Mr. John Dunne:

To give some examples of reductions in care, when tendering was introduced in 2010, organisations were allowed 48 hours to match a care worker to a particular case. In some parts of the country, one is now given four hours. Often one is not given details of the case to which one is being asked to match. There is not even a pretence of trying to get suitable matching. That is one example.

We have gone from requiring staff to have a full QQI level 5 qualification by 2012 to the current competency assessment approach, which costs deliverers. In our case it costs almost €100,000 a year to administer this monster, which is really a way for the HSE to say it has checked thoroughly that these people are competent in that it made them certify themselves rather than simply requiring them to have a qualification.

A major example is the 30-minute calls. They are poor anyhow but in respect of 30-minute double assists, where one has to do something with somebody using a hoist, which involves two staff working together, we refuse to take those cases on the basis that it is a serious risk and we will not deal with it. However, it is becoming commonplace to be asked to do it.

There is another example that is less tangible. I would argue that in the past ten years there has been a stripping out of social care into purely personal care. Personal care is starting to be neglected in favour of clinical care. However, the social care is very important. When we talk about home care, it is meant to be an integrated, wraparound service. It is not just a case of getting in there and stopping a person from dying today.

In terms of where the money is going, I agree with the Alzheimer's Society of Ireland, it is not going to us. If the members could get an answer to that question, I would be very interested to hear it. I am taking a crude figure as an example. There was an office within the HSE, and I am taking into account the costs of the leader, the support team and all the rest, which had a budget of approximately €500,000 a year to manage home care. There are now two. I do not understand the reason for that. The members might get to the bottom of it but in terms of this issue, there is €0.5 million on the spot.

The second question was about access getting more difficult. It has become routine in the past year for the HSE to arrive into a house and tell the person that because he or she gets the carer's allowance he or she will not get the home care package.

This will cost the State money in two ways. The State defended an action from the European Commission in the European courts on the exportability of carer's allowance. It defended that action on the basis that this was an income support, not a payment for the delivery of home care services. The HSE is now saying that is exactly what it is. Income support for carers comes to €1 billion per year. Exportability will be a significant slice of that. That is reckless. Quite frankly, it is lunacy. I do not believe it is being done intentionally but it does reflect a style of policy making that involves saying "this is what we are doing" with no consultation or discussion, instead of bringing people into a room and saying "this is what we intend to do, tell us if there is anything wrong with it and we will see if we can fix it." The HSE seems to like to learn not just by bumping into things but by jumping off cliffs and then discovering what is going wrong.

Regarding the second problem, we have met people who have been told that in order to get services they needed as part of a home care package they could not undertake themselves, they had to give up their carer's allowance. We had a case where somebody did that and then went back and said they had given back their carer's allowance to be told there was no budget to give them support. Another case involved an able-bodied young adult son being required to move out of the house before they would consider that home care was needed. That is how difficult it is becoming to get home care.