Professor Roger O'Sullivan:

I thank the committee for the opportunity to present. I am director of ageing research and development at the Institute of Public Health, IPH. I understand a copy of the IPH submission has been shared with the joint committee. IPH is jointly funded by the Departments of Health in Ireland and Northern Ireland and provides research and analysis support to both Departments. Our work focuses on promoting health and well-being, improving health equity and reducing health inequalities.

IPH was commissioned by the Department of Health to assist with the development of the public consultation process on the new draft regulations for providers of home support services, undertake an analysis of the public consultation responses and produce a report on the submissions received. The draft regulations set out proposals for regulating public, private and not-for-profit providers of home support services to obtain a licence. Home support in this context covers assistance with a wide range of activities to help a person live at home if they are ill, frail or have a disability. This can include help with washing, dressing, getting around, social activities and essential household tasks.

The aim of this public consultation was to seek the views of organisations and individuals on the scope, content and potential impact of the draft regulations, to help inform their development and to contribute to a regulatory impact assessment. This public consultation used a survey as the primary method for seeking views on the draft regulations. The survey included a combination of open and closed questions. Submissions were received online, with an option to email or post the survey, and some submissions were made outside the survey format. The public consultation took place over a six-week period from 16 June 2022 and this was extended for a further week on request until August 2022.

The public consultation was promoted by a Department of Health press release on its website and on the Government public consultation hub, as well as on social media and via email. The Department of Health held several online meetings with stakeholder groups, including the disability, participation and consultation network. Plain English and easy-read summaries of the draft regulations were developed by IPH and made available along with the consultation documents. In total 210 submissions were received, 198 through the survey questionnaire and 12 via a free-form submission format. The majority of responses were made by individuals - 118 - of which 43 were a combination of service users, their family members and others with support needs. There were 92 responses from organisations, including home support providers, healthcare organisations, advocacy, public sector, and worker representative bodies. IPH’s role was to summarise the public consultation responses. We did not comment on or evaluate the views expressed by respondents.

I will now provide an overview of the public consultation responses. Please note that this is a summary and further details are available in the report submitted with this opening statement. Some 74% of survey respondents believed the impact of the proposed regulations would be positive, 4% negative, and 22% were unsure. Home support regulations were considered as key to providing better quality of service and guidance for all involved in home support services. Some 85% of respondents indicated this view, which was consistent across all sectors, including service users, providers, and State bodies.

It was felt that by specifying minimum standards, the regulations would create a level playing field for providers that would ensure higher and more consistent standards of delivery. Some 82% of respondents felt the regulations would provide greater protection to service users, which was considered particularly important if they were vulnerable due to ill health or reduced cognition. Clarity was sought by all sectors on how the home support regulations relate to the overall architecture of publicly-funded home support provision.

There was a concern by some that the regulations reflected a form of home support provision based on a model of services for older people rather than the diversity of users. There was widespread support across all sectors for having minimum qualifications for home support workers to improve service standards - at 78%. On the other hand, there was also concern that this could worsen existing staff shortages. Improved conditions for home support workers were seen as vital to creating a more sustainable workforce and high quality service for home support service users. Respondents indicated that implementing the regulations could be onerous for providers and home support workers in terms of increased record-keeping and documentation, and that this could impact negatively on the service user. There were concerns that some types of home support service are excluded from the draft regulations, particularly services for children - 28% disagreed - services by healthcare professionals - 27% disagreed - and services provided by individuals directly employed by service users - 30% disagreed.

To summarise, across the public consultation submissions there was a high level of support for the proposed regulations, with benefits viewed as better quality and consistency of service, guidance for all involved in home support services, greater protection for service users, and a more qualified workforce with clearer career pathways. However, 46% of respondents also expressed concerns on the new draft regulations, such as home support becoming inflexible, may be costly to comply with, and may increase ongoing challenges around staffing. Respondents also highlighted the importance of recognising the diversity of need among those requiring home support.

I will finish with a quote from a home support service user who responded to the consultation:

I live alone without family ... I couldn’t remain at home without home support services. Sometimes I feel rushed but understand that home support workers are very busy and do not have much time to get to the next house. I value this service and those who provide it. [I] think that the regulations will improve services for me and home support workers.

I thank the committee for the opportunity to present today and I welcome any questions members may have.