Mr. Ed Murphy:

I think the average paid by the HSE under current tender is approximately €23.50 per hour, but I cannot confirm that. As I said, the HCCI rate is €13.80. On top of this, we pay PRSI, bank holidays and annual leave. In all cases, a nurse will assess a client before we go in and on a quarterly basis thereafter. We also have costs around insurance, quality control and office administration. The average cost of efficient administration of an office for any organisation would be in the region of 30% to 32%.

In our case, in terms of a contribution to profit and further investment, we are running at a figure in the area of 6% to 8%. In the past year, to be efficient in our scheduling, customer relationship management and telemonitoring systems, our organisation has spent over €1 million on technology to be more professional and efficient, as well as to provide for better transparency and accountability. The HSE, rightly, requires us to be accountable for every hour we use to ensure there is good value for money for the taxpayer, etc. We have the technologies in place, but they do not come cheap.

We are in a position to pay more and offer better conditions of employment. It could be the same carer doing work for the HSE, but we may use him or her for a private client. If it is a private client, we can offer better conditions of employment such as group hours, not if-and-when contracts, and pay for transport because we are in charge. With respect, in the HSE's case, it has to get the best value for money. If it is not paying transport or whatever else, it is difficult for us to do so. In the case of a private client, we are totally in control, particularly of the travel part of contracts of employment. The average shift with a private client is three hours. In many countries the shifts can be two, three and four hours. It is a different ball game when we are in control in dealing with private clients. Accordingly, one of our genuine recommendations, having seen it in other countries, is the provision of client directed home care. That is where we give the client the choice, but it is not only the client. Up to 70% to 80% of the people making decisions on home care for, say, an 83 year old client are usually the sons or daughters. We give them a choice of provider, whether they want to use the HSE, a voluntary, not for profit or private care service. I do not mind which provider it is. They should have a choice of provider and care plan. One must ensure it is a care plan which suits them. It should not involve a half-hour or one-hour shift or the carer being at the home at 9 a.m. or 11 p.m. They should be given a choice not only of care plan in terms of what, when and how it will happen but also of schedule. If they do not like a provider, they should have the chance to move to another one when and if they want. Consumer-directed care is implemented in many countries. It gives group carers a chance to reduce transport and cluster carers and clients on the same street or in the same area. It gives us flexibility and adaptability we can use with private clients. That is difficult to do in the case of the HSE.