Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after “That” and substitute the following: “Dáil Éireann resolves that the Health (Amendment) (Professional Home Care) Bill 2020 be deemed to be read a second time this day twelve months, in order to allow the Minister for Health to further consider some of the issues with the Bill, and having regard to the fact that the Minister for Health is already in the process of developing a comprehensive regulatory framework to regulate home support services.”

I am grateful for the opportunity to be here to discuss the important topic of the regulation of home support services. The development of a statutory scheme for the regulation and financing of home support services is a priority for me as Minister of State with responsibility for older people and is in line with successive Governments’ aims to support as many people as possible to live independently for as long as possible in their own homes and communities.

I would also like to say that I very much appreciate Deputies Colm Burke and Higgins’s intention in bringing forward this Bill and their commitment to introducing legislation to guarantee safe, secure home care for all members of society who need it. I am aware that Deputy Colm Burke has been a strong advocate of regulation in the home care sector for a long time and has previously brought forward a similar Private Members' Bill covering this topic. However, while I very much respect the motivation behind the Bill, some extra time is needed to consider further issues relating to it. For this reason I have tabled the amendment to the motion. The additional time sought from the House today will allow for a considered response to the proposals put forward by Deputies Colm Burke and Higgins. I look forward to working with the Deputies to ensure that a comprehensive regulatory framework grounded in an appropriate legal basis is developed. Indeed, this is what my Department is already planning for. I would like to take this opportunity to inform the House of my intentions in this regard.

First let me take a moment to briefly set out how home support services are currently overseen by the HSE. All publicly-funded home support is either delivered through the HSE by directly employed staff or commissioned by the HSE by way of a tender and delivered by the voluntary sector or private providers. While there is currently no statutory regulation of home-support services in Ireland, the HSE has put a number of controls in place to quality-assure the services provided and to safeguard service users. As part of this, the HSE has developed national standards to quality-assure all home care services they fund which align with HIQA’s national standards for safer, better healthcare. All HSE-funded home care providers are expected to comply with these standards.

The HSE has no remit to oversee the services purchased directly by individuals from providers operating independently in the open market. However, I understand that compliance with national standards is a prerequisite for membership of Home and Community Care Ireland which is the national representative body for for-profit providers of home-support services.

I agree that building on the safeguards already in place through the HSE, a comprehensive regulatory framework needs to be put in place on a statutory footing to protect recipients of home care and ensure that a standard, high quality, consistent service is in place across the country. However,while fully supporting the aim of the Bill in this regard, I have concerns with the proposed approach. There are characteristics particular to home care which make its regulation different to residential care and I am of the view that a bespoke regulatory framework for home support services is the appropriate approach.

The main issue I have is that the Bill proposes to include home care providers within the current HIQA regulatory arrangements by amending the definition of "designated centre" in the Health Act 2007. I do not agree that this is the right approach to take, as home care services are not delivered in any one centre but at different locations and in people's homes. Indeed, I believe that this approach would be unworkable.

Instead of extending the register of designated centres, I am strongly of the view that the appropriate approach to adopt to the regulation of home support providers is to develop a bespoke licensing system. HIQA supports this approach. In its March 2017 paper, "Exploring the regulation of health and social care services - Older People's services", HIQA recommended a service provider-based approach and a model of registration based around the service provider with an accompanying suite of regulations tailored for different service types.

In HIQA's view, following a model of registering or certifying the service provider as opposed to the physical location at which the service is provided offers a number of advantages: it provides clarity to service users, providers and regulators; separate regulations can be tailored to the service model; service providers can be more flexible and innovative, for example, they could accommodate service users with different support needs in the same settings; and administration would be reduced for the service provider and the regulator.

Within this context, my Department is engaged in the development of an appropriate regulatory framework for home support services. The central challenge in the development of this regulatory framework is to ensure quality, transparency and accountability while simultaneously supporting the provision of family and unpaid care and encouraging the development of innovative and technology-based solutions to meeting care and support needs.

I will set out for the House at a high level what this proposed approach will encompass. First, it is proposed to draft primary legislation to regulate home support services through the licensing of public and private providers. The objective of such a licensing system is to improve patient safety by ensuring that home support providers do not operate below the standard set by ministerial regulations. The approach being taken in the draft primary legislation will require home support providers to apply to a regulator for licences to undertake home support activities. It would be an offence for a person or provider to carry on a home support activity, either publicly or privately funded, unless he or she was licensed to do so. If a licensed provider is not meeting licensing requirements, the ultimate sanction is the withdrawal of the licence, but other options will be provided to address failings where withdrawal of the licence is not the appropriate action, particularly as a first option of action.

Second, in tandem with the development of primary legislation, my Department is progressing work on the development of minimum standards that will form the criteria against which the regulator will determine whether a home support provider's service is of the requisite standard for the provider to be licensed to operate. Pending the enactment of the requisite primary legislation, providers would be encouraged to meet these minimum standards on a voluntary basis. In this regard, my Department plans to undertake a targeted stakeholder consultation on these draft minimum standards before the end of the year. I would be more than happy to involve Deputies Colm Burke and Higgins in this process. I will be in touch with home support providers in due course to advise them of my intention and I look forward to engaging with the sector further on the development of appropriate minimum standards, which will serve to safeguard home support users.

Third, the development of primary legislation and minimum standards is expected to be complemented by the development of national standards for home support services by HIQA. My Department has already submitted a proposal for the development of national standards. That proposal is due to be considered by the board of HIQA at its meeting scheduled for next week. I am of the view that the power for HIQA to develop standards for home support services already exists in the Health Act 2007. As such, I do not agree that it needs to be provided for separately as proposed in the Bill before us.

If my Department's proposal is accepted, HIQA will follow its established procedure to support the development of new national standards. This will involve a national and international evidence review as well as stakeholder engagement. Therefore, I am of the view that it is not appropriate, as proposed by Deputies Colm Burke and Higgins, to include specific requirements in primary legislation about what should be included in such standards. HIQA already has considerable experience in the development of standards and we should leave it to develop the standards through its tried and tested procedures. If the board of HIQA agrees to undertake the development of national standards for home support services, I expect that there will be ample opportunity for stakeholders to contribute to their development and to ensure that they include appropriate matters, such as those proposed in this Private Members' Bill. If Deputies Colm Burke and Higgins would like to become involved in that process, I would be more than happy to facilitate their engagement with HIQA.

It is important that all stakeholders be involved in the development of an appropriate regulatory framework for home support services. Along with my officials, I will be more than happy to ensure that the regulatory framework is developed in as collaborative a fashion as possible. We all want the same outcome, namely, a high quality and safe home support service. It is important that we all work together to achieve this outcome.

I strongly welcome the focus in the winter plan that was published today on providing a substantial increase in the number of home care hours available. I welcome the new Home First approach, which emphasises reablement and providing extensive home support packages to those with more complex needs. This expansion of home care is an integral part of the ongoing development of the much-needed statutory home care scheme, which is a programme for Government commitment.

I am pleased that this Home First approach will bring with it the roll-out of the single assessment tool, which many Deputies will know I have been championing for some time. It is essential that there be consistency in the context of how needs are assessed. Regardless of where someone is in the country or what type of service he or she is entering, be it home care or residential care, it is imperative that his or her postal address not matter. There should be the same assessment of need tool for every person in every country.

I once again extend my appreciation to Deputies Colm Burke and Higgins for raising this important matter and facilitating this important discussion in the House. Along with my officials, I look forward to engaging further on this critical issue with Deputies, especially Deputies Colm Burke and Higgins, as our work progresses in order to ensure that the most appropriate regulatory framework for home support providers is in place to safeguard all home support users.

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