Mr. Justin Moran:

I will take the questions in the order in which they were asked. When the Chairman asked how we maintain standards, the first word that came to my mind, and which was raised by Senator Burke, was "training". This is an area in which the Migrant Rights Centre of Ireland has done some work with home care workers, highlighting some of the challenges they face. Some challenges concern employment issues and zero-hour contracts. Senator Conway-Walsh referred to the issue of people hurtling across the country to try to deliver even 15 minutes of home care and then hurtling away somewhere else. What could be done? We could try to support training for home care workers, particularly as an increasing number of people with increasingly complex needs will be at home. We have come across care workers being put in a position where they are being asked to do things they do not believe they are fully trained or able for. I do not have figures for the Irish context in this regard. In our research, we came across an NHS briefing paper that highlighted that 60% of the NHS training budget went towards what could be described as the most highly skilled professionals, including doctors and nurses. Not nearly as much money went to the care workers, the health care assistants and people providing hands-on care.

With regard to maintaining and improving standards right now, the issue of training is critical. This relates to the point Senator Conway-Walsh raised on the limited amount of time available. If one has 15 or 30 minutes in which to get somebody up in the morning, there is no chance of building a relationship with that person. It can also be quite harassing for the older person. One has to get that person into the shower and usher them along the whole time. This can be quite pressurised. We need to do more to support workers and improve the process for the recruitment and retention of care workers to ensure caring is seen as a valid career path with training and professional development. If we can achieve this, and if the care workers have the time to deliver the service, we will see standards increase, as referred to by the Chairman. As I stated, the Migrant Rights Centre of Ireland has done work on this. I highly recommend it to the committee.

Regarding Senator Kelleher's point on political will and the period of two to three years, obviously we would prefer to see progress made sooner but we would prefer the job to be done right more than anything else. If it takes two to three years to develop a statutory scheme for home care that is effective and deals with the issues highlighted by the other members of the committee, that can be lived with, as long as it is not pushed on further. That is the medium to long-term solution. The crisis in home care is happening now. This was raised a couple of times by people talking about their experience of constituents coming to them and the question of how serious it is gaining access to home care.

When I talk about the political will expressed in comments of politicians and political parties suggesting they support home care, I always regard the October budget as the real representation of political will. Maybe this is a little cynical. The budget shows where money goes and does not go. Professor O'Shea, who was talking about budgeting earlier, was highlighting that, in general, based on taxation, which is how we are providing funding at present, we have seen community care cut back. To have greater representation of political will, as raised by Senator Kelleher, we would like to see more money invested in home care supports and home help hours. We would also like to have further clarity regarding where the money is going. Senator Conway-Walsh raised this. As I said in my presentation, there are very wide differences between community health organisations. The average member of the public could not tell one what a community health organisation is but, depending on which side of this CHO boundary one meets, one could get the care one needs. If one is on the other side, one does not get it at all. Although the money is going to the CHOs, it is a question of how it is being spent. It would be great to achieve clarity on that. If there is something the committee could focus on seriously while we are working on making progress on the statutory scheme, in addition to funding and transparency over funding, it is the expansion of reablement programmes. Three or four years ago in north Dublin, the HSE carried out a pilot study on reablement.

I could be wrong, but I believe that approximately 200 older people in acute hospitals were assessed as needing home help hours. Instead of getting home help hours, they went through a six-week reablement programme with very intensive supports, including occupational therapy and physiotherapy. It was like teaching the person how to live independently again. When the reablement programme had concluded, 80% of those older people were assessed as needing either no home help hours or fewer hours. The programme has also being rolled out in Glasgow and there is a very good case study, which we highlighted in our pre-budget submission on health. We have a successful HSE pilot programme in north Dublin. Could this be expanded and run on a national basis to see whether we can deliver reablement and, as a result of this, reduce demand for home help hours and free up resources?

I have addressed Senator Conway-Walsh's points on the issues of time and where the money is going, and the need for social interaction raised by the Acting Chairman. To go back to Senator Mullen's point, perhaps my colleagues have better information on the number of carers. The participation of organisations such as Family Carers Ireland and Care Alliance would be very important in the committee's deliberations and in the context of its work. They would be able to deliver a very informed perspective on it. Senator Mullen spoke about the experience of a carer coming in and stating that this is what he or she does and this is what he or she does not do.

Funding is critical. We support lot of the arguments made by Professor O'Shea, but what are we paying for? Earlier, a departmental official said people are willing to make contributions but for what are they making contributions? What do we mean by a statutory home care scheme? What does it actually mean? Is it home help hours or home care? What is the role of assistive technology? Will it deal with personal care or household tasks? We definitely need to deal with the issue of funding because if we do not, we will end up with a statutory scheme that delivers nothing.

We also need to develop a very clear idea that when we use the phrase "home care" everybody in this room and everybody applying for it has a very clear idea of what it actually means. For example, a standard home care basket, whatever that might be, might be free, but contributions might be paid for personal care services. This was being discussed as one of the Health Research Board's comparisons. I am a 39 year old man. If, in three years' time, I am told I must start paying a social insurance contribution towards long-term care, I would not have a problem with it. However, I would really like to know what I will get when I reach the age when I will be looking for that long-term care. Something that has always struck me is when consultation for the statutory home care scheme was announced and launched by the Department, all of the coverage in the newspapers the next day was about payments, how it will be paid for, whether it would be means tested and whether there would be co-payments or contributions. These are critical parts of the discussion, but we also need to know what we will pay for as well is how we will pay for it.