Mr. John Dunne:

If the HSE could get its staff to work for the hours that are needed, in terms of flexibility, and if it could address responsiveness in terms of disciplinary processes and all the rest I would not necessarily argue with that, but it is pretty clear to me at the moment that it would not work. It is not an ideological issue: it just would not work because the flexibility is not there. I attended this committee some years ago talking about a man who was being put to bed at 3 o'clock in the afternoon for the only reason that his HSE worker did not want to work any later. I was told three weeks later that the case had been sorted, but that is the system.

As Mr. Musgrave said, HIQA is the one that has most often been cited to do this but it would probably have to stop at the front door. The problem with that is there is a limit to how much one is regulating the quality of care. On the other hand, to get into a different sort of model, one must first look outside the health system. I have a mental image of a reasonably elderly lady carrying her adult son up a very narrow stairs because the only toilet in the house was upstairs and the son was profoundly disabled. That is an issue of housing adaptation. That is clearly a major health and safety issue, but are we going to mandate an initiative which states a house is unsuitable and a person must go into care. We are moving somewhat in that direction with Children First because once one starts to put in place safeguarding measures an inspector will deem a house to be unsafe and that will be the end of it. There is no debate and no regard to what the family wants. I do not know what the answer is but introducing HIQA into the process seems to be a reasonable step along the way.

For us, the direction of funding has to do with consolidation. We used to have 50 separate funding agreements with the HSE, and that has now been consolidated down to ten, which is very good. However, like the other organisations, last year there was a big debate and we were told there could be no increase in costs and no reduction in services. The HSE was doing both itself but that did not really matter; that was it. We went in and we kicked the stuffing and we got some increases here and we got some reduction in services there, but that is the mindset. As somebody said, that goes back to the legacy costs. We were awarded a contract in 2008 or 2010 and I got a contract modification recently to say the HSE would continue to pay us the same rate as was set then to deliver healthcare. The rate is €14 an hour and if one maps that onto the pay of a home care worker, one is ignoring the fact that, first, there are specifications in the contract around management. I mentioned already the competency assessment process, which costs approximately €100,000 a year. That has to be paid for out of the €14 an hour. There are three pages of policies. I do not mean a three page policy, I mean a three page list of policies with which we have to comply. That all costs. When people ask where the money is going, it is going on bureaucracy, which is required although it is not all necessary, but it is there and we are contracted to deliver it.

I was asked to comment on the tender process and gaming. The way the tender process is constructed, one is asked to quote for hours during different periods – day time hours, night time hours, weekend day time, weekend night time and bank holidays. It is strange to be asked to tender for bank holidays because there is a statutory definition of what they cost and it does not vary. In providing the scoring for each of the rates, there was a notional number of hours that would be provided. One of the frustrations of bidding in this competition is that one can be certain the statistics one is being given are wrong. In fact, it says in the tender that one cannot rely on any of the figures outlined. People look at the figures and they look at their own experience. Clearly, some people looked at it and said, sure there are very few night time calls so the lowest bid on the night time rate was lower than the lowest bid on the day time rate, which from her background Deputy O'Reilly might say is suggestive of gaming. The advantage of that is that one gets a very significant score by having that ridiculously low rate. That is the gaming element. Because one got a high score for the low price on night time rates, one was able to charge a higher rate for the day time rates, which is from where most of the billing comes, and one did not get penalised because one had off-set the penalty with the low score. People got through with the higher hourly rate in the day time than would have been optimal from the point of view of the HSE's budget.

A secondary issue is that we would argue that the low rate is borderline if not below the minimum wage. It is not below the formal minimum wage. People talk about travel expenses. The key cost with travel is time. It is a requirement under European law to recognise travel time, but it is not a requirement under Irish law, which is interesting, but European law takes precedence until such time as it is triggered in Ireland. Up to now it would have required a court case to trigger it, but interestingly there was a development in the European Court of Justice in the past fortnight which opened another avenue for that. The travel time is the major expense. When the HSE is paying its own staff, it pays them a slightly higher rate, but I would not begrudge that. There are all sorts of flexibility that organisations such as ours can give in terms of a little Christmas bonus or whatever else that allows us to even it up, but the big difference is travel time. I am a very innocent little man, and the thing that mystifies me most is that if we are contracted to deliver a package from 9 a.m. to 10 a.m., we deliver a package from 9 a.m. to 10 a.m., yet when I talk to people, especially in Dublin, they ask: what does 9 a.m. to 10 a.m. mean? I say it means 9 a.m. to 10 a.m., but apparently it does not. People take their travel time out of that hour. Even if the HSE wanted to give out a 15 minute package, it would have to pay us for 30 minutes under the rules of the tender. I wonder if people are experiencing a 15 minute care package because a chunk of time is being used for travel.