Ms Fiona Larthwell:

I thank the members of the committee for their invitation to meet today to discuss this general scheme for the health (amendment) (licensing of professional home support providers) Bill 2024. I am joined by two of my assistant principals, Mr. Cody York and Mr. Tommy Sheridan, from the older persons section within the Department of Health. I will now outline the background to and rationale for this draft legislation, before briefly addressing its main provisions.

As a matter of public policy through Sláintecare, Ireland is committed to supporting people who need our health and social care services to stay living at home for as long as possible. When Sláintecare was published, the State was investing approximately €403 million in home care and home help for older people - what is now called "home support".

This was to deliver about 16.2 million hours in 2017. Sláintecare called for an additional €120 million in funding over five years, by the end of 2022, which would have brought this to €523 million. The State had more than met this target by 2021 and this year the Oireachtas has allocated approximately €730 million to deliver 22 million hours of standard home support to older people, with a further 3.5 million hours to be delivered to people with a disability. At any one time, home support is to be delivered to over 54,000 people aged 65 and over, and 7,000 people with a disability. As of the end of April, the targets for older people were being exceeded. Preliminary figures show around 56,000 people were in receipt of home support and approximately 590,000 more hours had been delivered than at the same time last year.

Home support is not just delivered by the HSE and HSE-funded services. People with a range of personal circumstances also purchase it privately. Information is very limited on who is delivering services privately, how many hours they are delivering and what types of services this includes. However, estimates indicate as much as 25% of provision may be delivered privately. This would be a further 8.5 million hours being delivered nationwide.

Alongside the expansion of care, the type of support being provided has become more intensive as the level of needs that can be catered for at home have increased. This means that, on average, more hours are now being delivered per person. As home support has expanded and the needs of those at home have increased, it has become more urgent to ensure there is verifiable consistency and quality in care. There are inherent risks for service users in the provision of health and social care services by an unregulated sector. In vital areas such as infection prevention and control, staff training and clinical governance, there are no standards or regulations that all home support providers must comply with, whether HSE, HSE-funded or private. There is also no independent oversight of the provision of services; therefore there is no independent mechanism to ensure that the standards that do exist, such as HIQA’s national standards for better, safer healthcare 2012, are complied with.

The absence of regulation across the home support sector has contributed to geographical variation in the quality of care. A recurring theme in the responses to the Department’s public consultation on home support services was the need to address variation in provision across the country. Many stakeholders have raised concerns about the lack of regulation and there have been proposals to bring forward relevant legislation for some time. Recognising this consensus, the Government has committed to introducing legislation to regulate the sector.

As members will know, the Health Act of 2007 established the Health Information and Quality Authority, HIQA, and the Office of the Chief Inspector of Social Services. It also provided for a scheme of registration and inspection of residential services for older persons, people with disabilities and children in need of care and protection. HIQA’s functions include the setting of safety and quality standards in respect of these residential services and the Chief Inspector of Social Services monitors compliance with standards and regulations.

The purpose of the Bill is to introduce a framework for providers of home support services to be regulated by HIQA. This will be done through amending the Health Act of 2007, as necessary, to provide for functions in relation to the licensing of providers and to set out the licensing framework. These amendments will act to safeguard service users and raise the quality and consistency of care nationally, and will give partial effect to the programme for Government commitment to “Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care”.

The general scheme is modelled after the regulatory framework for residential services for older persons, also known as designated centres, set out under the Health Act 2007. It sets out to introduce a licensing framework for home support providers, who will be required to meet minimum standards set out under ministerial regulations in order to provide a service. The general scheme introduces a statutory framework to provide independent oversight of these minimum standards by conferring on HIQA’s Chief Inspector of Social Services the authority to grant, amend and ultimately revoke a license if a provider fails to meet the minimum standards set out in regulations or contravenes a provision of the Act. The chief inspector will be responsible for monitoring and assessing compliance of registered providers against regulations and HIQA standards. This regulatory framework and inspection process will ensure quality standards are met and will help build public confidence in the expanding provision of home support.

The licensing and regulatory framework will apply to services that deliver home support to adults aged 18 or older who, by reason of illness, frailty or disability, require this service. As such, it applies to provision under the auspices of both the Department of Health and the Department of Children, Equality, Disability, Integration and Youth. This means that there are roles and responsibilities set out for both Ministers in relation to the regulations and the legislation more generally.

Under the general scheme, the Chief Inspector of Social Services will have responsibility for establishing and maintaining a register for licensed home support services operating in Ireland. The chief inspector will also be responsible for monitoring and assessing compliance by registered providers against ministerial regulations and national standards developed by HIQA. It will be an offence to carry on the business of a home support service without a licence. Before getting a licence, providers must satisfy the Chief Inspector of Social Services that they can comply with these regulations and other requirements under the legislation.

Once licensed, if a registered home support provider is not meeting licensing requirements, the ultimate sanction is the withdrawal of the licence, but other options are provided for in the scheme to address failings where lesser sanctions or conditions would be more appropriate. This statutory framework will be supported by national quality standards that are being developed by HIQA. The national standards will focus on a human rights-based approach and aim to promote progressive quality improvements in services. An advisory group made up of 20 members has been convened to support the development of these standards, including people who use home support services, carer representatives, staff, advocacy groups and a range of statutory bodies. The next stage in the development of the standards is public consultation, expected to take place later this year.

Finally and importantly, the general scheme echoes new provisions in the Health (Miscellaneous Provisions) (No. 2) Bill 2024, which is proceeding through the Houses of the Oireachtas. This includes extending provisions in relation to the collection and reporting of data by HIQA that will be shared on an aggregated basis with the Department and other relevant public bodies as determined by ministerial regulations. As we progress through our programme of reform and legislative enhancement of home support, it is essential that this is based in evidence and data. Improving the amount and type of information we know about service providers and people who use services, particularly privately commissioned services, is fundamental to ensuring that new developments will be efficient, effective and meet people’s needs.

The ultimate objective of the proposed licensing system is to improve the safety and quality of home support services by ensuring that registered providers do not operate below the standard set by ministerial regulations and that those regulations are applied in a consistent and systematic way.

I thank HIQA, the HSE and officials from the Department of Children, Equality, Disability, Integration and Youth for their engagement and assistance on the general scheme and the ongoing development of this legislation and the wider regulatory framework. I thank the committee for giving its time and look forward to discussing the proposals