Mr. John Dunne:

That is true. People do it because, I suppose, in many cases they have to do it.

The HSE will say that a cost proposal and breakdown are required in the tender. Travel costs are included as a part of the breakdown of the hourly rate. There is no visibility of what distance someone is going to go and whether there will be a half an hour or a four-hour call. It is a nonsense. It is a box-ticking exercise. The travel thing, as I mentioned earlier, is completely broken to the point that the system is not working. I hope the new tender, which will happen later this year, will address this in a more sensible way. That would help.

The movement on the new tender process is in the direction of greater consolidation. That is probably a good idea. There are massive economies of scale in organising home care. We must consider the human contact part of the issue. From the State's point of view, there are considerable regulatory risks, if that is the right phrase. The tender for a contracted provider contains tens of pages that are simply lists of the standards with which they must comply. We are not talking about a 100-page document that defines the standards; we are talking about something that is bigger than a good, old-fashioned telephone book full of standards that must be met. There is bizarre stuff involved. We are strange as a voluntary organisation in that we are very diligent about all of this and go through all the standards included. I asked if we were using the IT system we were supposed to be using because I had never heard of it. The standards are changed every year. We asked if we could get access to the IT system and were told we could not. We said we were required under the tender to use the IT system and were still refused access. It is a very strange system in which people are drowning in regulations. A certain minimum scale is required.

Moving away from 83 providers, block commissioning cannot be done. A total of 500,000 hours cannot be commissioned that will allow proper employment contracts for home care workers if that is being done across 120 small providers. That is the trade-off. I am not taking away from any of the points Professor Lynch has made but this is the other side of the argument. As with everything, it is about striking an appropriate balance.