Michael Harty (Clare, Independent)
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Before I bring in Senator Dolan, I wish to make a comment. From a practical point of view, what triggers a request for home care? It depends upon the availability of families to supply support themselves. Many families make extraordinary efforts in supporting their family members, even their neighbours, in remaining in their homes. I am aware of cases in which people have been kept out of hospital and out of nursing homes by the extraordinary efforts made by family members who either are living with the person who needs care or come home to look after them, taking time off work. There is the intervention of the public health nurse, the community intervention teams and, eventually, palliative care teams that come in to look after patients. An extraordinary amount of care is provided in the home by family members. There is never a request for home care because they want to do it themselves. There are other families who cannot do this. I refer to patients living on their own and their families. Either they do not have a family or their family is scattered around the world so they do not have that capacity. An extraordinary amount of work is done by family members in looking after their sick and disabled relatives at home. Eventually, though, there is a trigger in that there is a requirement for home help or a home care package. It might come from the patient himself or herself, the public health nurse or the doctor, or, if the patient is in a hospital, when they are being discharged there is a requirement. There are many triggers for the requests for home help and home care packages. When this trigger is pulled, a request is put in to the HSE, usually by the public health nurse, but it could be by the hospital, and this is then assessed by the HSE.

Here I see a problem because now it goes out to tender. What are the criteria for the tendering process? How does one decide what someone needs and how it will be delivered? Quite often home care is delivered in a very fixed and strict manner. It might not fit the working arrangements of the people who live at home with the patient. They may have to go to work. There can therefore be a lack of flexibility when the home care is actually provided. As someone here mentioned, it may come when there is help at home and they need the help when they are not at home to look after their relative or friend. Is there sufficient flexibility in the system to do this? I am really interested in the criteria used to decide how much home help one gets and who gives it. I am aware of supported housing for elderly people where there might be four different organisations coming in to the same group of 15 or 16 houses when one person could deliver the home care for the people in that very concentrated area. There might be four different suppliers coming in to give the care, which does not make any sense. Is there joined-up thinking in how the tendering process is used effectively and cost-effectively? Furthermore, carers who provide care at home also require respite care. Is there sufficient support for carers who need a rest themselves from looking after their relatives? Perhaps the witnesses would like to discuss this point.