Mr. Bryan Meldrum:

I thank the Chairman and members of the committee for the invitation to appear before them to outline the current situation in the home care sector. I am co-chairman of Home and Community Care Ireland, HCCI, and joined by my colleague, Mr. Ed Murphy, who is a director. We are here to outline to the committee not only our organisation and the sector but, more importantly, the forthcoming increased demand for home care and the pressures this will place on the system. However, there is also the opportunity to create thousands of jobs and enable increased investment in the sector via appropriate regulation and the provision of reform funding.

Home care is defined as a support provided for persons who require assistance to continue to live independently outside a hospital or residential setting. This can be over a short-term period to recover from an operation or for an extended period. The duties associated with this type of care can vary and range from preparing meals to helping clients to wash and dress to providing more intensive palliative care support.

HCCI is a national organisation which represents 25 private home care providers across the island of Ireland. Our primary objective is to promote the highest professional standards of care in the home and client choice in a cost-effective manner. In providing care for 8,500 clients in their own homes throughout Ireland HCCI members play an important role in the development of the home care sector which is an integral part of the Government's stated policy of developing the primary care sector. We welcome the opportunity to appear before the committee, given the serious challenges facing the country such as an ageing population and reduced State investment in health care. As the Government seeks to implement more cost-effective solutions in the caring sector, increased investment will be required from outside sources, including the private sector, to ensure sustainable levels of investment in technology and people can be maintained.

HCCI believes increased transparency and a regulatory system that is reflective of the nature of the sector are essential to attract investors and create more jobs. There is no formal regulation of the home care sector, something on which HCCI continues to advocate. There are FETAC training qualifications which are appropriate for home care workers. All HCCI member company employees are trained to FETAC level 5 qualifications. There are 40,000 people employed in the home care industry, including by private providers, the HSE and not-for-profit organisations. We provide care for more than 70,000 people. HCCI member companies alone employ more than 6,000 of these 40,000 staff in every town, county and rural location. In many of the members' constituencies we would have at least four or five member organisations working in their local areas. We contribute more than €36 million to the economy annually.

Home care is provided in a number of ways by private providers, not-for-profit organisations, the HSE directly and individuals operating in the black market. The types of care include directly secured private provision or State-funded home care which falls into two schemes, namely, home help and home care.

Home helps account for €195 million each year and are provided direct by the HSE or not-for-profit Government funded organisations, also known as section 39 organisations. The private sector is not allowed to tender for this work. Home care packages account for €127 million each year and is provided by section 39 organisations and private providers. Directly secured private provision in the formal sector accounts for between €20 million and €25 million.

The sector is currently unregulated and comprises formal and informal care provision. Formal care is where carers are employed to provide assistance along clear contractual guidelines. HSE staff account for 70% of all home help services, not-for-profit organisations account for 18% of the current market and private companies provide the remaining 12%. Informal care is generally provided by family members, neighbours or via the black market and accounts for 10% of the present population over 65 years.

It is important to note that the black market in home care is not as we traditionally understand with murky dealings happening in the back of vans. Often black market home care is provided by people with the best of intentions, such as friends, relations and neighbours, who try to do what they believe is the right thing. There is also the cash-in-hand side of the business where advertisements are answered by unknown people with unknown qualifications. A large number of carers operate in the black market on a cash-in-hand basis. The issues for either type of care are significant. Black market carers do not pay taxes or, more significantly, are not properly trained or insured leaving many people in vulnerable situations in the event that an issue arises.