Ms Catherine Keogh:

We will see how good my eyesight is. I did not realise I would be delivering our opening statement. Of the home support hours referred to by my colleague, more than 18 million hours were funded by the public purse, with the HSE providing access either through the direct provision of 8.2 million hours by HSE staff or by funding the purchase of hours from private for-profit providers. It is noteworthy that HSE standards for the home support service only apply to services received either by or through the HSE. Where home support hours are privately purchased, there are no similar standards.

This presents a real risk to both home support service workers and service users. In a position paper entitled, Regulation of Homecare published, in December 2021, HIQA called for immediate reform, including the introduction of regulation, of Ireland’s homecare services. It is very clear that all commentators, including Fórsa, agree that there needs to be reform of the home support services in advance of the legislation to put home support services on a statutory footing, as envisaged in the Sláintecare report and as set out in the current programme for Government, to ensure a modern, dynamic, fit-for-purpose, adequately funded and standardised service.

Fórsa members carry out a number of key roles and functions in home support services. Our home support resource managers, formerly home help co-ordinators, are responsible for the day-to-day delivery of home support services within primary care and social care. Just over 100 home support resource managers manage the work of more than 5,000 directly employed healthcare support workers, which currently equates to approximately 10 million hours, as well as administering the complex home care package scheme. Fórsa members working as health and social care professionals, including occupational therapists, physiotherapists, speech and language therapists, dietitians, social workers, orthoptists and podiatrists, also form the majority of the multidisciplinary teams that are central to ensuring the evolving needs of home support service users are met.

When the HSE’s national service plan for 2021 provided for 5 million additional home support hours introducing additional capacity for long-term care avoidance and waiting list reduction, it fell on the shoulders of home support resource managers to incorporate these hours into an already overburdened system. The lack of a standardised approach was highlighted by widely differing approaches taken by the nine different community health organisations, CHOs. Some CHOs adopted the view that the increased budget was solely for the additional hours without any additional resources to support the administration of these hours. Other CHOs could see that to ask a home support resource manager to appropriately and effectively maximise the benefit of these hours to the benefit of people on waiting lists meant ensuring ancillary supports were put in place.

Our members working on the front line in delivering this essential service have expressed to us their absolute frustration at the lack of investment in the service over the past 20 years and the effect this has had on recruitment and retention of staff as well as on waiting lists. Fórsa has been highlighting to the HSE since 2018 the necessity for the introduction of a national IT system that will allow for the prompt payment of wages and travel time to the thousands of healthcare support workers who day in, day out are ensuring that people can stay in their homes for as long as possible. It is not acceptable that five years later, the HSE is only in the planning stages of this system and that laborious time-consuming manual systems are still the norm. When I counted five years, I was going "2018, 2019, 2020, 2021 and 2022" so I was not adding an extra year. I was counting them as calendar years.

The HSE has also established with unions and the Labour Court an ongoing commitment to the direct employment of home helps to maximum effect for those with the appropriate skill set. This commitment can only be honoured if those tasked with managing, and those working in, the service are resourced properly. Our members have also reported that they are often working with no clerical administrative support while they are carrying out a complex role with multiple demands. Furthermore, they inform us that thead hocapproach to recruitment and the inordinate time delay from job offer to start date is a key inhibitor to recruitment of healthcare support workers, particularly in such a competitive job market. While direct employment with the HSE is seen as the gold standard in home care work compared to the terms and conditions offered by the private for-profit service providers, the delays in recruitment processes are a significant factor in the HSE’s ability or otherwise to increase its capacity to meet the growing needs of the population and to upsize to be ready to meet increased demands that will follow the introduction of the statutory scheme.

The solutions to the problems I have set out are clear. There needs to be a standardised approach across all CHOs to the provision of home support services. There needs to be appropriate support structures in place both in terms of a dedicated clerical-administrative resource and a national IT system and there needs to be a streamlined recruitment system. It is important to remember that a great debt of gratitude is owed to the workers in the home support services for their outstanding performance throughout the ongoing Covid-19 pandemic. Through their work, they were able to ensure that as many people as possible received care safely in their own homes at the height of the pandemic. This made a crucial difference to the lives of the people to whom they provide the service and to the communities in which they live. Once again, I thank the committee for its attention and time. We will endeavour to answer any questions members may have.