Mr. Joseph Musgrave:

I thank the committee for inviting us to appear today. HCCI is the representative body for the private home care sector in Ireland. Our members, and their 10,000 carers, enable more than 20,000 people of all ages who need support to stay living in the comfort of their own homes. We welcome this opportunity to speak on home care issues with a particular focus on the current recruitment crisis. Our chairman, Jim Daly, a former Deputy and Minister of State, sends his apologies. He cannot attend today’s session due to a prior commitment in the European Parliament. I am delighted to be joined by the director of HCCI, Bereneice O'Rourke, who has 17 years' experience in the industry.

Members of the committee, and the wider public, should be in no doubt that we are in the midst of the most acute recruitment crisis home care has experienced in its history. In autumn 2021, the Government was quoting waiting lists for home care of 800 people. As of the end December 2021, the national waiting list was in excess of 5,000 people. This is an astonishing, and worrying, rate of growth. We currently project that our members alone need to hire 3,000 additional home care workers in 2022 just to reach the goal of providing 24 million hours of home care. This does not include the additional staff needed by the HSE and other home care colleagues.

What this means is that thousands of people with conditions ranging from dementia to post-fall rehabilitation must appeal to the kindness of friends or family to get them out of bed in the morning or suffer the indignity of asking for help to shower or use the bathroom. For others, it means being forced to leave their home and local community and be admitted into a nursing home against their wishes. This is the hard reality of a sector that, for too long, has not received the focus its workforce challenges require. This Government has made clear, in the programme for Government and in public statements, that it supports a home first policy.

We recognise that this Government and its predecessor have substantially increased funding for home care by a total of €150 million since budget 2020. While HCCI argued for this funding increase, we made clear that a workforce strategy would be needed to ensure our members could recruit enough home care workers to meet the projected increase in funded hours. In response to the HSE winter plan for 2021-22, we issued a document with workable solutions to ease the recruitment crisis to members of this committee, the HSE and the Government. That only the HSE and, indeed, some members of this committee engaged with HCCI, while the Government did not, is not good enough. Ireland still lacks a national home care workforce strategy. Most countries have a professional carer strategy and, indeed, the EU is currently developing its own care strategy.

HCCI gives credit to the Minister of State at the Department of Health, Deputy Mary Butler, for announcing, at our annual conference in October last year, the creation of a cross-departmental workforce advisory group. The group’s composition, however, has not been published nor have its terms of reference. In private meetings with officials from the Department of Enterprise, Trade and Employment, we have been told that action on items such as employment permits for home care workers will not be advanced until the advisory group produces at the very least interim recommendations.

Nevertheless, the group is welcome, and we recommend that it develops solutions in at least three key areas. The first of these concerns recognition and career. Front-line home care workers were the first line of defence keeping 50,000 home care clients safe from Covid-19 and preventing them going to hospital. We very much welcome the confirmation that they will receive the €1,000 bonus recently announced by the Government. We would like to see the work of the advisory group supported by a public awareness campaign to boost the profile of the sector and explain how rewarding it can be to enable people to retain their independence to stay in their own homes. We strongly believe that there should be a graded career structure in home care so that care workers can advance their careers and benefit from the rewards of taking on increased responsibilities that follow in other lines of work.

The second area where solutions are needed is in access to the sector. There should be more training options for home care workers, with earn-as-you-learn models such as apprenticeships. Currently, anyone interested in becoming a home care worker must either have two Quality and Qualifications Ireland, QQI, 5 modules or be told to get into a classroom before they can start working. This barrier to recruitment needs to change. During the pandemic, when this same QQI 5 requirement was relaxed by the HSE, recruitment doubled. Other countries, such as England and Australia, maintain high educational and training standards for their home care workers, but it is done on the job: there is no reason Ireland should not follow their example. Indeed, HCCI has developed just such a model in concert with the Royal College of Surgeons in Ireland, RCSI, although this has not yet gained approval from the HSE. We also believe carers from outside the European Economic Area, EEA, should be eligible for employment permits to work in the home care sector in the same way they can in hospitals and nursing homes. We must also correct the absurdity that home care workers lose out on certain social welfare entitlements if they take on extra work.

For this cohort of workers, merely taking on one extra hour on a Wednesday to help someone get out of bed could cost them their medical card.

The third area is pay and conditions. HCCI believes home care workers should be paid a minimum of the living wage and that this should be included as a condition of the next home care tender. The workforce advisory group the Minister of State, Deputy Butler, announced should also consider how we can ensure home care workers are paid both travel expenses and travel time. This will increase the cost of providing home care but it is the right thing to do. As described in previous sessions before this committee, the reality is that the HSE sets the conditions of the market. That carers do not receive payment for travel, except in rare circumstances, results from the current procurement practice.

Exacerbating the crisis is the fact that Ireland is more than two decades behind other countries in developing a professional home care sector. The statutory scheme for home care, which would offer a right to all those living in the State to access home care, was first due to come into force last year. We are now expecting it will not be introduced until 2023. It is HCCI’s view that had the State been obliged, through a statutory scheme, to focus on home care then a clear recruitment strategy would have been developed alongside it.

Members of the committee will be acutely aware of Ireland’s aging demographic. They will also be conscious of how severely the Covid-19 pandemic has affected those receiving care. The pandemic should herald a sea change in how we provide support to these people and lead to the sort of far-reaching reform to our healthcare system as the financial crisis had on banking.

Throughout the pandemic home proved, time and again, to be the safest place to provide care for those who need it. During the last two years we never saw cases exceed 1% of our client base of 20,000. That statistic reflects the hard work, adaptability and tremendous effort of home care workers, their office support staff and colleagues from across the HSE, and Government. I would like to take this opportunity to thank all of them for their dedication and collaboration.

While some delay in developing the scheme in light of Covid is understandable, the pandemic is a reason to accelerate work on the scheme rather than pause it. Until recently, the team at the Department, the reform unit, has been understaffed and rotated through three principal officers in less than 12 months. HCCI has confidence in the current team but it should be given every resource needed to ensure its work is completed by the end of this year. In an unfortunate irony part of the reason for the delay in developing the scheme is the fact that three of the four pilot sites are struggling to recruit the needed home care workers to staff them.

If we are to truly realise a home first vision, one where anyone who wishes can be cared for in the safety, comfort and familiar surroundings of their own home, then the workforce advisory group must move into action swiftly. It should make interim recommendations by May at the latest, with final recommendations by July, which should give sufficient time to inform budget 2023. Alongside this, the statutory scheme for home care cannot be any further delayed; committing to a definitive date for its introduction is critical.

We stand at a major intersection for home care in Ireland. One route leads to further delays, inequities and acrimony. This road will lead to the collapse of a home first vision and condemn thousands of citizens to be forced out of their own homes to receive care. The other road, the one the Government purports to follow, is one where access to home care is made a statutory right early in 2023, where being a home care worker becomes a true profession worthy of the name, and where partners work in collaboration to solve the inevitable challenges that will arise. HCCI and our members are ready and willing to do all we can to make this latter vision a reality.

Once again, I thank the members for this opportunity to appear before the committee and we look forward to answering their questions.