Mr. Fiacre Hensey:

We should not flog ourselves to death in respect of standards, regulations and so on. One good measure which has come from the past couple of tenders is the stipulation that carers should have formal qualifications. That began in the 2014 tender process, whereby one was obliged to have completed two FETAC level 5 modules. That increased to eight modules but was then reduced in the 2016 tender process. There is an inconsistency, but things have been done. Many of our members or carers have completed eight care modules, which is a significant qualification. Like the other delegates, we would welcome regulation, but we should not flog ourselves to death for not doing anything because we have done quite a lot. I reluctantly accept that it takes two or three years to come up with a regulation, policy or whatever else, but there are issues that can be progressed in spite of formal regulations not being in place. That will need will and co-operation. We are endeavouring to co-operate with the HSE in various fora to advance things, in spite of regulations not being in place.

There has been a crossover in the questions asked. I reiterate that the availability of carers is the biggest problem across the country in the delivery of home care services. We do not like to call ourselves a voluntary organisation because people then think we do everything for free. Recruitment is crucial for not-for-profit organisations, private companies or more acute business models and the State which is a provider of care through the HSE, but it is currently very difficult for it to take place. I have given the committee the solution and would like to think it has the power to approach the Departments of Employment Affairs and Social Protection and Health in that regard. If we do not move on this issue, it will not matter how much money we put into it. We need to make it an area in which people can work.

On the nature of care, as Mr. Moran and others have mentioned, the limited time period of 30 minutes was rolled out as a cost-saving ploy. Perhaps it might work for medical prompts or something similar, but in general it is not enough time. One hour was the standard amount of time spent with a client and some of us have followed that practice for nearly 50 years. I fully agree with Senator Rose Conway-Walsh that it should remain. It is very important that there be co-operation between the two Departments which as a non-political grouping we have tried to encourage. The committee probably has far more strength than we do to push it forward and it is the biggest thing for which I ask.

A significant change in the home care sector is the running down of the home help budget. There has been a drop of up to 25% in the home help budget as opposed to home care packages. As Ms Jackson said, as a result, one no longer has one to three hours for early intervention care but is forced into the complex 15 or 20 hours arrangement. That does not make any sense because we know that early intervention results in people staying at home for longer for 25% of those in receipt of care if one tracks them back to when the intervention happened. We need to focus on early intervention and not push it aside in favour of more complex arrangements. Things have got a little mixed up. Complex cases should be kept at home with better trained staff and not have to be dealt with in a hospital. If a person reaches a certain stage of deterioration or debilitation, he or she will have to go into hospital, but that process should be delayed, if not avoided. That can be done.

Historically assessments were holistic and took into account which neighbours and family members could provide support. One could then allocated the minimum number of hours because it would be complemented by the efforts of those around the client, but that has largely stopped and now a more formal structure is wanted. I am all for that and it could be done using the common summary assessment report, CSAR, or another assessment tool. In many places we had that holistic assessment. If one's assessment indicated that one needed three or five hours of support, it was very hard to provide that amount of care. We are inundated with requests to get people onto the ladder of care. At the same time, however, we must prioritise complex cases, which is a contradiction.

I take on board what has been said by Professor O'Shea about clients paying for extra hours of care. Historically, there was a means test and people who were able to pay, did so. If there is no money available, clients topping up their number of care hours might be one of the only ways for them to receive sufficient care. The majority of our members do not generally look for that business.

We need regulations and standards because of the inconsistencies nationwide. I reiterate that all of our members would welcome a system under which tenders would be scrapped and there would be some form of accreditation. There would be a list of accredited providers and people who had passed the test which would be available to anybody across the country who wanted it. He or she could select an organisation knowing that it ticked the boxes in terms of compliance and standards. It could be worked out without formal legislation.

The idea of a holistic, person-centred care approach has been done. It is now being piloted as a new idea in community health organisation three, CHO3, in the mid-west. In that approach the client has full say on how the hours are allocated. That is happening. That has been running since about September. If there is a family carer in a household his or her request might be to have a break because if he or she burns out one is in serious trouble. The home help or carer going in would release the person to go and take a walk, go down town, get out, get their hair done or whatever. That is as important in the continuity of care as it is to go in and prompt medicines, etc. I thank the committee very much.