Mr. Ed Murphy:

I thank the Chairman and members for inviting HCCI to address the committee. My name is Ed Murphy and I am a director of HCCI. I am joined by my fellow director, Mr. Ed Crotty. Ms Orlaith Carmody is our independent chairperson. She sends her apologies for not being present. She is fulfilling a long-standing engagement abroad.

Home and Community Care Ireland, which was established in 2007, is the representative body for private home care providers, with more than 70 members, employing an estimated 12,000 home carers and providing care to more than 20,000 clients. Some of our members are locally owned and managed home care providers and others are Irish branches of established international home care franchise organisations. As a consequence, some HCCI members have a network and exposure to international best practice.

HCCI is governed by a board of six member directors and an independent chairperson. One of the greatest challenges facing our economy is our ageing population, as Mr. Healy said. Every 15 minutes someone in Ireland turns 65 and every 30 minutes someone turns 80. In light of the health service struggles with long hospital waiting lists and the Government’s stated policy of removing bed blockers by promoting more care in patients' homes, there is an unprecedented demand for home care services. According to the ERSI report, Projections of Demand for Healthcare In Ireland 2015–2030, demand for home care will increase by 50% in the next 11 years. The Department of Health acknowledges that it is unable to keep up with demand. Approximately 4,600 people are on waiting lists for home care, including new applicants and those waiting for additional hours.

While the fair deal scheme obliges the State to provide nursing home places for eligible people, home care is allocated on the basis of resources, which means many people take up a nursing home place because they cannot afford or access home care. This issue was highlighted in the 2017 RTÉ documentary, "We Need to Talk to Dad", by broadcaster Brendan Courtney. A poll carried out by Amárach Research in light of the documentary found that 85% of people wanted to be cared for in their home.

On care workers, we estimate that 40,000 people are employed in home care across the public, voluntary and private sectors. However, the sector is facing enormous problems retaining carers. Owing to working conditions and a lack of professional respect we are faced with the impossible task of finding 25,000 new carers as a matter of urgency. There is a global crisis in home care, with a recent BBC "Panorama" programme suggesting that 1 million new carers will be needed in the UK over the next five years. This is confirmed by our partners in these markets. Home care in Ireland is facing a crisis and urgent steps need to be taken now. Currently, there is no regulation in the home care industry. In the absence of regulation, HCCI is the only body that submits to independent auditors and operates a self-governing framework. The HCCI approach is based on providing a fully managed, relationship and outcome-based home care service to every client who needs it. Every client is professionally assessed and monitored on an ongoing basis. Every carer is Garda vetted, trained, insured, managed and supervised, thereby ensuring the highest standards of care for the client. In addition, HCCI believes it delivers value for money to the taxpayer and is committed to continuing this practice.

The immediate concerns of the industry, as identified by the Oireachtas Library and Research Service, are a lack of regulation and standardisation of home care services throughout the country, which are urgently needed to safeguard the most vulnerable members of our society. In light of this, HCCI is calling for the following measures to be adopted. First, we would like home care be provided on a statutory basis, mirroring the legal entitlement to funding for long-stay care available through the nursing home support scheme. Second,we would like the establishment of an independent authority, such as HIQA, to implement regulation and standards and to drive quality and safe delivery of care to home care clients. Third, we would like a change to the currentHSE commissioning procedures to allow care workers operate a workable block weekly schedule, with travel costs included. Many carers also need support from the Department of Social Protection. Currently, if carers work just half an hour or one hour per day, as often occurs under current commissioning practices, they lose their full daily social welfare entitlement. The rules regarding social welfare entitlement need to be seriously examined. Fourth,we would like the introduction of a national register of trained and qualified home care practitioners, which protects both carers and clients. Fifth,we would like the current budgets for nursing home care and home care to be combined. This would enable the HSE to offer expanded home care packages to clients and the opportunity to live independently in the dignity and comfort of their own homes for as long as possible. Sixth, we would like nationwide implementation of client-directed home care, CDC. This has been successfully implemented in many countries and would involve offering a monetary contribution towards an individual’s home care needs, allowing him or her to choose a provider, public, private or voluntary and to also choose their own person-centred health care plan and schedule, which gives much greater satisfaction levels, as evidenced abroad, and is a proven way of getting people out of hospital quicker. All these points are expanded on in HCCI’s position paper, which members will have received, and is additional reading material to this presentation.

HCCI stresses that recruitment and retention of workers is in crisis in the home care sector. We welcome the opportunity to offer insight and to co-operate in bringing urgent change to bear on the legislation, regulation and commission of home care services to significantly expand the workforce. We thank the committee for the invitation, which is particularly timely as the 2018 HSE tender for home care services is live. Should these services be renewed under the existing arrangements, none of the recommendations we have set out to provide governance and significantly raise standards of service to vulnerable clients will be implemented for the next few years, thus deepening the crisis. As public representatives, members need to be aware of this and do all in their power to prevent the situation from worsening. Every citizen who is ageing, or who has a care requirement, should have the right to remain with dignity in his or her own home for as long as possible, which is what we, and every Oireachtas Member, would expect as a minimum standard for our own parents or loved ones.