every euro invested in home care is money that can be spent on where people want to be for as long as possible, which is in their own homes. If Scotland spends double what we spend does it mean there is a corresponding increase in the provision of the service or is it that they just provide more hours while having less in the way of informal caring or a lower dependence on carers allowance? A lot of people get carers allowance but many do not and if those people were to declare a one-day strike, this country would come to a complete standstill. They are not paid, formally or informally, but they get on with their work. Does Scotland supplement these people to a lesser degree because of the greater investment it puts in?