Mr. John Dunne:

Yes, there is the SAT, but I am not even talking about the technical assessment. What I mean is that there are people who sit down and say, "This is what this person needs." That then gets passed to a budget office, which says, "This is what this person is getting." This is an interesting approach, but my understanding is that is how it works.

Regarding the flexibility of hours, a pilot programme was trialled in Clare last year. I refer to client-directed home care, which is a model used internationally. The one thing I will tell the committee about this is that client-directed home care in Ireland has nothing to do with any of the international models but it does allow one improvement, that is, some flexibility around timing and how one phases one's hours. Given the industrial relations element of core hours and work outside certain hours, I was curious as to how client-directed home care was compatible with the current agreements in respect of HSE staff. I asked, what are the limits of this? The answer is that client-directed home care would be offered to people for whom the HSE feels it would be suitable. I do not know what this means but it covers a multitude and does not suggest a real openness to flexibility and so on. It is moving slowly in that direction, however. There are huge problems with client-directed home care. The way it happened in Clare is that people were handed a list of 20 providers when they were at a peak crisis and looking for home help and were told, "Off you go now. Sort it out." One of our worries and suspicions is that in areas where the HSE is struggling to deliver, even with the assistance of the contracted providers to deliver home care, by handing over that piece of paper, the responsibility suddenly passes to the family rather than to the HSE as the service provider. There are a lot of issues to consider, but if the committee hears talk of client-directed home care, and it probably will, it should be aware that it is highly problematic but may contain the seeds of something that will lead to flexibility down the road.