Mr. Ed Murphy:

The issue of the 30 minute shifts has been spoken about at length. I understand where Mr. Fitzgerald is coming from. Home and Community Care Ireland carried out a survey of both our clients and our carers and found that 96% of clients said they would rather not have 30 minute shifts, and 98% of carers said they do not want 30 minute shifts. We have to think of the clients, of course, but we have to think of the carers as well. It is extremely difficult to achieve. There are travel costs, and within the HSE tender there is no automatic right to get travel costs to cover 30 minute shifts. It is not catered for in the tender. Carers and clients do not want it. I would contend that if the 30 minutes was extended to 60 minutes the carers will always find something to do. It might be personal care, housekeeping, meal preparation or medication reminders. There is always something to do in a 60 minute visit, and I am very concerned that we will not be able to retain and recruit carers. The 30 minute shift makes it too difficult. We are not respecting the carer, which is really important here. Sending them around on 30 minute shifts is killing the industry.

Choice is also very important, as Deputy O'Reilly mentioned earlier. Even in the current system there is no choice. The client does not have a full choice of the provider he or she uses.

I am very happy if someone is given a full choice as to whether to use a private provider, a charity provider, a not-for-profit provider or the HSE. Currently people are not given the choice. They are told that the HSE will do it and if it cannot do the weekends, it will do the weekdays and give the weekends to someone else. The client does not have full choice over the provider being used. I do not care who is the right person to do it as it may be internal to the HSE, the local charity or a private entity; let the client and family decide. It should be the local provider and somebody who may have looked after a neighbour or friend. If the clients are happy, that is what matters. Let somebody working two doors down finish with Mrs. Murphy and go to Mrs. O'Connell. It is the right way to do it, whoever that person is and wherever the organisation is. It can be private, public or whatever.

Travel allowance is needed. There are many problems with carers and clients. The HSE has tried to bring in many incremental improvements for all the right reasons. Home care can become a far more vital part of the health care continuum. We might forget about all the issues we have to say we can bring the hospital to the home and train our carers to almost become medical in nature. We can pay them more and provide a more vital service to older people, GPs and the health care continuum. We have the technology to include in the home care package that will not only allow us to look after a person when we are in the home but also enable us to monitor and manage the person's health and well-being when we are not in the home. It could become part of a consumer-directed care package today. We could monitor people 24 hours per day rather than for an hour or half hour as we are currently doing. It is a limited service that we are giving and I am worried that home care is the poorer relation in the health care system. We can do so much better and there is such an opportunity for home care to provide a far more reasonable, cost-effective and vital part of the health care continuum, with the possibility of upskilling carers and introducing technology. We could make a significant difference to health care overall in Ireland.