Mr. Damian Ginley:

I thank the committee for the opportunity to highlight some observations on this important matter on behalf of SIPTU's health division. I am here with my colleague, Ms Aideen Carberry. SIPTU's health division represents 40,000 workers across private and public health organisations. SIPTU has significant membership across the community home care health sector. When looking at the strategic workforce challenges in front-line home care roles in home support, we must accept at the outset that each is delivered in very different environments with different levels of autonomy and responsibility. Services are delivered through one-off direct HSE public services, voluntary not-for-profit services, which are also known as section 39 organisations, and private home care providers. Organisations compete for home care hours via a tender process.

Our population demographic is getting older. Over the next two decades the proportion of those aged over 65 will increase from 14% of the population to 22.4% and the ESRI predicts that the demand for home support services will rise by 48% in the years ahead. The HSE national service plan for 2021 set a target of 24 million hours for home support services, an additional 5 million hours on the 2020 allocation.

The predominant role within the home care sector is that of health care support assistant, HCSA, formerly known as home help. The HCSA reports to the home support co-ordinator or organiser. He or she provides direct patient care to members of our community in the client’s home environment. With the continued roll-out of community-based services, the demand for this type of role will only increase. The HCSA plays an integral role in the delivery of health services as without same, a larger percentage of our community would require inpatient hospital or nursing home care. Our members were not found wanting during the Covid pandemic.

When we discuss recruitment, we must first look at the different pay arrangements across the sector. Within the direct HSE-run services,significant progress has been achieved for our members in recent years through a number of agreements involving the Workplace Relations Commission, WRC, the Labour Court and HSE circulars. The agreements provide for full access to contracts of employment, recognised travel time, superannuation and sick pay for our members. The hourly rate now established for HSE HCSAs ranges from €14.52 to €18.72 per hour, which is the same as our healthcare assistants in hospital settings.

Staff terms and conditions of employment vary in section 39 organisations. In many cases, pay was linked to the public services until 2008. The HSE cut funding to these services arising from the economic crisis, which resulted in pay cuts being applied. A WRC agreement in 2019 for section 39 organisations approved restoration of pay cuts over three phases. A new ICTU-led campaign for further pay movement within the sector has launched as there remain differences in the terms versus those in the HSE. There is limited, if any, access to paid sick leave, travel time, etc. Section 39 providers have anecdotally cited difficulties with the HSE’s tendering process. They have cited being in competition with for-profit providers, which offer lesser terms and conditions of employment, and, therefore, lose out on tendered work as they cannot afford to offer the work for less than private providers. They also have cited losing out on HSE tenders as being a rationale for not being able to afford to increase the terms and conditions of our members.

Staff working in private organisations are facing significant challenges with regard to their terms and conditions. There are concerns around precarious contracts of employment. Hourly rates start from just above minimum wages rates. Staff have limited, if any, access to sick pay, maternity pay and pensions. The private sector operates on a for-profit model. Workers are not covered by any collective negotiating agreements. In most cases, there is aggressive resistance to trade unions and workers trying to organise. There is evidence to suggest that due to the lack of regulation of the sector, there is large-scale turnover of staff and lack of continuity of care to clients.

It is evident that pay and conditions are mutually inclusive. The development of quality jobs across the sector will result in better service, less attrition, user confidence and, ultimately, quality care. The Sláintecare principle of providing the right care at the right time in the right place will only be achieved when the front-line home care roles are recognised, developed, and paid appropriately.

Recruitment and retention of staff are paramount to the delivery of services. Quality jobs provide quality care. Despite significant progress, we continue to see challenges with recruitment of new HCSAs within the HSE. This results in significant vacancies within the service. The rosters are then filled by agency or private providers. The staff working for the private providers are on reduced terms and hourly rates. It is also evident that there are vacancies in the private and not-for-profit sectors due to high turnover and staff morale within the sector. In recent years, the percentage of homecare provided by HSE is reducing with an increased dependence on private providers.

In some HSE CHO regions, the private provider will potentially be the dominant provider if current trends continue. There is no logic to this from an employee perspective when one considers the terms and conditions outlined above. Why would somebody apply for a role in the private sector first when a similar role is available in the public service with better terms? It does not make sense that a private provider is able to recruit staff on lesser terms while the HSE has numerous vacancies across the regions. Our members have identified vacancies in several regions throughout the country, as outlined in our written submission.

Information suggests that difficulties with the current recruitment model are resulting in vacancies across the HSE. Recruitment is centralised and removed from the home support office. Sometimes it is outsourced. Issues highlighted include a lack of information on upcoming campaigns, delays in progressing campaigns, and unrealistic offers of employment, for example, roles not offered within local catchment areas or contracts offered on significantly reduced hours, such as ten hours. A return of recruitment to local home support offices is required. More home care management resources would assist and ensure localised recruitment campaigns can be progressed in a timely manner. An increase in resources would also address issues raised regarding delays in implementing Workplace Relations Commission agreements, rosters and pay awards within HSE home support.

In conclusion, we would like consideration to be given to the following areas going forward. The improved conditions of employment vis-à-vispublic versus private facilities should ensure the HSE is in a better position to attract staff to provide home care services. A renewed emphasis on HSE recruitment campaigns is required with local-county focus - wider national panels have not worked. Continued investment in the roll-out of home care packages is needed in line with Sláintecare and HSE service delivery plans with a focus on delivery of hours via direct HSE employees. We are seeking the implementation of the roster element of the HCSA agreement. This would provide stability to workers while also assisting in addressing some of the other issues raised. Offers of permanent contracts of employment with guaranteed hours, including flexible family-friendly rosters are required, as the workforce is predominately female. Progression of the HSE steering groups established under the WRC agreement is also requested. Career progression options need to be considered to encourage retention through a career pathway for home care workers with ongoing supported training. Increased funding for training is also required to ensure the availability of a Quality and Qualifications Ireland, QQI, level 5 workforce to meet growing demands. There needs to be more engagement with stakeholders on securing directly provided home care jobs for workers in tandem with the increased service plan funding provided to meet the growing demands.

Failure to deliver the key element of increased community services, as proposed under Sláintecare, will have knock-on implications for the rest of the rest of the health system. A clear commitment from Government to directly provide home care support is required. A more focused emphasis on HSE recruitment of HCSA doctors should go some way to removing the race to the bottom in the tender process. There should be a review of the current tendering process to determine actual costs. It is estimated that the cost of providing private home care is equal to, if not greater than, the cost of HSE care despite the low wages applicable in the private sector. We need to remove profit from the provision of home care.

We would welcome the establishment of a collective bargaining forum for staff in the private home care provider sector. SIPTU remains available to engage with parties to ensure the full implementation of the above recommendations and conclusions.