Mr. John Dunne:

Professor Lynch and I were talking about the home care question outside when we were waiting to come in. I am always nervous of saying "Four legs good, two legs bad", which is from Animal Farm. The idea of "private sector bad, public sector good" is certainly not universally true. The question is about what sort of system one wants to model. I have no ideological hang-ups one way or the other. The State has, to date, proven to be completely unable to deliver a 24-7 care model in the community. That is possibly because it has not tried hard enough. I do not know. Coming from where it is, it would be very difficult to turn a switch and say it is going to do things differently from 1 January next year. It would require an enormous change, not just to finance but also industrial relations and norms which are well-established. One then adds into the mix the not-for-profit and commercial organisations like us. There has been a debate in our sector. I have been clear that the best commercial organisations are pretty good and the bad ones are shocking, but it is also true that the best not-for-profit organisations are pretty good and the bad ones are shocking. One may argue that the motivations are different, but the fact is that you cannot point to any part of the market and say it is the perfect model.

To be fair to the HSE, there is some sophisticated thinking which implicitly acknowledges the current model is not fit for purpose. I do not think it is moving towards and I do not think it needs to move towards doing away with external contracting. There will probably be more block commissioning. Rather than offering casual work of two hours here and there, it would allow people to be employed on a secure, permanent basis. That allows things like training. As mentioned earlier, people need to be offered a career path. It is all very well to say we will employ people. The rates vary. The headline rate is for the basic core hours. At this stage, it is probably about €14 per hour. I am sure there are groups which pay less, but not many, because people will not work for less. There are also extra associated costs. One significant issue at the moment is that there is no provision for either travel time, which is a legal requirement, or travel expenses. There is a public system which pays its staff to travel and a contracted sector which is not funded to do that, seemingly as a matter of principle, though not a very good principle.

Many matters could be reformed but I cannot envisage a situation where there would not be reliance on a mix of the two. Speaking as someone involved in the tendering process, it is a pain in the neck to have to put on one's best suit every couple of years to go out and make a case, facing competition with other people. The competitions produce bizarre results. In one part of the country, there was a quality floor and price was the differentiator. The winning bid was from a commercial provider that was named earlier. It had just attracted €25 million in seed funding for a nursing home and decided that this would be a good sideline. It swooped into one area, promising the sun, moon and stars. It came first in the tender, but it has never delivered an hour of home care, because it did not know what it was talking about. The system was not able to filter that out. We need to learn to get better at that kind of thing.

In principle, one is looking at a core State service. I do not mean the easy 8 a.m. to 6 p.m., Monday to Friday times. By core, I mean that the State should be at the heart of this. A model to provide flexible support will be needed for the future.