Mr. Damian Ginley:

In response to the Deputy's first question, my understanding is that a lot of how home care packages are currently allocated and provided is based on the historical arrangement. As she rightly said, many of these services are provided via the section 39 not-for-profit organisations. We have experienced a significant challenge with that in the greater Dublin region. My colleague, Ms Carberry, has vast experience there. Section 39 organisations tender for work and the problem is that their experience is that they are tendering against organisations in the for-profit sector, which offer lesser terms and conditions again. It has proven very hard for our members in the sector to make any inroads. Ultimately, organisations say the level of funding will determine the rate of pay. We have highlighted in our submission our concern that the public service agreement signed in 2010 commits clearly to the direct provision of labour to the greatest extent possible. In that context we will ask the HSE to ensure that, now we have established HCSA terms and conditions that are respectable, based on the role and the level of responsibility, etc., we build on that. If we do not, and if the private sector is not managed, staff will leave home support services, and that will have a knock-on implication for the wider health arrangements. The whole principle of Sláintecare, as the Deputy will be acutely aware, is about care in the community and at home. If we do not deliver on that, it will end up hitting the hospitals, nursing homes, etc.