Mr. John Dunne:

I am told that. I have not actually run a Japanese tender myself. It is an alternative to the race-to-the-bottom model. Our current system is, frankly, crazy. Since the first tender came in in 2010, the required standards have gone down. They have gotten more extensive but the core ones like having qualified staff have been watered down progressively. That then becomes a floor. The idea is that providers have to demonstrate on paper that they can meet this floor standard and after that it becomes purely about price. Not only that, the assessment of the quality and everything else is done by people who by definition do not know very much about it. The reason for that is that no one can do an assessment of the tender who is involved in the management of the service, because they have existing relationships with some of the bidders. You wind up in a situation where people are locked in a room with a set of forms that they have not designed and are asked to make a decision based on that. It gets reduced to something crazy.

In the last tender, providers were asked for a pricing schedule for the core hours, weekend hours, Sundays, bank holidays and so on. However, the pricing table was gamed. Anyone who understands these things could have looked at it and seen the overnight rates were only being given a 20% weighting, for example. That is what happened in this particular case. The provider quoted an overnight rate that was actually less per hour than the daily rate. On account of that, it was able to charge a higher daily rate and still get an overall lower score for pricing in the tender, which means the State has paid a lot more money since then because the weightings were wrong. Nobody is delivering overnight hours, by and large, around the country. There was a figure in there and the provider said it would do that practically for free but would charge a little bit extra for the core hours, which is what is being billed all the time.

I do not believe the system is capable of delivering a proper tender. I do not say that lightly. Do not get me wrong; I am not saying that if I was in charge of it I could do a better job. The system just does not work, for all sorts of understandable reasons. You cannot build quality into a competitive tender. That may sound like a fairly extraordinary thing to say. It can be done but only at the level of box-ticking because quality in home care happens behind the front door. At the moment, the HSE is the commissioner, the provider and the regulator, as the Senator said herself. When HIQA becomes the regulator it has said clearly that it will stop at the front door. It is all about providers showing they have a system in place to deal with all the potential problems. It does not actually look at how they would deal with those problems and it does not look at what is happening in the house. I do not know how to get around that with home care.