Mr. Joseph Musgrave:

I thank the Chairman and members for inviting Home and Community Care Ireland, HCCI, along with our colleagues from other organisations, to speak with the committee on the issue of how to improve home care in Ireland. I am joined today by Mr. Ed Crotty, managing director of Heritage Homecare and a board director of HCCI.

HCCI represents more than 70 member companies which provide care to 20,000 clients and employ 12,000 carers. I was appointed chief executive of HCCI on Monday, 17 September of this year.

There are a range of things we can do to improve home care in Ireland. From HCCI's perspective, we need a non-exhaustive list to ensure operational changes, to increase the supply of carers, to professionalise the caring workforce, to improve trust and dialogue between the key stakeholders, and to work together to ensure Sláintecare's success.

One of the most pressing issues facing the service is waiting times. While any increased funding to expand capacity would be welcome, there are crucial operational changes that need to be made. At present, none of the IT systems talks to one another – those in the acute system do not talk to the public health nurses and the allocation of home care packages is poorly commissioned.

This negatively impacts the ability to forward plan and to build capacity.

The current allocation of packages, which is done by fastest finger first as per the HSE’s 2018 tender, is sub-optimal. HCCI would prefer to see a different model that would be uniform across all CHOs, allow providers to participate in holistic care planning and thus end the widespread practice of inefficient rostering. This would provide more meaningful work for carers. The current home care package is designed to fit all situations, but the type of support needed in rural Ireland differs from that of urban Ireland. We need to look at a new funding model for home care. Lessons can be learned from the fair deal scheme for nursing home care.

As our population ages - we are all familiar with the statistics - we will need to expand the home care workforce. To do so sustainably, and to attract and retain the talent of people that we would all wish to care for our loved ones should the circumstance arise, we need to stop a race to the bottom on pay and increase the pool of available labour. HCCI submitted a case to the economic migration policy unit to allow non-EEA workers into Ireland to become home carers. We think it is vital that we broaden the base of available workers. In addition, HCCI is currently working on a submission to the Department of Employment Affairs and Social Protection in the hopes we can end the current system that punishes a worker for providing home care while in receipt of State benefits.

We need to change the HSE procurement rules so that the tendering process is a tool to improve the conditions of the workforce as well as to deliver value for money. The reality is that the HSE sets the conditions of the market. That carers do not receive travel allowances, except in rare circumstances, is as a result of the procurement practices of the HSE. Caring needs to become more culturally embedded, and turned into a profession with a defined and rewarding career pathway. Innovations are limited only by our imaginations. Why not provide a mandatory caring module in transition year, for instance? Professionalisation should also spell the end of a single hourly rate for carers. Specialist skills should be rewarded, as they are in every other industry. HCCI is pleased the HSE have conducted a review into the career of health care assistants, and we eagerly await the results.

HCCI welcomes this hearing today, but we are disappointed the attitude of this committee does not seem to be replicated elsewhere. One month after my appointment, I wrote to the Minister of State at the Department of Health, Deputy Jim Daly, to request a meeting with him or his officials to talk about the range of issues facing the sector. That letter has not received a response from the Minister of State. The HSE last held a home care providers forum in April 2018. This meeting of the HSE, HCCI and the non-profits should be a regular occurrence, and it is deeply regrettable the meeting scheduled for 5 December was postponed by the HSE. My hope is that in addition to the forum becoming a regular place to discuss operational issues, a high-level working group will be formed, convened by the Department, between the principal stakeholders so that we can work together and form long-term policy proposals. We also need more transparency in the operation of the service. Recent work by members of this committee shed light on the current waiting lists, and work by my colleagues at the Care Alliance similarly enlightened us. However, it would be better if the HSE regularly reported a standardised set of figures on the operation of home care across all nine CHOs. HCCI would welcome this extra scrutiny and transparency, for only in understanding the true picture can we all act on an informed basis.

Two developments that will shape the future of home care – namely, the statutory entitlement to home care and Sláintecare – provide a rare opportunity for us to rethink some of our assumptions and design a robust and sustainable home care service. Laura Magahy and her team are, by all accounts, doing great work at this early stage and I hope for a formal meeting with her soon. HCCI would like to see a framework that draws on the expertise of the relevant stakeholders and meets regularly to ensure Sláintecare is a success. We need to clarify how we will fund the expansion in community services needed to support the reforms, as well as start preparing the entire sector so that it is ready to provide this care. The regulation of home care is vital, and therefore we should be teasing out now what model of regulation will deliver the best outcome in the future.