Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

The Chair has raised an important issue from the point of view of the people being provided with the service. They need to be sure they can rely on the service from a security and reliability perspective as well as everything else. This relates to turning up on the day and that may be difficult in certain circumstances. The delivery of home care should be reviewed as if it were a large institution spread over a wide area, because that is the level of service that is required.

We have spent many years in this committee and other committees talking about the need for home care as a means of relieving the overcrowding in hospitals and so on. Everybody agreed with that. However, the difficulty is that it is a very expensive service. Distributing a service across a wide catchment area is not as easy as distributing a service in a single building. There is a huge difference in terms of expenditure, commitment and how it is supervised. The issue is much bigger. I notice it is said the chief inspector of social services will have the responsibility for establishing and maintaining the register for licensed home support services operating in Ireland. The chief inspector will also be responsible for monitoring and assessing compliance by registered home support providers against the ministerial regulation standards developed by HIQA. This did not always work too well in the past with institutions. In fact, it did not work at all in some of them and some of the cases that received public attention are still ongoing without resolution. That should not be the case.

One of the things we have to do, is provide the recipients of the service with an assurance they are in safe hands. As I said earlier, there is a vast difference in the quality and intensity of services required between one type of recipient and another throughout a community. In one case, it may just be a call with a walk around.

Close observation is required. Whoever comes into the home has to be able to observe any trends as well as any drifts from the regulation that might take place and be able to make a decision and alert the higher authorities.

There should be a hub from whence the services operate, whether it be a nursing home, hospital or a combination of both. I am not certain which, but it requires that in order to ensure that the same quality, level and standards apply in both cases. If they do not, we are slipping backward. If they do, we are improving and evolving.

The demand is also evolving. There are far more people now in the household at work, which means they cannot attend to even their parents in the way they would have liked. That places responsibility on services such as home support and home care services. In those circumstances, we need to be able to tell people two things, namely, that they are in safe, professional or, as the case may be, quasi-professional hands, and also in the hands of people who know what to do in a particular type of situation that may, can and will arise.